Tuesday, May 5, 2015

So, You Want a Tubal Ligation (but you're under 30 and don't have kids)

This article is meant both to be a resource for those who are seeking or considering sterilization, and to share my experience with the process in a broader sense. For those of you actively seeking to be sterilized that may have been turned away or dismissed - do not stop, do not give up, do not decide to just wait. I spent years seeking a tubal ligation, and all it took was finding the right doctor: a doctor who not only listened to me, but respected me and my decision.


I have no interest in wasting time, so this is the list where I found the doctor who performed my procedure:

It's the single most important thing in this article, and it's worth drawing a bit of attention.


A friend shared this link with me on Facebook after I had spent 3 years trying to find a doctor, and within a few months, the procedure was done. I am now fully healed from the surgery with no complications to date.


Now, I’ll share my experience leading up to that ending:


When I was 13 or so, I’d decided a lot of things about myself. Many of those things have changed by now - I’m 27 now - and some have never budged. I had talked to my mother about sterilization by the time I hit puberty. She told me she had actually wanted to be sterilized too, but the doctors told her they wouldn’t consider it until after she was 23: She was just too young. And thank goodness they had made her wait, because she couldn’t be happier to have a son and daughter. I assumed that was normal, and figured I would just wait it out. I didn’t want children, but if that was how things worked, I’d manage. I understood at that time that not having children was a huge, irreversible decision, that people might change their minds, and that while I didn’t expect to change my own, a doctor would have no reason to just take my word for it. So, I waited.


My reasons for seeking sterilization and choosing to be childfree are fairly straightforward: I have no desire to have children and never have. The idea of raising a child has never appealed to me. Depression and poor eyesight also both run in my family, which I would rather not pass onto a future generation. So, even if something changed my mind about wanting to raise a child, I would elect to adopt, rather than have a child of my own.


The matter of depression also figured largely into seeking a tubal ligation. By the time I’d reached high school, I had already made attempts on my life that thankfully had no lasting impact. I had been on and off antidepressants, which seemed to have no beneficial impact on my state of mental well-being and often had a host of nasty side effects. University was no simpler, and it was then that I had a breakdown resulting in my hospitalization


It was also during university that I began using birth control. It began when I was in an unhealthy relationship where birth control was the only reliable alternative to an unwanted pregnancy. Much like the antidepressants, the use of birth control had unpleasant and unpredictable physical and psychological effects on me - I used it only when I was in a sexually active relationship, though it brought me just as much anxiety as peace of mind.


It was a few years after university that my life had developed into something more stable: I had a job and a home, and was gradually learning how to build healthier, though at that point still unsuccessful, relationships. My focus gradually shifted heavily toward my work.  When I turned 24, I asked my gynecologist about getting a tubal ligation.


I had high hopes. After being shamed by nurses at a clinic years ago for requesting an STD screening, and having a cold and mis-sized speculum forced into my vagina in a humiliating experience at a planned parenthood a few years before, I had been reluctant to even enter a gynecologist’s office. However, the very kind and experienced woman that had performed my exam the previous year had actually eased a lot of those unvoiced fears by simply doing her job incredibly well. So, when I broached the topic of a tubal with her, I was crushed to hear her dismiss my request summarily: I was too young, and she doubted anyone would consider my request. If I wanted “permanent” birth control at my age, I should get an IUD.


I had read about IUDs, and despite what I had read, found that a tubal was a better solution. The copper IUD was the only possibility - I had no interest in inserting hormones into my body with no idea of how they’d affect me and no easy way to remove it. However, the copper IUD only lasted 5 years and had a non-negligible rate of rejection from the body along with a litany of hazards. However, she had no interest in hearing me out. So I asked for help.


One of the benefits of my workplace is access to health service assistance: they help with scheduling appointments, finding providers, estimating costs, etc… I decided to bring my request to them. The first time, they found a promising doctor on the east coast. At their recommendation, I sent a letter for his review, explaining my situation. I called and confirmed receipt of the letter, and to this day never heard another word from that office.


I wasn’t in a huge rush, but I also didn’t have time to burn. My job and living situation was becoming increasingly stressful, and I was contemplating finding new employment. A new employer would bring a lot of unknowns, including insurance coverage and income. Assuming I could even find a surgeon to perform the operation, the cost could run in excess of 12 thousand dollars when not covered by insurance.  I followed up with some local doctors at consultations, and each time I was turned away with little explanation outside of my age and that they didn’t want me to regret it. It didn’t matter if I offered to sign a waiver of responsibility. A friend recommended I follow up a lead she’d found for me at a Planned Parenthood, and hesitantly, I scheduled an appointment there.


