Tubal Reversal Blog ‘informed consent’

Chapel Hill Tubal Reversal Center is the only medical facility specifically for tubal ligation reversal surgery. We provide the most detailed and accurate information about tubal reversal available from any doctor, hospital, or medical institution. Let me explain how we are able to do this.

Electronic Patient Database

Keeping track of patients following surgery makes excellent sense from a clinical point of view. Continuing follow-up after surgery helps ensure the best care for each patient and allows us to evaluate the success of tubal reversal surgery and the care we provide. Setting up and maintaining a system to ensure ongoing follow-up is not usually found in a private medical practice since this is costly and time-consuming and requires staff knowledgeable in database management. Regardless of the cost and time requirement, Dr. Berger has made it a priority because of his commitment to giving patients all of the information they should have in order to make an informed decision about tubal reversal surgery.

At Chapel Hill Tubal Reversal Center, we have a computer system where every nurse enters patient information before, during, and after their surgery. In fact, all 11 of our nurses contact patients, record data, and make daily entries into computerized records. With this follow-up information, we can analyze and report accurate statistical data about the long-term outcomes of tubal reversal procedures performed here.

Information Sources

The patient follow-up system consists of information collected in many different ways and includes a minimum of 6 calls or e-mails to the patient in the first year following surgery.

1. Post-operative nurse visit the morning after surgery
2. Telephone follow-up on the second postoperative day
3. Telephone follow-up on the third postoperative day
4. E-mail questionnaire at two weeks
5. Telephone contact at 6 months
6. Telephone contact at 12 months

Other information is collected and recorded any time we communicate with patients post-operatively. These contacts are usually initiated by patients to report pregnancies and the outcomes of pregnancies. When patients report new pregnancies, we request that they complete a Pregnancy Report Form. Each week, we summarize the new pregnancy results in the Weekly Pregnancy Report Forum of the Tubal Reversal Message Board and also give more details in the New Pregnancy Announcements.

Summary

After reading our information and statistics and comparing it to what might be available from other doctors, we believe patients will recognize that Chapel Hill Tubal Reversal Center is the only facility where accuracy of information is considered to be a priority and sharing it with prospective patients is considered to be a necessity. Providing facts rather than offering misleading or speculative statements about tubal reversal success is one mission of our practice. We believe this is the right thing to do.

I hope this information is helpful to you as you consider whether tubal reversal surgery is right for you, and if so, why it is in your best interests to have it performed at Chapel Hill Tubal Reversal Center.

Submitted by Julia Smith RN
Nurse Administrator
Chapel Hill Tubal Reversal Center
919-656-8204

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.

What Is Informed Consent?

Informed consent means that a person has access to and understands all relevant information about a medical or surgical treatment necessary to make an informed decision about it. In the case of tubal ligation reversal, informed consent means that a person understands how it the surgery is performed, the alternative treatment of in vitro fertilization, and the potential benefits, risks, and likelihood of success from these treatments.

The Informed Consent Process

When meeting with patients during their consultation, I explain the outpatient tubal reversal procedure that I perform. Even before we meet at the preoperative consultation, patients review extensive information on the Chapel Hill Tubal Reversal Center website, receive printed information about the procedure, and can watch a video or dvd showing each step in the tubal reversal operation.

We also discuss the relative advantages and disadvantages of the alternative treatment of in vitro fertilization. Most important, we provide complete and accurate statistics about pregnancy rates and birth rates after the tubal reversal procedures I have performed.

Benefits and Risks

The primary benefit from tubal reversal surgery is the opportunity to become pregnant at any time in the future. It is simpler, safer, and less expensive than the alternative treatment (in vitro fertilization or IVF). The main risk associated with IVF is multiple pregnancy (33%), compared with the risk of ectopic pregnancy after tubal reversal surgery (10-15%). The medical complication of ectopic pregnancy is tubal rupture. This can be prevented by adhering to our recommended protocol for early pregnancy monitoring.

What is the Expected Success Rate?

Pregnancy and birth rates are the most important measures of success after tubal reversal for most couples. To determine what these are, a doctor must include all tubal reversal procedures and maintain follow-up with patients to learn their subsequent pregnancy histories. Since pregnancies can occur at any time, the follow-up effort and data recording must be done on a continuing basis.

Each week we provide feedback about new pregnancies reported to us via Weekly Pregnancy Reports and Pregnancy Announcements. Information about both the pregnant women and those who have not yet become pregnant is updated annually and published in our Tubal Reversal Pregnancy Study Report. The pregnancy rates and birth rates shown in this report permit prospective patients to learn the statistical probability for success, based on the experience of previous patients for whom I have performed a tubal ligation reversal.

To my knowledge, Chapel Hill Tubal Reversal Center is the only medical facility that collects, analyzes, and publishes complete and accurate statistics about the success of tubal reversal surgery based on all patients who have had the procedure performed. With this detailed information, and only this kind of information, it becomes possible to make a fully informed decision about tubal reversal surgery.