Postpartum Sterilization after a Preterm Delivery Is Not Associated with Decision Regret

Abstract

Background

Although sterilization is one of the most effective methods of birth control, some physicians may hesitate to perform postpartum sterilizations on patients after preterm birth, as preterm labor and delivery may preclude adequate counseling.

Methods

This is a cross-sectional study conducted at a single, tertiary care, academic institution of adult pregnant patients who experienced a spontaneous or iatrogenic preterm delivery between March 15, 2011, and May 10, 2014 and underwent postpartum female surgical sterilization within 12 wk of delivery. A validated Decision Regret Scale was administered 7 to 11 y later. Univariate and bivariate analyses were conducted. Unadjusted and multivariate logistic regression analyses identified factors associated with moderate to severe decision regret.

Results

Most participants (75.5%) with a preterm delivery reported no or mild regret associated with their sterilization. Circumstances surrounding the sterilization decision were positive, as 85.7% reported having enough information, 81.6% reported enough emotional support, and 75.5% reported adequate decision time. Adjusting for maternal and gestational age at delivery plus other covariates, only those reporting they had adequate time to make their sterilization decision remained significantly associated with no or mild regret (odds ratio: 0.002, 95% confidence interval: <0.001–0.61).

Discussion

Study results indicated high confidence in the sterilization decision, which was not affected by maternal age at delivery or the fact that the individual had a preterm delivery, emphasizing the importance of individualized counseling and support for patients during the decision-making process.

Conclusion

Providing adequate time for patients to decide on postpartum surgical sterilization was the most important factor for decreased sterilization regret.

Implications

The decision for sterilization should be made using a patient-centered, shared decision-making framework.

Highlights

• Among patients with a preterm delivery who underwent postpartum surgical sterilization, maternal age at delivery was not associated with increased decision regret.

• Providing adequate time for patients to decide on postpartum surgical sterilization was the most important factor for decreased sterilization regret among patients with a preterm delivery.

• We must trust the patient knows they are making the right decision for themselves in that moment, even if this is at the time of a preterm delivery.