Tubal ligations are a one#time, low#risk way to \orever \ree yoursel

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N CANADA, TUBAL LIGATION!—!or “getting your tubes
tied”!—!is the contraceptive method of choice for 7 percent
of Canadian women of child-bearing age, according to the
2002 Canadian Contraception Study. The procedure, which
clamps or clips the Fallopian tubes to prevent eggs from moving
into the uterus, is more than 99-percent effective and is covered
by insurance. But while most women are satisfied with the result,
some experience regret, especially if a change in circumstances
prompts them to rethink their decision to be sterilized. Doctors
may feel conflicted about performing tubal ligation for this reason.
The procedure can be reversed, but that means more surgery and
it can be pricey. And there’s no guarantee you’ll be able to conceive
afterwards. So how do you know if it’s right for you? Three women
share their stories.
TARRAH SEYMOUR: “I don’t want any more kids.”
Twenty-two-year-old Brampton, Ont., resident Tarrah Seymour
always wanted to get married and have two children while she
was still young. When she met her future husband on the first
day of college orientation, she didn’t waste any time making it
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AUGUST 2010 |
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happen. Princeton, now a shy toddler obsessed with toy cars, was
born a week before graduation. When baby number two arrived,
Seymour’s husband opted to stay home as she started a new career
in security at a local superstore.
The last step of Seymour’s plan was tubal ligation. Like her
mother, she wanted the procedure immediately after her scheduled Caesarean section. To her it made sense: It would take just
a few extra minutes, she would already be in the operating room,
she wouldn’t have to recuperate twice, and she didn’t want any
more kids. But when, at a regular appointment, she asked her OB/
GYN to perform the surgery, he refused. “He just said no right away,”
says Seymour. “He said, ‘You’re too young and I won’t do it.’!”
Like many Canadian doctors, Seymour’s obstetrician was wary
about sterilizing someone so young. Since there are no guidelines
for the procedure!— the Society of Obstetricians and Gynaecologists of Canada is currently drafting them, but they won’t be
available until next year!—!most doctors screen candidates on
a case-by-case basis to try to determine the likelihood of regret.
Doctors take into account a patient’s age, any risk associated
with a postpartum surgery, the odds of the current relationship 4
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by Rosemary Counter
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failing, whether the woman has other young
children and the possibility of loss of a child.
By these standards, Seymour rated high for
potential regret and her doctor refused to
perform the procedure. But she vowed not
to back down.
“I could have kept my mouth shut after
my appointment,” she says. But, infuriated
with her obstetrician, who also would not
refer her to another doctor, Seymour!—!then
quickly approaching her due date!—!was left
cold-calling doctors she found through a
Google search. Increasingly frustrated,
Seymour made a different call!—!to the
Toronto Star.
The press played up the story and Seymour says she still receives a lot of support
from women who recognize her in stores
and spill their own similar tales. Of course,
she was criticized, too. “A lot of people
bashed me online,” she says. Her critics
advised her to go back on the Pill or suggested her husband have a less invasive,
easily reversed vasectomy. (He’s willing.)
But, sick of contraceptives and strongly
opposed to abortion, Seymour had made
up her mind: “This is my decision and it
doesn’t have to do with his parts. I don’t
want any more kids.”
By chance, and just in time, Seymour
landed back with the obstetrician who had
delivered Princeton. Armed with a list of
reasons, she asked for her tubal ligation
once again. Perhaps because of the media
coverage (Seymour was too nervous to ask
why he agreed), the doctor gave the okay and
scheduled her surgery. “I was shaking when
I signed the paper,” she says. “I’d wanted this
for so long and now it was happening.”
Seymour’s daughter, Amelia, was delivered last fall and the surgery followed. A
year later, still thrilled with her decision and
without regrets, she recalls the operation:
Tools in hand, the surgeon asked her if she
was sure and she said yes. He asked her if she
knew it was permanent and she replied yes
again. “I kept saying, ‘Yes, yes, I know what
I’m doing.’ And then he did it.”
KIMLI WELSH: “I don’t want
kids. This is my right.”
Diapers and patty cakes are not for Kimli
Welsh. “As terrible as it sounds,” she says,
“I have nightmares where I have kids.” This
is not a new thing; the 36-year-old Vancouver writer has known since she was a
child that children aren’t for her. Welsh’s
husband agrees; they’ve been married for
almost a decade and are happily child-free.
They’re not, however, happily sterilized.
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AUGUST 2010 |
chatelaine.com
HIS vs. HERS
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LISTEN UP, LADIES
No needle, no scalpel. Check out the new-school vasectomy
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“I started doing research into tube tying
when I was 20, and I knew it was going to
be a struggle,” she says. By 32, then married and with a laundry list of complaints
about various contraceptives, Welsh finally
brought up tubal ligation with her gynecologist. “She was very taken aback,” Welsh
says. “She said I was going to change my
mind.” Instead, Welsh changed doctors.
