Successful tendering - there are many solutions

Comments (20)


There are many solutions for a great tender submission
meldunn.com.au

One of the great mysteries of the "open" competitive tendering process is that each of us has experienced defeat. What mystifies us is that there must have been a mistake - we had the best solution. Of course we did. So did the other three unsuccessful tenderers as did, we hope, the successful one!

So, consider this hypothetical tender, which simply asks for a proposal to "make the following equation true by only adding one line to it":

I X = V I

Simple enough. Prepare your team to consider what is being asked. Review all the documentation to ensure that nothing has been overlooked. And prepare your tender. You do this, and your tender response is simply:

I X (does not equal sign) V I

Compliant. One line added to the equal sign to make the equation true and correct. Clearly the winning tender - or is it?

As with all projects and activities, there may be many approaches that could be implemented to lead to the same minimum requirements. And this is good and vitally important if we genuinely seek solutions that create long-term sustainable benefits. Still, we can do more than just meeting 'minimum requirements' to ensure compliance.

We all have a responsibility to ensure that we challenge the thinking that is presented in the design, the tender documentation, donor policy etc, not just to prepare a response that 'meets' stated requirements. If we did not do this, then the tendering process would simply come down to a price comparison, which does not necessarily translate to the best solution to the problem.

So who is the "we" to take all this responsibility? Is it us as individuals? Is it the managing contractors? Agencies? Clearly, it is all of us in whatever role we are adopting as it relates to a tender or activity in question.

The tendering process should remain directly connected to the activity's implementation and its results. So during the preparation of the submission some key questions need always be asked:

-Why are we doing this
-Who are we targeting
-Where will any impac be realised
-How will we know
-How would we measure it

And there are probably many more, all of which have something in common - starting with the end in mind.

This responsibility to ask key questions does not rest solely with those preparing the tender response. Clearly it forms part of any methodology to design an activity, and it really should also be part of the tender assessment process if there is a genuine commitment to finding the best approach to any activity. I once received some 'feedback', and I am sure I am not alone here, that "but it wasn't asked for in the tender". This is unacceptable and indicates a lack of consideration to the question "why are they proposing this?" It may still have been judged to be not the desired approach, however merely dismissing alternative approaches because [possibly] it wasn't thought of in the design phase, is not being true to the cause.

So, working on an assumption that the design and preparation is sound and complete, responding to this hypothetical tender with the "does not equal" sign as your 'approach' will certainly ensure that the needs of the 'project' are met. But, what if you spent some time thinking about other options, you might have considered submitting this 'tender' response:

I X 6 = V I

Where in the 'tender' did it ask for a straight line? So here is another solution to the same problem that may in fact be superior to the earlier response. Our role then is to evaluate the merits of the options, and then our tender response needs to fully demonstrate why the option we finally propose will be the best solution for the activity.

We are seldom likely to be a sole tenderer, so a critical success factor is considering what the competition is doing. So by going through the above process for our hypothetical tender, we now have two options to consider. Now we are presented not only with the consideration of which option is best for the activity, but also, what might our competition be considering? This means you are in a position to consider their team, their approach and their strengths and weaknesses. And by doing this, not only can you frame your response by demonstrating why your methods, team etc are most appropriate you can demonstrate this from a comparative standpoint.

All of this requires a commitment from us as potential tenderers or team members to looking for the absolute best solution for the proposed activity. And clearly it needs complete transparency amongst all stakeholders to ensure the best solution is successful, not the "best, because" option. And it equally requires a commitment from those assessing tenders and proposals to consider why alternatives or additions are being proposed, and evaluating these on their merits.



Attention to detail.

It is critical for all of us in preparing proposals and tenders to maintain a commitment to having attention to detail. Nowhere in our hypothetical tender were we told that the solution could only be reached using mathematical symbols, and maybe you have more solutions still.

S I X = V I

globizdev.com

About the Author

Mel Dunn is Managing Director of Global Business and Development Solutions (globizdev.com
), which works with individuals and organisations that are committed to business success and the success of others.

Comments

Aaron 08.06.2010. 22:06

What enables a couple to have a long successful marriage? I spent some time recently with a couple of 80-somethings, man and wife. They were very loving and supportive of each other, yet quite different in personality and tastes. If you have a long-term successful marriage, how did you do it? Or how do you think you can do it? Again, curiosity on my part.

Aaron

Admin 08.06.2010. 22:06

This is the most critical aspect of marriage. One person can enter the marriage with an outlook that this will be forever, no matter what comes our way as a couple during our lifetime.

If the other person in this marriage, does not have this mindset from the start, then the road will be a difficult one and could end in divorce. It's as simple as that in many cases.

Two people have to have the same type of commitment from the start and until death to us part.

