STERALISATION FOR WOMEN/ LAPAROSCOPIC TUBAL OCCLUSION

STERALISATION FOR WOMEN/ LAPAROSCOPIC TUBAL OCCLUSION Information Leaflet Your Health. Our Priority.

of 9 Sterilisation is an operation to make you unable to become pregnant. This booklet tells you about it. You must decide if sterilisation is the best method of family planning for you. It is a major decision and you must be sure that it is the right one for you before you have the operation. Your doctor will give you any advice you need and help you to decide. But you must make the decision. The booklet has been kept simple to make it easy to read. It tells you about the operation and what will happen to you in hospital. It tells you about what you can do when you go home. The booklet may not tell you all that you want to know. If you have more questions, you should ask your doctor. You can also ask the Consultant when you attend for your consultation at the hospital. Deciding about sterilisation Are you sure that you know about all the other types of family planning? If you are not sure, discuss this with your doctor or the doctor at the family planning clinic. If you still have questions which have not been answered, write them down, then ask your GP or the doctor at the family planning clinic. You can also ask the doctor at the hospital. Do not make a decision until all your questions have been answered and you are sure that you are making the right decision. Have you talked to your husband about vasectomy? Are you sure that you will never wish to be pregnant again? Have you thought about the possibility that you might lose a child or remarry? Are you sure that you will not regret the operation? Are you sure that you will not feel less feminine? If you are under pressure to have the operation, be even more careful about the decision. The pressures may go away but the sterilisation will not. It is important to be sure that sterilisation is the best method of family planning for you. Read the booklet several times to be sure that you know about sterilisation. What is the aim of sterilisation / female tubal occlusion? Pregnancy occurs when the egg and sperm meet (the meeting usually occurs in the fallopian tubes). This is called fertilisation. After this happens, the fertilised egg moves into the uterus and the baby starts growing there.

of 9 The aim of sterilisation is to block the fallopian tubes so that the egg and sperm cannot meet. How are the tubes blocked? There are many ways to block the tubes. They can be tied or cut or another way is to have clips put on the tubes. The clips squeeze the tubes and block them. The sperm swim along the tubes, but cannot get past the clips. The sperm do not reach the egg, so pregnancy does not happen. Laparoscopic sterilisation The operation is usually done using the laparoscope. The laparoscope is a thin telescope, a similar width to a pen. You will be given a general anaesthetic to put you to sleep. A needle is put into your tummy and some gas put in through the needle. This makes a gas bubble inside. The gas bubble pushes the bowel aside so that the doctor can see the womb and tubes through the laparoscope. A small cut is then made in the belly button. The laparoscope is put through the cut into the gas bubble. The doctor can then see the womb and tubes. Another small cut is then made just above the hairline. The clip gun is put in through this cut and the clips are put on the tubes. The laparoscope and clip gun are then taken out. The gas is let out. Then the cuts are stitched. The operation takes about ten minutes.

of 9 At Caesarean Section If you have completed your family and you know you need to have a Caesarean Section, you may wish to be sterilised at the same time. It only takes a few minutes at the end of the Caesarean operation. However, most doctors like you to wait at least three months following the birth of your baby. You can then have laparoscopic sterilisation. It also means that you have three months to make sure that the baby is healthy. Many mothers prefer to wait even longer. They want to see the baby reach the toddler stage and know that there is very little chance of the baby coming to harm from cot death or other problems. This all needs to be thought about carefully. Your doctor and midwife will be happy to discuss it with you. Decisions made during pregnancy Pregnancy is not always the best time to decide about sterilisation. You may be so fed up that you decide to have the operation, but then regret it later. Be sure before you decide. Sterilisation a few months after pregnancy If you can organise coming back to hospital a few months after having the baby, this is often better than being sterilised immediately after having the baby. You will need to have some other method of family planning to use until after you have had the operation. Risks of the operation Serious risks Failure, resulting in unplanned pregnancy; the lifetime failure rate is 1 in 200. The possibility of a future pregnancy occurring in the fallopian tube if failure occurs (ectopic pregnancy). Failure to gain entry to the abdomen. Uterine perforation. Injuries to the bowel, bladder or blood vessels are serious but infrequent risks - 3 in every 1000 procedures. One woman in every 12000 undergoing laparoscopy dies as a result of complications (more recent evidence suggests that the mortality rate may be lower). Frequent risks Bruising Shoulder-tip pain

