When reviewing contraception options for patients, I admit that I don’t often discuss female sterilization unless the patient inquires. It isn’t that I have anything against tubal ligation. Quite simply, among my patients, there is a very specific population that usually opts for sterilization — women in their late thirties or early forties who have had a few children and don’t want to take any chances in adding to their families.
Last year I saw a new patient, a married woman in her mid-thirties who had never been pregnant and had been on oral contraception since her early twenties. When I asked her if she was happy on her pill or wanted to discuss other birth control methods, she immediately inquired about having a tubal ligation.
She must have seen a look of surprise on my face, because she quickly told me that her last doctor had refused to perform a tubal ligation on a childless woman without the written consent of her husband.
She went on to explain that although her husband was in complete agreement with her decision to have her tubes tied, they were both angry about the principal behind the doctor’s requirement. Wasn’t this decision her contraceptive choice to make? Would a urologist require a wife’s consent before performing a vasectomy?
I did not ask why her husband had not opted for a vasectomy, which is a far less invasive procedure. I did not think it was my business. I continued with her well-woman exam and referred her to one of the physicians in my practice for a surgical consultation. She had her tubes tied a few weeks later, after the physician extensively counseled the woman on the risks, benefits, alternatives and permanence of female sterilization.
When I saw this patient again last week for her annual exam, she was very happy. She explained to me that her husband has a rare inherited bleeding disorder that they were very concerned about passing on to any children. She reported that they were currently looking into adoption.
Finally, she expressed appreciation at my and my physician colleague’s lack of judgment during the counseling and set-up of her tubal ligation. She also explained that she would have shared the details of her husband’s disorder with us had we hesitated to sterilize a childless woman. She elaborated that they were both defensive after encountering such resistance from her former gynecologist.
I understand this couple’s position, but I have also seen the other side of this issue. I recently saw a patient who had her tubes tied a few years ago after having her third child. She has since divorced her husband and is dating a childless man who wants to have a family. The patient inquired about having her tubal ligation reversed.
This is not an uncommon question. Tubal ligation reversal surgery is almost never covered by insurance, with costs averaging between $3,500 and $6,000. Success rates ranging anywhere from 35% to 85%, and is largely dependent on patient age and the type of sterilization that was initially performed.
Life circumstances can change, which is why it is so important that patients understand that sterilization is not something that should be done without great consideration. However, tubal ligation should be a contraceptive choice for every woman, regardless of her age, marital status or parity. Extensive counseling and informed consent should be required prior to any sterilization procedure, including vasectomy.
Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.