Accessibility to postpartum tubal ligation after a vaginal delivery: When the Medicaid policy is not a limiting factor

Documentation of prenatal contraceptive counseling and fulfillment of permanent contraception: a retrospective cohort study

“…This aligns with prior studies demonstrating that patients who receive prenatal counseling are more likely to receive postpartum contraception in general [ 3 – 6 ]. Given the known multi-level barriers to postpartum permanent contraception, our findings suggest that early counseling is important to ensure that patients have time to discuss and finalize their contraceptive plan, that a plan for fulfillment can be made that mitigates known barriers such as operating room and surgeon availability, and that the required Medicaid sterilization consent form can be signed and necessary waiting period elapsed prior to delivery [ 16 , 20 ].…”

“…Given the multi-level factors and barriers to permanent contraception at the patient-, physician-, hospital-, and policy-level, prenatal counseling is hypothesized to improve postpartum receipt of desired permanent contraception [ 13 ]. For example, the federal Medicaid sterilization policy mandates a 30-day waiting period between the time that the required consent form is signed and when surgery can be completed [ 15 , 16 ]. If prenatal contraceptive counseling is not performed, patients with Medicaid who desire permanent contraception face structural barriers to inpatient postpartum permanent contraception and must instead pursue interval outpatient permanent contraception with its own associated barriers to fulfillment [ 15 , 17 ].…”