Consenting to Tubal Ligation During Childbirth
I received an email message today from a patient that prompted me to write about informed consent for tubal ligation. (See my previous blog about informed consent for tubal reversal.) Here is the message that was sent to me.
Hello, Dr. Berger,
You performed tubal reversal surgery on me on 10/29/07, and I just found out that I’m pregnant. Thank you so much! This is such a blessing. I filled out the report and have heard back from Sarah Meacham. I’ll make sure to follow her instructions.
I’m writing because I have a friend named Samantha who wants to get reversal surgery, but she would like to make sure she’s a candidate based on the information in her operative report. I told her that I would send it to you so you can look it over, so it’s attached. She and her husband have two cute little girls, but she agreed to the tubal ligation on the operating table after she gave birth to her youngest at the prodding of her doctor. She said that she made a terrible mistake and wants more children. And like me, no one she’s asked in south Florida will even consider the procedure that you do. When I told her about you, she was ecstatic. And now that I’m pregnant, she knows that it works!
Thank you again for the miracles you work for so many women. God bless you and your staff!
Sincerely,
Amy P.
I was glad to hear that Amy was pregnant and had recommended to Samantha that she come here for her tubal reversal procedure, but this part of the message caught my attention:
“…she agreed to the tubal ligation on the operating table after she gave birth to her youngest at the prodding of her doctor. She said that she made a terrible mistake…”
What Is Informed Consent?
Before performing a tubal ligation - an elective operation - a doctor should always obtain the patient’s informed consent. Informed consent is the process through which the patient becomes educated about the procedure - including its benefits, risks and alternatives - and makes the decision to have the procedure performed. Informed consent implies that the patient fully understands the issues, has asked any questions she has, had her questions answered, and makes her decision under no duress. Adequate time should be allowed for a patient to think about all of the issues before consenting to the operation.
Should Consent For Tubal Ligation be Made During Childbirth?
Many tubal reversal patients have told me that the first time they discussed a tubal ligation with their doctor while they were on their way to the operating room for a C-section. Some regretted their decision while they were on the operating table or when they awoke in the recovery room. Other patients have said they had a tubal ligation in response to pressure from their spouse, parents, or their doctor. Labor and delivery is not the best time to think about an issue with such profound and lasting results as surgical sterilization. This should be discussed and thought about at leisure, not during the stress of childbirth.
Dr. Berger’s Comment
Besides the doctor’s responsibilities in obtaining informed consent, the patient also has a responsibility when giving it. A tubal ligation is not an emergency operation. Having a tubal ligation is a decision that should be carefully considered and not made in haste. There is adequate time during the pregnancy for a doctor and patient to discuss the issue of sterilization. Bringing this up for the first time on the way to the delivery room is a mistake, in my opinion. A more deliberate approach to the process of informed consent by both doctor and patient would help avoid mistaken decisions, such as in Samantha’s case.
January 15th, 2008 at 2:55 pm
I agree with Dr. Berger’s comment. The patient has a responsibility to ask questions. Before coming to work for Dr. Berger, I had no clue that there were multiple methods of “tying the tubes”. Just goes to show that one has to do their homework!
January 15th, 2008 at 3:19 pm
I often hear from patients that they had the ligation because their doctor or spouse talked them into it. It is really unfortunate that other people seem to have no problem making such an important decision for another person! I think it should be recommended that women wait at least 6 months after the birth of child to decide if they would like a tubal ligation. Thank goodness for Dr. Berger! He gives women a second chance to have children.
January 15th, 2008 at 4:07 pm
It always saddens me when I hear that a woman was “talked into having her tubes tied. ” I feel that the decision to take the step of having a tubal ligation should be one that a person has time to think about. It is such a big step and should ultimately be the woman’s choice. I also think that a woman should be given the time and complete information before signing the consents; after all, that is where “informed consent” is. I am very thankful to Dr. Berger’s dedication not only to the tubal reversal procedure but also to his patients. All of our patients are given information up front - even before they walk through our doors. This gives them a chance to have the information on hand and to be able to ask any questions that they have.
