Unmet postpartum sterilization demand at a tertiary care center: associated factors and alternate contraception one year postpartum
- Author(s): Kuperman, Julie M.
- Advisor(s): Sridhar, Aparna
- et al.
Unmet demand for postpartum sterilization (PPBTL) is prevalent. We investigated predictors of unfulfilled PPBTL and alternate contraceptive method.
In this retrospective chart review, we identified women presenting for delivery to an urban tertiary center in New York City in 2011 that indicated a desire for PPBLT and
prenatally signed the mandatory state sterilization consent indicating a desire for PPBTL.
We collected demographic and medical data, and, when sterilization was not performed, alternate contraception for one year postpartum.
391 women met inclusion criteria and 63% received the desired PPBTL. Unfulfilled PPBTL (37%) was associated with being younger, having higher gravidity, receiving low-risk prenatal care, without prenatal complications, delivering vaginally, on a weekend or night shift, lower body mass index at admission and signing the sterilization consent later in pregnancy. Only mode of delivery was found to be significant when controlling for other factors with logistic regression. Women without PPBTL were not discharged home with highly effective reversible contraception; only eight were known to be using an intrauterine device by eight weeks postpartum, and 18 by six and 12 months. Twenty-four (16%) underwent interval sterilization, all by six months postpartum.
At this institution, PPBTL is less likely in women who delivered vaginally. Few women without desired PPBTL obtained interval sterilization or utilized highly effective reversible contraception. We thus recommend antepartum counseling include discussion of alternate effective contraceptives in case of unmet PPBTL and expedited referral for interval sterilization at discharge.