Contraception discussion at 34 weeks scan

[Eek3under3]

I had my 34 week scan today and the consultant asked me if I’m planning to have more children/ what I plan to do for contraception. I was a bit taken aback…and didn’t have the nerve to say with 3 under 3 there will be no chance of getting pregnant.

She suggested I have the implant or coil put in on the PN ward. Has anyone else had this suggested? I didn’t realise it was a conversation for now. I feel uncomfortable about the permanence of these even though I’m not planning to have any more children…

Having 3 under 3 is probably the reason they've raised it - there's clearly every chance it could happen!

Well, what ARE your plans for contraception?

Was he worried about your health if you were to get pregnant again soon if you've been pregnant three times in three years? Contraception was discussed with the midwife after birth every time, but I wasn't under a consultant's care.

I think it's a good idea. It's easy to get so tied up in having a baby and family life that that would just go on the 'to do' list and never actually get done! PLUS I had to wait 3 months to have a coil fitted due to the massive waiting list. It's much easier to have it put in and then taken out if you decide, then to not have it in at all and wish you did have it so you don't need to remember a pill, or buy condoms and use them etc etc

Congrats on your babies by the way!

Than*

@TeresaBlue true. Twins plus surprise baby 2.5 years later. I felt a bit judged but guess I shouldn’t be so sensitive. Next time I might give the honest answer…!

It’s a massively important part of obstetrics and midwifery. You might be happy to have three under three but many wouldn’t be and even more bury their head in the sand that they don’t need contraception…. Until they do need it and end up pregnant again when it’s not even been on their radar.

I know this because I used to see those women in my clinics.

if they’re offering long acting contraceptive options on postnatal ward, for some women that’s a really useful service. If it’s not relevant for you then just don’t worry about it :)

@DenholmElliot1 believe me, I plan to keep my legs FIRMLY crossed. Surprise baby was conceived on our first night away from the twins. It took me nearly a year pp to even consider having sex again.

I had assumed I would take the pill, but maybe for ease the implant is an easier option.

Are you high risk pregnancy or is there a reason another pregnancy might not be wise? They mentioned sterilisation to me during my 3rd pregnancy when I was scheduled a C-section and well it was because they wouldn’t usually recommend a 4th csection however never said why at the time, I was only 29 but I thought it was odd it was mentioned and declined as it felt very final….during my section there were some issues and they asked me again if I wanted more children and I said I’d wanted one more maybe but hadn’t decided. Following the section she gave me a lot of risks I could face next time with a 4th csection….obviously it was too late to sterilise me then however and I kind of wish they’d given me the risks and reasons for suggesting a sterilisation the first time they mentioned it in pregnancy.

i accidentally fell pregnant again and will be having my 4th csection and am pretty high risk this time- I will be having extra scans to check for these serious risks and they’ve said my csection could be quite complex, I have no doubt they will strongly recommend I be sterilised this time.

This is their field of practice I doubt they were saying it to be rude, they see women day in day out and it’s probably a normal thing to mention to them and something that’s just on the list of things to mention, there may be various reasons behind it, mainly health reasons.

Nothing wrong with asking. My consultant asked if I wanted my tubes tied during my third c section. I declined as I knew I wanted a 4th. I certainly didn't feel judged and I had three under four.

I think it’s routine. I was asked at 34 week appt did I want sterilisation (4 c/s planned) I said NO! That I’d like a coil…. I was so clear the dr wrote in capitals
‘PATIENT DOES NOT WANT STERILISATION’

fast forward 3 weeks and I was very unwell with a uti. Totally confused and got bullied daily as an inpatient - told I’d die if had anymore children , not shown any info re the procedure or alternative options. I kept saying I wanted a coil they wouldn’t discuss and carried on. Then a dr came and said ‘if you have more you’ll have a bleed. It’ll be like a hose, you won’t survive’

He thrust the papers at me hours before my c/s and told me I had to sign. So I did . Under extreme pressure it was awful.

i regretted it so much immediately I was only 30. I got pnd and then 18 months later finally had an appt where I had to ask what procedure did I even have ??? Clips or tubes cut ? They said they had cut a portion out, tied them AND burnt the ends . I was so devastated.

went through 5 years of ivf then a reversal of sterilisation. It was a traumatic time .

I requested my notes as said I wanted to complain because at 34 w it had been clearly recorded that I didn’t want that and they had bullied me . They told me that they had lost my notes !!! I got them in the end (using a way I shouldn’t have but they were acting unlawfully) and it was clearly documented how they planned to keep coming daily to push sterilisation despite me declining at 34 w. I even got that page from my notes it had been pulled out and put elsewhere !

cross posted- no judgement either way, I’ve known people who want big families who are TTC straight away postnatally! I was saying to my student earlier, in this job it’s always best not to assume, one woman might be up for two babies in a year and the next would look at you in horror at the thought of sex before 6 weeks or longer! No right answer at all.

Hope it all goes well and the twins enjoy their little sibling :)

Fitting a coil post partum increases the risk of perforation. It is better to wait.

Someone I knew had one fitted after twins. It was her first venture into contraception as twins were 5/6 and she had had huge gaps between each pregnancy, but sometimes you just have to call it a day. 🤷‍♀️ It ended up outside her womb and she had to wait 4 months to get it removed. He DH had a vasectomy while she waited.

You could just cut out the middle bit and go straight for vasectomy?

I would just respond that you will discuss contraception with your GP at your 6-8 week check if they bring it up again. There is no way I could have meaningfully consented to have the implant or a coil put in hours after giving birth!

It's routine. I was asked whilst pregnant with my twins although I'd made clear several times I had no tubes left due to ectopics and needed IVF to get pregnant - she did have to good grace to look a bit embarrassed and apologised - they just read from a set script

Are you following this up with a lawsuit or some sort of malpractice case?

I complained and i did look into legal action but nobody would touch the case - said as I’d signed a consent form then they couldn’t do anything ? Even though I don’t feel it was informed consent

The complaint process was horrific - the hospital claimed they didn’t offer counselling or literature before as they did t have any literature ( I called anonymously and asked to be posted info for sterilisation and they sent me it it stated on there ‘2001’ so they had had info available at least 11 years prior to what happened to me !)

They claimed to have lost my notes and when I got then they said they ‘couldn’t identify the drs involved’ I stated it’s clear from the names who they were and I got their registration numbers they still wouldn’t respond and it was hugely stressful.

i called some medical negligence places and nobody was interested. I had to just resign myself to the fact I had to deal with it myself - funded counselling and therapy to see if I could get over it , then when I couldn’t medical treatment.

And for all they told me horror stories I had 2 more no complications at all after my reversal !

“No chance of getting pregnant”...but there is, that’s why they ask!

Coils and implants aren’t permanent either, they can be removed at any time.

I think it's sensible to have the discussion at 34 weeks, and the offer of an implant/coil when you are on the maternity ward sounds really sensible, along the lines of "while you are up there".

You usually get asked on the ward or at the 6 week check when you are exhausted and can't think straight. You've also then got a tiny baby and often no help.

Completely standard- coils / implants directly after birth is a really good way of preventing unwanted pregnancies.

Thanks everyone, I felt put on the spot but feel a but more rational now. Understand it’s a sensible thing to consider! I have suggested DH has a vasectomy….

You need it!

It was discussed at my 34 week appointment. I said I would sort it out once baby was born. Sleep deprived, up to our armpits in nappies and night feeding and completely forgot about it. And we now have a 15 month old and a 9 week old, whoops.

No, and I had five babies in four years and consultant care. I would make a complaint it’s inappropriate.