An updated assessment of postpartum sterilization fulfillment after vaginal delivery

Kristen K. Wolfe, Machelle D. Wilson, Melody Hou, Mitchell D Creinin

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objective: To describe sterilization completion rates after vaginal delivery and indications for unfulfilled procedures. Study design: We used labor and delivery operating room and delivery logs to identify all women over 20. years of age with a completed live vaginal birth beyond 24. weeks gestation over a 33-month period (March 1, 2012 to November 30, 2014). We reviewed the electronic medical records of all of these patients and identified those who requested a sterilization procedure as indicated in a physician's admission note or antenatal record. Results: We identified 3514 live vaginal births beyond 24. weeks gestation during the study period of which 219 requested postpartum sterilization. Sterilization occurred in 114 (52%). The most common reason for unfulfilled procedures was lack of valid federally mandated consent (n=46 [44%]). Fifty-nine percent (27 of 46) of these women had little or no prenatal care. Only one (0.5%) woman had documented completion of consent with the required time elapsed prior to delivery and no consent form available. Of the women with valid consent documentation, the most common indication for an unfulfilled procedure was patient refusal (n=30 [51%]). Body mass index was an independent predictor of an unfulfilled procedure (p<.001) among women with adequate consent. Conclusions: Inability to complete federally mandated consent is a principal cause of unfulfilled postpartum sterilization and primarily affects women desiring sterilization who lack sufficient prenatal care. Of women who meet consent criteria, the primary reason women eligible for sterilization did not undergo the procedure was due to withdrawing their request. Implications: Because women commonly do not undergo a requested sterilization after vaginal deliveries, antepartum counseling should include alternate contraception choices. Documented consent that fulfills all federally mandated criteria remains the most common barrier to requested sterilization after vaginal delivery; providers and policymakers should work together to help unburden women from this mandate.

Original languageEnglish (US)
JournalContraception
DOIs
StateAccepted/In press - Mar 17 2017

Fingerprint

Postpartum Period
Prenatal Care
Live Birth
Delivery Rooms
Consent Forms
Pregnancy
Electronic Health Records
Operating Rooms
Contraception
Documentation
Counseling
Body Mass Index
Physicians

Keywords

  • BTL
  • Consent
  • Postpartum
  • PPTL
  • Sterilization
  • Tubal ligation

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

Cite this

An updated assessment of postpartum sterilization fulfillment after vaginal delivery. / Wolfe, Kristen K.; Wilson, Machelle D.; Hou, Melody; Creinin, Mitchell D.

In: Contraception, 17.03.2017.

Research output: Contribution to journalArticle

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abstract = "Objective: To describe sterilization completion rates after vaginal delivery and indications for unfulfilled procedures. Study design: We used labor and delivery operating room and delivery logs to identify all women over 20. years of age with a completed live vaginal birth beyond 24. weeks gestation over a 33-month period (March 1, 2012 to November 30, 2014). We reviewed the electronic medical records of all of these patients and identified those who requested a sterilization procedure as indicated in a physician's admission note or antenatal record. Results: We identified 3514 live vaginal births beyond 24. weeks gestation during the study period of which 219 requested postpartum sterilization. Sterilization occurred in 114 (52{\%}). The most common reason for unfulfilled procedures was lack of valid federally mandated consent (n=46 [44{\%}]). Fifty-nine percent (27 of 46) of these women had little or no prenatal care. Only one (0.5{\%}) woman had documented completion of consent with the required time elapsed prior to delivery and no consent form available. Of the women with valid consent documentation, the most common indication for an unfulfilled procedure was patient refusal (n=30 [51{\%}]). Body mass index was an independent predictor of an unfulfilled procedure (p<.001) among women with adequate consent. Conclusions: Inability to complete federally mandated consent is a principal cause of unfulfilled postpartum sterilization and primarily affects women desiring sterilization who lack sufficient prenatal care. Of women who meet consent criteria, the primary reason women eligible for sterilization did not undergo the procedure was due to withdrawing their request. Implications: Because women commonly do not undergo a requested sterilization after vaginal deliveries, antepartum counseling should include alternate contraception choices. Documented consent that fulfills all federally mandated criteria remains the most common barrier to requested sterilization after vaginal delivery; providers and policymakers should work together to help unburden women from this mandate.",
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N2 - Objective: To describe sterilization completion rates after vaginal delivery and indications for unfulfilled procedures. Study design: We used labor and delivery operating room and delivery logs to identify all women over 20. years of age with a completed live vaginal birth beyond 24. weeks gestation over a 33-month period (March 1, 2012 to November 30, 2014). We reviewed the electronic medical records of all of these patients and identified those who requested a sterilization procedure as indicated in a physician's admission note or antenatal record. Results: We identified 3514 live vaginal births beyond 24. weeks gestation during the study period of which 219 requested postpartum sterilization. Sterilization occurred in 114 (52%). The most common reason for unfulfilled procedures was lack of valid federally mandated consent (n=46 [44%]). Fifty-nine percent (27 of 46) of these women had little or no prenatal care. Only one (0.5%) woman had documented completion of consent with the required time elapsed prior to delivery and no consent form available. Of the women with valid consent documentation, the most common indication for an unfulfilled procedure was patient refusal (n=30 [51%]). Body mass index was an independent predictor of an unfulfilled procedure (p<.001) among women with adequate consent. Conclusions: Inability to complete federally mandated consent is a principal cause of unfulfilled postpartum sterilization and primarily affects women desiring sterilization who lack sufficient prenatal care. Of women who meet consent criteria, the primary reason women eligible for sterilization did not undergo the procedure was due to withdrawing their request. Implications: Because women commonly do not undergo a requested sterilization after vaginal deliveries, antepartum counseling should include alternate contraception choices. Documented consent that fulfills all federally mandated criteria remains the most common barrier to requested sterilization after vaginal delivery; providers and policymakers should work together to help unburden women from this mandate.

AB - Objective: To describe sterilization completion rates after vaginal delivery and indications for unfulfilled procedures. Study design: We used labor and delivery operating room and delivery logs to identify all women over 20. years of age with a completed live vaginal birth beyond 24. weeks gestation over a 33-month period (March 1, 2012 to November 30, 2014). We reviewed the electronic medical records of all of these patients and identified those who requested a sterilization procedure as indicated in a physician's admission note or antenatal record. Results: We identified 3514 live vaginal births beyond 24. weeks gestation during the study period of which 219 requested postpartum sterilization. Sterilization occurred in 114 (52%). The most common reason for unfulfilled procedures was lack of valid federally mandated consent (n=46 [44%]). Fifty-nine percent (27 of 46) of these women had little or no prenatal care. Only one (0.5%) woman had documented completion of consent with the required time elapsed prior to delivery and no consent form available. Of the women with valid consent documentation, the most common indication for an unfulfilled procedure was patient refusal (n=30 [51%]). Body mass index was an independent predictor of an unfulfilled procedure (p<.001) among women with adequate consent. Conclusions: Inability to complete federally mandated consent is a principal cause of unfulfilled postpartum sterilization and primarily affects women desiring sterilization who lack sufficient prenatal care. Of women who meet consent criteria, the primary reason women eligible for sterilization did not undergo the procedure was due to withdrawing their request. Implications: Because women commonly do not undergo a requested sterilization after vaginal deliveries, antepartum counseling should include alternate contraception choices. Documented consent that fulfills all federally mandated criteria remains the most common barrier to requested sterilization after vaginal delivery; providers and policymakers should work together to help unburden women from this mandate.

KW - BTL

KW - Consent

KW - Postpartum

KW - PPTL

KW - Sterilization

KW - Tubal ligation

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