Think about that for a second. Surely we all know that life will send all of us extremely tough situations at some points in our life. It?s a given. It could be a job loss, a death of a family member, etc., but we all know that we simply don?t go through life without having to survive situations we weren't expecting or prepared for in life. These are the times that two people in a committed marriage must lean on each other and offer each other unlimited support.

The two shall become as one and this is the truth. You are that person?s best friend and lover for life. That person will always be in your corner to pick you up along the way and vice versa even when they don't temporary like you, they will always love you down deep.

Now, here?s a couple of things that I have found important in my 33 year marriage and this sure has worked for us.

If he?s in a down mood, which is not very often, I keep my mouth shut and I give him space. I am more tender to him and I try to keep quiet in the house (my children are now adults). I try to speak in a manner that?s positive and I basically lay off bringing up anything that may disturb him or stress him further.

He does the same for me. If I?m down or worried about something, he let?s me vent, poor man but it works for us. If I am upset about something, not with him but something that is worrying me, I don?t talk much. I?m the type that analyzes until I find a solution.

Neither of us gripe out loud or nag. If I have something to say, I say it quickly and bluntly at times but I get it off my chest and that?s it. I do not go on and on nagging.

Same for him, if something happens that ticks him off, he?ll say it, sometimes I respond in a like manner but it?s over quick and we get it out, cool off and it?s over.

One more thing, it?s common sense, two people can?t be in a bad mood at the same time, one has to back off and go in the other direction.

These are the things I feel are the most important in a marriage.

Of course, this is a vow we take before God also. As they say, for better or for worse in most situations.

I do believe their are three exceptions and they are infidelity, abuse or addiction. That?s just my opinion.

Best Wishes!

Admin

pdudenhefer 16.02.2008. 16:53

2 questions-I live in zone 9-Is it too early to fertilize my plants,shrubs,and lawn? Is it too early to start my veggie garden-sweet corn,tomatos,okra

pdudenhefer

Admin 16.02.2008. 16:53

Hi:
You are in a wonderful zone to plant year around. The temperatures are warm this time of year and so is your ground temperature. I would go ahead and fertilize as well as prep for your garden. Zone nine can have an occasional cold snap and if that happens, cover your tender vegetables. I visited zone nine a couple of weeks ago and the weather was beautiful. Good luck to you and I hope you have a successful garden this year.

I will link you to the plan - prep - plant page of my website. There are tips on how to plan for a garden. I will also link you to the site map as this page has everything that is on the website. Browse through and see if there is any other information you could use for your plants as well as your upcoming garden. Have a great day!
Kimberly

http://www.landscape-solutions-for-you.com/plan.html

http://www.landscape-solutions-for-you.com/Site.html

Admin

DoA 08.04.2009. 12:17

Writing a business proposal to be the advertising firm? I was wondering if there was general guidelines to writing a proposal. I'm trying to work with a company and be there advertising person. I have great ideas and cheaper ways to do it but not the experience.
Help me bid for this job

DoA

Admin 08.04.2009. 12:17

It really depends on a couple of things. At http://www.learntowriteproposals.com we like to look at what the client's needs are and build our proposal around that.

Have they asked you for a proposal or issued a Request for Proposal (RFP) or are you submitting a proactive proposal (one where they haven't issued an invitation to multiple suppliers)?

A formal business proposal is usually only sent in response to a RFP or invitation to tender by a client. Remember that very few unsolicited proposals do well - you are better spending your efforts building a relationship with the client and then submitting a proactive proposal when you know what their needs are and how you can solve their problems.

However, if you have some relationship or at least following a phone call, permission to send in a pro-active proposal then it is very important to demonstrate value to the client. The client isn't interested in just reading about you - they want to know what value you add to their business.

The key to writing a successful proposal though is persuading the client and demonstrating value. Ask yourself "What is their business need and what are you going to do to provide a solution that meets that need?"

In your circumstances it might be "what is the unique about the service or product I can offer and how does that benefit the client?"

Persuade the client by providing a solution and backing it up with evidence that you can deliver. Solution + credibility + value = persuasion. Be credible in your price as well as reputation.

As each organization's circumstances are different it sometimes isn't the best approach to look for a ready-made proposal, as it simply doesn't make sense to your (or the client's) particular circumstances.

You can get a free proposal template from http://www.learntowriteproposals.com, which gives you the outline and structure of your proposal. We also have a best practice resource library and online proposal guide.

We also offer proposal writing and review services. I'm not trying to rude, but judging by the spelling and grammar in your question this might be something that you want to consider - I would at the least get someone to proofread your proposal before you send it.

Admin

nikonan21 11.02.2009. 02:45

Any help out there on how to get a sample sales Proposal? How does a sales proposal look like? Can you help me with website or any info to find a sample sales Proposal?
Thanks

nikonan21

Admin 11.02.2009. 02:45

It really depends on a couple of things. At http://www.learntowriteproposals.com we like to look at what the client's needs are and build our proposal around that?

