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?

Sorry pressed send too soon

All anybody has to say is sorry I need to have a proper discussion about this with my husband , consultant or whoever else, I also don’t like the idea that some people have that just because a woman is having a baby that they don’t know their own mind

I also don’t like the idea that some people have that just because a woman is having a baby that they don’t know their own mind

^^I don't either. OP was asked and she said 'no'. She didn't like the doctor that much, I can't see the issue tbh, it's clear that different trusts have different policies.

Nico

That lady would be well within her rights to make a formal complaint if she decided she no longer wanted to be sterilised.

I get what you and she are saying, but you know the old adage of 'if it's not written down, it hasn't happened'.

Consent forms are a bit ambiguous in order to cover emergencies, not for stuff like sterilisations.

Don't get involved next time or at least pass it WAY, WAY up the line. Your PIN is too precious to risk it like this.

I've got various Matrons and the clinical director involved in similar cases before now. They've all backed me 100%.

30 mins before giving birth when you're all ready for surgery and in a gown is not an appropriate time to start pressing a woman to be permanently sterilised.

With any situation where it's a big deal the advice is always not to make snap decisions and to go away and think about it, discuss it with relevant people (eg husband / partner) sleep on it etc

Apparently unless it's a woman's reproductive future where absolutely the thing to do is first try to talk her out of the procedure that is happening in 30 mins and when she stands firm on that. proceed to saying well we might as well tie your tubes while you're at it.

This is pressurising (now or never! how long is the waiting list if you come back later? 1 operation better than 2 etc) and just totally inappropriate.

I am really surprised that a few posters think this is OK and even that the poster is a total pain in the arse putting in irrelevant complaints just to cause trouble.

It's really not OK.

Also I've had 2 sections and there was no mention of sections at all, same as other posters experiences. Most women don't get sterilised, it's not like it's totally standard for women to say right kids done tie it all off.

I wonder if it's beign pushed more these days for some reason. And strange that women who want to be sterilised otherwise are so often told no.

A woman naked under a gown prepped for surgery and going down for epidural / block in 30 mins is pretty vulnerable.

It's not a question of women not knowing their own minds but a combination of the fact they will likely be under stress, uncomfortable, worried, looking forward to having baby etc a really complex mix of emotions and possibly not in the best place to focus 100% on something else and make a permanent decision with a clear head.

It surprises me that anyone sees "on the trolley about to be cut open" as a good time for this stuff.

Totally out of order please escalate to hospital complaints dept PALS. You stood your ground but she may pressurise somebody else who says yes just because she is a senior doctor and goes along with her suggestion. Just because you have chosen not to have any more babies does not mean you want to be sterilized.

And you just know the people saying yes this is an excellent time to do this

Would have zero sympathy with any women who didn't really understand / felt pressured / in the moment said yes etc
And then later realised they had made a terrible mistake.

These same posters would say
You made your mind up you pay the consequences.

Given that I asked at week 32 whilst pregnant with my 2nd and was told absolutely not as I hadn't raised it early enough by the consultant obstetrician I was seeing, I think you are absolutely justified in being upset/annoyed OP.

I signed the consent form for the section at the same time and without further discussion she crossed out the "any further procedure" bit on the form with lots and lots of black ink before letting me anywhere near it.

I’m not surprised people think this is ok- it’s the kind of thing that happens so regularly statistically some people must think it’s ok.

It’s still wrong and barbaric though.

Lots of people liked public hangings/bear baiting etc etc etc.... doesn’t mean those things are acceptable. And before anyone jumps down my throat not necessarily the same types of people who think this is ok, it’s a wider point about public opinion and it’s validity as a moral compass.

to do it another time would be to double up on NHS resources

Yeah, who cares about the law on consent, eh? Threads like this always depress me with the number of posters shouting about how irrelevant consent is and how the clever doctors should be able to do what they want regardless.

I am glad you intend to make a formal complaint, op, this was unacceptable behaviour and the next woman on the receiving end of this kind of treatment may not be in a position to stand her ground.

Consent for medical treatment is not legally valid if it is not fully informed, freely given without any pressure or coercion being felt by the patient and given by somebody who has the mental capacity to make that specific decision. If it is not legally valid then the medical professional has committed the criminal offence of assault. It's also a civil trespass against the person. The posters who think it doesn't matter are wrong, legally and ethically.

Thirty minutes before major surgery being pressured to make a life altering decision does not meet the first two, and it's debatable whether it would meet the last either in such circumstances - do you have the capacity to retain, weigh up, evaluate and repeat back all the relevant information as it applies to you if you undergo sterilisation at that point? I doubt it (not least because the information wasn't provided).

It is not vexatious to complain about somebody violating the law and their professional conduct regs. Next time the registrar does it somebody's life could be destroyed. Patients come first.

I know I definitely didn’t give informed consent
They bullied me

Thanks everyone, there's so much useful stuff on this thread now that will really help with my complaint. Thanks in particular AnoukSpirit -you're so right.

Even if I am a right pain in the arse*, I still deserve to be treated with respect and according to guidelines on consent.

*Being a right pain in the arse holds people to account. Go me.

