Ethics of Tubal Ligation – Part 2
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. She changed her mind in her thirties and came to Chapel Hill Tubal Reversal Center for a reverse sterilization procedure. Her fallopian tubes had been electrocoagulated extensively and the reversal operation was a difficult one to perform, requiring tubal implantation into the uterine cavity.
One of today’s patients is a 26 year old who had a tubal ligation at age 22 and had never had children. The doctor who performed her tubal ligation first applied Falope rings to the tubes, then proceeded to burn them in several locations. In her case, tubal reversal was not possible at all. During her operation, I wondered why any doctor would perform such a destructive type of tubal ligation for a young woman with no children. The Falope ring alone would have been sufficient to prevent pregnancy, yet allow reversal at a later time if she changed her mind about having children. Fortunately, she has the option of treatment by IVF. Still, why would a doctor perform an operation that essentially destroyed the tubes in such a young woman when there are a variety of other less destructive procedures for performing a tubal ligation? Is this ethical medical treatment?
I am very interested in what others think about this issue. Please leave your comments!!
More about Tubal Ligation Ethics
Submitted by Gary S. Berger, M.D.
November 17th, 2009 at 1:55 pm
Emily
The intent of the blog post was not to say doctors should not perform or women should not have tubal ligations.
We were simply asking why perform such an aggressive procedure on a patient when a simpler approach would work just as well and have the same effect and allow the possibility of a tubal reversal?
We believe in choice but not penalization.
November 17th, 2009 at 1:41 pm
It is deeply insulting and infantalizing to say that doctors should not perform tubals on women who are under 30 and/or have no children. Doctors should fully inform these patients, but ultimately it is the patient’s choice. These are adult women who have every right to control their reproductive decision. And the patient should (and I believe many do) carefully consider what they want, and what exactly will take place during the procedure, with the knowledge that tubal ligation is intended to be permanent.
October 14th, 2009 at 7:09 pm
Any adult over the age of 21 can have a tubal ligation. You should talk to your doctor but I recommend a reversible intrauterine device (IUD). Many woman who have a tubal ligation will regret their decision. You should read our blog, Guilt or Regret About Tubes Tied, to help you understand.
October 14th, 2009 at 6:57 pm
I have a baby 6 months of age and I am pregnant again. I don’t want anymore babies. I am 24 years old now. Can I have a tubal ligation even at the age of 24.
August 17th, 2009 at 10:35 am
I am not sure why any doctor would do this to women. I am wondering why my doctor would give me a tubal at all. I came into a hospital with my water broken and he asked if I wanted a tubal because I have children already.
I was a complete emotional wreck and he knew that as he called the psyche ward on me. I was having such a breakdown about having a c-section done. He then asked if I wanted a tubal ligation and I said ‘Yes’ and ‘No’ all in the same sentence. They included the tubal paperwork in my papers and I signed them, but I instantly regretted it after the c-section. I wanted to say no right after but they had given me something to calm my nerves and I passed out before I could remember to say it. Why would he cut my tubes, knowing I was a wreck emotionally, knowing I had doubts and wasn’t sure if I wanted to be sterilized, and knowing he had no history on me and not knowing me as a person.
I am not crazy, I just hate modern medical treatments. I would much rather live a life of natural and homeopathic remedies but sometimes things aren’t going right and I realize medical intervention is necessary. I just can’t believe I am 28 and now essentially sterile.
I have been crying off and on for the last 6 months (since I had my daughter) about my tubal ligation. I keep looking at her and knowing I will never have another little bundle of joy and how she is growing up so fast and I will never have these moments again. Sigh, now to go cry………
April 11th, 2009 at 1:30 pm
I had my tubal ligation when I was 25. I was single. I’d never been pregnant, and KNEW that I NEVER wanted children.
Planned Parenthood had given me a list of doctors to consult about it, and the one I chose gave me all of the information about it, and also asked me more than once if I was sure. I also signed a waiver saying that he wasn’t responsible for MY decision, which was true.
The procedure I decided on was to have sections of the tubes removed and the ends cauterized. As I said, I was fully informed of the fact that this would mean the likelihood of a reversal was very small and the likelihood of the reversal resulting in pregnancy was even smaller.
I am 45 years old now, and happily married for almost 10 years.
I did not want children and do not regret my decision.
My husband doesn’t want them either. I met him many years later.