Have they asked you for a proposal or issued a Request for Proposal (RFP) or are you submitting a proactive proposal (one where they haven't issued an invitation to multiple suppliers)?

A formal business proposal is usually only sent in response to a RFP or invitation to tender by a client. Remember that very few unsolicited proposals do well - you are better spending your efforts building a relationship with the client and then submitting a proactive proposal when you know what their needs are and how you can solve their problems.

However, if you have some relationship or at least following a phone call, permission to send in a pro-active proposal then it is very important to demonstrate value to the client. The client isn't interested in just reading about you - they want to know what value you add to their business.

The key to writing a successful proposal though is persuading the client and demonstrating value. Ask yourself "What is their business need and what are you going to do to provide a solution that meets that need?"

Persuade the client by providing a solution and backing it up with evidence that you can deliver. Solution + credibility + value = persuasion. Be credible in your price as well as reputation.

As each organization's circumstances are different it sometimes isn't the best approach to look for a ready-made proposal, as it simply doesn't make sense to your (or the client's) particular circumstances.

You can get a free proposal template from http://www.learntowriteproposals.com, which gives you the outline and structure of your proposal. We also have a best practice resource library and online proposal guide.

In our premium content we have other templates which include guidance text to help you know how to complete your proposal. The template packs also include letter proposal templates which show you how to create a shorter proposal if you don't need to create a full, formal proposal.

If you need further assistance then you can get in touch with us through http://www.learntowriteproposals.com

Admin

lambeltran@sbcglobal.net 28.08.2007. 08:24

Why can't i get my Hydrangea's to bloom??? I live in Orange County CA, and they get 1/2 day of sun. The leaves grow, and it starts to bloom, but then they just die.

lambeltran@sbcglobal.net

Admin 28.08.2007. 08:24

Didn't you say that you have blooms but that they die? If that is true, then focusing on what prevents hydrangeas from blooming will not solve your problem as suggested by the previous 2 posts. We must instead look to probable causes of bloom blight or damage. Here are some reasonable possibilities:

BACTERIA BLIGHT
Bacterial wilt can blight (they just die) flower clusters. Leaves may be affected as well. This disease is worse after heavy rains and hot weather. If severe, wilting and root rot can occur, followed by plant death. The causal organism is Pseudomonas solanacearum, and no chemical control is available.

BOTRYIS
Botrytis (grey mold) also affects blooms, but this disease generally produces a grey mold, thus its common name. In fact, Botrytis on hydrangea is usually limited to the ?ower buds and especially the petals. The small water-soaked spots seen on the petals quickly expand into reddish brown irregular blotches. Brightly colored petals quickly fade to a brown, withered mass that can be covered with a fuzzy
grey growth. Botrytis blight could be the source of your frustration.

Fungicides will protect hydrangea from Botrytis blight only if used in combination with good management practices. Start treatments when the plant is beginning to bloom and continue until ?nished. Fungicides: Chipco GT, Dithane, Fore, Protect, or Halt.

Remove infected plant material & dispose. Remove plant litter. Do not overhead water. Clean pruning tools with 10% bleach or 75% alcohol solution between cuts.

THRIPS
Another possibility is the western flower thrip. These sap sucking insects can be in your hydrangea buds, damaging the blooms before they deploy. Thrips are difficult to control because they are in the flower buds.

Colorado State University Extension Service:

-Dislodge them by applying a strong stream of water to the affected plant. Larvae are wingless and will not find their way back to your plant. This is one time you will want to use overhead watering as it kills many of the thrips.

-Placing aluminum foil mulches under the plants has been found in some instances to disorient the thrips.

-Remove and discard affected blossoms and plant parts.

-Thrips prefer tender new growth. Avoid excess pruning which may stimulate new growth or applying high nitrogen fertilizers.

-Avoid planting near dry, weed or grassy areas. Thrips migrate from these areas into the garden.

-The location of the insects makes it difficult to reach them with insecticides. Products that have been somewhat successful are: horticultural oils, insecticidal soaps, Neem, pyrethroids, acephate (non-food crops only), Nicotine, Orthene and Trumpet.

Two biological controls have shown promise in Colorado. They are Beauvaria bassiana (Naruralis O, Botanigard) and Spinosad.

The MSU Dept. of Horticulture also has identified Spinosad as a low toxic & effective biological control of thrips. The product name is Conserve SC. "Conserve SC has a "moderate" spectrum of activity. It is most effective on chewing insects including beetles (particularly Chrysomelidae), caterpillars and sawfly larvae. Leafmining flies, fungus gnat and shore fly larvae are also potential target pests. It appears to have good activity on thrips and sporadic activity against mite species.