But every doctor said the same thing.
Despite years of hard work, and frequent
blogging about her frustrations, Welsh has
been unable to find a doctor willing to take
her on as a patient and perform the sur-
gery. “Every office I call is accepting new
patients!—!if you’re carrying a baby, trying to make a baby, thinking about having
a baby, have already had a baby or are a
baby,” she says.
Since a woman’s candidacy for tubal ligation is stronger if she already has children,
Canadian women with no plans to reproduce (numbers vary from 7 to 17 percent, depending on age)!—!the very people who most
want the surgery!—!are largely denied. “It has
been mentioned to me by doctors multiple
times,” she says. “If I had kids already and
wanted no more, they’d go right in there.” 4
health ^ejXkjjed
On the other hand, should Welsh’s
husband choose to have a vasectomy, he
could easily get one. Though it is also
down to a doctor’s discretion, male sterilization in Canada is done at twice the rate
of female sterilization!—!and Welsh can
hardly imagine any doctor lecturing her
husband on the joys of fatherhood. “He’d
just walk into the doctor’s office and be
done in an hour,” she says.
Even if her husband decides to get
the snip, Welsh says she still wants her
tubes tied, simply because it’s her right.
But without a doctor to do it, Welsh’s
options are limited. So Welsh, now 34,
and her doctor agreed to a compromise:
implanting an effective (but less permanent) IUD, until they revisit the topic in
five years.
“At that point, I’ll be 39 and a half
years old. I don’t know what makes me
more sure at 39 than at 34, or 24,” she
says. When the time finally rolls around,
Welsh plans to insist on the surgery. Does
she think that by then, at the tail end of
her conventional reproducing years, it
is possible her biological clock will kick
in? “Absolutely not,” she replies without
pause. “I’m as certain on this as I’ve been
about anything in my life.”
ROXANNE RICHARD: “Don’t do
anything permanent.”
Roxanne Richard, a 38-year-old paramedic living in Ottawa, was married
with four children by the age of 22. So
when her doctor suggested tubal ligation
following the fourth delivery, the surgery
seemed like a good option. “When you’ve
just had a baby, you’re vulnerable and
stressed and tired. You’re not thinking
about having another baby,” she says.
Richard feels in retrospect that she was
pressured by the doctors to have a surgery she didn’t need or even know much
about. “I didn’t think it through as much
as I should have,” she adds.
Her regret about the procedure kicked
in soon after the operation. Just a few
months later, when she was comfortably settled into a routine, Richard’s head
cleared and she found more time to think.
“Your baby starts to get older and you start
wondering, ‘Would I do it all again?’ And
then you realize, I don’t have that option
anymore because it’s been taken away from
me. You mourn your body, that feeling of
being a woman.”
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AUGUST 2010 |
chatelaine.com
Richard got divorced in 2004, and a
year later she became consumed with
baby fever. By then, she was with a new
partner, although she says her desire to
conceive again was unrelated to their
relationship. Two years ago, she scheduled
her tubal-reversal surgery. After paying
$6,000 (a fee not covered by the provincial
government) and going through a painful procedure and a long recovery time,
Richard understood that there was still
no guarantee she’d be able to conceive.
“About six weeks after my surgery, I felt
better,” she says. “And I was pregnant.”
To the young women considering tying
their tubes, Richard advises they think
carefully about other, more easily reversible options: “Take the Pill, do something!—
but nothing permanent.” Despite all she
had to go through, Richard’s story has a
happy ending: Her daughter Avery is now
18 months old; Avery’s doting siblings are
16 to 21. And she’s pregnant again!—!her
sixth child is due in December.
THE DOCTOR’S POINT OF VIEW
Every time a patient walks through Vyta
Senikas’ door wanting her tubes tied, the
OB/GYN has to make a choice. The associate executive VP of the Society of Obstetricians and Gynaecologists of Canada
uses her 25 years of experience to make
the call on who is a suitable candidate.
“Typically, women wanting a reversal
are 25 to 30 and have one or two children,
and they’re asking for it because they have
a new partner or their circumstances have
changed,” says Senikas. “We have to very
carefully explain to patients that, as good
as the surgery is, there’s no guarantee
a reversal will result in pregnancy.”
But as the science has improved, so
have our sensibilities. Senikas remembers a time when tubal ligations required
a husband’s signature and were never
performed on single women. To decide
if the patient was old enough, doctors used
a blanket formula: “You took the patient’s
age, multiplied it by the number of children she had and added 10. If you got to
100, she got her surgery,” she explains. “I
remember thinking to myself, What guy
dreamed that up?” Thirty years later,
things aren’t so simple, but at least doctors
and patients are talking before they tie. An
informed discussion with your doctor is
the only way to get what you want!—!and
to be sure that you want it. ‡