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 think it's a reasonable question, how it is phrased matters though

I feel like we have met the same registrar. My decision to have an elective section was aggressively questioned half an hour before my section; I had my section planned with the consultant from 12 weeks and was 38 on the day - I wasn't going to change my mind.

Congratulations on your new baby.

I think it’s great you advocated for yourself and made a complaint but I’m unclear as to how you’d take it further and why. What more do you want? You were not sterilised and you are getting an apology. You did not have a procedure without consent. It is likely that things will be learned from this throughout the trust.

So really, they're saying that what they did was OK. You just overreacted and you will receive a non-apology.

This is NOT OK. I cannot believe that anybody could possibly think it's OK to even ask a woman in such a vulnerable position to make a potentially life altering decision. How could that possibly be construed as valid consent? It's no wonder that dubious practices continue for decades - even when somebody like you takes it further, you're just fobbed off with an 'I'm sorry you're upset' response and they continue doing exactly as they always have.

Schuyler but she's not getting an apology because they think they were wrong. She's receiving an 'I'm sorry you're unhappy...' apology. Not the same thing at all; the OP doesn't want an apology for the way she feels. I imagine she wants assurance that they accept that this was an inappropriate question, does not constitute valid consent and that it won't happen again.

And from the response she's received, it doesn't sound as though the Trust has learned anything.

It seems like they’re not taking any real responsibility as a trust but hopefully the individual registrar will be a bit more sensitive next time.
From your OP it sounds to me like she didn’t agree with your decision to have a section and ‘offered’ sterilisation to shock you into realising (a) you did want more children; and (b) you should have a vaginal birth. I think the offer of sterilisation came from a place of a frustration and annoyance with you.

It doesn't sound like they've understood or taken on board the issue about legally valid consent, as you express so clearly. Therefore any "reflective practice" can't have been that effective (or reflective if it was just "we're right but the patient is sulking") and won't actually address your main concern.

The excuse you received in your meeting is indicative of someone who is not up to date on the legal position. They might have gotten away with that justification in years gone by, but the law has moved on.

Some patients may wish for less info, but they can't tell whether that is the case for the patient in front of them if they only initiate the conversation for the first time five minutes before an irreversible medical procedure. A surgeon can only accept a patient rejecting full info if they've assessed they have the capacity to do so, and you can't do that in five minutes either.

It's pretty scary how poorly they understand their serious legal responsibilities around consent.

The NHS is defensive and rarely takes accountability for anything unless forced to by the courts. I'm not suggesting you take them to court, but if you go through formal complaint process and onto ombudsman just make sure you're mentally prepared.

I think the offer of sterilisation came from a place of a frustration and annoyance with you.

Sorry, are you suggesting that would have been more or less unethical?

I had one with 8 month old DS and the consultant tried to bully me into being induced instead about half an hour before the op. DH and I were sitting in our scrubs and she spoke to me in such a derogatory manner. I informed her we were done having children and she essentially said that with four children under my belt she didn’t trust I was done .

Some consultants are absolute jobsworth bastards. A consultant came in the morning after I’d had an extremely traumatic miscarriage which almost killed me to essentially tell me to find better contraception so this doesn’t happen again! It was a 100% planned pregnancy and I was devastated.

I remember this thread! It stuck in my head because I had a planned caesarean a few weeks later.
Oddly enough I was offered one too. By the surgeon, after introducing his team. I was sat on the operating table. He said "so it's just a caesarean today, or are we doing a sterilisation too?"
Obviously I said no as I had no information and am only in my early 30s. It seems stupid to offer this so late as I might have taken them up on it as my husband wants a vasectomy now.

This is so odd as both me and my sister asked for sterilisation during planned sections recently and were told no. As it happened I tried for a VBac but had I been offered a sterilisation I mayve had a ELCS.

Although, I think aside from the curveball of the whole situation it’s not really sensible to ask a heavily pregnant that anyway. Now I’ve had my baby I can see that a sterilisation wouldn’t be right- I Had an awful pregnancy and was OTT. I still don’t want anymore but no need for a sterilisation

Please OP report this to the hospital because that is not right x

I 100% knew with my second that I wanted to be sterilised at the time of birth, and raised it at my first antenatal appointment (had to have sections for medical reasons). They still checked with me at several points along the way. I think in some ways what you are up against here is underresourcing, OPyour reg clearly hadn't had time to read your notes, as if she had she would have known not to question you about your decision to have a section. That also means that she had no knowledge of your discussions or not about sterilisation. I think there is a fine balance to strike here between pushing for sterilisation (which is clearly wrong) and infantilising pregnant women (or indeed all women) as though they are incapable of making a decision about sterilisation (also wrong). I think your reg fell afoul of that, butparticularly given the obvious fact she hadn't read your notes (and yes, she should have done that, but see above about underresourcing). I don't actually think she was wrong to offer, though, because pregnant women, even pregnant women who are about to have c sections, aren't incompetent or unaware. TBH I DO think the consultant you saw the previous day dropped the ball not to discuss it with you, because that would have given you the opportunity to think about it and decide for yourself. Not wanting a sterilisation is FINE, and completely your decision, your reg handled the situation terribly, but please be careful that the outcome you are looking for doesn't take choices away from other women.

