Ethics of Tubal Ligation
Tubal Sterilization For Young Women With No Children
One of today’s patients at Chapel Hill Surgical Center was a woman in her thirties who recently become married and had a tubal ligation at age 24 years when she had no children. Her tubal ligation had been performed by a tubal coagulation procedure in which the fallopian tubes were burned at the junction of her uterus. The tubal lumen or opening within the uterine wall was scarred completely on both the right and left sides from the burning procedure. Therefore, the only way to perform a tubal reversal was through the technique of tubouterine implantation.
I mention this case because it was unnecessarily destructive, especially when performed for a young woman with no children. Many studies show that these are women who are most likely to change their minds later on and want to be able to have children. In this case, almost any other tubal ligation procedure would have been preferable. In my view, the best choice of a tubal ligation for a young woman with no children is the clip method (either Hulka clip or Filshie clip).
I have encountered other cases like this in the past. I wonder if the doctor who performed her tubal ligation considered the possibility that the patient might change her mind, and therefore it would be preferable to perform a tubal ligation better suited to reversing at a later time, should the need arise.
Comments Welcome
I am interested in what other people think about this.
December 26th, 2007 at 9:18 pm
I think physicians should always consider the possibility that women may change their minds about having children in the future. It would be a good idea to offer women, especially young women who have not had any children, birth control options other than tubal ligation - and if they had to do a tubal ligation that they would just simply place a clip on each tube. I like the idea of leaving women the option to change their minds. This is one reason I enjoy being a part of the tubal reversal procedure. It offers hope to women that have changed their minds.
December 28th, 2007 at 9:53 am
Over the years I have scheduled many women for reversal surgery with Dr. Berger who have had no pregnancies prior to deciding to undergo tubal ligation surgery. Normally, they have made this decision in their early 20s. It surprises me that a doctor would even agree to sterilize a healthy woman in her early 20s who has never had a pregnancy. In my opinion, there should definitely be some restrictions to protect a young woman in this situation, so that the type of ligation performed is one with a good chance of reversal.
December 28th, 2007 at 11:02 am
I too have seen this many times. It is heartbreaking to see a patient’s hopes destroyed as they are told the news by Dr Berger. This is a perfect example of why everyone needs be their own patient advocate. For years I have seen patients accept, unconditionally, what is told them by their physician. This is just not acceptable. Patients need to learn to doubt, to ask questions, to explore their options and then listen to their doctor and make an informed decision
December 28th, 2007 at 11:31 am
I often wonder about this type of situation. How could any physician believe that a tubal ligation is the right birth control choice for a woman in her twenties who has never had children? There are so many types of available birth control and a tubal ligation should be the last resort. I just hope physicians discuss all of the available option with their patients and that these young women realize that they have less drastic choices.
December 29th, 2007 at 3:18 pm
Since starting on this journey to become pregnant again I have often wondered,why use a method that will damage a womans tubes so badly ? Regardless of how many children she has had. Life situations change, mine did and now I’m struggling to try and become pregnant again. Why not use clamps or clips all the time ? I’m not a medical doctor so perhaps I have over looked some reasoning here but using a method that causes less damage seems smart to me. Using tubal ligation for a woman who has never had children makes no sense at all.
December 29th, 2007 at 6:16 pm
Some doctors may use destructive methods of tubal ligation to keep from being sued for “wrongful pregnancy”. I know one doctor who was sued by a patient who became pregnant after a tubal ligation. After that, this doctor burned the tubes completely for any patient wanting a tubal ligation. The tendency of some people to sue their doctor if they have less than a perfect outcome results in many doctors practicing defensively. It is too bad things are this way, at least in the US.
January 15th, 2008 at 9:57 am
I think that details of the sterilization procedures are not always reviewed prior to surgery. Most of the women that I speak with indicate that they do not recall a specific tubal ligation method being listed on the consent form. Unless the details are discussed prior to the delivery, this is a tough decision for a woman who has just given birth to make.
January 31st, 2008 at 4:03 pm
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