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 also had this experience.
I was under consultant care for multiple reasons and so was at a consultant appointment approx. Every 2 weeks for the whole pregnancy, c section booked. Sterilisation was NEVER mentioned except 5 minutes before going to theater. Which I though bizarre.

@thetimekeeper
It is wildly unethical and unreasonable. Apologies for any confusion in my response.

This is an interesting thread. I'm genuinely surprised that being offered a sterilisation just before a C-Section is seen as such a bad thing. I haven't been in the situation myself but I think if it had happened to me I'd have just said yes or no and not given it anymore thought. If I wasn't sure then I would have asked more questions. I think I would have welcomed the option to be honest.

Surely most people who are pregnant have given some thought as to whether or not they want to have more likes and what type of contraception they will use.

Anyway it's interesting to see that so many people find that it's not an appropriate thing to ask.

I don't personally think that you should get an apology as I think it is too subjective and because other people would have wanted to be asked. However I don't think it's a bad thing that you complained. You have every right to feel as you do and it will be useful for the consultant to understand that some people will be upset if they are asked about it.

@GrabbyGertie It's considered to be a bad thing because some women may feel under pressure to agree to it. Being asked 5 minutes before an ELSC is not an adequate amount of time to make a fully informed decision and give informed consent. It's completely unethical. It would be slightly different if the woman tells the doctor she would like to be sterilised without being prompted. It could then be assumed that she has some knowledge about the procedure and the consequences. She would still need a doctor to go through all of the details with her so she could give her informed consent. A lot of women just blindly agree to all sorts of medical interventions when they're in a vulnerable position of giving birth which is why aims.org.uk exists to campaign for better maternity services. Of course it should be something that is explained to the woman in the months before the ELSC and not 5 minutes before. Like I said, being asked isn't what they need to apologise for, it's the timing and the manner in which OP was asked.

@Grabbygertie the reason people are appalled at this type of situation is that here is a clear legal and medical framework laid out for obtaining informed consent, especially in the situation of elective procedures.

What the OP described meets neither of these.

Thanks @MatildaTheCat and @GrabbyGertie

This might be relevant - I had a category 3 c-section which means no maternal or fetal compromise but needs early delivery and needs to deliver within 24 hours.

I needed to deliver because I was age 40, at term plus 2 days when I decided to have a c-section the day before. The risk of stillbirth for my age bracket increases each day past your due date. So if anyone was going to talk to me about sterilization, they had 24 hours in which to do so. The registrar chose 5 mins before I went to the operating theatre.

I had never thought of sterilization - it's just not something I've ever considered or thought relevant. No health professional has ever suggested it either. The first time anyone suggested it was 5 mins before going to theatre.

Not cool.

I am the OP. I thought I would update you on this because I am grateful for everyone's help. Your support gave me a confidence boost.

My complaint is now with the Parliamentary and Health Services Ombudsman and they emailed today to say there is evidence to indicate failings in my treatment by the Trust. They have more work to do, but this is encouraging.

So thank you to everyone who responded, you have hopefully contributed to better maternity care for women in the future.

Well done OP - I'm pleased you've had the courage to take this further. Maternity services in this country are inadequate to say the least and IME, women are treated like idiots.

Keep us updated!

OP I think you were right to pursue this. There should be a limit of consent gained at least 24 hours but preferably more than a week before the procedure is performed to ensure the patient has chance to think about it.
The reasons are obvious - say a woman wants two children but the second one dies during delivery or shortly afterwards. They may well change their mind and decide to have another child at some point. That is obviously not the sort of scenario to bring up when someone is going to give birth within 30 minutes. But it needs to be considered before consent is given. Sterilisation is of zero medical benefit so it's not necessary to gain last minute consent

Well done OP! Progress.

I’d have said “ nunya” she’d be like what “ none ya business on whether I’ll use hormonal ( that’s for me to think through in the fullness of time) but obviously at a minimum condoms. Do you think I don’t understand contraception at 40?”

Yanbu. I had the opposite problem. I asked to be sterilised at the same time as my c-section with dc4. I was told no because it wasn't enough time to think it through (2 days before). I then accidentally got pregnant with dc5. Asked at every appointment and put it in my birth plan but told no again.

Well done OP. Not needed this particular set of gynae care yet but I've experienced similar pushiness wrt birth control and I'm saddened but not at all surprised that this happens.

