In reading my tweetdeck this morning catching up on the conversations that were happening last night, I came across a very interesting one on tubal ligation. Specifically will an OB/GYN perform a tubal ligation on a woman who has not had kids or is considered “too young?”
My first thought was that if a woman wants a tubal ligation who is anyone to stop her? We don’t get upset if a man wants a vasectomy, do we? No, we think wow that is someone who is taking responsibility for their life and birth-control. Why should we get upset or refuse surgery to a woman who wants the same thing? Why should a woman who doesn’t want kids have to pump their bodies full of hormones or rely on a non-foolproof form of birth-control like condoms?
Looking at the failure rates, tubal ligation results in about 1 pregnancy in 1000 women sterilized, while a condom when properly used result in 2 pregnancies in every 100 women. Hmm, so doing the math, the tubal ligation is a much more effective form of birth-control.
The arguments against tubal ligation seem to stem from the surgeon thinking the woman might change her mind later in life. Well, this doesn’t really ring true. If a woman decides she doesn’t want to have children, if she is at all ambivalent she will choose one of the other forms of birth-control. She will choose the pill, condoms or an IUD. Most people do not opt for surgery UNLESS they are sure. The other argument I have heard is usually thrown at couples. Yes a vasectomy is an easier procedure, but it isn’t for all couples. Hell if you are single and don’t want kids taking care of this for yourself makes good sense. As stated earlier other forms of birth-control are not permanent or 100% effective. While not 100% effective, a tubal ligation is permanent and the .04% failure rate is pretty damn nice.
I am not suggesting that tubal ligation is for every woman or for every couple. If I were a single woman who didn’t want kids and I had really thought it through, I would be pissed if I couldn’t find someone who would perform the surgery for me. If the surgery isn’t covered and I am willing to pay for it, why should others be able to make the decision for me? If people made the decision to sterilize women without their consent we would be outraged. This is the opposite, people are taking away some women’s choices by refusing to perform this surgery. Would they rather perform abortions instead?
I also read this article from the Toronto Sun about a young couple with two kids being denied a tubal ligation after her scheduled c-section because of her age. Who but they should decide how many children they should have?
I love my children and I am so happy that I have them, but not all women feel the need to have children. Not all women are meant to be mothers. I think that is what really rankles about this subject. I wanted to be a mother, but if I didn’t I would want to be respected for my decision. I want to be respected for my decision to have children, because in the end it is MY DECISION.
What do you think? Should doctors be able to refuse to perform tubal ligation unless they deem the woman has had enough children or is old enough? Should it be entirely the decision of the woman who wants the procedure?
I commented on another blog about this issue but here is the gist of it: I think if you are considered an adult, you should have the choice. However, that is a huge step to take for someone so young and I would hope that anyone approaching a doctor for that kind of procedure would a) seriously consider the ramifications for a good length of time and b) have to speak to someone in a professional setting about the choice they are making. And it shouldn’t be an instant: walk into a doctor’s office and bang, have the surgery next day. If she came back in a year and STILL wanted one. Well okay then.
I’d hate for her to do it, go along her merry life and then decide oh, maybe another child would be nice, try for a reversal, have issues, sue the doctor for LETTING her have such a heinous surgery at such a tender age, blah blah blah. Sadly, this is not an unrealistic scenario in our sue-happy, nothing is my fault society.
As for the man getting a vasectomy: well, I know that doctors will also counsel a man to not make such a move without seriously considering the ramifications.
Personally, I think today’s 20-somethings are mostly morons that don’t know what they want out of life. Letting some of them make a choice like this will come back to bite society…but then again, perhaps limiting their reproductive abilities IS a good thing 😉
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I hadn’t heard about this issue but that’s unbelievable. Ultimately, whether I think someone is too young or not is irrelevant. It’s a personal decision about someone’s personal body. I know someone very close to me who had two kids and decided to have their tubes tied (as they used to call it) when she was still relatively young in her mid 30s. She regretted in about 4 years later and really wanted mroe children. She tends now towards telling people to wait on that surgery since it is rather final (sometimes reversible of course) but she would never dream of telling someone they couldn’t do so. I mean, for God’s sake, the world let’s someone get 10 plastic surgeries in a DAY and yet shakes their head over a woman making a decision about her own reproduction?
.-= Sarah@EmergingMummy´s last blog ..In which sometimes I want =-.
I totally agree with this post. I knew a woman in university who argued for and eventually got a tubal ligation at 21. Knowing her, she was incredibly well-informed and was absolutely certain of her lack of interest in having children. I think it depends on the maturity of the individual more than anything else.
I myself am child-free and never really wanted to be a mother – although I love kids, I don’t want them full-time. I got tired of people telling me in my teens and twenties that I would change my mind one day when I found the right man. Well, I did find the right man 12 years ago and I’m 40 in a few months, still without kids. In fact, a year into my relationship with my husband I ended up having to have an abortion because of a failed contraceptive method; not something I ever wanted to do or ever want to do again. I think it goes to show that with foresight and commitment to a life choice, perhaps taking matters into your own hands early on is a better idea.
