Tell me about your tubal.
November 8, 2006 4:59 PM   Subscribe

I'm looking for advice and personal experience regarding getting a tubal ligation.

I'm in my mid 20's, and my GP flat out told me that I wasn't a candidate. It took a lot of talking to convince her that I was serious and she reluctantly gave me a referral but in her mind, it's to get the process started so that I can get it when I finally hit 30. They gynecologist agreed to see me for a consultation in a few weeks and did not outright refuse me because of my age. I still expect a fair amount of resistance because I'm unmarried and childless although I am in a stable long term relationship. I expected it, but I still don't like it, which is why I want to be prepared.

I am located in Los Angeles and looking for any information regarding making a convincing case to my doctor, experiences with the procedure itself and recovery, and doctor referrals just in case I get turned down. My email is in my profile.
posted by deadlypenguin to Health & Fitness (25 answers total) 8 users marked this as a favorite
I was separated, with two children and 30 when I arranged for my tubal ligation. Even so, the doctor was going to insist on my estranged husband's signature. He ran through the consequences and asked me to consider what I would do if my children died in an accident. I said they were irreplaceable and I had no intention or desire of ever looking after babies again, at which point he laughed (can we say inappropriate?) and called me fiesty.

The actual operation was keyhole day surgery, I checked in at 8am and was home by 1pm. The discomfort/pain lasted about two weeks (IIRC) and was easily treated with panadol.

This was 9 years ago and in Australia (my children were 5 & 7 years old). The freedom of permanent contraception is wonderful. I very much recommend it.

However, despite my conviction that two children were (and are) enough, around age 35, I often had an enormous desire to be pregnant again. This was cured by my sister-in-law having a baby, and I stopped looking at those early years with rose coloured glasses and remembered the two years of sleeplessness, the endless nappies (diapers) and tears. I'm very glad that I wasn't able to give in to that temporary and uncharacteristic desire.

Best wishes in controlling your own reproductive system. The only advice I have is to continue to be assertive with your medical practitioners, and to have a list of points that you reiterate (though why you should have to explain yourself is beyond me).
posted by b33j at 5:22 PM on November 8, 2006

I had a tubal when I was 27 (~8 years ago, unmarried, no kids, I didn't discuss my relationship status with the docs. Noone's business but my own). It took me 2 doctor's visits to get the go ahead, but the second visit was easy; it was a different doc (my old one had left) and he simply noted that I had already expressed my desire to have a tubal and agreed (although he was "sad"). I can't really tell you how to argue your case, but I think it helped that I'm naturally fairly serious and expect to be taken seriously. At least, I tried hard to project that, and it worked. I kept it simple and to the point: "I do not ever want to have children, I have always known this, and I am competely sure of my decision" I didn't approach it as if I were asking permission (not that you are).

Can't help you with referrals, as I'm on the east coast. Procedure and recovery: For me, super easy. I had laparoscopic surgery, it was no longer than an hour, and I had no problem driving myself home (my guy was with me, but he didn't drive standard). I got home, threw up my Lorna Doones because of the anaesthesia, and slept for a couple of hours. No problem after that. 2 small incisions: one in my belly button, one hidden in my pubic hair. Back to work the next day, back to working out within 2 or three days. Very little pain. No long term side effects that I'm aware of, except sex is better because I never have to worry about pregnancy. It was truly one of the best things I've ever done.

P.S.: it was also completely covered by my insurance. Hopefully you will find that to be the case as well.
posted by MsElaineous at 5:29 PM on November 8, 2006 [2 favorites]

Have you considered Essure? It's less invasive and there are doctors in LA trained to do it.
posted by amber_dale at 7:24 PM on November 8, 2006

In 1993, Wisconsin, I had a tubal when I was 30. No problems... just took me a little while afterwards to get over the anesthetics. I had a friend drive me home.
posted by chase at 7:27 PM on November 8, 2006

Response by poster: amber_dale: I'm allergic to nickel (and copper for that matter). It seems incredibly stupid that they wouldn't use surgical steel or titanium for Essure, but there you have it.
posted by deadlypenguin at 7:31 PM on November 8, 2006

Response by poster: Oops. Apparently Essure does use nickel-titatium and stainless steel, but the nickel in nickel-titatium disqualifies me.
posted by deadlypenguin at 7:34 PM on November 8, 2006

MorethanonewaytoskinacatFilter: If you are in a long term relationship, have you considered having your partner get a vasectomy? I think the resistance would be far less (I was 29 and the doctor barely asked, "Are you sure?"), the recovery was basically no problem, and if insurance is an issue, the cost is far less, from what I understand. I realize this isn't what you asked, but since you didn't mention it at all in the question, I thought I'd at least raise the idea.
posted by Rock Steady at 7:36 PM on November 8, 2006

