ZINE: Ask me about my tubal ligation (part 3 of 6)

(posted by Sarah Lawrance)

[This is the 3rd of 6 posts where I share the content of my recent zine, “Ask me about my tubal ligation”, published by EXILE Press in February 2010. To read the 1st post, click here. To order a copy, feel free to visit exilebooks.orgmicrocosmpublishing.com, or akpress.org (coming soon). Thanks for your interest  :) ]

Part 2: The Doctors

My family doctor

I was 24 by this time, and I made an appointment to see my family doctor to discuss contraception options. I was very nervous and embarrassed to be in there because it was the first time I had to acknowledge, for the record, that sex was now a part of my life. It was terrifying. I was so afraid of being judged, which I now recognize as ridiculous. I also just didn’t like my doctor very much, and hated talking to her about things that were sensitive or important to me. She never seemed to take me seriously; this visit was no exception.

Going in, I knew what I wanted. People had been telling me for a long time that I would never find a doctor who would perform the surgery on “someone so young,” so I knew it was going to be an uphill battle. Knowing nothing about how elective surgeries worked, I assumed there was a long waiting list and figured the process would probably take a few years so I should get started right away. I was determined to get this done, somehow.

I told the doctor I had no interest in having children, ever, and now that I was sexually active with men I wanted contraception. I told her that I had felt this way for a long time, and that I wanted permanent contraception; I wanted information about getting a tubal ligation. I don’t remember the details of our conversation very well, but I recall her steering me in another direction right away, saying I was too young and that no doctor would perform the surgery. She pushed the benefits and “beneficial” side effects of birth control pills and IUDs, and when I expressed concern about the hormones she dismissed it by saying the amount of the hormone that gets released into the body is minimal. I figured that if the amount of hormone was significant enough to cause the remarkable changes in cervical contractions and breast size that she was advertising then it was too much. I didn’t want any chemicals changing my body’s chemistry. She simply dismissed my concerns and handed me a bunch of pamphlets for birth control products.

I can understand in some ways how insisting on permanent contraception so “early” in my sexual life might seem a little hasty to some, but remember that I spent many years fearing pregnancy so intensely that I expressly avoided intercourse. I knew what I wanted. In spite of the doctor’s attempts to steer me away from it, I again insisted that I wanted a tubal ligation. She told me that no one would perform one on me unless I was at least 30 years old or already had three kids. I thought those were pretty arbitrary numbers. Besides, the point of having the surgery was so that I would not have three kids, or any. I indicated this, and she told me that I would change my mind and regret it later, so I should instead use a 5-year IUD and then come back if I still wanted the procedure. Maybe then someone would be willing to perform the procedure on a childless woman.

At some point during this conversation I said that, at the very least, I wanted information on how to go about getting one. I asked her what I would have to do to convince her. Finally, she told me that she was not the one who had to be convinced; I would need a referral to a gynecologist, and they would be the one to do the procedure if they chose to do it. I asked for a referral. She refused to refer me, stating that it would be futile. I insisted because I at least wanted to know the steps involved in the process so that I could properly inform myself. I think that was what made her give in—she couldn’t very well deny my request for education—and she proceeded to refer me to a gynecologist on my campus.

To be clear: I recognize the doctor’s obligation to make patients aware of the possible side effects and risks of any surgery. But this must be done in a respectful way, in a way that recognizes a patient’s autonomy. It is unacceptable for anyone to deny your reproductive autonomy because they think you might “change your mind”, especially when this judgment is not based on something you said or did but on traits like your age and sex. I mean, how can an institution act in your “best interest” when it knows next to nothing about you except your demographic characteristics?

Gynecologist: Attempt #1

A few months later I finally met with the gynecologist who would perform (or not) the surgery. She seemed a lot friendlier than my family doctor and a lot more willing to listen to my situation. I gave her the same explanations I gave my family doctor about not wanting kids, etc, and expressed my desire for permanent contraception.

Throughout my explanation she appeared to be listening carefully, but when I finished she adopted a patronizing tone and explained how she once had a patient in this same position who was a little older than I was. She had performed the procedure on this patient, but several years later the patient returned to her demanding that the procedure be reversed because she had fallen in love and had now changed her mind about having children. The procedure is not reversible. The patient was actually angry with the doctor for “letting” her make “such a foolish decision” at “such a young age”. I don’t know if the story is true, but I knew I was supposed to infer that I might similarly change my mind one day, when I find “the right guy”. I think one reason she didn’t take my request seriously was because I was not in a relationship at the time. She sympathized with my feminist passions, but suggested that I would someday grow out of this phase, saying the other patient had used similar reasoning and eventually changed her mind. The gynecologist ultimately didn’t want to feel guilty for taking this kind of option away from me. Well, what about my option to remain child-free?