I'm glad you complained OP and I'm sorry that they don't really seem to be taking your complaint seriously!

I had this when I was in having DS2. He was an ELCS turned EMCS. I was second on the list anyway due to previous EMCS and gestational diabetes, but I started bleeding heavily whilst waiting my turn. So as I was waiting on them prepping the emergency theatre for me, a consultant came by to discuss the c section. DH informed her that I was being taken for an emergency as it was clear she didn't know, which was fine given that it had only happened a few minutes before. I'm lying in bed, pressing pads to me to catch the bleeding, terrified of what might be happening and she asked if I wanted sterilised "while they're at it". This was only my second baby and I was only 26 at the time. She said clearly I experience a lot of complications and I should put my own health first before thinking of more babies. My first EMCS was only due to a failed induction and this one had only literally just bloody happened. I was so confused and she just kept talking at me, not to me, about the benefits and why I should do it and how it saves further surgery. I don't plan to ever be sterilised. My husband lost his rag a little bit with her and told her to leave

Forgot to add - I stupidly never complained. I was too baffled and scared at the time to even think about what she was saying, and then after I was too caught up with DS2. I'd forgotten it even happened until we got home a few weeks later. It makes me really uncomfortable to know that they can just go ahead and badger women who are in such vulnerable positions. I'm sure the vast majority of women who do want sterilised would ask before they're sat there waiting to be taken to theatre! It's awful practice. I wish I had complained.

I had this when I went for a laparoscopy for endo. When the surgeon came round for the last chat, she asked if I wanted to be sterilized. I didn't think they could do it that way.

I was 34 at the time with one child. DH and I had already decided we didn't want any more , but the decision being thrown in my face was a shock

Yanbu. You should report this person

The same thing happened to me, except I didn't say I didn't want any more or anything like that. She just asked if I wanted "tubal ligation" or something, in a foreign accent, 30 mins before my planned section! Totally inappropriate and so casual how she asked me.

My friend was offered this and did and he it was 30 minutes before. This was her 3rd and i said i was surprised she did it. she said she didn't want any more 100% i kept my mouth shut but though what if something where to happen or you changed your mind. As it was too late and she'd had it done i kept my mouth shut

Well done op. So glad you took it further

I've had two c sections and no one mentioned sterilisation so it does seem to be trust variation.

I don't know if you can stomach it but for me I'd be pushing for a policy to be put in place. Probably something quite basic giving women time and information to give informed consent.

Any half wit should know the operating table/five minutes before an operation is not an appropriate time.

I would ask what plans they intend to put in place to prevent this from happening again.

Very unsatisfactory. They’d be in a huge amount of trouble if you’d had your tubes tied then complained you were coerced into it.

30 minutes before isn’t giving you enough time to think about it.

I was offered one during my 12 week scan

Thanks everyone!

By 'taking it further' I mean reporting it to the Health Services Ombudsman.

The consultant said that our of 10 registrars/consultants around 3 of those would do the same thing (i.e. offer sterilizaton 5 mins before for the first time). He said that it saves the trust and patient going through 2 operations.

In the consultant's view, it's just about a variation in practitioners and patients. He kept talking about it being a joint conversation/partnership between the doctor and patient, which it definitely wasn't! I recommended he re-reads the guidance on sterilization himself.

So they won't be taking any action to prevent it happening again because they don't think it's a big problem. His only consession was that it "wasn't ideal."

He said that consent is a massive thing at the moment, it's drilled into them all the time and they are all very aware of it.

I asked for 3 things:

a) a written apology from the registrar
b) for the registrar to be reminded of the guidance on valid consent
c) for her to reflect on her practice or be disciplined

I'll see what the letter says before I do anything else but it sounded like it will be very much a non apology.

YANBU, though for myself I wish someone had asked me this before before delivery 4 years ago. I had to be rushed to theatre with complications after delivering my third, and they wouldn’t tie my tubes at the time as they said me being newly post-delivery meant I wasn’t in the right frame of mind to make that sort of decision. I had gone in for a natural delivery, so it never occurred to me to say that it was definitely our last pregnancy one of us would be getting sterilized afterwards. When they rushed me into theatre after delivery with complications, I said to them that it was our last and that I’d like them to tie my tubes whilst they were in there. No joy. Now 4 years later I’m still trying to convince nervous DH to let them snip him.

@seasiderabbit I have sent you a PM.