If you want it done, YOU CAN FIND a doctor, and DON’T DO IT if you are prone to changing your mind, or if you’re doing it for some man, OR if you think you’d change your mind FOR a man…
January 9th, 2009 at 5:35 pm
I am seventeen years old and am absolutely one hundred percent positive I will never want children. I would have a tubal litigation on my eighteenth birthday if I could find a doctor who would perform it.
The purpose of me posting this is to say that there are some women like me who KNOW children are not in their future. If they are legal adults it is nobody else’s business if they want a tubal. It is inappropriate and wrong to say that this decision can’t be made until you are in your thirties.
It’s a personal decision. If a woman chooses to have the operation at a young age all it means is that she is mentally precocious and knows she isn’t maternal.
November 22nd, 2008 at 2:26 pm
I have no children, have never wanted children, and do not think I will change my mind at this point in my life (I’m in my late thirties). I had a tubal ligation performed. One of the falope rings was placed incorrectly, and I became pregnant less than one month after the tubal ligation surgery. I had an abortion, immediately, which is exactly what I had told the surgeon I would do if the surgery failed.
While I have sympathy for those who regret their tubal ligations, please realize that one reason my surgery failed is that surgeons are reluctant to change their techniques and make surgical sterilization truly permanent. The failure rate is much too high.
September 12th, 2008 at 11:08 pm
I’m 36 and have a set of 17 year old twin girls. I am now remarried and my husband desperately wants a child. After having a local consult and being told my right tube was badly scarred and might not be repairable, my husband internet researched and found CHTRC. Dr. M was able to repair both tubes with great legnths(L 5.5,R 6.5) seemingly with ease as we never thought to mention the local consult’s projected outcome-I was very impressed with that!!
August 31st, 2008 at 12:08 am
I’m 23, and would like a tubal litigation but no doctor is willing to do it.
My husband and I have one son, who was born 9 weeks early due to pre-eclampsia. From that I have stage 1 kidney disease. I have tried an IUD but bled for 9 months, and have tried birth control but it raises my blood pressure. For women who have medical problems it should be considered.
August 12th, 2008 at 10:13 am
Yes it would be nice if more Dr.s were aware of the benifits that using the falope ring or filshie clips have, such as easier reversal.
July 31st, 2008 at 8:53 am
I think that it is totally ethical for a woman 18 years of age or older to have a TL, no matter what her medical or family situation may be. I do think it is awful for a doctor to do something like that. It is my opinion, that he either just did not care or was just flat out a doctor who perhaps did not have enough expertise to be doing such procedures.
I was 18 when I became pregnant with my first child, and 26 when I had my TL. In, regards to Pam’s blog, I think she’s right. If a woman can choose to have an abortion, cosmetic surgery to alter herself, have sex and babies, ect. then she should be able to make that decision for herself, and certainly when her health and possibly, her life is at risk. I do regret having my TL, but that was my choice at moment in my life. That is part of life…every decision we make in some shape, form or fashion will affect us one way or the other. The idea is to make the best of life as we can. That’s why I want a TR, and I can’t wait.
July 30th, 2008 at 12:59 pm
My daughter is 19 and she has 2 beautiful, healthy children, son and a daughter. She has been in a 5 year relationship with her children’s father and they are still together. She is wanting a Tubal now at age 19 but no physician will do it at her age. She was diagnosed with Epilepsy in 2005 and she has to take seizure medication daily for the rest of her life. Studies show that the medication she is on and birth control pills or anything with estrogen will not be effective. She also has a Bicornuate Uterus which made her pregnancy’s very difficult and will not allow an IUD or Mirena to be placed for birth control. I think in a case like this a physician should take in consideration for a tubal. She has had her children and both parents do not want any more.
July 22nd, 2008 at 11:35 am
It would make the most sense if the doctor had used one of the less destructive forms of TL. I do think it is a women’s choice whether or not to have a TL regardless of age or number of children. The doctors role is to give them the best, most complete information possible.
July 21st, 2008 at 8:44 am
Immediately after giving birth does not seem like the best time to make a decision about sterilization. Because so many women report regret of their decision to have a ligation, a non “permanent” sterilization procedure should be offered, like the coil, IUD. With the state of mind of the new mom and a very young woman believing children are not in her future, a non permanent procedure should be advised, at least for a period of time. Life can bring about many changes and surprise us all.
July 19th, 2008 at 3:26 pm
After returning home, this is the patient’s response regarding her situation:
“My surgery site looks good, and I took my steri strips off on the 5th day as instructed. Everyone was really nice at your facility, and I felt like you guys took good care of me. I wish my surgery could have been sucessful, and I had no idea that the previous doctor that had done my first surgery had cauterized me. He never disclosed that to me, and he only stated he had put the rings on and it was completely reversible whenever I was ready to have it undone. So it was a complete shock what Dr. Berger found. I was pretty devestated, but I realized that there was nothing I could do. Thank you again though, and I appreciate the info on the IVF specialists in my area.”
