Overview

Sterilisation is a permanent way of preventing pregnancy. It usually involves having an operation.

You could consider sterilisation at the time of caesarean section birth, also called C-section, if you:

• decide you do not want more children
• wish to use a permanent method of contraception

During the caesarean section, you can have an operation called tubal ligation. The fallopian tubes are a pair of tubes along which eggs travel from the ovaries to the womb (uterus). Tubal ligation is when we close the fallopian tubes by cutting and tying them.

This means that your eggs can no longer be fertilised by sperm through sexual intercourse. The egg dissolves inside you and your periods happen as usual.

This information should support, but not replace, discussions you have with health professionals. The doctor 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.

Success rates

Sterilisation does not work if the tubes that have been cut or blocked join up later on. One in every 200 to 500 women who have sterilisation by tubal ligation may get pregnant at some point after sterilisation. It can be immediately after or even several years later. The risk of failure is lower if we operate at the time of a caesarean section, than if done laparoscopically (keyhole surgery).

There is less chance of a pregnancy after a vasectomy than after tubal ligation.

Risks of sterilisation

There is no evidence that:

• There is no evidence that a tubal ligation causes problems that would lead to a hysterectomy later in your life.
• There is no evidence that having a tubal ligation affects your sex drive.
• There is no effect on the timing of menopause.
• If you are over 30 years old when you have a tubal ligation, it is not linked to getting heavier or irregular periods.
• If you are under 30 years old when you have a tubal ligation, there is little evidence about how having a tubal ligation affects your periods.
• Research suggests that tubal ligation may provide some protection from ovarian cancer.

Ectopic pregnancy

If you get pregnant after sterilisation by tubal ligation there is a risk that the pregnancy will develop in the fallopian tube rather than in the uterus (womb). This is called an ectopic pregnancy and requires medical attention.

For this reason, if you miss your periods after you have been sterilised, you need to see your doctor urgently.

Regretting your decision

Research has shown that if you choose to have a sterilisation procedure during pregnancy or delivery, you may regret it later. It is thought that the incidence of regret in women who undergo sterilisation at less than 30 years of age, is greater.

It's best to give yourself time to think about what you want to do. Try not to rush into making a decision. If you do decide you want a tubal ligation at the same time as a caesarean, your doctor or midwife should make sure that you have been offered counselling and that you make the decision at least 2 weeks before your caesarean.

All sterilisation operations are meant to be permanent. The chances of successfully reversing this are generally low. If you change your mind, there is no guarantee of success and you will have to pay to have the operation reversed.

Vasectomy (male sterilisation)

If you are in a relationship, you may also want to consider vasectomy (sterilisation procedure for men). Vasectomy is usually done under local anaesthetic (a medicine that numbs a specific part of the body). Ejaculation will be possible but semen will no longer contain sperm, so you cannot become pregnant. The sperm in the testicles is naturally reabsorbed back into the body and does not build up.

Partners of men who have had a vasectomy are 10 times less likely to become pregnant than women who have had tubal ligation.

If you are in a long-term relationship, you should consider both methods and decide which is best for you as a couple.

Reversible long-term contraception

Your doctor, midwife or nurse will tell you about long-term methods that you can use to avoid getting pregnant. The main advantage of the following 3 methods is that they can be reversed. Like tubal ligation and vasectomy, there are both risks and benefits associated with them. If you would like more information about these methods, please speak to your doctor, midwife or a family planning nurse. The NHS website also has more about the choices of contraception. 

Copper IUDs (intrauterine device or ‘coil’) 

The intrauterine device is put into your uterus and can safely stay there for up to 10 years, depending on the type used. If you are over 40 when it is fitted, it can be left in until you reach the menopause. IUD can be fitted 6 weeks after your delivery in the local family planning clinic or by your GP.

A progestogen IUS (intrauterine system)

This is a hormone-releasing system which lasts for 5 years and is called a Mirena® system. The Mirena system is as effective as vasectomy and more effective than tubal ligation. It is also reversible.

Progestogen implant 

This is a small flexible tube inserted under the skin of the arm to release the hormone progestogen. The implant lasts for 3 years. This method is more effective than tubal ligation and is reversible.

After the procedure

After the procedure you receive the same care as others who have had a caesarean. You need to follow our guidance about recovering after a caesarean birth.

Contact your GP as soon as possible if you:

• miss your period or you think you might be pregnant
• have sudden or unusual pain in your abdomen
• have any unusual vaginal bleeding
• have a light or delayed period

Follow-up appointments

You will have the usual postnatal follow-up appointments, but you will not have a separate follow-up appointment for the sterilisation procedure.