I read an article yesterday on women who have had to fight with physicians to have tubal ligations. The women featured in the story have been certain about their intentions to stay childless, yet it took an amazing amount of effort for them to find physicians willing to perform the procedure which would (in most cases) create permanent sterility.
The article addresses that those who have never had children and those under 30 are most likely to experience resistance to their choice of permanent contraception. The theory is that if you’ve never had a child, you may just not realize YET that you want one. And if you’re under 30, and already have children, well, what if you decide you wish to have another when you’re a bit older, or Gd forbid, one of your children dies? I only wish I were making that up. I know several women who sought sterilization and were given that argument as a reason why it wasn’t an acceptable choice. Because getting pregnant again and having a new baby will TOTALLY replace the dead child. Like a kitten.
As a friend of mine brought up on my Facebook page this weekend, it’s important to acknowledge the many people (women and men) who have been sterilized without their consent in Canada in both distant and recent history: Aboriginal people, people of colour, women who gave birth to babies via c-section who were considered too high a risk to get pregnant again, people with disabilities (physical, developmental, and psychiatric), and women who’d had “too many” children outside of marriage. The motivation is the same for refusing the procedure and for enforcing it: some people just aren’t perceived as capable of making smart choices about their fertility, and it is the role of physicians/the State to make that choice for them.
I have friends who, both childless and who had their children young, be turned down flat more times than they can count, first by family physicians, then by gynaecologists. They can make all kinds of health care choices for themselves that may or may not be permanent: tooth removal rather than repair (because it’s cheaper) is one that comes to mind. Donating a kidney is another. Both may have serious long term health repercussions for the person involved, but if you’ve got rotten teeth and no money, no physician or dentist is going to step up and say, “But you can’t! Think about the years of headaches you’re going to have because your bite’s going to be completely screwed!” Likewise, no one is going to stop you from giving a loved one or even a stranger a kidney, even if you have no guarantee that you’re not going to need it yourself one day.
While the risks of general anaesthetic are not negligible, the risk of pregnancy after the procedure is roughly 1 in 200, and 6% of sterilization failures lead to ectopic pregnancy, generally, it is a safe and effective procedure for the vast majority of people who have fallopian tubes. The risk of post-procedure regret exists, I agree. I know women who have had tubal reversals in attempts to get pregnant later in life. We all make choices we regret. But they should be *our* choices to make, our regrets to have, if we have them. The fact that one of the women in the article had to have her partner’s consent before the doctor found her argument legitimate is horrifying to me.
This is hitting close to home for me, because I have a referral next month for a tubal. I have 2 kids, and I’m in my late 30s. I’ve also had some ongoing chronic illness. My family doc didn’t blink an eyelash when I asked for the gyn referral. She said, “You have nothing to justify to me. You’ve got big kids. I trust you know you’re done.” I love how matter of fact she was with me, though I did wonder if she’d have had the same reaction if I’d gone in at 28, with an infant and a toddler, and asked for the same referral. Or if I’d gone in at 25, before getting pregnant in the first place (which I wouldn’t have, because I’ve always wanted children, but play along with me in the hypothetical space for just a sec). I am thankful that she didn’t go through other options in an effort to dissuade me, like other people in my situation have had to deal with.
Many are offered an IUD. Its effectiveness rate is almost equal to (and the Mirena is actually slightly higher than) sterilization. So why wouldn’t I consider one? I’ve got a few reasons, actually: I do *not* do well with hormones. The Mirena excretes a small amount of progesterone into the uterus as part of its way of making it an inhospitable place for fertilization. It’s entirely possible that hormones that far away from my brain wouldn’t make me crazier, but I’m not willing to spend $300+ to test the theory. As for the less expensive copper model, it’s associated with increased bleeding. My hemoglobin and iron stores are traditionally low. My periods are currently manageable. It seems like a bad idea to introduce something into my body that could lead to me getting much sicker.
And other forms of contraception? Can’t take the pill, Nuva Ring or the Patch (see above for hormones = CRAZY PANTS OF CRAZINESS more than usual crazy for me). Depo Provera? Crazy + significant risk of bone density loss. Barrier methods? Diaphragms and cervical caps are significantly less effective without spermicide (to which I react rather violently, and avoid like the plague for fear of a fire being lit inside my vagina). I use condoms, but I have to find unlubed ones because the lube on condoms (even the silicone ones) also leaves me with flaming cooch of doom. You know what? As effective as they can be, condoms sometimes break.
I am DONE with worrying that I’m going to get pregnant if my contraception (always condoms + fertility awareness, combined with periodic abstinence and withdrawal when fertile) fails. Also? Seriously? FOUR methods of contraception, and it’s still not as effective as two clean snips, some cauterization, and a couple of stitches. I look forward to my consult next month, and hope the surgery is scheduled quickly and goes smoothly.
I also hope that more women and others with fallopian tubes are someday seen as capable of making their own choices about their bodies, whether or not those choices are popular.