My wife had one immediately following the birth of our third child. Literally. After an hour, they wheeled her into another room and did the procedure. She was still feeling the epidural. It was simple and the recovery time was about two days. YMMV. She is very happy she did it, but to say there is no worry of pregnancy is mis-stating the facts. There is a chance of a tubal pregnancy which can be very dangerous. My saint of a wife, being slightly paranoid, has had a few scares that she was pregnant. We also know of tubes coming untied. It is very rare and unlikely, but it can happen. She was 30 at the time.
posted by JohnnyGunn at 7:38 PM on November 8, 2006 say there is no worry of pregnancy is mis-stating the facts.

Indeed there is a small possibility of failure, but that risk was low enough that I stopped worrying about pregnancy. YMMV.
posted by b33j at 7:51 PM on November 8, 2006

I had a tubal done after the birth of my second child. I had a ten year spread between my two children. A bottle of wine and a tight insurance company (30 pills at a time), was my demise. I was 35, married.

My tubal was done right after the baby was born, I had a lot of pain in my right fallopian tube. My Dr thought it may have been a blood clot or scar tissue, for almost a year, I was in severe pain whenever I ovulated from my right ovulary. Some of the side effects I had was a serious decline in my sex drive. I had minor PMS before, but it seemed really amplified. My periods became heavy and clotty. At one point I was having a period every 14 days, my uterus was out of sync. I had to take birthcontrol pills for 6 months, so much for the "care free" birthcontrol. I wound up having a full hysterectomy at age 42.

My Doctor tried to talk my husband into a vasectomy. He warned both of us of the possible side effects I could suffer. My husband is now sorry we didn't go that route. Matter of fact, he has talked several of his friends to "go under the knife" instead of a tubal for the female.

I respect your choice not to have children. You mentioned you were in a long term relationship. How would your partner feel about having a vasectomy?

As far as the hysterectomy, I LOVE it!!! Nice white sheets on the unstained bed!

Can't help you in referals, I live in the Deep South. Best of luck to you.
posted by JujuB at 7:55 PM on November 8, 2006 [1 favorite]

I had my tubes tied by laparoscopic surgery when I was 27. I requested the procedure immediately after the birth of my only child at age 26. We won't go into the horrible labor and delivery here, but I vowed never to do that again. In fact, I wrote myself a letter about how bad an experience it was, just in case I forgot and thought that having another baby might be a good idea. Doctor thought I should wait a year, which wasn't a problem as it had taken me four years to get pregnant in the first place and I wasn't terribly worried about accidents. It's been a long time, but I remember being in the hospital overnight, coming home with two bandaids, staying home the next day, and then going back to work. They probably boot you out the same day now. I've never seriously regretted my choice to have only one child.
posted by Joleta at 8:56 PM on November 8, 2006

A lot of people ask for tubals and in the back of their mind is "I can have it reversed if I change my mind." Actually reversal is uncertain and difficult - it doesn't always work, and that's always tragic - and the idea that you might come back and ask for a reversal is exactly what your doc doesn't want to hear.

So if you can state with certainty that you will never want your tubal reversed, and maybe even explain why, that might go a long way towards the process of partnering with your doc to go forward on this.
posted by ikkyu2 at 10:18 PM on November 8, 2006

Er, to be clear, I meant, "if you can state those things to your doc." You don't have to state them here in this thread!
posted by ikkyu2 at 10:20 PM on November 8, 2006

When I was 23, unmarried and childless, my long-term girlfriend and I went to see a urologist about a vasectomy. He refused, saying that there was no way he would do it on an unmarried man in his early 20s. We were both highly indignant that he would interfere to that degree in our personal decisions.

She later became my wife. She later became my ex-wife.

Now I am 30 years older, married for 23 years to my last wife, and my younger of two daughters graduates from high school this year. I wish I could recall who the urologist was so that I could tell him that he was right.
posted by megatherium at 4:12 AM on November 9, 2006

Have you considered a Mirena IUS? It lasts for 5 years, has the benefit of progestin which can help lighten and even stop your periods, and it's actually the most effective birth control method out there (more effective than sterilization, even). It is also made of plastic, not copper or nickel. I am not saying you shouldn't still pursue a tubal ligation if that's what you want, just suggesting this as another option you may not have considered.
posted by tuff at 4:44 AM on November 9, 2006

The Story of My Tubal

Ok, so I spend the greater part of Wednesday drinking up to my midnight cutoff of no food/drink/water or whatever. I stay at manfriend’s and wake up at the asscrack of dawn so he can drive me out to Suburban Hospital. I have to be there at 6:30 and we get there a little after 6 and he drops me off and goes back home to bed. I wander around the hospital until I find surgery registration on the second floor.

