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Table 2 Advantages of tubal occlusions performed during caesarean sections over interval reversible contraceptive methods

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

1. Immediately very effective, only a copper IUD has that advantage, and abstinence, a condom/diaphragm/coitus interruptus work also immediately, but not very effectively.
2. Patients can’t make mistakes after starting the method.
3. Technically, the procedure is virtually always successful. While, for example, IUDs are sometimes misplaced or fear/panic/pain stops the insertion procedure.
4. TO is never abandoned because of side effects, stock-outs or rumours.
5. The method never needs to be abandoned because the patient develops a contra-indication (e.g., high blood pressure, thrombosis, breast cancer, latex allergy, migraine, cirrhosis, cholestasis, smoking, pelvic TB/actinomycosis, fibroids or forgetfulness.
6. One can be absolutely certain that the patient is not already pregnant.
7. If the tubes are removed entirely ― easy during a CS, ― then method failure, including extra-uterine pregnancy, is extremely rare.
8. If the tubes are removed entirely ― easy during a CS ―, then the future ovarian cancer incidence is likely to decrease by about a third, that is probably a larger reduction than resulting from the use of combined oral contraception.
9. There exist no medical contraindications for implementation a TO during a CS.
10. When sutures are used during a CS (clips are irrational) the TO can be cost-free.
11. No further action is needed for method continuation as opposed to acquiring new pills, condoms or injections, replacing and removing IUDs or implants.
12. Patients are independent of supply networks, i.e., there is contraceptive security. This also means that there are no more contraceptive costs.
13. For women who are antenatally certain that they don’t want to become pregnant again, peripartum TOs will be followed by much fewer unintended pregnancies than will the patients’ intent to start a reversible method later.
14. The partner can’t sabotage the method (throw away the pills, not cooperate with “natural” contraception or condom use) and he does not need to know.
15. After postpartum discharge, the woman/couple likely never needs to worry (again) about contraception.
16. Staunch Catholics will need to confess a TO as a contraceptive sin only once as opposed to the use of condoms, pills, rings or injections. Women can’t be made to stop TO. Some priests demand removal of an implant or IUD on pain of sacrament refusal, but circumventing a tubectomy with IVF is also a Catholic “sin” so priests can’t demand that.
  1. TO Tubal occlusions, CS Caesarean sections
  2. Mutatis mutandis, hysteroscopic TOs share with TO during CS six of the above advantages (i.e., No. 4,5,11,12,14 and 16) vis-à-vis reversible contraception
  3. Mutatis mutandis, laparoscopic TOs share with TO during CS ten of the above advantages (i.e., No. 1,2,4,5,7 ― but not that easy, 8 ― but not that easy, 11,12,14 and 16) vis-à-vis reversible contraception