July 15th, 2008 at 4:43 am
I had Hulka clips put on 3.5 years ago…I had a nine month old baby, was suffering post natal depression, and felt i could not cope with another child. The surgeon said i would be better having the coil fitted as he thought i would regret being steralized but the thought of getting pregnant again at that precise time was too much to bear. He went ahead with Hulka clips and said “see you back here in 4 years for a reversal”….”No way” i thought. For the last 6 months i have cried myself to sleep knowing now that i can’t have anymore children. My circumstances changed. The post natal depression went away, as did my husband who had made my life a misery. I am now engaged to the most wonderful man i have ever met. He has never had a child of his own. We have looked into reversal but raising that amount of cash in one lump sum without going into debt is going to take time. I wish i had been in the right frame of mind to listen to my surgeon. He knew what he was talking about. In the UK you dont have to have any counselling to make sure you are not going to regret your decision. For anyone thinking about being steralized i would say try the coil for 5 years, its the same percentage as the permanent way but at least can get it reversed without taking out a loan. If then after 5 years you still feel the same then go for the clips. You never know when your circumstances will change. We would dearly love a little baby but i guess it’s up to fate now….
July 14th, 2008 at 5:43 pm
Thanks for the information on tubal ligation. I can’t think of any reasons that a doctor would do that…It’s sad.
We recently wrote an article on at Brain Blogger. When treating patients, a lot of doctors qualify their patients as “good” and “bad”. Sometimes, a doctor may pass on a “bad” patient to another doctor, saying that the patient is “beyond the scope of his practice.” Though sometimes there is a good reason behind this, is it ethically right to pass on an annoying patient to another doctor?
We would like to read your comments on our article. Thank you.
Sincerely,
Kelly
July 14th, 2008 at 1:09 pm
I do feel very badly for our patients whose tubes are so badly damaged that they can’t be repaired. These women come to Chapel Hill with hope that the ability to carry a child will be restored and it must be devastating to learn that their tubes were not repairable. I hope all women are given the opportunity to fully discuss tubal ligation with their physicians are able to make a decision with as much information as possible.
July 14th, 2008 at 11:06 am
In some cases I feel that the doctor is really trying to protect himself or herself from future litigation by destroying the fallopian tubes rather than take the minute chance that a patient would still become pregnant after a tubal ligation procedure.
July 14th, 2008 at 7:07 am
More information and education will help women discuss the ramifications of various ligation procedures. Hopefully, this will affect the information given when a consent is requested, and decrease the unfortunate situations.
July 14th, 2008 at 7:00 am
It is heartbreaking for me to watch my patient and their family recieve this kind of news after they have arrived here in Chapel Hill with such high hopes. I was almost in tears the other day as we rolled this patient into the recovery room with her family member there waiting. What if this were my daughter? What if this were my son’s new wife?
I believe we have come to a time in medicine when finding doctors who really listen and get to know their patients is not an easy task.
Thank you Dr Berger for bringing this important topic to the TR blog.
July 14th, 2008 at 6:43 am
Both of these cases were sad! Since most people are not aware of the different methods of ligation, I think that physicians should explain in detail the exact method that he/she plans to perform. No one knows what the future holds!
July 14th, 2008 at 6:43 am
This topic is developing some great discussion. Thanks for posting your thoughts.
July 13th, 2008 at 7:10 pm
I know some DR’s that like. I think they should rethink the entire procedure for TL’s and actually tell the women just what they are in for.
I was 21 when I had my TL done, but completely different curcomstances. I was in a bad relationship and wanted out. I thought that was my only way out,Not to have anymore kids. I was wrong. My dr. only asked me once if thats what I really wanted. I was 21, had 4 kids and in a horrible relationship…Did I really know what I wanted? On my way into the surgery room, I looked up and mumbled “i’ve changed my mind” the nurse wheeling me in said ( I will never forget this) “Don’t be a baby, it’s only your nerves talking.” What a huge mistake! I can see why woman do use this method as a form of birth control. many insurance companys wont pay for IUD’s, Norplant, or other types of contraceptives but will pay for sterilization. REDICULAS! I agree with other women.. its about Money, not about the care for the patient and what they really need.