I get there and I have to be checked in by some guy who is handing out this pager like thing. It’s basically the same thing you get in restaurants. Fancy places like Applebee’s when you’re waiting for a table. Pager handing out guy asks me who I’m here with. I tell him I’m by myself. He doesn’t really know how to respond so he just looks at me and then writes down (ALONE) next to my name. They send me down to the end of the waiting room where I have to check in with some hospital volunteer. She takes my name and asks me who I’m here with. I tell her I’m not. And she gets this sort of alarmed look and asks me if I have a way home. I tell her I have something arranged and this seems to satisfy her enough.

So I wait for about an hour. Most of the people in the surgery waiting room are old. It’s 7 in the morning and the old people are done the fuck up like this is church. I keep staring at the coffee machine and eavesdropping on people’s conversations. Nothing terribly interesting though.

I get called to the front desk for insurance paperwork. I get asked if I have an advance directive (doh). I say ‘not officially’. She asks me who I’m here with. I say no one and she gives me a ‘You’re here alone?’ Yes, yes I am. She states that my next of kin is Girl and I say that’s right. She asks how we’re related and I say we aren’t. She then says ‘Don’t you have any family?’ I kind of glare at her. At this point I’m standing at the counter and sort of propping my head up on my hand. She then asks if I’m all right and I tell her I just want some coffee, Jesus.

So I go back into the old people holding pen and wait some more until I get called in for prep. Nurse takes my weight and blood pressure and then asks me who I’m with. I say no one and I swear you could almost hear the Sheila Brofslovski WHAT WHAT WHAT come out of her head. This starts a dialogue about how I got here. I say I was dropped off. She then asks me how I’m getting home. I state that someone will come get me and we go around this a few times until she’s satisfied that I’m not lying when I tell her my car is not at the hospital.

I get led to some gurney thing behind a curtain and get my blood pressure taken again. Some guy comes in to draw blood and he’s really truly awful about it. The nurse gives me a plastic bag and tells me to put everything in it and put on this retardable hospital gown. I look across and there are 2 old guys in the gurneys over there and I asked how long they were going to be around. When the answer was something longer than 5 minutes I told her that curtain is staying closed because I didn’t want any creepy old dudes staring at me. This is about the beginning of where I just decide to drop being good and let loose with being belligerent.

So I’m now in this stupid hospital getup and the nurse comes back with a waiver or some consent form for me to sign then starts going on about how they have to have a contact to call to prove that someone is going to get me out of the hospital and that I’m not leaving on my own. I tell her fine, but I don’t know manriend’s phone number. I really don’t. It’s stored in the phone and fuck if I know. I make her retrieve my bag so I can get the phone and I demand that I call him right now since I know he’s not going to answer the phone if it doesn’t come from me. So I give him the heads up and the instruction to have a coffee in the car when he gets there and that I’m going to want a double bacon cheeseburger later on. Nurse overheard all of this and told me that coffee and anesthetic don’t mix and that I’d better eat light today. Obviously this woman has not caught on that I am not a delicate little wilting flower all alone in the big scary hospital about to lose her fertility forever. I can put away food like a man and I really just want to get this party started so I can go home and get stoned on painkillers and watch movies and eat a got damn bacon cheeseburger and never worry about a baby ruining my life.

Another nurse shows up. This one is here to get an IV started. This is probably the only time I ever got nervous that day. I ask her if it’s going to hurt and she says a little. I ask if it’s better or worse than the guy who STABBED ME for my blood this morning. She was kind of shocked that I said that because according to her, he’s usually painless. I disagree. So going on, I’ve never had an IV before but it turned out they give you a minor shot of lidocaine before they dig that tunnel for the drip. She asks me who I’m here with. I say no one. She gives me ‘You don’t have anyone to be with you?’ I told her it was pointless to make him sit in a waiting room for 6 HOURS while I’m unconscious. I then said I wouldn’t wait in a hospital for him for 6 hours either. She then states ‘Well you must not like him very much’. RARRRRR.