The doctor I met at the Planned Parenthood was amazed that I was meeting this much resistance from the professionals I had spoken with. So far as she was concerned, it was my body and my decision, and it seemed unexpected for Seattle, a city thought of as fairly liberal. However, Planned Parenthood only offered the Essure procedure, which for reasons very similar to the copper IUD, I did not wish to pursue. It was a disappointment, but at least reassuring to know that a medical professional out there could see where I was coming from.


The next lead, from my employer’s referral service, was a doctor in a Northern suburb of Seattle. I rode the bus over an hour to get there, wearing a hat my boyfriend had given me for Christmas just a few weeks ago. I entered the exam room and took a seat on the cushioned table- I’d done this several times by now and it didn’t ease the anxiety a bit. The doctor entered the room and introduced himself - I’d never had a male gynecologist before, and coming from a history of abusive relationships with male partners, It’d be lying to say it didn’t make me uneasy. He asked a few questions, and when he got to the one about how many children I’d had, I felt my heart sink. He asked again when I said none. He went on to the spiel about how I was too young, and I felt the tears well up in my eyes - I’ve always been easy to cry. I explained my situation as calmly as I could - he handed me some tissues, and we reached an agreement: I’d use the Nuvaring - a hormonal birth control that could be removed easily if there were complications, and we’d revisit the tubal ligation the following January. This would give him time to establish a patient-doctor rapport. He’d never performed a tubal on someone so young without children and wanted some time to adjust to the idea. I felt that I’d been heard out, and by the time I was leaving the office, I was ecstatic. After 2 years of being turned away, I had finally found a doctor. I lost the hat somewhere between the office and arriving home - I was too distracted and happy to notice wherever it got off to.


The Nuvaring had annoying side effects, like every birth control I’d tried. The first few months were rough, and in the interest of establishing patient-doctor rapport, I sent my doctor letters occasionally with updates on the status. I received no reply, but also didn’t expect a busy doctor to have time to send responses. I simply felt it was my due diligence. When I had my annual exam that October, I realized that my earlier happiness was misplaced.


At my annual exam, my doctor was happy that after a few months of physical and emotional instability, my Nuvaring was working out so well for me. He even suggested that I use two in a row to reduce the number of periods I had. In my earlier visit, I had explained that I had no desire to change how my body’s cycles operated and was perfectly happy with how it functioned, aside from the whole bearing children part. In fact, because this was now working so well, he didn’t see the need for a tubal at all. I left the exam crushed. I had wasted months as my work and housing situation continued to deteriorate. The one spot of sunshine was the continual development of a healthy and loving relationship in my life. I was now engaged and had a wealth of emotional support from my fiance.


Waiting until January was pointless, using my employer’s referral service was fruitless, and approaching every OBGYN that happened to be in my network was a road to repeated disappointment. I had informed my employer I’d be leaving by February - it wasn’t worth trying to “hang in there” at my own expense just to keep my insurance. I related the disappointment of my exam on Facebook, and received a wealth of support from empathetic and sympathetic friends, in addition to the Reddit link at the top of this entry. I called the office of the doctor who ended up performing my surgery the following day and scheduled an appointment. I came to her office with my fiance for moral support, with a mental list of all of the evidence I might need to support my case, and ended up needing none of it.


My doctor listened to what I had to say, didn’t second guess me, explained the logistics of the procedure, and let me know that I’d receive a follow up call to schedule the procedure shortly. After years of being told “no,” it was a surreal experience. Within less than two months, it was all said and done.


She also provided some insight into where some of the resistance I met with may have come from. She explained that for earlier generations of doctors there was likely the stigma of forced sterilizations that were performed earlier in our country’s history, as well as a heavier leaning towards paternal medicine vs. patient autonomy.


All of this said, I wanted to share a little of my experience. It’s been nearly a 15 year journey for me and it was rough at times. I hope that raising awareness and being open about it will make it easier for others in the future.

Thanks for reading. 

Comments appreciated, and please bear in mind that this is not heavily edited and may contain some grammatical errors. I’d rather publish it with its flaws than spend too much time mulling over it.

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