Hydrangeas are tolerant of a very wide pH range (4.5 - 8.0). Aluminum dissolves and is available as a micronutrient between a pH of 5.2 to 5.8. Aluminum has been identified as the micronutrient repsonsible for turning blooms blue on a Mop Head hydrangea. Aluminum is not responsible for the retention of hydrangea blooms. At a pH level of 5.0, availability of the macro-nutrients Nitrogen, Phosphorus, Potassium, Sulfur, Calcium, & Magnesium are significantly restricted and become a bigger issue for the plant's health than the availability of aluminum.

Admin

softballgirly 11.01.2013. 15:11

what did bob rae accomplish? he was the leader of the liberal party... so what did he accomplish?

softballgirly

Admin 11.01.2013. 15:11

Rae was made an Officer of the Order of Canada in 2000, and in 2004 he was awarded the Order of Ontario.

Rae helped the Toronto Symphony Orchestra restructure following an extended strike by its musicians at the beginning of the 1999?2000 season.

Rae worked on the Red Cross tainted blood issue and also worked towards a resolution of the fishing conflict in Burnt Church, New Brunswick.

In 2005, Rae wrote a report for the Liberal government of Dalton McGuinty on post-secondary education, commonly referred to as the Rae Report. His report called for increased government funding to colleges and universities, and enhanced student aid especially for low-income students.

An Exceptional Record of Public Service
Education ? In 2004, Premier McGuinty appointed Rae to review strategies to improve higher education. In early 2005, He tendered his report, ?Ontario: A Leader in Learning,? His report led to significant investments for students, universities and community colleges.

Health Services ? In 2000, He was appointed Chief Negotiator of the Canadian Red Cross Society in its restructuring after Canadian federal and provincial governments assumed responsibility for blood services.

Federalism - He initiated discussions to form the Forum of Federations which he served as Chair for seven years. He advised and worked on federalism and constitutional matters in Sri Lanka, Sudan and Iraq.

Trade and Commerce ? With the re-emergence of the softwood lumber dispute in 2001, and the deal set to expire, He became counsel to the Free Trade Lumber Council, an organization of companies dedicated to achieving free and fair trade between Canada and the U.S. in lumber and wood products.

Aboriginal Canadians ? In 2000, He was appointed mediator in the matter concerning aboriginal fishing rights in Burnt Church, NB and helped bring about a successful, negotiated solution.

Security ? He served on the Security Intelligence Review Committee and in 2005 advised the federal government on questions of public interest arising from the investigation of the 1985 Air India bombing. His report, ?Lessons to Be Learned,? was an important step forward in addressing this terrorist bombing.

Admin

Becca 07.07.2006. 00:53

Why do parents insist on 'spanking', 'smacking', and 'whooping' their children? "Hitting children is not tender or compassionate treatment. It does not model the way we want our children to act. Some day our society will be kinder, gentler and less violent when we all stop hitting children. To stop hitting children will mean, by the very extermination of the practice, that we will be less violent."

Corporal punishment of children is fully prohibited in following 15 countries: Austria,Finland, Latvia, Croatia, Germany, Norway, Cyprus, Israel, Sweden, Denmark, Iceland, Ukraine, Romania, Bulgaria, and Hungary. The UN Committee on the Rights of Children has recommended that all states prohibit corporal punishment in the family!

With clear evidence that spanking is a cruel form of punishment, and leads to a violent society...why do parents insist on abusing their power and their children?
To those that were spanked as children or spank their children, please don't tell me that it doesn't do damage. It really does. Please STOP hitting your children.
http://www.askdrsears.com/html/6/T062100.asp#T062101
I am the mother of a four year old daughter.
I just cannot IMAGINE being that cruel to my daughter. I am not judging anyone...just looking for answers and the rationale behind using corpral punishment with children. There ARE alternative ways to teach your children.

Someone wanted suggestions:
http://www.stophitting.com
http://www.naturalchild.com/guest/john_valusek.html
http://www.parentmagic.com
http://www.gentlechristianmothers.com
http://www.parentinginjesusfootsteps.org

Becca

Admin 07.07.2006. 00:53

It's interesting how defensive all the pro-spanking people are. Its almost like they're pleading to not get whooped!

OK, I will concede its possible that a moderate or limited amount of spanking is better than doing nothing to correct bad behavior. But millions of parents are much more successful by using other methods, and I'm afraid once you set a precident of using corporal punishment, you are in danger of creating a cycle of physical abuse.

The comment "well, you must not be a parent" really struck me as absurd because if someone cares this much about a parenting issue than to me she is almost certainly a parent (it turns out she is currenting raising a 4 year old). And whether we are parents or not (I am), the decisions made by parents affect us all. We all have to deal with the consequences of bad parenting. The most obvious consequence being criminal behavior.