Remember this thread? I took my complaint to the Parliamentary Health Services Ombudsman and I WON! They ruled that the consultant was wrong to ask me about sterilisation when she did because it went against all the national guidelines.

The Trust now has to acknowledge its failings, train all their obstetrics staff on consent at the time of sterilisation, formulate an action plan with evidence (and send a copy to me), and pay me financial compensation.

Thank you so much to everyone on this thread who gave me advice and encouraged me to complain. Big thanks in particular to @MatildaTheCat @greybluegeometry @NothingOnTellyAgain and @AnoukSpirit for your wise words. I appreciate it.

Wow! I’m really pleased you’ve made changes to the system and instigated training to help women in future.

What was the compensation for you for though? Apologies, skipped through thread.

It shouldn't be offered that close, it's a decision that you need to consider beforehand not make a last minute decision.

I was asked before I had my coil retrieved from my abdomen the day before surgery I was asked if I was planning to be sterilised did they want them to do it at the same time - I had no issue with them asking then, I did complain when I was asked again just before being wheeled down to theatre

@SnackSizeRaisin

OP I think you were right to pursue this. There should be a limit of consent gained at least 24 hours but preferably more than a week before the procedure is performed to ensure the patient has chance to think about it. The reasons are obvious - say a woman wants two children but the second one dies during delivery or shortly afterwards. They may well change their mind and decide to have another child at some point. That is obviously not the sort of scenario to bring up when someone is going to give birth within 30 minutes. But it needs to be considered before consent is given. Sterilisation is of zero medical benefit so it's not necessary to gain last minute consent

I remember being at a planned section and sterilisation once years ago where the baby was born but needed quite a bit of resusitation. The obstetrician refused to do the sterilisation until the baby was breathing unaided and was ok - stood there with her abdomen open for about 20 minutes before continuing - on the basis of it may change her mine if this baby didn't make it

@Seasiderabbit congratulations on pursuing this, I think unless something untoward has happened to you in a medical setting it’s hard to comprehend just how difficult and daunting it’s is to not just make a complaint but to then have to listen to justification and minimisation of your (very valid) concerns. To then research the correct avenues, follow their lengthy and often complicated processes is even more difficult especially if you have neither a medical or legal background.

This type of incident isn’t unusual but it is wrong and if we continue to push back things can change.

Informed consent matters!

Sounds like a good idea to have it all done in one go.

I daresay it is common practice, eg they are taught to ask, to discuss contraception or sterilisation with pregnant women who do not want any more children. You said you wanted no more.

You are amazing op! It’s so tempting to let stuff like this go, you have helped countless women by preventing them having this horrible experience. Thank you so much!

Congrats OP! This will make a difference to so many people! And well done for seeing it through.

I had a copper coil. I have had bad experiences with hormonal birth control and said so, but had to stand v firm against the HCP pushing me to get a mirena instead of a copper. They were so pushy that eventually, whilst lying on the table at point of insertion, my gut instinct lead me to ask "that's definitely not a mirena is it?" It was and they apologised and got me a copper. I refuse to believe it was a mistake though and I wish I'd complained at the time.

The nurse who eventually removed it years later also debunked the stories they used to pressure me. Too late now but I will NEVER not speak up again, and knowing other people have done it and had results makes me more confident.

I think it was unethical, regardless of her intention.I'm complaining RIGHT NOW

Sounds like she thought you were telling her it was what you wanted/had discussed already. I mean, why were you telling her you didn't want any more children if it wasn't in any way relevant to her?

She offered, you declined. I'm really not seeing the problem here. But sure, complain away, people here seem to love complaining at everyone.

Just saw the update. More validation for the complaining classes.

@greybluegeometry

Difficult one. If you are sterilised at the same time as having your CS then it saves a second operation later

Yes, because as we know, all women get sterilised when they decide they have completed their families.

The op had decided she was not going to have more children.

Many would have jumped at the opportunity to be sterilised at the same time as having a section. No need to worry any more about unplanned pregnancies!

Anyway she only had to say, "No", which she did.

Its strange alright, on my last baby it was a planned section, when i got there I asked while she was doing the section could I get my tubes tied and she said no way, this was a conversation I should be having with her well in advance, which it probably was. I went on to have another baby 2 years later.