Getting Your Tubes Tied Is a Giant Pain in the Ass

[REP]

Getting Your Tubes Tied Is a Giant Pain in the Ass

Erin Gloria Ryan

For women who know deep down that they never want children, that hell no response to the thought of motherhood endures long after the echoes of a temper tantrum in the candy aisle at Target subside. But women who want to be sterilized often face obstacles that aren't present for other medical procedures — obnoxious, patronizing speeches from doctors, flat out refusal from health care providers, requests for spousal permission or proof that the woman seeking to dam up her Fallopian tubes would be an unfit mother. And, despite the fact that this is 2012, there's no end in sight.
It's arguably more financially and socially responsible to go childless (or child-free, if you want to use phraseology that upsets self-righteous parents) in a world populated by seven billion hungry mouths, but many women who decided that being a mother is not for them often meet unexpected resistance from doctors. And the younger the woman making the choice, the less likely doctors are to trust that choice.

Slate's J. Bryan Lowder takes a peek between the ears of several doctors who deal with patients who wish to be sterilized. What could a doctor possibly know about a woman's future mental state or her confidence in her decision that she herself doesn't? Many seem concerned that young women who say they want to permanently zone their uteruses for recreation rather than fetal residency don't really mean it; they're just being silly young women who are making a permanent decision about a temporary aversion to parenthood. And they're not entirely off base about women changing their minds; Lowder points out that a Collaborative Review of Sterilization (CREST) study found that 20.3% of women who received tubal ligations prior to age 30 report that they later regret the decision. For women who were over 30 when they tied the knots, about 13% felt remorseful. Despite this, only 1.1% of women who receive tubal ligations attempt to have the procedure reversed.

On one hand, a doctor should make sure that a patient is informed of what a medical procedure entails, possible risks, and other pertinent information before performing a serious, difficult-to-reverse surgery — when not performed as part of a cesarean section or vaginal childbirth, getting ones tubes tied can be a major undertaking. And there are semi-permanent and long term alternatives to tubal ligation on the market that provide just about the same certainty that tube-tying provides without the permanence — IUD's, for example, or Implanon. Essure, a coil that's inserted into the fallopian tubes, can keep a woman unpregnant, is permanent like tubal ligation, and is less invasive. But on the other hand: This is a legal medical procedure. These women are adults. If a patient is informed of what a procedure entails before receiving care, whether or not a patient regrets a procedure in a decade is not the doctor's responsibility. If "regret" was a valid reason for a lawsuit, tattoo artists would have to carry unbelievably expensive "sorry you thought a circle of dolphins surrounding a yin yang symbol would be a cool thing to get permanently put on your lower back" insurance.

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As a Child-free woman who spent nearly 20 years trying to find a doctor who would perform this procedure - in my case, not only was it my dearest wish to have it done, it became medically important that I did not become pregnant - I can attest to the truth of this article, though I've seen other studies that show lower "regret" numbers for sterilized nullaparas.

Also, Essure is not considered reversible; it permanently scars the Fallopian tubes around the device.

[Warpy]

1. Given the relatively low numbers for post op regret

I have no idea why doctors are continuing to be so rudely and inappropriately paternalistic. I had a fight to get an IUD and those were considered temporary. A little present from one of my ex's girlfriends made sure that it was permanent.

I knew at the age of eight or nine that the last thing I ever wanted to be called was "Mama." I never played with dolls and showed absolutely no aptitude for or interest in motherhood.

I often wonder what would have happened if I'd approached it as "This is the only way you will be able to prevent abortions." I'm sure Dr. Patronizing would have to pick his lower jaw off the floor.

[REP]

5. Are you me? :-)

I knew I didn't want children when I was nine!

When it became apparent that my kidneys agreed with my reproductive choice and I was told that I should not attempt a pregnancy, I asked to be sterilized. Oh no, we don't do that on women your age. Since I'd just been treated for cancer, my choices at that time were Shit, Go Blind or Depo Provera - which turns out to be not that great for kidney patients either, but better than pregnancy.

