Highly pressured to be sterilised at c section. AIBU

[Deathstarevicki]

I have had come sections due to my children being breached and never gone into labour naturally. On the consultation for my 3rd I was asked, so are we sterilizing you at the same time? I was shocked and caught off guard by this and felt pressured and had to explain and justify why I did not. Then on my 4th the same again, I declined. I have always been advised that my insides are in good condition and I'm fine to have more if I wish by the surgeon.
Iv just had my 5th that went perfectly with no complications or issues but felt incredibly pressured all the way through and had to decline it at least 5 times. AIBU to find this practice out of order?

If I wasn't having a section I would need to see a councillor and be referred to make sure that is the right decision for me.
This time 2 consultants got stroppy about ithe with the surgeon who performed the surgery trying to talk me into 3 times. So I had to refuse and explain 3 times before my op why I did not want this. I really think it's wrong to spring this on woman in a vulnerable position when they may not of even considered this as an option. His reason were "I was going to be a mess inside with my organs fused together, he may damage them getting my baby out but he will fix them after". While he was performing my section I asked if I was a mess in there and he said no I'm fine it's not bad at all and that my choice of marina coil is probably the best option for me.

Am I missing something and medical professionals are now on a quota or commission to sterilise c section mothers as there is I believe unfair pressure on the mothers. I am in the uk

Apols for DM link but this is what happened to a woman who had six caesarians: Link

She lost six litres of blood due to a dangerous complication called placenta accreta, common in women with past caesars as I'm sure you know. She developed clotting and ended up losing her limbs.

I was sterilised during CS, birth of 2nd child. 1st was forceps delivery. My health deteriorated after DS1, that was reason for CS for DS2, my health not childs.

I do wish I was not sterilised as I am v. broody, but I am 46 and in poor health, so it probably was a sensible decision. Obst. offered it to me, I didn't ask for it (1999)

Also OP I think the surgeons were asking to cover themselves medico legally should you have any problems in your next pregnancy, they want to be clear that they advised against it, we live in a litigious society.

Adhesions (internal scar tissue) can be very dangerous. I know, I've has small bowel obstructions from it. Life saving surgery, bowel resections. The more surgery you have the worse it gets. They can be quite abrupt at times, but they are right to take it seriously. I had two young children and nearly died from obstructions. But if you want to risk keeping having babies and putting your life at risk well i suppose at the end of the day that is up to you. I want to emphasise it's not quite as simple as sorting it out.

I'm at the stage now of them saying no more surgery- unless to save my life. It;s not an easy place to be in.

I'm having my fourth section in 3 weeks and only got asked last week if I wanted sterilising. Wasn't expecting it as I thought it was too late to ask. I jumped at the chance! But my body is likely to be fucked this time. So no way am I taking the chance of going for number 5.

But that's me. Your body, your choice. They have to encourage you to consider it though because the chances of it going wrong from here on are significantly bigger. It's their job to keep people healthy, regardless of how good you look inside currently, one more pregnancy can change that drastically.

I had an emcs with ds (baby 11)

Is that eleven?

I have always understood that sterilisation after CS was less likely to be successful as the reproductive organs have not returned to normal from pregnancy. Also, it is not the best time to make that sort of decision.

Of course, if the pregnancy was accidental and you have decided that this is your best way forward from the beginning, and wish to avoid a second op, knowing the likely failure rate, then it seems reasonable.

The failure rate from vasectomy is significantly better - getting on for 10 times, which is pretty impressive.

Having the Mirena is possibly a good option, I chose not to as it can be a concerns with lots of scar tissue on the womb, as coil insertion can have a higher risk of perforation. But some kind of long term contraception which is reliable might be a good plan.

Well I'm with you OP.
Thee are some good reasons to say that more than 3 school are dangerous. It's the issues with all scarring going on inside. Exceltbthat YOU don't have any and therefore the risk associated for YOU is low (unlike some PP on this thread that already had a lot of issues with scarring on the 3rd cs).
Not everyone is the same and that should be acknowledged.
That also explains the difference of ideas between the guy who did the CS and didn't have any issue with you having another one no those who actually never had you as a patient in the operating table.

Also I fully agree that the timing is totally wrong. Discussion tidying tubes when you are getting ready for surgery is NOT the time to do so.

Finally, can I ask why it should be you doing the surgery and not your DH? Why has the idea of the vasectomy never been talked about?

Fwiw, my SIL asked to have her tubes tied up when she went for her CS. It was refused by the surgeon saying that a CS wasn't the time to do that. Same surgeon also said it was easier and safer for her DH to have a vasectomy instead.....

I was asked to tick a box on a form an hour before I had a planned c section. It was my first pregnancy too! I ticked no but I hope if I'd said yes I would have been questioned on it, it seemed very bizarre to ask me at that time.

