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.
See Tubal Ligation Ethics – Part 2. There are also more pages about the Ethics of Tubal Ligation on the Chapel Hill Tubal Reversal Center web site.
July 25th, 2009 at 1:40 am
I am 22 years old, and I want a tubal ligation done. No doctor will do it. I have rhuematoid arthritis, am on loads of medication, and have tried all kinds of birth control. I have been getting chronic yeast infections for five years, ever since I started taking the pill. I don’t want anymore artificial hormones in my body. The IUD didn’t work for me. I never want children. My doctor told me I cant have kids because of my disease. So why can’t I have a tubal ligation done!
April 30th, 2009 at 6:32 am
I have been asking for TL since I was a teenager. I have never ever wanted children or to be a mother. I am now 30 and am finally able to get one done. I think it should be the patients decision, pure and simple. Only I should have the right to choose what I do with my body.
October 2nd, 2008 at 5:41 pm
I was denied a TL when I was in my early twenties. I was also denied an IUD when I asked for that as an option. Are young men denied vasectomies? Now that I have more experience in life I am bitter and angry that my rights as an adult were so trampled and disregarded. I can’t believe that it is OK to deny legal services to an adult. It’s as if I was being forced into the Catholic religion. How can anyone claim that America has freedom…it just isn’t the case if you are a young woman.
August 21st, 2008 at 4:43 am
I was 22 when I got my tl done. The doctor talked me into it and since I was about to have one of each. I was in a great marriagew with a guy I had been with since I was 14. I talked it over with my husband and we decided before my daughter was born to have it done. I regret it 4 years later. My husband left me for another women and 2 years later I find myself in a great relationship with someone who doesn’t have any kids and would love to be a dad one day. We’ve been wanting to get married for a while now but now I’m scared to get married due to us not having almost 10k to do the reversal. I wish the doctor had told me about iud. I would of chosen that in a heart beat. Girls don’t do it you will regret it later.
July 17th, 2008 at 12:58 pm
Here’s my dilema with the Dr. that did my TL. I was 25 and had 2 kids and just your ordinary type of BC was not working for us so at the advice of my godmother I said I will have a TL. The Dr. (which was very good and very nice and had good bedside manners) suggested that due to my age I should get something that will allow me to get it reversed easly if something should happen to my husband since he is older then me by a few years. So he suggested that he will put clips on there. Needless to say, when I received my Operative Report to send to Dr. B I found out I had a bipolar couterization and it looked like I had this done in 3 spots where 1cm was cut on each tube. So my thing is that I had something done that I did not know I had it done and something different then what the Dr. and i had discussed. That is not fair that he did something other then what made sense for my age and now that i have had the TR and had 2 BFPs both of which ended in M/C and one the second due to twins in a M/C E/P because one of the twins was in the tube, I ma just mad and regret it even more then before. Women under 30 should not be talked into TL even if they ask for it, but things like copper IUD and other BC options should be taught to the women so that we don’t end up with these big regrets.
July 11th, 2008 at 10:18 pm
I would like to see women under 30 only receive the rings, which seem to be the easiest to reverse, since many women this young tend to change their mind later on in their 30s. I think what you described was a mutilation of her female reproductive organs and should not have been allowed at all. There really needs to be better counseling for women electing to have tubal ligation so they are aware of what is being done to them and allow them to even chose their method, just in case they think there may be an option for reversal in the future. Most women seem unaware of the effects of tubal ligation prior to surgery, or the difficulty of reversal. I am glad to see you are questioning the ethics of your peers, Dr. Berger, that is commendable.
July 11th, 2008 at 6:30 pm
A recent discussion on the Tubal Reversal Blog was about the Ethics of Tubal Ligation. This was regarding a patient who had been sterilized when she was 24 years old and had no children.
July 11th, 2008 at 5:38 pm
I had my tubes tied by a doctor who HAD a former patient get pregnant after a TL that he had performed. I just had my tubes reversed July 1 2008 and was only able to get one tube repaired at 2 or 2.5 cm. I do not in ANY way blame the doctor who tied my tubes. He did an excellent job, just as i expected him to do. If i hadn’t been going for a permenant form of birth control, i would have chosen an IUD. Of course now that I have changed my mind, I would like to have more tube to work with, but i dont think the doctor’s who perform TL’s are doing anything wrong. I do not regret getting mine done, it was the right choice for me at the time. I know several friends who choose never to have children, and I feel they should be able to get their tubes tied with less of a problem if they so decide.
July 11th, 2008 at 3:05 pm
Vanessa,
There are many women who once were in situations similar to yours, with absolute certainty that they would not want to bear children ever, who have a change of heart once their life situation changes. There is an excellent, highly effective, nonhormonal, long-term, reversible method available: the copper IUD.
But, I admit that this method is not for every woman. The article here is not arguing that women be denied tubal ligation, but just suggesting that it might be more ethical in these cases to use a surgical method that is more easily reversible.
Women younger than 30 at the time of their surgery are the ones most likely to regret that decision later. In one study in which more than 10,000 women who had been sterilized were interviewed 14 years after the fact, 20% of those that had had their tubes tied before age 30 expressed regret. That’s a very high percentage, in my opinion.
July 10th, 2008 at 9:47 pm
I am almost 27 and have been with my husband for 7 years, he is older than me and already has a grown son. He has no bearing on my decision, but he is fine with whatever I wish to do as long as I am happy. I have thought a lot about children, and am sure that I do not want any. I think that a woman who can not have a child is in a much better situation than a woman who has one and doesn’t want to. I do not want to take birth control medications because of the risks involved-CANCER, HEART ATTACK, STROKE… If I ever decide I want children (unlikely), I will adopt. I think that women are taught at a young age that it is our responsibility in life to have children and we aren’t really commended for deciding that we don’t all need to have children! Why should I have to risk my way of life because a doctor can’t understand or respect that I don’t want to make babies?
January 31st, 2008 at 4:03 pm
[...] Berger’s Tubal Reversal Blog « Ethics of Tubal Ligation Case Study: 28 Year Old Mother of 3 Has a Tubal Reversal [...]
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.
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.
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 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 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 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 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.