And no, being spanked does not necessarily make us criminals. But it undoubtedly a significant factor in leading a child down that road. Plus, I have twice visited a country where spanking is unheard of - Norway. And I can tell you they have much more civil society there. They raise their kids right. They work hard at it. They don't take the easy way out by resorting to violence.

Spanking is weak! Its a short term fix. It teaches children to live in fear and expect someone to control them rather than to control their own behavior. There are other solutions. Be stern. Give your kid a "time-out" - denying them freedom really makes them think! Also, award good behavior when you see it.

Lastly, if you strike your child, don't be surprised when you're child grows up big and strong and strikes you back!

Admin

jai 30.03.2009. 22:11

how do you write a busines proposal? Array

jai

Admin 30.03.2009. 22:11

It really depends on a couple of things. At http://www.learntowriteproposals.com we like to look at what the client's needs are and build our proposal around that.

Have they asked you for a proposal or issued a Request for Proposal (RFP) or are you submitting a proactive proposal (one where they haven't issued an invitation to multiple suppliers)?

A formal business proposal is usually only sent in response to a RFP or invitation to tender by a client. Remember that very few unsolicited proposals do well - you are better spending your efforts building a relationship with the client and then submitting a proactive proposal when you know what their needs are and how you can solve their problems.

However, if you have some relationship or at least following a phone call, permission to send in a pro-active proposal then it is very important to demonstrate value to the client. The client isn't interested in just reading about you - they want to know what value you add to their business.

The key to writing a successful proposal though is persuading the client and demonstrating value. Ask yourself "What is their business need and what are you going to do to provide a solution that meets that need?"

In your circumstances it might be "what is the unique about the service or product I can offer and how does that benefit the client?"

Persuade the client by providing a solution and backing it up with evidence that you can deliver. Solution + credibility + value = persuasion. Be credible in your price as well as reputation.

As each organization's circumstances are different it sometimes isn't the best approach to look for a ready-made proposal, as it simply doesn't make sense to your (or the client's) particular circumstances.

You can get a free proposal template from http://www.learntowriteproposals.com, which gives you the outline and structure of your proposal. We also have a best practice resource library and online proposal guide.

We also offer proposal writing and review services. I'm not trying to rude, but judging by the spelling and grammar in your question this might be something that you want to consider - I would at the least get someone to proofread your proposal before you send it.

Admin

Jake 22.07.2007. 06:35

Guys (18+) why don't you pay attention to your woman? Why is it that guys don't ask girls how their day is, or how they did on a test, or whatever! It drives me crazy because I know how much my bf loves me but it always seems like he doesn't care. If he cared wouldn't he want to know how my day was?

Also, he never kisses me anymore. And I'm talking about real passionate kisses. I even try to give him a tender loving, tongue, kiss but he just gives me pecks. WHY????

I'm 22, we've been together 2 years and living together for 1.

Jake

Admin 22.07.2007. 06:35

The answer to this question is very complicated.

Some of the solution is to communicate the complete truth to him. How you feel and what you want. If for example you want more kisses tell him that's what you need because you feel insecure if you don't get it. More importantly you need to communicate why your insecure and how that makes you feel. If you want a successful relationship then all you need to do is put some time into it. I suggest you read a relationship book 'Conscious Living' by Gay Hendricks. Other books like 'Men are from Mars, Women are from Venus' are also great. I believe these books will help you in your relationship 100%. If you want to disscus the books when you read them then email me I would be happy to have a book buddie *seriously*. The people that write these books have P.H.D's and help many people in relationships so they have lots of credibility. Anyone else can email me about this too..

Admin

dee 23.10.2006. 02:52

could i be pregnant??? 8 years ago i had my tubes cut and they burn the ends to.......now after having intercourse last week i am feeling nausea and my breast are feeling tender......could this mean what i think it mean????

dee

Admin 23.10.2006. 02:52

No... but look for the warnings in here...

