Recent developments have made female permanent contraception an increasingly attractive option, and pregnant women in particular ought to be counselled about it

Table 1 Advantages of tubal occlusions performed during caesarean sections compared to hysteroscopic tubal occlusions performed later

1.	A TO during a CS is immediately effective.
2.	Patients can’t make post TO contraceptive mistakes.
3.	No need to check months later (ultrasound or X-ray) whether the TO was successful.
4.	When sutures are used during a CS (clips are irrational) the TO can be cost-free.
5.	One can be absolutely certain that the patient is not already pregnant.
6.	If the tubes are removed entirely ― easy during a CS ―, then method failure, including extra-uterine pregnancy, is extremely rare.
7.	If the tubes are removed entirely ― easy during a CS ―, then the future ovarian cancer incidence is likely to decrease by about a third.
8.	There exist no medical contraindications for a TO performed during CS.
9.	Technically, the procedure is virtually always successful.
10.	For women who turn out to deliver by CS and are certain that they want no more pregnancies, planning a TO during that CS will have a much lower failure rate than planning to postpone the TO (or partner’s vasectomy) until some months after delivery.
11.	If the tubes are just ligated, not removed, reconstructive surgery is possible.
12.	After postpartum discharge, the woman/couple very likely never needs to worry about contraception.

TO Tubal occlusions, CS Caesarean sections
Planning a mini-laparotomy for soon after a vaginal delivery shares, mutatis mutandis, with a CS/TO, ― when compared to an hysteroscopic TO later ― the advantages No. 1,2,3,5,6,7,9,11,12 and to some extent ― some postpartum bravery is needed, or theatre or staff might be not available ― No. 10. Compared to a laparoscopic TO later the advantages No. 5,9,12 and to some extent 6,7 and 10 apply to a postpartum mini-laparotomy
Compared to a hysteroscopic TO, an interval minilap TO (clips are with that approach also irrational) has, mutatis mutandis, advantages No. 1,2,3,6,7 and 11. In practice, many (perhaps 50%) hysteroscopic TOs seem to be performed under anaesthesia and not in an office setting, and they are in the US very expensive even more expensive than laparoscopic TOs [39]

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