Dr C shows up. Dr C isn’t dressed for surgery. He starts talking to me and wants to make sure that I understand that this procedure is permanent and blah blah blah and basically he isn’t going to scrub up until I say I haven’t changed my mind. I interrupted him and said ‘Dude, this is like CHRISTMAS’. He backs off a bit and and asks if I have any questions. I ask him if there’s any follow up to this to make sure it works. He says no, but that they do take pictures of the tubes after they’ve had the rings placed on them. I get really excited and ask if I can have a postcard of this. He’s a bit stunned but says yes, and I respond with ‘awesome’. He then retorts with ‘You’re sick’. I ask him if we can get the show going. He tells me we’re up in about 20-30 and takes off.

Dr. Anasthesiologist then shows up. Gives me a form to fill out and we go through 20 questions on medical history. She asks who I’m here with. I say no one. She asks if I have a ride home and I say yes. She says ok and, sweet jesus, drops the issue right there. When she was verifying patient information and checking my bracelet she asked if I was a bull. I told her yes. She said she was too and then asked if I had the personality traits of it. I told her I sure did. She goes away and comes back in 10 minutes with the cocktail. We’re ready to go in and she shoots that thing into my IV and I’m instantly wasted and giggling like an idiot. The surg nurse wheeling the gurney asks me how many children I have and I shout NONE and HE’S BEEN TRYING TO TALK ME OUT OF IT EVER SINCE I ASKED and I’m still giggling and then she drops the mask on me.

Some time later…

I wake up in post op recovery and I’m stoned. Stoned and in excruciating pain. I roll over and sleep for at least another hour until the machine that goes bing starts binging. Apparently I’ve laid on the automatic blood pressure cuff the wrong way. Not like it matters since my blood pressure is normally something like 88/60. I get semi coherent and am approached by some post op nurse. She asks me if she can get my family from the waiting room. I tell her I’m here alone and she’s somewhat horrified by this. I tell her someone is coming to get me later on and god can I please have something. She shoots the IV full of morphine which is about 100 ways of awesome and then gives me this hot air blower thing. I fall asleep again for a while. I wake up again and decide to check out the incision. It’s just two small ones with bandaids but I do notice that they’ve mowed a more than generous swath out of my pubes. I am not terribly thrilled about that. I look around a bit and someone notices I’m up and asks if I want something to drink. I opt for some water and Saltines. I eat one cracker and realize that I have the most raging case of cottonmouth ever. I’m still in pain so she gets me an ibuprofen. No really, ibuprofen. She then pulls something out of the side of the gurney and tells me my pad fell out. Now I have the Sheila Brofslovski what what what coming out of my head. She gives me some spiel about how there will be a little bleeding and pulls out this new one which is like 2 feet long and 2 inches thick. I tell her there’s no way I’m wearing that. Pads are for 12 year old mormon girls who think tampons take their virginity away from Jesus. She tells me nothing up the twat for 2 weeks and I take that thing and just sort of stare at it and decide against it. They won’t let me out of the hospital until I pee which is so not happening because I couldn’t have my got damned coffee this morning so I opt for a coke hoping the caffeine helps. At this point she lets me get partially dressed so I’m wearing black cargo pants and a hospital gown and I keep wandering back and forth from the bed thing to the bathroom and swearing because I want out of there and I’m in pain. I ask again if they can give me anything and she said someone just gave me ibuprofen. I give her a ‘Jesus, you think that’s working?’. They shoot me up with morphine again and at that point I am dead set on getting out of there. I call manfriend and while I’m on the phone with him I walk up to the desk nurse on duty and ask ‘Where am I’ she tells me ‘You’re at Suburban Hospital Medical Center you’ve just had blah blah’ I interrupt her (and manfriend heard this since he was on the phone) with ‘I KNOW THAT. I’M TRYING TO GET OUT OF HERE AND I NEED TO TELL SOMEONE WHERE TO PICK ME UP’. She gives me some number for him to call when he gets there and I spend the next half hour pacing around post op and trying to pee and waiting for that phone to ring. I never actually do pee, I just tell them I did.

Manfriend calls upstairs and he’s waiting outside for me. They won’t let me leave. I’m pacing around the floor with my prescription for percocet and bitching that this would be way easier and faster for me if they’d just let me take the stairs down one floor. But no, it’s against policy, and I have to be wheeled down. In a wheelchair. So the candy striper guy shows up and takes me downstairs. We get close enough to the front door and I tell him to stop. I get out of the chair and I run to the door. Yes I am running out to the car after abdominal surgery and I really don’t care. I just left wheelchair dude standing there. Manfriend has my coffee and 2 oxycodones which totally don’t help so we hightail it to Walgreens. I’m in Walgreens with all the tape and gauze on my hand and the bracelet still on and I throw the script up there and she fills it pretty damn fast.