[NV Whino]

2. When I got mine at age 30

The doc (male) told me that every woman should experience pregnancy. I tuned him out and proceeded with the tubal. One of the best things I ever did. I never, even for a moment, entertained the thought of having children.

[Gormy Cuss]

3. That was an extraordinarily arrogant comment by the doc.

Most of those resistant to performing tubal ligations on young women phrase it as preserving the option should the women change their minds, but to say women need to experience pregnancy is just ridiculous.

It's anecdotal but so far I've never encountered an early adopter of tubal ligation who later regretted it. Some women just know that they don't want to have children early on.

[handmade34]

4. had it done twice...

no problem... in Vermont

[REP]

6. I've had a tubal ligation and a uterine ablation - but only once each

My doc did a fulguration because she didn't want to have to do it again!

[kdmorris]

7. I had 3 children with my abusive ex-husband

And after I left, I was so determined that no one would have control over my body that I tried to get my tubes tied (I was 24). No doctor would do it without my ex-husband's permission until I was legally divorced or 25 years old. Pissed me off so much that it became my priority in life to get my tubes tied.

I got divorced, turned 25 and scheduled the surgery. I actually do regret it now, but that's only because I met and married an awesome man (tkmorris) who had no biological children of his own just 2 years later. He raised my daughters as his own children, but we have always wanted to have a child together and getting tubes untied is expensive.

But the attitude that I couldn't do something without my ex-husband's permission always angered me.

[REP]

8. That seems to follow CREST findings:

"According to the Collaborative Review of Sterilization (CREST) study, the cumulative probability of expressing regret following tubal sterilization was 12.7% (95% CI, 11.2–14.3). Several patient characteristics have been determined to be predictors of regret: young age at the time of sterilization, sterilization postpartum, divorce and/or remarriage subsequent to sterilization, being poor (eg, Medicaid patients), and being of Hispanic origin. Reprinted from Fertility and Sterility, Volume 74, Schmidt JE et al, “Requesting information about and obtaining reversal after tubal sterilization: findings from the U.S. Collaborative Review of Sterilization,” pp. 892–898, Copyright 2000, with permission from Elsevier."

[kdmorris]

9. Except for "being of Hispanic origin"

I fit that profile to a T. Medicaid would not pay for other long-term methods of birth control that couldn't be taken away by the dominant partner in the relationship (Norplant for example). My birth control pills were always found and destroyed by my ex-husband.

[LadyHawkAZ]

10. Get your tubes tied and regret it, you have many options

Have a kid and regret it, you're screwed for the rest of your life.

[gollygee]

11. I had a hard time getting my tubes tied and I already had two kids

I had to tell the doctor I would get an abortion if I got pregnant again before he'd agree to do it. I can't believe how much work it took. And I could only find the one who "still did that" in the first place.

[LeftyMom]

12. In most cases there's no reason not to try a LARC first,

since the failure rates are comparable and the risks are generally lower.

[REP]

13. Except for wanting it over and done with

Those can be great for those who have given birth, but many of those devices just don't work for nullaparas - our anatomy is often just too small.

[LeftyMom]

14. Pretty much every other country in the world routinely puts IUDs in nulliparas.

Including countries where the populations run smaller than most Americans. That you can't is largely an urban legend.

[gkhouston]

15. I'd say it's largely ass-covering. n/t

[REP]

17. I think they just weren't making them for the US market

I've been baby-proofed for over a decade now, but way back when, there just weren't things small enough to fit me - except pediatric speculums. Even when I had my ablation, despite there being newer and better technology, I had to undergo a hydrothermal ablation, because there weren't appliances small enough for my uterus. The last time I saw my doc - who is awesome about making sure her Child-free patients get the fertility care they want - she couldn't wait to tell me she got in a NovaSure device suitable for NPs.