@AnoukSpirit

It depresses me in these threads when people quote me out of context and try to suggest something I didn't say.

Of course consent is required. I didn't suggest that it would be reasonable to just go ahead and do it to save the NHS money FFS!

I said it wasn't unreasonable to ask at that time, due to the fact the that op decided to have an elective c section at short notice. That's hardly the same thing as just going ahead without consent.

And I also qualified it with the fact that op said she had decided to have no more children, so may have already been considering it, and may already know if it was for them.

Perfectly reasonable to ask if you wanted one, far better that it’s done then and there if you do plan on being sterilised. But she didn’t ask did she? I would make a complaint.

I would have taken the option if someone had asked me when I had emcs with child 3. I don't think it's inappropriate to ask as long as the surgeon didn't push a decision on you. I would've happily been sterilised since my last baby but of course they won't do that until every other route has been tried. You can't just ask to be sterilised and get it done easily. For all the surgeon knew you had already discussed contraception with your partner before. So I don't think he was wrong to ask as long as he didn't try to persuade you if you said no.

That's hardly the same thing as just going ahead without consent.

Legally, it is. If you don't have legally valid consent, you don't have consent. And you can't meet the conditions for legally valid consent in the circumstances you describe even if I quoted your full post.

HTH.

I'm the OP. Here's an update.

I complained to the hospital. I was offered a meeting and a written response to my complaint. In short, I complained that the registrar could not have got valid consent for sterilization at that time (it was actually FIVE minutes before I went to theatre - I got a copy of my hospital notes).

The meeting was today. The investigating officer and a senior consultant were present and the meeting was recorded. I'll get a copy of the recording. The consultant said that he wouldn't have done what the registrar did, but that's just variation in practice. He also said he thought her offering to sterilize me was her making an "off the cuff" comment. He went to great lengths to explain how some patients need loads of information and want a long time to think about treatments, and others don't. He seemed to be implying that I would want a lot of information but that others are fine to make a snap decision. I also got the impression I should be grateful, because getting sterilized at the same time as a c-section saves them money, because they don't have to do further surgery on another occasion.

My complaint was about the legal principles of valid consent and that they were not present. I read the guidance from the Royal College and they are very clear.

I don't think variation in practice or whether I personally am the sort of person who needs a lot of information are relevant. The registrar shouldn't have suggested sterilization in a weird and confusing way 5 minutes before I went to the operating theatre! That's why there is clear guidance and principles on consent, to avoid ambiguity and variation in practice. The right time to discuss this, if at all, were the day before when I met a consultant to talk through the pros and cons of a c-section and signed the consent form.

I'll get the written response to my complaint soon which will also include an apology from the registrar that says, "I'm sorry you felt unhappy with the way I spoke to you etc etc."

Not sure whether to take it further or just not bother. The consultant apparently did reflective practice with the registrar. So maybe she will think twice next time. But I still don't think it's right that someone can be "off the cuff" about something so serious and potentially life changing.

Any views?

What are your expectations? What are you hoping to achieve by the end of this?.

OP, thanks for doing this. I remember your post and even though it sounds like the meeting didn’t directly address your main concern with following policy, it’s really important that you went on record.

There’s a good chance I’ll be having an ELC soon and I am unbelievably anxious about encountering pushy or disapproving medics at the last minute. I’d have no objection to encountering them in the days before, but not at the eleventh hour! So well done.

Sterilization is never a decision that should be made with less than 24 hours notice

I ended up having gynae surgery (my coil perforated my uterus) and they asked me if I wanted to be sterilised both the day before the op and then again just before I went down. I ended up complaining about the second questioning.

I have no issue with them asking once - it was presented along the lines of 'were you planning to be sterilised as we could do it at the same time' - but when I said I wasn't ready to make that decision that should have been the end to it. I should NEVER have been asked while signing a consent form while prepped for theatre

They did agree it was completely inappropriate to ask someone to make a life altering decision with less than an hours notice

I'm glad you made your complaint OP. 5 minutes is definitely not enough time to make a fully informed decision. It's completely unethical! I would want this to be something that no doctor should be able to discuss with the patient 5 minutes before the c section when they weren't due to have it done. I would want there to be a consultation period of where it is first discussed, the patient can go away with all of the information and make their choice. If the patient says at the time of their c section that they want it doing they should still have someone take their time to discuss it with them first. Maybe they could sign a waiver on a consent form since it's so short notice??

Some women would feel very vulnerable and just agree to it when they haven't thought it through. It's not something can can be easily reversed and the reversal is largely unsuccessful. Also the NHS won't fund a reversal.
Completely unacceptable and shouldn't be allowed to happen. Well done OP for sticking up for yourself and future mamas!

What else would you like them to do?

I recently had my tubes tied during a c section with my third baby. I had requested it during my first ante natal visit at 11 weeks and I was asked during my visits if I was still happy with my decision and asked again before the procedure after the baby was delivered if I was happy to go ahead. I know in the hospital I delivered in the policy is that normally it needs to be requested and discussed before a specific timeframe during the pregnancy and it absolutely would never be a last minute decision.

What do you mean by "take it further"?