I believe DR’s should have special training for Ligations, as the Doctors that have to have it for reversal(DR b and dr. M for example) to make sure they really and truely know what they are doing. And to make sure this kind of BUTCHERY stops! Thats just my 2 cents. THANK GOD for DR Berger and his staff!
Jessie
EDD 12/30/08~ 3rd Miracle Berger Baby!!!
July 12th, 2008 at 12:47 pm
[...] More about Tubal Ligation Ethics including Tubal Ligation Ethics – Part 2. [...]
July 12th, 2008 at 11:35 am
Thank you everyone for your comments. We really appreciate everyone’s input. Most women do not even know that there are several different ways a doctor can perform a tubal ligation. A women should have choices! Especially in the situation of sterilization before she has had any children.
July 12th, 2008 at 8:57 am
I am a 41 yr. old mother of 5 children, all born via C-section, ages 12,11,10,6, and 3. I am extremely blessed. Having said that, I had a tubal ligation with my last delivery and now wonder why I let myself be convinced to do it.
I can recall at delivery of my baby in the O.R. as I viewed my new bundle of joy what a miracle and I said to my husband, maybe we shouldn’t, and my Dr. said no we were going to…. and it was done.
I know that moment is frought with fear, pain, and hormones. However, if a patient shows ANY degree of change of heart, Dr. and staff ought not to proceed. It is indicative of someone who clearly shows that she is not committed to the finality of tubal ligation.
Despite having 5 children, I still desire more. Despite the diffiicult days of washing lauundry, endless homework and time-outs…I let everyone elses view of a large family and its requirements (financial, emotional etc…) convince me to do something I wasn’t committed to. I have also let these views and my age cloud my ability to schedule a reversal for the past year, as I’ve visited this site frequently.
I hope this insight is helpful.
July 12th, 2008 at 8:17 am
As I meet patients at their consults and hear their stories I often wonder why physicians do not chose to use the least damaging forms of tubal ligation? It seems to me that one would realize that there are many times in life where circumstances change and women should have the option of changing their minds at any given time. One of the good things about my job is that each day as I meet the patients for their consults I know that they each hopefully have the opportunity for a new beginning and it all began with the dedication that Dr. Berger has to tubal reversal surgery.
July 12th, 2008 at 12:49 am
Both of the stories you posted were disturbing and very sad. Medicine to many doctors has become a business. They don’t care about the long-term results for these women – only the insurance payment. They spend very little time talking or counseling patients before procedures. Let’s face it – neither of those physicians will live the consequences of the surguries they performed.
Both patients sought a tubal ligation and for that I can’t totally blame the doctor, however given their ages and the fact one had not had any children it would have seemed they would have given it more consideration and left the tubes in such a way that a reversal might have been possible. The rings would have prevented pregnancy alone – why the extra burning and damage?
Many of us were lucky that we sought ligation but were able to have the reversal done successful. Many – like myself – had a doctor that counseled me, gave me plenty of time before the surgury was done and even tried to convince me to wait longer. Unfortunately I didn’t, but I found Chapel Hill and was blessed to have Dr.Bergers skilled hands restore me.
I really believe that ligations need to be a procedure that are reserved for women that have several children or are a bit older. So many times circumstances change – divorce, death of a child, a change in financial or emotional convictions and even PTLS and women are left with little options.
July 11th, 2008 at 8:16 pm
I do not believe that any doctor should sterilize a woman regardless of how old she is, but especially on a woman under the age of 30. There are so many other options out there.
A woman never knows when her circumstances will change or her feelings regarding family and children will change.
This doctor was obviously in the wrong profession to do something so destructive. He should have given it thought to how old this woman was and considered she may change her mind and want a reversal later on.
July 11th, 2008 at 7:17 pm
I do not know about whether or not it is “unethical” for a doctor to sterilize a women who requests it and has no children but I do strongly believe it shows extremely poor judgment and short-sightedness to do it at such a young age (20s). I know several women who have known from a very early age that they were not maternal and have never wanted children. It does happen. However, I would NEVER agree with a doctor who sterilizes someone in her 20’s with no children. It is simply too young. There definitely should be a serious analysis of what is driving the person to do this and possibly uncover some “red flags”. Also, there should be a waiting period and counseling before it ever happens. It is wrong for any doctor to talk to a patient and then simply sterilize without more prodding for information and delaying the surgery, forcing the woman to seriously consider possible life changes and the long term ramifications. Also, as a ligation can lead to PTLS (as I am painfully aware)..doctors should never perform them at any age, children or not, without advising of the potential consequences there too!