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Bilateral tubal ligation is a form of female sterilization. It is the most commonly used method of family planning worldwide and it is a permanent method of fertility control. However the failure rate is 0.1 – 0.8%. A case report of a booked Gravida 5, Para 3+1, Alive 3 who had two previous Caesarean Sections and a previous Uterine Rupture is presented. She had a Bilateral Tubal Ligation (BTL) performed. She however presented six years after this with a spontaneous pregnancy. She presented in the first trimester, the pregnancy was followed up and she eventually had elective caesarean section and repeat bilateral tubal ligation.