Tubal Sterilization

Tubal sterilization is intended to be a permanent method of birth control. More and more women today choose sterilization. They know that this single procedure can provide highly effective protection against pregnancy for the remainder of their reproductive years. They also know that there is an increased chance of failure with many temporary methods, that some temporary methods have bothersome side effects, and that some may be inconvenient.
Sterilization does not decrease a woman's sexual pleasure. It is often the answer for women who have completed their families and for women who do not want children.
How Tubal Sterilization Works
Tubal sterilization closes off the fallopian tubes, where an egg is fertilized by a sperm. When the tubes are closed, sperm cannot reach the egg, and pregnancy cannot happen.
Sterilization does not affect femininity. It is very unlikely that sterilization will affect your sex organs, or your sexuality. No glands or organs will be removed or changed. All of your hormones will still be produced. Your ovaries will release eggs. Your menstrual cycles will most likely follow their regular pattern.
Effectiveness
Sterilization is more than 99 percent effective in the first year. In following years, there is a limited possibility that tubes may reconnect by themselves. Up to one out of 100 women become pregnant each year after sterilization. About one out of three of these pregnancies are ectopic (develop in a fallopian tube) and may require emergency surgery.
What are the signs of ectopic pregnancy? The signs of ectopic pregnancy include · severe pain on one or both sides of the lower abdomen · abdominal pain and spotting, especially after a missed menstrual period or a very light one faint or dizzy feeling If you think you have an ectopic pregnancy and can't reach your clinician, go to a hospital emergency room quickly.
Tubal sterilization provides no protection against sexually transmitted infections. Latex or female condoms can reduce the risk of infection.
You must consider the operation permanent. You and your partner will need no other birth control method after a successful tubal sterilization. It is possible to reverse it in some cases, but your decision not to have a child in the future must be firm. You must be absolutely sure you will never change your mind or regret your choice ? no matter how your life changes.
Sterilization will not cause symptoms of menopause (change of life) or make menopause happen earlier.
Reasons for Considering Sterilization
·You want to enjoy having sex without causing pregnancy.
·You don't want to have a child in the future.
·You and your partner agree that your family is complete, and no more children are wanted.
·You and your partner have concerns about the side effects of other methods.
·Other methods are unacceptable.
·Your health would be threatened by a future pregnancy.
·You don't want to pass on a hereditary illness or disability.
·You and your partner decide tubal sterilization is better for you than vasectomy is for him.
Reasons Against Considering Sterilization
·You may want to have a child in the future.
·You are being pressured by your partner, friends, or family. (You must want the procedure. You may want to involve others for advice or opinions, but the decision is ultimately yours ? only you can determine what is right for you.)
·You have problems that may be temporary ? marriage or sexual problems, short-term mental or physical illnesses, financial worries, or being out of work. Sterilization is not a good solution for problems such as these.
·You have not considered possible changes in your life, such as divorce, remarriage, or death of children.
·You have not discussed having a tubal sterilization with your partner or anyone else you would like to have as part of your decision-making process.
Thinking It Over
Consider all other methods before you choose sterilization. Birth control pills, the shot, the ring, the patch, and IUDs (intrauterine devices) can be similarly effective. Most women can use them with little risk of serious complications. Other methods, such as diaphragms, caps, shields, fertility awareness-based methods, withdrawal, latex or female condoms, spermicide foams, creams, jellies, and suppositories, are not as effective as sterilization. But they have very few serious side effects, if any.
Discussing the operation with one's partner beforehand is usually helpful for most relationships. Your partner may consider sterilization for himself instead of you. Sterilization for men is called vasectomy. Vasectomy is simpler, costs less, and has fewer risks than tubal sterilization. But vasectomy must also be considered permanent. So, think carefully about what sterilization will mean for you and your relationship before you make your decision.
Sterilization Methods
Sterilizations are done in hospitals or in clinics. They are done with conscious sedation (awake, relaxed, and drowsy), deep sedation (asleep), or under anesthesia: local (patient is awake), regional (body is numb from the navel to the feet), or general (patient is asleep).
Closing the tubes for sterilization can be done in several ways. Sometimes, small microinserts are used to stimulate blocking of the tubes. This method requires no incision. Sometimes the tubes are closed off by tying and cutting (tubal ligation), sealing (electrocautery), or applying clips, clamps, or rings. Sometimes, a small piece of the tube is removed. These methods require incision.
A woman's health condition may indicate which procedure is better suited for her. Previous surgery and body weight are two factors to consider when choosing the best and safest method. Women who have had certain types of abdominal surgery may require specialized procedures. Consult your health care provider if you have any questions.
More than half of all sterilizations are performed shortly after childbirth or abortion. (The decision to combine sterilization with other procedures needs to be made in advance.) The no-incision method of sterilization cannot be performed until at least six weeks after a woman has delivered a baby, had a miscarriage, or had an abortion.