[Taverner]

16. Make the man get a V-sect!

I got one, and they even gave me fun drugs afterwards!

Whooopeeee!!!!

[yardwork]

18. And recovery is much less for the male procedure! It's a much more minor procedure.

This is the obvious solution for couples who are in committed relationships, but it takes a man who is self-confident and responsible. My former husband was very happy to get a vasectomy. It made our life much simpler and I'm sure that he's never had a moment's regret. It saved me having to undergo a much more invasive procedure.

[REP]

22. Two anecdotes.

My ex (we were never married, thanks be) had a vasectomy and walked home from it. No problem.

I had a very, very rare complication from my tubal fulguration due to my weird health issues (small intestine was bruised during retraction). Nonetheless, I felt well enough to do my laundry at a laundromat the same day. Not true of my upper ureteroscopy/YAG laser procedure (etc - there was a shitload of equipment up in there) to remove a a staghorn forming in my the bottom of a kidney; I could barely move for days after that, and no extra openings were cut to do it!

[gollygee]

19. I'd given birth that year and had spent my out-of-pocket annual maximum

so it was free for me to do it, or we'd pay for him to do it. He said he'd do it anyway and that those decisions shouldn't be based on money, but to me it was 6 of one, half dozen of the other, and I'd rather not spend the money.

[LadyHawkAZ]

20. Not so great for those of us women

who don't plan to keep the same partner forever. Great idea for a permanent couple though.

[REP]

21. I've been with my partner 20 years. I still want to control MY body.

I plan on being with him until fertility isn't an issue and beyond - but I like having my body the way I want it, and for me, that means no Fallopian tubes and no endometrium. Him having a vasectomy resolves some things, but it doesn't make me any less fertile. To some women, this does matter!

[LadyHawkAZ]

23. I certainly won't disagree with that

I got turned down five times- three before the kids and two after.

I mentioned that to a friend some years back (right after rejection #4 I think) and their genius idea was "Why not just have ______ get a vasectomy? Problem solved! heh heh heh". I was living with two guys, and this person knew it- that's two vasectomies, not one, so wouldn't it be easier and more sensible to just have ME done? I mean, I'm the one who has to worry about getting pregnant, so...

It seriously irked me that at 34 I was still too immature to decide if I wanted kids or not, so a man had to do it for me AND be the one to control it.

[REP]

24. Would you have needed a note from a man to remain pregnant?

Isn't maddening how all these doctors say we'll change our minds when we say we don't want a(nother) child, but if we're pregnant at any age - no questions about that.

Maddening isn't the right word. Infuriating!

I feel compelled to add that after getting the runaround for years, I asked my male PCP for a referral, who provided one to my current GYN. Neither asked anything beyond required informed consent and were very supportive of my decision. Good doctors are out there but it takes lots of asking sometimes

[4th law of robotics]

25. "Make" the man?

You mean discuss it as equals and the wife can offer her opinion but ultimately has no say over what he does with his body.

[unblock]

26. if it's a pain in the ass, i'd say your surgeon missed the mark....

[REP]

28. I didn't write the headline...

...but see above where I detail the extremely rare complication I had from mine, which almost qualifies!

[prole_for_peace]

27. I have been taking hormonal birth control for 30 years

and this weekend decided I am not getting a refill on my pills when this pack runs out. I want the Essure permanent birth control but it needs backup methods for about 3 months and I really don't want to go back on my decision about the pill.

I mentioned a vasectomy to my partner but just gave me that look. I might just tell him that I have been the responsible one for the 17 years we have been together and it is his turn.

[LaurenG]

29. I had a great doctor

I had mine tied at 21 about 18 months after my son was born.

The doctor did ask me several questions and told me he thought that I was way to young to do this but that he respected that I was certain I wanted to do this. He did a laparoscopic tubal banding with silicone bands, he said if there were a reversible procedure this would be the easiest to reverse. I am in my 50's now and I don't regret doing it.