January 15th, 2008 at 7:32 pm
Excellent information and recommendations. A doctor should not expect a patient - who may have been medicated - to give informed consent. As Dr. Berger mentioned, however, each person has the responsibility to ask questions and make her wishes known to the doctor. Although many women are intimidated by the doctor, it is appropriate to ask questions and expect answers at a time when you can be relaxed, unmedicated, and have time for follow-up questions and responses — well ahead of the delivery date.
January 15th, 2008 at 8:07 pm
I think a woman should be given a chance to really think about having a tubal ligation and not be forced into a decision right after giving birth. That is not the time to make a major life-changing decision! Women need to be made aware of the impact that a tubal ligation will have on their lives. I’m so glad Dr. Berger is able to help women of all ages reverse their tubal ligations and move on the a new chapter in their lives!
January 16th, 2008 at 8:41 am
I don’t think it’s right for any physician to ask a woman right after giving birth if they want a tubal ligation. The woman first of all would not have a clear head to make a decision like that. I think all women before and after child birth should be educated on what a tubal ligation really is and the side effects it could cause. It’s a blessing to have Dr. Berger who is highly educated on tubal ligation reversals - he can and has helped women correct a decision they have come to regret.
January 16th, 2008 at 9:41 am
I totally agree with all of the previous comments. I am especially saddened when one of our patients states that she forced into tubal ligation by her parents because she was very young and already had an unplanned pregnancy. Situations change and teenagers grow up to be responsible adults. There is no reason for them to be punished forever because of past mistakes. I am so glad that Dr. Berger is able to restore fertility and allow these women to lead a fulfilling adult life.
January 16th, 2008 at 10:00 am
We hear this over and over again and it is so sad. When our patients come here for tubal ligation reversal, they speak with our Tubal Reversal nurse, our nurse anesthetist or anesthesiologist and Dr Berger before signing their consent forms. We cover every aspect of their care, including the potential risks and complications. We truly want our patients to be informed, to ask the appropriate questions and to be able make an informed decision under no duress. Thank you Dr Berger for touching on this very important topic.
Pam Mills, CRNA
January 16th, 2008 at 4:58 pm
Consenting to Tubal Ligation During Childbirth
I received an email message today from a patient that prompted me to write about informed consent for tubal ligation. (See my previous blog about informed consent for tubal reversal.) Here is the message that was sent to me.
January 16th, 2008 at 5:15 pm
Consenting to Tubal Ligation During Childbirth
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September 14th, 2008 at 5:43 pm
The same thing happened to me. Right after I gave birth to my son, my military doctor asked me if I wanted to get my tubes tied. We had never discussed this before. I had just had my son and had had an epidural I didn’t know what to answer, but my doctor stood there waiting for a response. I told him to ask my husband. Still to this day, I don’t know what happened because we later got divorced and are not in good terms now. I’ve been married for the past six years to a man whose never had children and really wants a child. His parents have no grandchildren. We’ve tried unsuccessfully to get pregnant. Unfortunately, our health insurance does not cover fertility treatments.
September 16th, 2008 at 11:28 am
In Oct. 2000, I gave birth to a healthy baby boy. I currently have 3 children and have had 5 pregnancy. However after my 3rd child I have not been able to conceive. He will be 8 next month. I honestly believe that the Dr. performed an unauthorized tubal ligation. I have no way of proving it, but I have not been able to get pregnant since. Is there any test that can be done to reverse this problem. I would love to have another child before I’m 40. I am a US Navy veteran who loves her country. The VA does not provide fertility treatment at this time. Please help.
September 16th, 2008 at 7:24 pm
Carmen - You could request a copy of your operative report if you had a c-section to see if a tubal ligation was performed. Otherwise, you could have a hysterosalpingogram (HSG) to determine if your fallopian tubes are open or blocked.