No-Incision Method ? Hysteroscopic Tubal Sterilization
A no-incision method for tubal sterilization is now available. With Essure, a clinician inserts two small, soft metallic coils ? microinserts ? through the vagina, cervix, and uterus into the fallopian tubes. Once in place, the coils cause scar tissue to grow, blocking the tubes. After two years of follow-up, Essure was found to be 99.8 percent effective at preventing pregnancy.
During the procedure, the clinician uses local anesthesia to numb the cervix. You may be offered other medication to help you relax and reduce your discomfort. A small, rigid, tube-like instrument called a scope is inserted into the vagina and through the cervix. Fluid moving through the scope helps the clinician see the opening of the tubes. The microinserts are positioned in the opening of the tubes.
Three months after insertion, a test called a hysterosalpingogram (HSG) is performed to make sure the tubes are permanently blocked. HSG is an x-ray test that takes pictures of the uterus and fallopian tubes after a dye has been inserted through the cervix. Until the HSG shows that the inserts are in the correct position and the tubes are blocked, another method of birth control must be used.
Essure offers some advantages over traditional methods of tubal sterilization:
·It is safer.
·General anesthesia is unnecessary.
·A surgical or hospital setting is unnecessary.
·Recovery is faster.
·No incisions are necessary ? there is no visible scarring.
Risks
Essure was approved by the U.S. Food and Drug Administration in 2002. Long-term side-effects are not known. Women who have any type of sterilization procedure have a slight chance of ectopic pregnancy. Studies of women using Essure found the following additional potential risks after two years of follow-up:
·Microinserts may not be put in place during the first procedure or are placed incorrectly. It may be necessary to have a second procedure if both are not placed, or if they are not placed correctly.
·Microinserts may be expelled.
·The uterus may be perforated. This rare complication may require surgery to repair.
·Microinserts may be damaged during other medical procedures, such as dilation and curettage (D&C), endometrial biopsy, or procedures that require the use of radio frequency.
·Other rare complications include over-absorption of fluids, a broken microinsert, changes in the menstrual cycle, infection, and pelvic or back pain.
Incision Methods ? Transabdominal Tubal Sterilization
Laparoscopy
Laparoscopy is one of the two most common methods of sterilization. First the abdomen is inflated with an injection of harmless gas (carbon dioxide). This allows the organs to be seen clearly. Then the surgeon makes a small incision near the navel and inserts a laparoscope (a rod-like instrument with a light and a viewing lens) to locate the tubes. The surgeon also may insert an instrument for closing the tubes, usually through a second small opening. Sometimes only one incision and one instrument are used.
The procedure can be performed in outpatient surgical clinics. It usually takes 20 to 30 minutes. Very little scarring occurs. Women often go home the same day.
Mini-laparotomy
Mini-laparotomy is another common method of sterilization. It is often performed after childbirth. No gas or visualizing instrument is used in mini-laparotomy. A small incision is made in the lower abdomen, just above the pubic hair. (If the operation takes place within 48 hours of delivery, the incision is made just below the navel.) The surgeon locates the tubes, then ties, clips, or uses electrocautery to block them off. The incision is then closed. Women usually recover in a few days.
Laparotomy
Laparotomy is major surgery. It is less commonly used than mini-laparotomy and laparoscopy. The surgeon makes a two-to-five-inch incision in the abdomen. The surgeon locates and closes off the tubes. The operation requires general or regional anesthesia. A woman may need to be hospitalized for two to four days. It may take several weeks at home to completely recover. If the procedure is done after delivery, the woman's hospital stay may be extended by one or two days.
Risks
Complications can occur with any kind of surgery. Laparoscopy, mini-laparotomy, and laparotomy are considered low-risk surgeries. The complications that can occur during or after these incision methods include
·bleeding
·infection
·reaction to the anesthetic
Infection is rare, and it is treated with antibiotics. Very rarely, the bowel, bladder, uterus, or blood vessels are injured. You may need additional surgery to repair this.
Complications may develop in one to four percent of sterilizations performed through the abdomen. Deaths resulting from tubal sterilization are extremely rare and are usually caused by a reaction to general anesthesia. The rate is about two deaths per 100,000 women who have a sterilization procedure performed. This rate is substantially lower than the death rate from pregnancy and childbirth ? 7.3 per 100,000 women.
Higher Risk Surgery ? Hysterectomy
Hysterectomy is the removal of the uterus. It is major surgery and is not usually used for sterilization. It is used to correct significant medical conditions. Hysterectomy ends menstruation as well as the possibility of pregnancy. It does not necessarily affect the fallopian tubes. However, some medical conditions also call for the removal of a tube and/or ovary, on one side or both.
Hysterectomy is performed through the abdomen or vagina. Sometimes a combined approach is used. Women need to spend several days in the hospital. They usually spend several weeks at home recuperating. They should abstain from sexual intercourse for four to six weeks, until the health care provider advises it is all right.
Complications after hysterectomy occur in 10 to 20 percent of cases. Because hysterectomy is usually performed in conjunction with a significant medical condition, the risk of death is much greater than it is for tubal sterilization ? 300 to 500 per 100,000 cases. The cost is also considerably greater.
