to think sterlization shouldn't be offered 30 mins before a c-section?

[Seasiderabbit]

A hospital registrar came to visit me on her rounds 30 mins before I went into theatre for an elective c-section. I'd never met her before. (Some context - I decided to have the c-section the previous day in conjunction with a hospital consultant for very good reasons. I'd signed the consent forms and done the pre-op etc.

So, with 30 mins to go before going into theatre, the registrar questioned my decision to have a cesarean and told me how difficult it would be to have a future vaginal delivery. I told her that with 2 children already and age 40, we have decided not to have any moe children. She then said "So, what you are telling me, what you are trying to say, is that you want your tubes tying at the same time as your cesarean." I said that no, I did not want that. She then questioned me about what contraception I'd be using in future.

I was vulnerable - in a hospital gown and nervous before going into theatre. She was standing over me, her tone throughout was passive- aggressive and hectoring. It was also clear from a couple of things she said that she hadn't looked at my notes.

AIBU to think this is out of order? Isn't sterilization something you need time to think about with all the relevant pros and cons?

I was offered & accepted the offer of sterilization after my baby had been delivered & before I was stitched up.
There has been no discussion before other than my very difficult pregnancies.
I did feel a bit under pressure when the consultant was discussing it with my DH.
Ultimately it was the best decision & saved a future operation but I wish we’d had the discussion prior to laying on an operating table !

I don’t think they should accept consent in these circumstances so in my opinion it’s too late to ask. I would complain.

The thing is, how do you know that she knew that no one had discussed it with you before? Most women I know have had this discussion with their healthcare professionals at some point in their pregnancy, and so to have that discussion in the final stages would not have been a shock.

When I was pregnant with my final baby, we discussed it throughout the pregnancy, and then when I was admitted to hospital (and in the pre-surgery checks, the week before) each doctor that I saw in the hospital asked me again and went over my options. I signed several sets of consent paper. They also double checked with me just before they actually did the procedure as well.

She only asked. Someone clearly should have discussed contraception and your options beforehand, but no one clearly has, and her approach might have been a little clumsy but I can't help feeling that your anger is misguided here.

Ultimately it was the best decision & saved a future operation but I wish we’d had the discussion prior to laying on an operating table !

I just think that's appalling. You can't possibly give fully informed consent on the operating table having just delivered your baby! That's a ridiculous time to mention it. Even worse than the OP's 30 minute warning.

I find it so frustrating how different areas are. I'm late 30's, 5 biological kids (1 Dss who is my son). My youngest two were conceived on the coil and implant respectively. My youngest has a myriad of health problems (some of which we knew from 20 weeks) and I can't even have a proper discussion with anyone about being sterilised because I'm under 40!

@lyralalala - It was very bizarre.
I felt a bit like a science subject. The consultant called my DH down from the head end of the bed where were cooing over DS.
He had his hand inside my uterus & was stretching it out to show my DH how thin it was & therefore his advice was to sterilze there & then.
I think I said (in a hazy fog) ok if that’s what you think is right.
I was 30

I think that's awful, if you would of asked me during labour if I was going to have any more children I would of said no way not after this pregnancy, and may well have took it. Now a year later Im thinking more and more about another child.

I do find it interesting how I know someone who has very valid reasons for wanting a sterilisation, after 5 children. Every birth has been dangerous and babies born premature, some conceived while on contraception. Yet they won't offer her one in case she changes her mind?

Have/of 🙄

@cheesychipsfortea Did he start discussing it with your DH before you?!

I'd complain about that in your shoes - you weren't in a position to give proper consent to that.

@Cheesychipsfortea that is shocking.

"I actually think it was a fair question and I’d i genuinely didn’t want anymore I would of snapped her hand off as other contraception is not 100% so if your having a c section and don’t want more dc it’s a no brainier really."

Sterilisation isn't 100% either. Apparently the Mirena is more effective than sterilization.

I'm genuinely shocked by this, and even more surprised that so many people on this thread thinks it's OK. How can a woman possibly give informed consent 30 minutes before she's due to give birth? I even think the day before isn't appropriate, either. 24 hours to make a potentially life changing decision? I've know for 10 years that I didn't want more children but being sterilised had really never occurred to me. I certainly wouldn't want to be rushed into a decision like that.

OP, you really should complain. Pregnant women are often treated by medical professionals as though they are completely incompetent and this is just another example of this.

Think it actually goes against rcog guidelines which recommends a specific minimum timeframe between consultation and sterilisation.

I've seen a dr refuse to do it at an elective section when the woman was begging him to do it due to this.