I think it's a good idea to put it forward as an option to you but you should have access to some counselling to discuss your feelings around it as it's a big decision. Have you asked for counselling?

FFS. People's propensity for selfishness and blaming others never ceases to amaze me.

How about you focus on the children you already have, and staying alive and healthy to raise them, rather than risking your life and health by insisting on multiple dangerous pregnancies and surgeries?

Is that not up to the SURGEON who did all the CS to advise the OP whether it's a dangerous thing to do for her or not??

From the OP, said surgeon, the one person who is really able to make a comment on whether this is dangerous or not for the OP, doesn't seem to have any issue.

Why shouldnt the OP follow the advise of a PROFESSIONAL who knows what he is taking about as well as knowing the OP's particular case?

Surely the RCOG advice is correct here - it seems crazy that hours before you go in to have a baby you're being asked to make such huge, non-emergency decisions - especially when it's been declined twice before.

There will be scaring from that many CS. I have had three and on my last my obn said I was fine for another but she also said not to risk it as chances of a complication increases from have 3CS and being older.

DH and I started out wanting 4. We have 3. We are extremely fortunate to have the 3 we have and consider DS the equivalent of 2DC because of his ASD.

I guess medical practice must have changed a bit then - a friend of mine's wife had 3 CS because her pelvis was too narrow to give birth naturally. They didn't want to do more than 3 CS, because of scarring etc. - although I do know that people can have more than 3 - so suggested sterilisation. However, they did NOT offer to do it at the same time as her CS, in fact when she asked, they said they would NOT do it at the same time because their focus is on getting the baby out and closing up again in minimum time. Instead, her DH (my friend) had the snip later.

How things change, eh.

More than 3 sections is starting to get dangerous.

^I think this is now considered to be outdated. AFAIK it is not best practice to advise 3 sections only. Obviously the risk increases with every C/S in the same way that every N/D has increased risks (although they may not be proportional) During my last c/s (no 3) I asked if it would be advisable not to have any more. He said whilst there is an increased risk of adhesions etc there was no reason not to. The world record according to my surgeon is 12 c/s'. Mine dealt with a patient who had had 9.

There is a lot of drama and hyperbole being spun here.

You need to stop breeding

^I'm not sure that 5 children really warrants this type of nasty comment?

OP if there is a next time write on the cover of your file "Patient has declined sterilization".

Yes exactly. Women can have more than 3 CS. As I posted above, 9% of women who have 6 CS have to have a hysterectomy. That still leaves 91% who did not.

Is that not up to the SURGEON who did all the CS to advise the OP whether it's a dangerous thing to do for her or not??

You can't really say, "Please don't have any more kids" to the patient. If they have more pregnancies all you can do is advise them of the risks and that's as a team, not just the person doing the operating

You also can't predict who will have adhesions. I've done a 3rd LSCS which was fine, yet I've done a section for 1 previous and it took 2 hours just to get to the point where the baby could be delivered

There is a lot of drama and hyperbole being spun here

Adhesions can be dealt with. It's when you've got a placenta which has gone though the previous scar and is emedded nicely in the bladder

Just so long as you don't try to sue the NHS for any later complications as a result of so many c sections and just so long as you don't mind if all consultants refuse to touch you with a barge pole because you are too much of a risk and too irresponsible to listen to their advice then crack on.

70 years ago you and your babies would have been dead three or four times over by now but just so long as you are allowed to do exactly as you please, each time using up valuable NHS resources and taking more and more risks that put pressure on the HCPs because it's your 'right' then who are we, or indeed obstetricians to argue?

The doctors were offering you the medically best choice. You refused it. They are not the ones being unreasonable - they are doing the right thing.

Er, they are trying to stop you from dying. YABVU. Also you need to stop breeding.

Jesus wept Iwas there's no need for that crass comment!

OP. I think you're reading them the wrong way. I doubt that they're pressurising you and if they really are, they're doing it for your own safety. A friend of a friend is on baby no5, she was ever so poorly with baby no 4 and is now moaning that she's SO poorly with baby no 5 despite the fact she was warned by her medical team, several times, that this will happen if she continued with the pregnancy.

Whether you've had a complication free pregnancy this time or not is besides the point. DD was a perfect pregnancy. Still didnt stop us both becoming a medical emergency when my waters broke prematurely and it all happened very, very fast.

Well, adhesions can't be dealt with sadly. there is no way of getting rid of them and more surgery makes them worse. Even years after surgery you are still at risk of bowel obstructions. If they are causing something like a bowel obstructions you can have surgery ti have them cut, but they tend to return and case the same problems, and you get more into the bargain..

The reason you were offered sterilisation is that, as others have explained, the risk of something going terribly wrong increases with each c-section. Do you regard your family as complete with five children? If so, then I think I'd jump at the chance of having a sterilisation carried out at the same time as the final c-section - but that's me, of course. If you want more children, and understand the risks involved, that's up to you.