I explained that I would never blame her for my own decision, and that if I did somehow have a change of heart then I would be perfectly content with adoption. I re-articulated some personal and political elements of the decision (which you can read about in some later sections of this zine), but she didn’t waver. She reminded me that this procedure, like any other form of surgery, involved a degree of risk. She said that she could not perform this operation in good conscience, but said she would ask around to some of her male doctor friends who might consider it, and sent me away with some pamphlets. I don’t know how she “knew” that none of her female doctor friends would do it; she probably assumed that, as women, they would naturally feel the way she did about it. The only things I was able to get from her, besides pamphlets, were an explanation of how the surgery works and the knowledge that (thankfully!) my provincial health insurance would cover all the costs of the surgery.

I was frustrated. No, I was livid. I didn’t understand how someone other than me could be allowed to make such a decision for me. People as young as 16 can legally drive cars and other vehicles, thus putting lots of peoples’ lives at risk every single day. People consume legal drugs like alcohol and nicotine, thus endangering their own lives and those of people around them, and nobody is preventing them from doing so. People rarely question a person’s decision to have a baby, and many folks out there are actively encouraging young poverty-stricken girls who don’t want to be mothers to carry their pregnancies to term. All of this is happening, yet I can’t be allowed to say no, I don’t ever want to have a baby and I’d rather pre-empt the abortions. Someone can say, “Oops, I guess I’m having a baby,” but I can’t say, “None for me, thanks.” Around here it’s easier to have an abortion than to get one’s tubes tied, yet tube-tying is just as permanent and far less traumatic on a physical, emotional, or moral scale. I don’t mean to suggest that abortions are traumatic or that they are immoral, but my tubal ligation was none of those things, while abortions tend to have more of a mixed bag of repercussions for many people. Recognizing a person’s autonomy means recognizing their ability to make decisions for themselves. We need to take responsibility for our decisions, rather than having our decisions made for us.

Gynecologist: Attempt #2

I still don’t know if the gynecologist really intended to ask her colleagues about performing the surgery or if she was just hoping that this “phase” would pass and that I would forget about the whole thing. Maybe that actually happens? Who knows? I wasn’t about to give up because someone didn’t trust my judgment.

Six months later I still had heard nothing from her so I called her office and left a message for her. No response. A week later I called and left another message. No response. A month later I called again and left another message to see if she had had any luck with her friends. Still no response. So I made an appointment to see her as soon as I could, in late spring of 2008. Face-to-face she had to talk to me.

We finally met again and she said that she had consulted her friends and none of them would perform the surgery until I was at least 30 years old—which I still think is an arbitrary number—or until I had already had some kids—which totally defeats the purpose of the surgery! I don’t know if this was true or if she was just trying to discourage me from getting the surgery. I was infuriated, but I held it in. This time, I came prepared with a list of clear arguments. I explained my politics again, more explicitly this time. She reminded me that it was a permanent procedure, and non-reversible—as if I wasn’t aware? That was the whole reason I wanted it. I attempted to negotiate some agreement whereby she would not be held liable, even psychologically, if I changed my mind later, and promised that I would not come to her if I did change my mind someday.

I told her I had already consulted my partner, a man, and that he “was okay with it” and “happy to adopt” if we decided to do so someday. In reality, it was true that he was happy to adopt, but he refused to have any say in what I did with my body, insisting that it was my decision, and that he would support whatever route I chose to take. You’ve got to love feminist men! Though this should have been irrelevant (it is my body, after all), the doctor seemed to be giving in now. I had one last argument (more of a bullying tactic, really) saved up that I hoped I wouldn’t have to use, but I didn’t want to lose my chance. I asked her, “What do I need to do to convince you? Do I have to wait until I accidentally get pregnant and come here and ask you to abort it for me? I don’t want that.” This seemed to be enough, because she finally shook her head and sighed in exasperation.

“Ok,” she said reluctantly, opening her drawer to take out some paperwork.

“‘Ok’?” My heart stopped. “What do you mean?”

She looked at me long and hard. “Ok, I’ll perform your surgery. But that doesn’t mean I won’t wake up one day and change my mind before then.”

I was in disbelief! After all the trouble she had given me, I was afraid I would have to pester her for several years before she finally agreed to do it. I could barely contain my excitement.

Since no one had given me any information yet on how to schedule such surgeries, I was surprised and thrilled to discover that it would take place in August of this year (it was now May or June). I was pleased that this didn’t give her much time to change her mind. Someone from the hospital was going to call me later in the summer to inform me of my surgery date and pre-surgery interview. Now all I had to do was wait.