of 9 Any extra procedures which may become necessary during the procedure Laparotomy (cut into the abdomen). If this is necessary your stay in hospital will be 3-4 days. Your recovery time at home will be approximately 6 weeks. Repair of damage to bowel, bladder or blood vessels. What happens when you come into hospital? Most sterilisation operations are done in the Day Case Unit. This means that you come into hospital, and have your operation and go home on the same day. When you arrive in the Day Case Unit, a nurse will show you to your trolley and ask you to put on a hospital gown. She will ask you about your health and about any drugs you are taking. She will ask if you are allergic to anything. You will be asked to wear a wristband with your name on it. You will be asked to sign a form which says that you agree to have the operation. If you have any questions, the nurse or doctor will answer them for you. The Anaesthetist will come to see you to make sure that you are fit to have the anaesthetic. Going to theatre Everyone is frightened of having an operation. When you go to theatre, a nurse from the ward will go with you. You will be taken to a room beside the theatre. There the Anaesthetist will put a needle in your hand and give you a drug to put you to sleep. The next thing you know, you will be back on your trolley. After the operation Most patients feel very sleepy for about an hour after the operation. The nurses will take care of you. If you are in pain or feel sick, they will give you something to make you feel better. Going home Most patients are ready to go home about three to four hours after the operation. As you will feel groggy, you must have someone to drive you home. You must also have someone at home with you for the first twenty-four hours. If you cannot arrange this, you can stay in hospital overnight. Please let us know before you come in if you need to stay, so that a bed can be arranged for you. Getting better It usually takes about 3-4 days to feel completely better. The main problem is that you will feel tired. After the first day you will be able to get about and do most things.

of 9 Work You should arrange to have a week off work. Driving You should not drive for at least two days after the operation. Even then you should not drive until you are sure that you are fit to do so. Stitches At Stepping Hill Hospital, we usually use absorbable stitches or glue, which do not need to be taken out. Painkillers You will have some discomfort for a day or two after the operation. It is a good idea to have a painkilling drug such as Paracetamol or Codeine at home in case you need it. Intercourse You can have intercourse as soon as you feel up to it, but it will probably be a few days before you feel well enough. What happens if I do get pregnant after the operation? Usually, the pregnancy carries on normally, just like any other. The only risk is that the egg may get stuck in the tube. This is called an ectopic pregnancy. It is dangerous and has to be removed. After sterilisation, see your doctor if you think you might be pregnant or if you have abnormal abdominal pain or vaginal bleeding. The usual reason for a pregnancy after a sterilisation operation is that the woman was already pregnant when the operation was done. A pregnancy serum/blood test will be performed before the operation to exclude the possibility of a pre-existing pregnancy. However, a negative test does not exclude the possibility of a luteal phase pregnancy (a very early pregnancy - 2-3/1000 pregnancies). Women at risk of pregnancy at the time of sterilisation include those who: Have had a late or missed period Have used inadequate contraception Have had unprotected sexual intercourse in cycle of operation Are in the luteal phase of cycle at time of surgery

of 9 To avoid a luteal phase pregnancy, follow this advice regarding contraception. Type of contraception Combined oral contraceptive pill Progestogen-only contraceptive pill Copper containing intrauterine device Levenogestrel-releasing intrauterine system Advice Finish current packet Continue until end of packet or next period, whichever is sooner Remove at next period Remove at least 7 days after sterilisation performed If you are not using an effective hormonal or mechanical method of contraception, use barrier methods up until the next period after surgery. Pregnancy has been known to occur even ten years after sterilisation. This can happen if the tubes recanalise (join back together). Can it be reversed? This operation is meant to be permanent. The chances of an operation to reverse it being successful vary a great deal. There is no guarantee of success. The reversal operation is not covered by the NHS and you will usually have to pay to have the operation reversed. Will my periods stay the same? If sterilisation has been done after 30 years of age, most women find that their periods do not change. If you have been on the pill, your periods may be heavier when you stop taking it. It is also the case that many women in their thirties find that their periods become heavier as they get older. This could happen to you whether you have been sterilised or not. So you could find that your periods do become heavier, but there is only a small chance of this happening. If your periods are already very heavy and you wish to be sterilised, perhaps you should think about hysterectomy. Your doctor would discuss this with you. Are there other alternatives? Yes Other long term methods that women can use to avoid getting pregnant include: Copper IUDs (which used to be known as the coil) the IUD (intrauterine device) is put into your womb and can safely stay there for up to eight years. If you are over 40 when it is fitted, it can be left in until you reach the menopause.

of 9 Mirena system a Progestogen IUS (intrauterine system) this is a hormone releasing IUD which lasts for five years. The Mirena system is as effective as vasectomy and more effective than tubal occlusion (female sterilisation). Contact us Jasmine Ward 0161 419 5508 / 5509

of 9 If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: 0161 419 5678. Email: PCS@stockport.nhs.uk. Our smoke free policy Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more. Leaflet number MAT125 Publication date October 2015 Review date October 2017 Department Jasmine Ward Location Stepping Hill Hospital