We get home and I pass out with a heating pad for about 2 hours. he goes and gets me a double bacon cheeseburger and those jalapeno things with cheese in them and I’m stoned and infertile and happy. the end.
posted by pieoverdone at 7:07 AM on November 9, 2006 [16 favorites]

pieoverdone, I hope you are a writer whose works I can read. Do you write or blog?
posted by JohnnyGunn at 7:27 AM on November 9, 2006

Pieoverdone, just wanted to mention that lots of hospitals have policies against letting people go home alone. I had to cancel a gastroscopy (which only requires sedation) because the hospital wouldn't let me go home in a taxi. Technically I was supposed to agree to be supervised for 24 hours. Just wanted to say that it would explain the "who are you here with" business.
posted by loiseau at 8:17 AM on November 9, 2006

To follow up on what Megatherium and Ikkyu2 said, I see patients almost every week who regret getting sterilized. They are intelligent rational people, but they couldn't predict the future.
The MIRENA has lower rate of subsequent pregancy than any form of tubal ligation, and is entirely reversible. Consider it on your list of options.
posted by roofus at 8:22 AM on November 9, 2006

Mirena has hormones though - big negative for a lot of women.

Thank you for your story, pieoverdone.

Sometimes on childfree boards, they will list doctors who are very agreeable about tubals in women without children. I'm trying to dig some up now, but it would be worth a look to find a doctor who is totally agreeable.
posted by agregoli at 8:59 AM on November 9, 2006

I had a tubal ligation after the birth of my second child. The ob-gyn told me that was an ideal time to do it because the Fallopian tubes would still be high up in the abdomen, near to my belly button, where the incision was made to get to them. I had the kind that the tubes are cut, tied off at each end and then each end was cauterized. Another thing the doc didn't mention was that since I was going to be in the recovery process from childbirth anyway, a lil' ol' ligation wouldn't be too noticeable. I had no recovery issues that I was aware of, a tiny, barely noticeable scar at the margin of my navel, I was only asked once to be sure that I didn't want any more children and I have never regretted my choice.
posted by Lynsey at 10:02 AM on November 9, 2006

Response by poster: Thank you Violet Hour, I'll keep that in mind for a backup, and thanks to everyone who shared their stories. My consult is for a doctor who does the laparoscopic procedure so hopefully it will be more like MsElaineous's experience and less like pieoverdone's, awesome as the story was.
posted by deadlypenguin at 10:31 AM on November 9, 2006

I had mine done at age 27 or so. Had to convince first a gynecologist (not my regular doctor) and then some other random doctor, that I wasn't crazy. The gyny had a big bulletin board in his office with BILL'S BABIES written over it, and had been very condescending to me about his legal worries - what if I married a lawyer in a year or two and he got sued for tying the tubes of a woman who wasn't fully compos mentis, etcetera.

I was compos mentis.

But as I was going under, this doctor was standing at my feet saying "This is it! NO BABIES!!!" I think that was tasteless.

I recovered fine, with only a little discomfort. Never regretted it for a minute. (The same gyny, coincidentally, gave my sister an exam before her wedding, and in the midst of the usual indignities told her it was "almost as good as sex".)
posted by zadcat at 9:38 PM on November 9, 2006

Response by poster: Well, the gyn I was referred to had a fantastic bedside manner. She was very understanding and helped me reach an informed decision. It was sort of a shock because not facing adversity for my decision allowed me to truly come to terms with my feelings instead of constantly be fighting for the right to have it done. I did decide to go through with it but I feel like I was able to approach it from a much more balanced point of view which I was immensely grateful for.

My biggest complaint for the entire process was the bloating from the gas used to distend my abdomen during the procedure. It cannot be fully expelled afterwards so it was just a matter of waiting until it was absorbed and then dispelled. Every time I moved the gas bubble would shift and press into something, it would be a good 20-30 minutes after moving positions before it settled and I could be almost comfortable. Imagine the worst bout of gas you've ever had complete with sharp cramps and horrible bloating, and then imagine it sticks around for 4 days. I think I would have preferred outright pain to the level of discomfort I was feeling, but it was completely worth the end result.

I didn't need painkillers at all (although I would have paid good money for a gas reliever that would have worked in my situation) and I have one scar in my bellybutton hidden in a fold and two tiny ones below the hairline.

As an added benefit, I mentioned in the consult that I had some cramping during my period and pain in certain positions during sex and she diagnosed me with mild endometriosis during the operation. It was all taken care of at the same time so now I am child free, cramp free, and pain free. The hat trick, as it were.
posted by deadlypenguin at 8:28 PM on January 26, 2007 [1 favorite]

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