Why is it inappropriate? You don’t want anymore children. It would be sensible to have your tubes tied. I think it was good of them to offer to be honest

I think actually asking is fine. Her manner sounds unprofessional, so you could complain about that for sure. But the actual asking if you would like to be sterilised during the surgery is appropriate. Every surgery comes with risks; doing it at the same time as the ceserean is not only better for you physically (not to have to go through two procedures) but more efficient regarding resources.

As an adult woman who is pregnant, a doctor would assume you had had discussions already with one of the many clinicians you see during your pregnancy about post partum contraception. If you didn’t, that’s a failure on the part of maternity care.

I see her actions as asking whether you had decided on or want sterilisation, as she wouldn’t have access to all of your previous notes, but if she also asks women who haven’t yet been asked about whether they’d like sterilising that’s good too as everyone should be offered the choice.

If you’re under the influence of medication that makes you drowsy or less ‘with it’ you should be offered it, but if you weren’t under the influence of anything I don’t see the problem. I’m sure if you’d said yes there’d have been further discussion instead of just ‘great’ and then it’s done. Patients make medical decisions all the time in hospitals when they’re stressed or anxious. I actually find it a bit weirdly infantilising to imply a woman in labour is therefore unable to make choices and decisions regarding her care.

Think it actually goes against rcog guidelines which recommends a specific minimum timeframe between consultation and sterilisation.

Nico I’d be very surprised if OP didn’t have the issue of being sterilised and contraception raised during any of her appointments during the pregnancy. This specific doctor had no way of knowing if that hadn’t happened.

Anyway OP, you’re well within your rights to complain about any aspect of care you feel is lacking. Let us know what their response is.

To confirm, sterilization never came up during any of my appointments because I'd planned a vaginal birth, not a c-section. Sterilization didn't come up the day before either, when I consented to a c-section. It's not something I've ever thought of.

@NicoAndTheNiners - I agree, there should be adequate time to think about it. I'll check those guidelines. It did seem like there was a reason behind it. Maybe something to do with her portfolio as a previous poster suggested or a hospital target.

The Registrar should have read my notes and not assumed anything. They make notes for a reason and surely one of those reasons is so new members of staff can check what's happening with the patient. In this case, she demonstrated that she hadn't read my notes at all with her first question which was "so you're having a c-section for an unstable lie." I wasn't -the baby was head down. The indication was patient choice.

I'll let you know how I get on.

No it shouldn't have been offered half an hour before! It's a decision that needs great thought and consideration.

I had an elective CS when I was 36 and asked to be sterilised at the same time - but I'd had months to consider it! And the staff still asked on CS day if I was sure I wanted to be sterilised, even after signing the consent form.

It's a massive decision - there's a huge difference between not wanting any more children and not being able to have any more.

And if someone else should have spoken to the OP then all that had to be said was “Have you discussed sterilisation so far?” or “Did anyone bring up the option for...”

Even if it had come up in a previous appt if it's not documented then it doesn't count.

The incident I'm actually thinking of (I'm a midwife) the woman was insistent that she'd been counselled for it in an antenatal appt but it seems like that dr forgot to document the conversation. So due to lack of evidence the operating dr refused to do it. The woman was furious. I had to advocate hard for her and argue with a consultant until in the end they agreed to do it so she didn't have to come back for a further operation. But they were very reluctant to do it and I could see why.

This would not be allowed in my Trust and as an obstetric scrub nurse I would not allow it and would take it higher if the surgeon insisted. I would also put in a formal complaint for breach of policy.

Half an hour before having a baby is not the most balanced time to make a desicion. I'd probably had agreed to it when I had my first c section but have gone on to have another baby. Also I know someone with 3 kids that asked her doctor for one but they flat out said no and wouldn't even refer it as she "may change her mind" so seems crazy they are even allowed to ask with 30mins notice.

Nico, I am surprised you were able to convince the Consultant? I would still not allow it though as a nurse.

I complained to the trust and then the nhs ombudsman about what happened to me. I was told it couldn’t progress as they couldn’t decipher the name of the dr who wrote the notes .....
so I found him after reading the name (it was clear) and spoke to him as he now works elsewhere he said he would be happy to speak to the trust but they refused to continue the investigation as THEY couldn’t decipher his name ....
The ombudsman said I wasn’t given written details or info pre sterilisation as ‘they didn’t have any’ in 2012
I called them and said I was thinking of the procedure could they send me up to date info and they sent me the trust booklet .....produced in 2001😳

Is it true that sterilisation ages you? My friend is adamant about this. “Puts you through the menopause and turns you into an old woman”. Probably shite but it puts me right off.

Sterilisation leaves your ovaries intact so does not put you through the menopause. I got sterilised 15 years ago and still haven't been through the menopause.

dinsey70 we don't have a policy about it at the hospital where I work. The scrub nurse wouldn't even have been aware of it. She would have been shown a signed consent form and been happy with that.