title: The right to informed choice. A study and opinion poll of women who were or were not given the option of a sterilisation with their caesarean section.
abstract: BACKGROUND
  In The Netherlands, caesarean sections (CSs) are rarely combined with tubal occlusion (TO), partly because discussing CS/TO near delivery is considered unethical and earlier hypothetical counselling--i.e. suppose you happen to need a CS--is rare. This results in more unintended pregnancies and is inconsistent with informed choice. We explored whether TO should indeed not be made routinely available to eligible women.
  
  
  RESULTS
  A questionnaire was mailed to 515 Para ≥2 who underwent in the past ≥1 CS. 498 (96.7%) responded. They were on average 35.3 years old, had 2.5 children, had undergone 1.6 CSs, and 3.3 years had passed since their index delivery, either a CS (393) or vaginal birth (105) after a previous CS. 87% of the 498 believed that pregnant mothers with ≥1 children should be routinely counselled about CS/TO. Indeed, 58% and 85% respectively, thought women/couples expecting their second or third child should still be given the TO option days before delivery, if omitted earlier. Counselled women, 138/498 (27.8%), were far more often satisfied than those without CS/TO option. 33/393 had a CS/TO. None indicated regret in the questionnaire. Another 119 also would have elected a CS/TO if given that option. Therefore, 152 (38.7%) of 393 Para ≥2 had or would have liked a concurrent TO. 118/119 wrote they still regretted missing this opportunity. The exception's husband had had a vasectomy. 100/119 were good TO candidates: they were ≥28 years when they delivered an apparently healthy baby of ≥37 weeks. The current contraceptive use of these 100 suggests that this group will have at least 8 unintended pregnancies before age 50.
  
  
  CONCLUSIONS
  The experiences and opinions of previous potential candidates for a CS/TO do not support the reluctance of Dutch obstetricians to counsel pregnant Para ≥1 about the TO option for a (potential) CS.
authors: Department of Obstetrics and Gynaecology, Bethesda Ziekenhuis, Hoogeveen, The Netherlands. verkuyl@freeler.nl
authors: Douwe A
authors: DA
authors: Verkuyl
authors: Gerda M
authors: GM
authors: van Goor
authors: Marjo J
authors: MJ
authors: Hanssen
authors: Margreet T
authors: MT
authors: Miedema
authors: Marnix
authors: M
authors: Koppe
mesh_terms: D000328:Adult; D002585:Cesarean Section; D002755:Choice Behavior; D005260:Female; D006801:Humans; D007258:Informed Consent; D009426:Netherlands; D011247:Pregnancy; D011795:Surveys and Questionnaires