Many pregnant and postpartum women know what it’s like to field questions as they’re about to give birth and just after: “are we having an IUD inserted today?” or “what birth control will you be taking after birth?” Most recently, we’ve heard, “are we having our tubes tied today?” in reference to the sterilization procedure otherwise known as a bilateral tubal ligation.
While medical professionals may think they’re just helping women get the services they want after birth, there is a nature of the timing and the wording of these questions that produce an effect of asking “leading questions”—that is, questions that inherently direct patients toward a certain course of action regarding their reproductive health.
Theresa Pittl, a member of Natural Womanhood’s board, shared her personal experience at this year’s Gala:
We have children and all three were born by C-section; our first was an emergency and the other two were planned. Little do people know when you go in for a planned C-section they ask you not just once but repeatedly: “honey, are we tying your tubes here today?”
And I’m like, “no, no we are not!
Why would I want to break something that is working exactly as it is intended to function?
Then they wheel you into the operating room; literally you’re about to have your beautiful little baby and they ask you again: “Are we tying your tubes here today?” And I’m like, “no! No, we’re not!”
Don’t feel pressured to decide on a tubal ligation—or any form of family planning—during such an emotionally fraught time
To time questions about a procedure as serious as a tubal ligation right before, during, or after the stressful experience of labor or surgery is to take advantage of a vulnerable moment, when no matter a woman’s long-term family planning goals, she may be ready to swear off children forever. It’d be like having a lawyer ask you to sign your will, determining which of your children will get what assets after you die, in the moment right after your teenage son slams the door in your face. Your judgment might be a little skewed at that moment, so most would recommend you make important decisions like this when you’ve had some space from stressful events and can think more clearly about the long view.
There are numerous reasons a woman may feel pressured in the moment to make a choice to sterilize herself via a tubal ligation that she wouldn’t have otherwise. Some women may feel judged in the moment for having hopes for a larger family, as if that is somehow selfish or bad for the planet, instead of acting according to her personal hopes and goals. Or perhaps her partner doesn’t want more children and she does, and instead of talking about it on their own time, the partner may take the medical professional’s prompting for a woman to “get her tubes tied” and pressure her to do “what the doctor suggests,” even though it’s not medically necessary. Never mind, also, how tubal ligation brings its own risks and complications to women’s health.
Moreover, there is no reason why such a decision needs to be timed at the “game time” of labor. Women have had numerous OB/GYN visits preparing for birth, and such a post-birth decision could and should be discussed long ahead of time. If a woman and her doctor have discussed the options ahead of time and she has refused birth control pills, the IUD, or tubal ligation ahead of time, that decision should be respected during labor, delivery, and recovery from birth.
There are better postpartum birth control options than getting your tubes tied
Offering patients birth control after birth has been happening for years, as I have experienced, most recently being offered an intrauterine device (IUD) immediately after birth. For me, it sounds like a horrible idea to insert an artificial device into the delicate area that is recovering from just giving birth. (If I can’t have relations with my husband for six weeks, how is having a metal device harmless?) But I also don’t want to postpone children for very long, because I’m in my late thirties, and what if I want to give my little new newborn a sibling that’s close in age (like I’m thankful my parents gave me)? If I was impressionable at that moment as opposed to geared to advocate for myself, I could have acted in a way that opposed my true wishes.
I am thankful for natural family planning and fertility awareness methods (FAM) because I feel well equipped to space children after birth without ruling them out completely, and without making any drastic changes to my hormonal makeup or physiology. Having learned the Creighton Method ten years ago, and having refreshed myself with an instructor before birth, I felt prepared on how to space children safely and effectively.
It’s one thing for providers to recommend a long-acting reversible contraceptive (LARC) such as an IUD after birth, as I was repeatedly offered after giving birth to my last child. But to suggest to women a sterilization procedure—tubal ligation—near that highly emotional moment of labor is ethically problematic. The risk is that the power of suggestion could guide a woman to make a choice she might otherwise have not made—and one she might regret when it is too late.
Thanks for this! It’s always horrifying to hear about 🙁 It’s also very important to know that hormonal contraception can cause a woman’s milk supply to crash. The Pill can be discontinued and maybe the supply can be recovered, but it’s not a simple thing to phone up and get an IUD removed. This can be devastating to a woman who had hoped to breastfeed, and I have *never* heard anyone tell me that they were warned about this at the time they were encouraged to being using it. The very worst is the Depo shot, because it is not reversible.
I agree with much of what you’ve said: If a woman is asked during her pregnancy about a tubal ligation (especially if she is having a c/s) that should be respected. I have always told patients that even if they have signed a consent for a tubal ligation, they can change their mind at anytime until the procedure is performed. However, just because one is asked at the time of c/s if they want a tubal ligation, please give us a little grace. I don’t think that is done to pressure women, but rather we don’t want to put a patient through a second procedure and/or miss a patient who desired permanent sterilization and some how that tubal ligation procedure didn’t make it to the c/s consent form that day; the fact is, sometimes women who have wanted a tubal ligation DO change their mind when they have that cute little baby in their arms. Also, if a physician does not feel the patient has made a thoughtful decision, was pressured by family or the father of the baby, etc, the physician can refuse to perform the procedure. I’ve had that happen a few times where I wasn’t comfortable doing something permanent.
I had a similar experience 32 years ago in the labor and delivery room at Christiana Hospital. I was in the middle of hard labor, and the nurse on duty asked me if I wanted a tubal ligation. She also asked me if I wanted to donate the organs of my baby. I was focused on natural delivery without any drugs and I was minutes away from delivery. I couldn’t speak at that moment, but in my head I was screaming, “how can you ask me that when I am going through this? I could very well say something I didn’t mean and regret it the rest of my life!” It was very unethical, and inhumane.
YES! I AGREE with everything you said. I was 37 last yr when I was pregnant and told about tubes being tied I agreed I was like yes never again do i want to go through this! I was so sure. Granted they did ask are you sure right during my c section when I was in agony and of course I said yes! Now I am looking up ways to afford a reversal. I’m so upset and yes I felt judged about having a fourth child. I always wanted a really big family and now I’m getting older 38 and my dreams are crushed because I don’t think I could ever afford the procedure. NEVER GET THIS OR EVEN THINK ABOUT WHILE PREGNANT! PLEASE WAIT until you are not pregnant and going through a million emotions at once. Please wait to properly make a sound decision because obviously while pregnant you never want to do it again!