Ethics of Tubal Ligation
Posted On: Wednesday, December 26th, 2007
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.
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
[...] Berger’s Tubal Reversal Blog « Ethics of Tubal Ligation Case Study: 28 Year Old Mother of 3 Has a Tubal Reversal [...]
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?
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 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 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 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 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.
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.
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.
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.
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!
October 8th, 2010 at 1:13 am
I begged for this procedure when I was 24. I already had 2 daughters and their father and I weren’t going to work out because of his major bi-polar that was continually getting worse. At 24, I was denied twice (different doctors) because I was too young, not married, and only had 2 kids (I guess 3 is what they want you to shoot for). Mind you, I didn’t want any more children. Just because I have a uterus doesn’t mean I have to use it. At 25, I met a man who was “supposedly” sterile after a military injury. I felt as though my prayers were answered. Well, he wasn’t sterile. I got pregnant and right from the beginning I begged him to let me terminate. He didn’t want me to because he wanted his child. I should’ve sneaked off and had it done but I never found anyone willing to take me. Anyways, I had a son. Months later, after having to quit bcps because of them making me ill, I got pregnant again (twins). This pregnancy turned out to be very traumatic (twins died) and I wanted a tubal after that. NOPE! This time was because of the fact that I had a traumatic pregnancy. Forget the fact that these people knew I had wanted this since I was 24. At 31, I’ve finally found someone willing to do this. This is 7 years and 3 kids after the time I first wanted it. Now, I’ve made my husband get a Vas but I haven’t touched him in over a year. I honestly suffer from severe depression and I have trouble bonding with my son. I regret having him almost every day of my life. I’m trapped in a marriage, with a man who lied to me, and raising a child that I never wanted to have. It’s messed me up so bad that I don’t even feel that I’m an adequate mother to my daughters. I honestly REGRET not having my tubes tied when I was 24. If I were to ever get pregnant again, I would NOT tell my husband and I would just sneak off and have an abortion.
You doctors who make us women jump through hoops to get our tubes tied, I hope you rot in hell some day and remember my story the next time a young woman is in front of you begging for this. I would much rather have gotten a tubal and regretted that than having a child and regretting him. It’s the most awful feeling in the world. My whole life was taken from me because I was denied this… and there is nothing I can do to get it back.
October 8th, 2010 at 9:38 am
I don’t understand why most doctors don’t just use clips now or at least leave enough tube just in case!!
October 8th, 2010 at 12:36 pm
Tamara – I agree completely with your point! Tubal clips or rings are highly effective and easily reversible. Bipolar coagulation and division of the tubes is also an effective method of female sterilization that can be reversed if need be. There are doctors who intentionally destroy large segments of the tubes rather than conserve normal tissue. This is unfortunate for women whose circumstances change and who may want to become pregnant again in the future.
January 19th, 2011 at 2:57 pm
hi ladies, i know i posted elsewhere on this site but i would like to do so here as well, i decided whole heartedly on a tubal ligation, before my doctors visit i looked at lots of sites including this one, but was still going to do it. yesterday i went to the doc, he agreed to give it to me but as i was fixing to say lets do it, i said tell me about the IUD, he told me this in our convo. i think i saved myself alot of heart ache. im getting paragard IUD soon, i am only 26 with 1 child. you ladies that posted here came to mind, and all the stastistics of regret…so i want to thank you ladies for posting, i cant say ur going to save all women in the future from this mistake…but i know for certain you saved one.
April 5th, 2011 at 8:26 pm
This really upsets me. It’s a doctor’s job to give a patient the care they wish to receive. I am 26 and I know I never want children. I have never wanted them and I never will. Whether I meet a great guy and want to spend my life with him, children of my own will never factor into the equation. I want to adopt children who are already here and need love and a good stable home. I cannot justify wanting to bring yet another life into this world with so many unwanted lives already occupying it.
So, you guys are essentially saying that a doctor must “save my from myself” by making me continue to pump medication into my system or implant devices which can detach and rupture my uterine wall (or cause countless other issues for me) to prevent me from having an unwanted pregnancy? That is inhumane and ridiculous! I don’t buy that doctor’s are so concerned about being sued. The proper documentation (including forcing the woman to be psychologically evaluated) should take care of that. I also do not believe it’s for the woman’s benefit so that it does not take a more drastic procedure down the road to reverse it. They just don’t want to take the chance of having to piggyback on another doctor’s work and having something go wrong and be blamed for it.
Yes, I am a 20-something, but I am not nor have I ever been one of those women with a burning desire to have children. I know this. It is extremely patronizing and insulting to tell me that one day my clock will start ticking as if I have to adhere to what my “gender roles” have already set forth for me. There are women who genuinely do not want children and should be allowed the ability to prevent that from happening. To prevent terminating unwanted pregnancies and sending yet another newborn to an adoption agency. My co-worker is 60 years old and she said neither she nor a couple of her friends (all the same age) ever wanted children. They are all married and childless and perfectly happy. They don’t “long” for motherhood. They never wanted it. I am the same. Not every woman wants children and it’s up to her to decide if she wants them or not. Just as it is up to her to deal with the consequences if she decides later on that she made a mistake. The laws of the land need to stop being so “sue” happy and protect physicians better from such types of malpractice suits for things which were consented to. It’s ridiculous!