Questions and Answers About Tubal Sterilization
Will sterilization end an existing pregnancy?
No. Sterilization will not be performed if you are pregnant.
Will it affect menopause?
No. Sterilization does not prevent or cause menopause or any of its symptoms.
Will it prevent sexually transmitted infections?
No.
Will I still have a period?
Yes. After the procedure, you will experience your normal pattern of menstrual cycles. If you were using birth control pills and your periods were irregular before you started using them, you will again experience irregular patterns. As women age, their periods change in frequency, duration, and amount of bleeding. As you approach menopause (late 40s to 50s), expect cycle irregularity, whether or not you have had a tubal sterilization.
Rarely, a woman's menstrual cycle may change after sterilization with Essure.
What happens to the eggs?
An egg is released each month. It dissolves and is absorbed by the body. Other dead and unused cells are absorbed naturally by the body throughout life.
Will I be as feminine?
Yes. The hormones that affect hair, voice, sex drive, muscle tone, breast size, etc. are still made in your ovaries. They will still flow throughout the body in the bloodstream.
Will I gain weight or develop facial hair?
No. Sterilization does not cause weight gain or facial hair.
Will it hurt?
Conscious sedation or a general, regional, or local anesthetic will be used. The choice depends on your physical condition and the method of sterilization being used. Conscious sedation or local and regional anesthesia are much safer than general anesthesia. There is much less risk of serious complications, including death.
General anesthesia is entirely painless. When a local anesthetic is injected or a regional anesthesia is administered, you may feel brief discomfort. The pain is relieved with medications and sometimes, sedatives. Most likely, you will feel little or no discomfort during the procedure. Some women who have sterilization with Essure report mild to moderate pain during the placement of the microinserts.
How will I feel after?
The discomfort you feel after the procedure depends on your general health, the type of procedure, and your tolerance of pain. You may feel tired and have slight abdominal pain. You may occasionally feel dizzy, nauseous, bloated, gassy, shoulder pain, or abdominal cramping. Women who have sterilization with Essure may have vaginal discharge, like a light menstrual period. Most or all symptoms will last one to three days.
Contact your clinician immediately if you
·bleed from an incision
·develop a rash or fever
·have difficulty breathing
·have fainting spells
·have severe, continuous abdominal pain
·have unusual discharge or odor from your vagina
How soon can I have sexual intercourse again?
A woman may have sexual intercourse as soon after tubal sterilization as she feels comfortable about it.
Will sterilization decrease my sexual pleasure?
No. In fact, many women and men report that they have less tension about unwanted pregnancy after sterilization, which increases their sexual pleasure.
Can sterilization be reversed?
If you are thinking about reversal, don't have a tubal sterilization. Reversal procedures require complicated surgery and cost thousands of dollars. Even though tubes can sometimes be rejoined, pregnancy cannot be guaranteed. Many women cannot even attempt reversals because there is not enough of their tubes left in the reproductive tract.
How soon can I go back to work after sterilization? That depends on your general health, attitude, job, and the method of sterilization that you have. With mini-laparotomy and laparoscopy, recovery is usually complete in a day or two. You may want to take it easy for the next week or so. In any case, you should avoid heavy lifting for about one week. Recovery from sterilization with Essure is faster ? some women return to normal activities the same day as the procedure. Others take a day or two.
How much does a tubal sterilization cost?
Nationwide, the cost of tubal sterilization ranges from $1,500 to $6,000. Some clinics and doctors adjust fees on a sliding scale according to income. Procedures that require hospitalization are more expensive. Costs vary from community to community, based on regional and local expenses. Contact your nearest Planned Parenthood health center 1-800-230-PLAN for information about costs in your area.
Is help with payment available?
Private health insurance policies may pay some or most of the cost. In nearly all states, Medicaid pays but puts some restrictions on patient eligibility. A 30-day waiting period is required from the signing of the consent form to the time that federally funded procedures are performed. Federally funded sterilizations may not be performed on anyone under 21 or anyone incapable of legal consent. Check with your local welfare department to see if you are covered.
Is it legal to sterilize anyone who doesn't want it?
No. Sterilization is legal for mentally competent, adult women and men in all 50 states only if it is voluntary. No mentally competent person can be forced to have the operation. It is also illegal to deny, or threaten to deny, welfare benefits to women and men who choose to remain fertile.
Can anyone become sterilized?
Under some circumstances ? if a person is single or childless ? sterilization may be difficult to arrange. Policies and practices vary with individual providers and hospitals, and from place to place.
Do I need my husband's or partner's consent?
No. However, discussing the operation beforehand is usually best for most relationships.
How can I get a sterilization?
For assistance, contact
·your family health care provider
·your local hospital
·your local public health department
·your local Planned Parenthood® health center. Call toll-free 1-800-230-PLAN for the Planned Parenthood center nearest you.
http://www.plannedparenthood.org/birth-control-pregnancy/birth-control/tubal-sterilization.htm

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