What women need to know about getting their tubes tied

MORE women who do not wish to become pregnant in the future are opting for sterilisation post-childbirth.

According to obstetrician-gynaecologist Dr Anna-Kay Taylor Christmas, the procedure — known as post-partum tubal ligation — is the most effective birth control method.

However, she recommends that before women follow through on a request for this procedure, that be certain it is what they want because a successful reversal is not guaranteed.

“Tubal ligation (also commonly called a tie-off), is a form of permanent contraception or sterilisation, where the fallopian tubes are permanently obstructed to prevent further pregnancies,” Dr Taylor Christmas said.

The obstetrician-gynaecologist said once the procedure is done, it prevents the sperm and the egg from passing through the fallopian tubes, which would otherwise allow fertilisation and pregnancy.

“Tubal ligation is the most common sterilisation procedure performed and has a relatively low risk of complications. It is meant to be permanent, and therefore a careful selection of the correct patients for this procedure helps to decrease the likelihood of regret and desire for reversal,” Dr Taylor Christmas advised, noting that reversal is not always possible and is often a very expensive and difficult process.

If successfully done, however, the woman has a five per cent chance of pregnancy.

If a pregnant woman requests to have a tubal ligation post-childbirth, Dr Taylor Christmas said that it may be performed at the time of a caesarean section (C-section) or in the immediate days following a vaginal delivery, using one of several methods to occlude the tubes — including the use of rings or clips, electrocautery (essentially burning), or excision of the tubal segments (partial or complete).

“Doing the procedure at the time of C-section allows everything to be done at the same time, saving the patient from a separate procedure and further anaesthetic. Doing it shortly after vaginal delivery, before discharge home, also saves the patient from a separate admission for another procedure, requiring more time off from work or sick leave. However, of course, the procedure may be performed at any other time outside of the post-partum period,” Dr Taylor Christmas advised.

She said if the woman decides to have the procedure done outside of the post-partum period, it can be done as a day procedure using anaesthesia and laparoscopic approach, which would result in minimal pain and a very rapid discharge from hospital and recovery. However, the doctor admitted that this is not always the case.

“In the public system in Jamaica, due to insufficient access to laparoscopic surgery, it is often performed through a mini-incision open surgery, which also allows for same-day discharge home but causes more pain and has a higher risk for minor complications like fever and bleeding, due to the larger incision,” Dr Taylor Christmas explained.

While tubal ligation is more effective than all other birth control methods, the obstetrician-gynaecologist said that there is a small risk of failure which could result in a subsequent pregnancy.

“Approximately one in every 200 procedures fails, and with this, there is a higher risk of ectopic pregnancy. Failure tends to occur when the blocked ends of the tube rejoin and allow the sperm and egg to meet,” Dr Taylor Christmas underscored.

Most recorded failures, she reasoned, has often been linked to the timing of the procedure. She said that there is a slightly higher risk of failure when the procedure is done immediately after delivery versus outside of pregnancy and the post-partum period.

Apart from the risk of failure, Dr Taylor Christmas said that there is also another challenge with tubal ligation that has to do with the woman later regretting her decision. She said that a woman might regret having her tubes tied for a number of reasons, including:

• If she did it in her youth, for example, she had it done younger than 30 years old;

• The number of children she has (usually two or less);

• Not being in a relationship or being in a relationship that’s in crisis;

• If, at the time, she was experiencing psychological or psychosocial issues;

• If she were coerced into doing it;

• If she didn’t get adequate counselling or information on the procedure.

In order to decrease the chance of the patient regretting the procedure, Dr Taylor Christmas said doctors should ensure that they provide adequate counselling as well as recommend alternatives. These include:

• Long-acting reversible contraceptives, like the implant (for example Jadelle or Implanon) or intrauterine devices (for example Mirena or copper T). These provide a very low risk of pregnancy plus a rapid return to fertility with their removal if a future pregnancy is later desired.

• Vasectomy — an in-office procedure that causes male sterilisation without the anaesthetic risks associated with major surgery, and greater ease of reversal if future fertility is later desired.

In light of these factors, the obstetrician-gynaecologist said health care providers often avoid doing tubal ligations when the decision is made during labour or immediately after delivery. However, if discussions regarding the procedure were ongoing from early pregnancy, then health care providers are usually more comfortable doing the procedure.

“We often suggest counselling and sufficient time to consider all the options available, if these were not discussed pre-pregnancy or early in the pregnancy. Ultimately, however, the decision on whether or not to have a tubal ligation lies with the woman, and we are here to offer information and support to help her make the decision that is in her best interest,” Dr Taylor Christmas shared.

She also advised patients that while this procedure protects against pregnancy, women should remember that it does not protect them against sexually transmitted diseases such as syphilis, gonorrhoea, herpes, and HIV, and as such, condoms should always be worn during sexual intercourse.