September 25th, 2011 at 10:01 pm
Winter,
I COMPLETELY agree with you. Thank you so much for posting your opinion.
October 7th, 2011 at 4:32 pm
If a woman asks for a tubal ligation, I think its safe to assume that she doesn’t want to have children. Otherwise, she wouldn’t be having the procedure done, but instead buying birth control. If a doctor gives a woman Hulka clips, her chances of getting pregnant still exist. That’s why I don’t really support this method. No one should ever assume that just because a woman is young that she is naive about her choices. If she says she doesn’t want children, you can only take her word for it and avoid assuming she’ll changer her mind just because she isn’t married and hasn’t found the “right guy” yet. Although, it is shocking to me that so many woman actually have the procedure reversed.
October 8th, 2011 at 3:47 am
Winter -
Thank you SOOO much, I completely agree with you!! I just got married and am still trying to have a tubal ligation. My husband just had a vasectomy, we went in a week ago for a consult and this week he had the surgery. I had to call around to about a dozen different doctors before one would even give me the time of day, then at the appointment we talked for an hour, she made me take a pap smear, then told me I had to wait 6 months before she would see me again, and if I said the same thing then she would give me the surgery. Unfortunately I moved before those 6 months where up so now am unable to get it from her so have to look for ANOTHER doctor in a much smaller area. I am just so incredibly angry at the injustice of it all. I am not going to be a very happy camper if another doctor tells me I have to wait another 6 months. And I will find anther doctor, I am beyond determined that I do not want kids of my own.
Women who get tubals in their early 20′s then regret it and try to take it back give the rest of us who think through our decisions a bad name. Please, women, if you have ANY doubts, don’t get one, get an IUD or something, so that the rest of us who know we never want kids don’t have to fight so hard for it!!
I know this was somewhat ranting but this is one of only 3 topics that I feel incredibly strongly about. Please, if you’re reading this, help change it.
November 15th, 2011 at 7:45 pm
I am 23 and never in my life have I wanted children. Being a mother is not something I would enjoy and I find no value in the experience of parenting. It is extremely upsetting to me, as a young woman in America, to know that I am looked down upon by doctors who refuse to let me make decisions with my own body. Of course some people will change their mind, people are people and they are finicky creatures, but for these doctors to look EXCLUSIVELY at the women who try to get a reversal procedure done and to completely IGNORE the women who are happy with the results is devastating. Some of us are not meant to be parents. Some of us will never be able to afford it. Some of us DO NOT VALUE motherhood, but I value my body and my rights. I have gone to eight doctors and all of them have refused to tie my tubes. I pay $100 every month for my birth control and I still fear pregnancy. I don’t feel free or in control. Why can’t I get the procedure and be done with it? For all the talk about accidental pregnancies, welfare moms, and overpopulation, doctors sure as hell don’t seem to care about an option that works for the benefit of everyone.
November 15th, 2011 at 11:46 pm
Personally I think it’s ridiculous for a doctor to refuse a sane-minded person the right to make a decision about their own body, particularly a decision that has such a significant impact on their life.
Just have her sign a legal waver and IF it turns out to be a mistake then it’s a mistake the woman has to live with.
I’m almost 27 with no children (and am NEVER going to have any), have tried every hormonal and non-hormonal contraception method available to me.
Despite being at a high risk on heart attack, stroke etc. I tried all the hormonal and kept throwing up from them. I tried copper IUD but it was painful and kept expelling. Caps and sponges kept falling out. Allergic to latex and other rubbers so kept breaking.
Have had 2 abortions (Note: NOT something I’m proud of). 1 was from a rape and failed morning-after pill. The 2nd was my fault as after exhausting all options (including repeated requests for tubal ligation), I tried to rely on using withdrawal and avoiding my most fertile times but obviously didn’t work.
Yet STILL havent found a doctor willing to do it so have no option but to not have sex at all or risk another pregnancy. Partner wants kids one day (with someone else in the future) so not willing to get snip (also doesn’t know that I fell pregnant and aborted his child from him “pulling out”).
It is not the doctor’s body or life. It is THE WOMAN’S body, THE WOMAN’S life and therefore should be THE WOMAN’S decision!!
December 19th, 2011 at 10:51 pm
Wow all of these stories… I myself am happily married with three beautiful children. i am contemplating having a TL done. I have the copper IUD, but after not being able to find the strings, the doctors did a US and told me that it moved up into my fallopian tube, so now I have to go in and have it removed at a out patient surgery. I am not looking forward to it at all, I have only had it placed for a year and was expecting not to have to worry about anything for ten. I am scared for the side effects of a TL, so I am goin to cont to pray for some guidance of what to do.
December 20th, 2011 at 3:36 am
I live in Australia and will be 28 next March. I’ve never wanted children for many reasons and I know deeply that having children isn’t for me. My boyfriend doesn’t want kids either and is saving for a vasectomy. This is my body and I am over trying temporary birth control methods as they mess up my cycles etc. I want something permanent for peace of mind, and I want to stay responsible. I have spoken at length with my psychologist and she agrees with me completely and even applauds my decision. My doctor has referred me to a gynaecologist, fingers crossed.