After traumatic birth experience, young mom wants to tie-off

Dear Dr Mitchell,

I am 25 years old and have one child and no desire for another. I had a traumatic birth experience, where my very large baby was delivered vaginally, resulting in the team using forceps, me getting a large tear, and my baby having an arm fracture. My body has still not recovered — I have incontinence and my pelvic muscles feel weak. I have asked for a tubal ligation but was told that I'm too young and I need to have out my lot first. I refuse to have any more children, and want to know why I would be refused this procedure, when it's the best option for me.

I am truly sorry to learn about your difficult experience at the time of the delivery of your baby. The size of the baby can sometimes be accurately assessed and a planned caesarean section can be done to prevent a traumatic vaginal delivery if the baby is 4kg or any heavier.

However, this can happen with a smaller baby and the weight as assessed before delivery does not help in preventing this from happening. The forceps delivery was a life-saving intervention and a fracture of the arm can sometimes happen in an effort to expedite delivery and to prevent a prolonged period of low oxygen to the baby since this can result in brain damage.

The incontinence will improve significantly with pelvic floor exercises, namely kegels, to strengthen the pelvic floor muscles around the base of the bladder, vagina and anus. This requires a lot of patience and is best done in a supervised setting. With help from a physiotherapist in the initial stages, the outcome is usually very good.

The decision to do a tubal ligation is not in your best interest even if you do not decide to have another baby as you're only 25 years old with your entire life ahead of you.

Tubal ligation is a permanent procedure that prevents you from becoming pregnant normally.

There are other long-term methods which are just as effective in preventing pregnancy. The use of the intra-uterine contraceptive device Copper-T gives you effective contraception for up to 10 years. A hormonal implant can be carefully placed under the skin and is effective for up to five years.

These methods allow you time to heal mentally and to see your baby grow up without having the fears of an unplanned pregnancy. You are young, your situation in life can change, with a change of heart, and it is always a good thing to have options in life. When you grow older and your child bonds with you it will warm your heart and you will never know where life will take you. Do not do any irreversible procedure at this time since all of the complications that you now experience will get better with time and your baby will be perfect.

Consult your gynaecologist and have the intrauterine contraceptive device inserted, and keep focused on the pelvic floor exercises while you enjoy the bonding experience with your baby.

Best regards.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Avenue, Kingston 5 or fax to 876-968-2025. All responses are published. Dr Mitchell cannot provide personal responses.

DISCLAIMER:

The contents of this article are for informational purposes only, and must not be relied upon as an alternative to medical advice or treatment from your own doctor.

Dr Sharmaine MITCHELL

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