Sterilisation at the time of Caesarean Section

As you approach your planned caesarean section, you may have considered the option of sterilisation if you have decided you do not want more children or wish to use a permanent method of contraception.

Sterilisation can be carried out at the same time as a caesarean section but there are things you should consider before making your decision. This information should support, but not replace, discussions you have with health professionals. They should tell you more about what the operation involves before you make a final decision. You should have a chance to talk about the operation in detail, to raise any questions or worries you may have, and to think about what it will mean for you.

Information for you to consider when deciding if sterilisation is for you:

1. Permanent: It is important for you to realise that this is a permanent form of contraception. You must have decided that you don’t want more children. Although sterilisation can sometimes be reversed, sterilisation carried out at the time of a caesarean section is harder to reverse and the success rates for reversal are low. There is no funding for women to have reversal on the NHS and having reversal performed privately costs up to £4000. This is why you should be sure that your family is complete before asking for the procedure.
2. Risk of regret: Studies have shown that this is higher in those who are sterilised at the time of pregnancy. Pregnancy is often a time of mixed emotions and if you are in any way undecided about your decision, it is important not to go ahead. You need to be sure that the decision is right for you even if your baby was to suffer a fatal illness in the future.
3. Doesn’t always work: Failure is higher in sterilisation which is done at the time of caesarean section at 1 in 133. This means that 1 woman in every 133 who has the procedure at the time of caesarean section may fall pregnant at any time after the operation.
   This is compared with those done 6 or more months later at 1 in 200. This means that 1 woman in every 200 who has the procedure may fall pregnant at any time after the operation.
   This is due to the ends of the tubes reconnecting. If you did become pregnant after sterilisation there is a high chance (30%) that the pregnancy could be in your fallopian tube. This is known as an ectopic pregnancy which is serious and can be life-threatening.
   • Alternatives: Here are some reliable methods which may offer additional benefits:
   • Vasectomy which is sterilisation in the man. It is done under local anaesthetic, and most men have no lasting problems following this operation. Following the operation several sperm samples may need to be provided for testing to confirm the operation has been successful. 
     After this confirmation the operation can fail in 1 in 2000 cases. That is 10 times less chance of failure compared with female sterilisation.
   • Copper coil (T-safe) – lasts for up to 10 years. Failure rates are like sterilisation at 1 in 200.
   • Mirena coil – a coil with hormone in it. It lasts for 8 years. Failure rates are about 1 in 500.
   • Contraceptive implants (Nexplanon) – inserted just under the skin in the upper arm: It lasts for 3 years. Failure rates are less than 1 in 1000 cases.

The coils and implants are as effective as sterilisation but can be removed if you decide you want further children. The Mirena coil is also useful to treat heavy periods.

Further information about contraceptive methods is available from your midwife, GP, family planning clinic and health visitor.

How is sterilisation performed?

Usually, a portion of the fallopian tube is removed, and the remaining ends are tied with a stitch. There is a small risk of further bleeding in addition to that from your caesarean section.

If you decide to be sterilised at the time of caesarean section, you must discuss this with a doctor.

It must be agreed, usually in clinic, before your caesarean section takes place and the consent form signed. Medical staff will not usually perform your sterilisation if you request on the day of your caesarean section.

Any other questions?

If you have any further questions, please ask your midwife or doctor at your next appointment.