Why is it that it is OK to have as many abortions as one “wants” but not OK to have a tubal ligation as a safe, effective method of birth control? It makes no sense to me. When I had had four kids by the age of 28 we had a hard time getting a vasectomy. They would not even consider a tubal. I though that things had changed. People seem to have their priorities wrong. Children are wonderful and necessary for the continuation of the species but not every woman is meant to have them. Let those of us who want kids have them if we can and when we have had as many as we want and can support emotionally and financially, decide for ourselves how to prevent further pregnancies.
This general refusal by most doctors is just making me angry now. It’s paternalism masked as concern, and defining women by their ability to reproduce. Argh.
.-= Derek K. Miller´s last blog ..Morning routine =-.
Yeah the assumption that all women want kids is very annoying…also that a surgeon/doc has the right to ask or question our decisions…look at the reverse. I had a friend who is a mom of 4 asked if she wanted her tubes tied…the docs assumed because she is lower income and native that she couldn’t POSSIBLY manage or want the kids she has. She is a great mom.
Even me…when having my not by choice c section was asked if I wanted my tubes tied while I was there.
So they can decide when I have had enough too???
.-= Crunchy´s last blog ..Emotion =-.
Having had a tubal ligation I’m pretty sure you know what I think on the matter. Obviously I feel that if a woman wants a tubal ligation she should be allowed to have one.
A woman I worked with was single. Never ever wanted to have kids and was turned down by multiple doctors when she sought a tubal ligation. It took her years before she was allowed to have one. We celebrated her surgery with a uterus/ovary cake with cut tubes. 🙂
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Yup, the world over – a friend back in Scotland was told to wait until she was older before having a tubal ligation. i think she started asking around 23y old.
at the same time and age i couldn’t imagine having a child – ever – but i didn’t consider surgery as a final step. i now have a child but it took almost 14 years to arrive at the decision to have one.
thoughts can change, life changes, but i don’t think it’s up to the docs to make the decision – all they need to do is make sure the decision is made after the patient is fully informed. end of story
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First, do no harm.
People choose, all the time, to do things that are bad for them (smoking) or potentially irreversible (tattoos) or about which they may change their minds later (did I *really* think those red plaid pants were the coolest thing EVAR?) They have the right to do so. When it comes to medical procedures, though, doctors do have the right not to offer a procedure that they think is potentially harmful (whether physically or mentally) and they CERTAINLY have the right to ask questions, make sure the patient is fully informed etc. I’m not sure it’s possible to make this particular issue completely cut-and-dried, as in, should it be the doctor who decides or should it be the woman? There needs to be communication and ideally a joint decision. If an 18-year-old came to me and asked for a tubal, I would almost certainly refuse (and not just because it’s not my area, haha). I would try and keep the lines of communication open, and explore why she felt that (potentially irreversible) option was the best choice for her. And yeah, that may sound paternalistic, but I’ve also known a LOT of women who didn’t have any interest in having kids of their own until their late twenties/early thirties, and suddenly bam the clock switched on or whatever.
I think this is a particularly “hot-button” topic because we can invoke “woman’s right to choose” on it and there’s a lot of emotion and baggage around that. But people come in all the time asking for things which their doctors may feel are a) inappropriate, b) dangerous, c) unnecessary, or d) all of the above, and just because the person wants it doesn’t obligate us to offer it. And from my one month on Urology a long time ago, I do remember similar conversations with young men requesting vasectomies: really trying to be sure that they had thought it through. Again, maybe paternalistic, but it’s my responsibility as a physician to ask the questions, to be SURE, before I do something to your body.
I think Derek’s comment about paternalism is probably right on the money… though I would also say (caveat: having lost a child & spent much time in/around subject I am not the most objective) that in terms purely of danger to the patient, a tubal ligation is much more dangerous than a vasectomy. There’s a reason Dr. Pollock here in YVR can perform 20 – 40 vasectomies a day: it takes about half an hour, no general anaesthetic, no opening the abdominal wall. My husband was rather grumpy a couple of days but that was all. Tubal ligation usually requires a hospital stay.
That said, particularly re: the article you referenced, since she was having a c-section it would only have taken them a few moments to complete the operation at the same time. It’s generally recommended that way, in fact.
Part of me also wonders if there isn’t some lingering, vestigial discomfort on the part of the medical community regarding tubal ligation, given that it was the method of choice in this country for forced sterilisation and our eugenics program. My cynical side also wonders if there isn’t an assumption sometimes that “clearly this woman (or couple) are highly competent, thoughtful people, exactly the type who would be good parents” thus pressure of a different sort. My *really* cynical side goes with one of the commenters above: you can’t shame a woman for choosing a tubal ligation the way you can for an abortion (or infertility, come to that).
Enough wittering on. Sorry.
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