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Goodbye Pill. Hello Sterilization.

Why childless young women are opting for the 'tubal.'

By Stephanie Konefall 20 Sep 2006 | TheTyee.ca

Stephanie Konefall is a second-year graduate student at Simon Fraser University and a graduate of Malaspina University-College who lives on Vancouver Island and Protection Island, B.C.

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'I want to focus on other things.'

[Editor's note: this is the second of a two part series on being young and sterile by choice. To read the first part, click here].

"I knew I would never want to undo it, so I decided it would be okay to get them cut," says Melissa Day. She's 34 years old and childless, and three years ago had a tubal ligation: what's commonly known as getting your tubes tied.

The procedure prevents the passage of the ovum into the uterus where it can be fertilized by the male's sperm, by closing the fallopian tubes. It's a surgical solution to birth control.

Day's older sister went through a lot trying to get pregnant and have children. Her sister had two miscarriages and is now in the process of adopting an infant. Day was by her side the whole time and it lead her to the conclusion that the trauma isn't worth it. "I don't need to go through that," she says and adds that she's just "not the mommy type anyway."

Before the surgery, Day briefly changed her mind. "I got really nervous for a few days after I told [the doctor] I wanted to have them cut, and I called to change my mind and tell him just clip them." Clipping the tubes instead would mean the procedure would be reversible. "I spoke to the nurse who told me I had to talk to the doctor when I went in to have my surgery, but I was really nervous and totally forgot when I got to the hospital."

She feels more settled about the surgery now. Tugging the waistband of her jersey pants down an inch to display the one-inch scar, she says she knows she made the right choice. "I don't even think about it now," she says simply.

Melanie Sawyer, a 27-year-old law student from Vancouver Island, also chose to have her "tubes tied" instead of using birth control pills or other forms of contraception. "I had a close call," she says. "I missed a couple of [birth control] pills, and by the time I remembered, it was three days after I'd had sex." Sawyer considers herself lucky. "It would have really messed up my plans if I had gotten pregnant again, and I want to really focus on doing other things now." Sawyer now has a stepson, but doesn't want to have children of her own.

No regrets?

They're not alone. Dr. P.J. Mitchell, an obstetric surgeon in Nanaimo B.C., sees "maybe seven or eight women a week" who are considering tubal ligation: women both with and without children. "As many as 90 per cent of them go ahead with the surgery after receiving all the facts," he says. "Little seems to challenge their decisions."

And reliability isn't the only reason women choose sterilization. Christine Franic, a nursing student in Nanaimo, notes that financial considerations may also play a role. Once the surgery is done, "there is no expense, no monthly cost" to birth control. As well, risks associated with the operation are short-term only. "They are primarily to do with the anaesthetic, and within this age group the risk is very low."

Some studies have also claimed to show health benefits associated with tubal ligation. "Preventing or lessening the risks of some diseases, including polycystic ovary syndrome, endometriosis, and a reduction in ovarian and breast cancer risks, can often be a reason for people looking into this surgery," Franic says. But they are likely to be disappointed. "Unfortunately, it's bullshit, but many people will read reports about the correlation between having the surgery and lessening the chances of ovarian cancer and think it's a real option."

Dr. Mitchell agrees.

"There is no hard evidence to suggest that there is a strong correlation between the two ideas," he says. "However, most patients coming in with that idea in mind are already prepared to go ahead with [the surgery] anyway. It simply could have been an added benefit.

"If the patient suffers from a disease like [polycystic ovary syndrome] and is confident that she does not intend on having a child or additional children, the surgery may be the best possible option for them." It's a decision that shouldn't be taken lightly, however. "This surgery should be considered permanent," Dr. Mitchell says. "There are different options for the actual process, but once done you wouldn't want to undo it."

Home by dinnertime

According to the Society of Obstetricians and Gynaecologists of Canada (SOGC), the most common options for the surgery can be accomplished through two processes: laparoscopy or minilaparotomy. According to Dr. Mitchell, laparoscopy is the most common and least invasive. "It's a simple procedure that is done through two tiny incisions: one at the belly button and one low on the abdomen," he says. "It doesn't take a long recovery period and the patient can usually expect to be at home that evening."

Minilaparotomy, or a minilap, is done with a single incision to the abdomen. While the procedure also has a minimal recovery time (about 24 hours), it also requires a larger and more noticeable incision resulting in a bigger scar. Both surgeries allow for options in the way the tubes are sealed. In Canada, three means are available: clips or clamps; rings, which pinch off the tubes in a loop; or coagulation (cauterizing), which is the procedure Melissa Day chose.

Popularity seesaw

While the method used is generally left up to the patients, Dr. Mitchell stresses that medical staff must consider other factors before the surgery date is set. "Most women who come in to consult with a surgeon are pretty prepared already," he says. "But as a medical professional, it's [the surgeon's] job to make sure [the patients] believe what they are saying as well. For example, usually a patient under 30 years is questioned about her reasoning a little bit more than, say, a 45-year-old who has raised three children already."

But the surgery is not withheld unless there are medical reasons to do so. "I had a 21-year-old patient come in who was married and had two children and wanted to go to school and become a professional," Dr. Mitchell remembers. "She had taken some time to consider and we had a consultation that included her husband. In the end they went away with the information and didn't come back for three months. "When they came in again there was more surety and I felt comfortable knowing they had considered their options."

As a birth control choice, the surgery has seesawed in popularity over past decades. Rising use in the early 1960s ended as oral contraceptives became more widely available. More recently, emergency contraception (the "morning-after" pill) has also supplanted its use. But while other methods dominate, tubal ligation is once again being discussed as an option.

"I heard about it from my mother," says Sawyer. "She suggested that it might be something to consider if I really didn't want to have children, which I don't."

Day says she learned about the option in high school. "It was one of those things that I heard about in a health class textbook and really ignored until I realized its impact," she says. "But you talk about these things too, you know. Women talk about this stuff."

She says it just means she has one less thing to worry about.

Stephanie Konefall is a second-year graduate student at Simon Fraser University and a graduate of Malaspina University-College who lives on Vancouver Island and Protection Island, B.C.

A version of this story ran in the Malaspina Incline this summer.

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