A systemic problem

I find it really interesting that I, a white, middle-class, able-bodied person, was having a lot of difficulty securing this surgery, while historically and contemporarily women in various minority groups have had such surgeries forced upon them without appropriately informed consent, sometimes with no consent at all, and sometimes without even knowing it was happening. Most often targeted were young, poor, unmarried women—often at the onset of puberty—in an effort to “protect” them from the perils of childbearing while poor or otherwise “unfit”. This was done under the guise of being “for their own good” to mask the classist, sexist, and often racist intent. Within the past 100 years in North America, forced (or “compulsory”) sterilization was imposed on indigenous and Métis women, incarcerated women, women with physical impairments (ex: blindness), women thought to be mentally ill (ex: cognitive impairment, depression, promiscuity, thievery), and women of other visible minority status as a way to prevent the spread of “undesirable” genetic traits (yes, even criminality was thought to be genetic). This was an early form of eugenics practice, and it continued in North America until about the 1970s and 1980s.

Elsewhere around the world, including in Germany, Mexico, Peru, Brazil, Colombia, India, China, Switzerland, and Sweden, indigenous and mixed-race women have been forcibly sterilized. Roma women in the Czech Republic have also been targeted in this way, as recently as 2003, and sex workers in many places have been forced to undergo the surgery. In some cases these were officially state-sanctioned activities. Often the surgeries were performed during procedures like dental surgery, abortion, or immediately after childbirth, and many women only discovered much later that they had been sterilized. Medical institutions have coerced women into “consenting” to the surgery by lying about its purpose and permanence, by bribing them, and by withholding abortion care unless they consented to sterilization.

All of this and my own experience with trying to secure a sterilization surgery are just two sides of a very ugly medical institution, and of medicine in patriarchal systems more generally. The systemic nature of this form of racism, sexism, colonialism, ablism, classism, and paternalism is evident here, and I expand more on my own experience of the sexist and paternalistic elements throughout this zine.

The surgery

I won’t spend much time on the details of the surgery or pre-surgery. My pre-surgery appointment was a quick visit to the hospital a few weeks before the surgery itself, where a nurse described to me the procedure I was going to undergo. I don’t remember the details of our conversation, but I think someone took some blood to make sure I was healthy enough for the surgery. They sent me home and they gave me instructions of things to do and not do before going to the hospital for the procedure, such as not eating/drinking anything during the 12 hours beforehand.

Surgery day came and went without much fuss. I arrived at the hospital on time and put on a hospital gown. The surgery was delayed by a couple of hours so I hung out with my partner Matt in the waiting area, starving, until I was eventually put on a wheely bed and rolled away. They parked me in the hallway outside the operating room where I had to wait for the surgeon, my gynecologist. As I was lying there, of course I was afraid. All the usual hospital-related myths were racing through my head, including the fear that they might make a mistake and operate on the wrong part of my body by accident, the fear that the anaesthesia might not work properly and that I might wake up screaming in the middle of surgery, the fear that something else might go wrong and I might never wake up, etc, as well as the fear that the gynecologist might change her mind at the very last minute.

When she finally arrived she asked me one last time if I was certain I wanted to go through with it, and I gave her an emphatic “yes”. She explained the procedure to me, saying that she would make two small incisions, one in my belly button and one in my pubic hairline. In one incision they would insert a camera and light so they could watch what they were doing on a screen (this surgical method is called a laparoscopy), while in the other hole they would insert the surgical instruments that would cut the fallopian tubes and clamp/seal the ends. They would need to fill my abdomen with carbon dioxide gas at the beginning so that my organs wouldn’t be all crowded together, and she warned me that the gas would cause me some discomfort in the first couple of days as it worked its way up my body into my left shoulder and eventually out of me. She also said I would probably bleed from my vagina for a few hours after the surgery, and that this was normal. That’s all I remember before they knocked me out.

Anyway, waking up from the surgery was pretty miserable. I was drifting in and out of consciousness and had some severe cramp-like pain in my abdomen, like my insides were being pulled and twisted and torn by someone with dirty hands. This is pretty common, I believe. They gave me another dose of painkillers (morphine or demerol, I think, since I don’t react well to codeine), but I don’t remember it working very well. The nurse was talking to me to see how I was doing, asking me how many kids I had (and was shocked that I had none), and I was groggily forced into my clothes and into a wheelchair so they could send me home.

I was lucky enough to have two men in my life who were able to play supportive roles in the process. My best friend’s partner, who is also a good friend of mine, got off work early the day of my surgery in order to drive me home from the hospital, since Matt and I don’t have a car, and since I wanted to keep the rest of my family out of this until I could figure out how to tell them. This assistance might not seem like much, but it was a big deal because my friend never takes time off work, even when he’s really sick, so it meant a lot that he thought my surgery was important enough to merit it. It was also a big deal because he was supportive of my decision even though he admittedly didn’t understand it or the politics behind it. “That Sarah, she’s always so independent,” he said to Matt while they were waiting for me to wake up. Even though he didn’t understand or necessarily agree with what I was doing, he still supported me in my decision.

The other man in my life who played a vital supportive role was, of course, my partner Matt. I say “of course” only because I already mentioned him above, and not because of course boyfriends and husbands are supportive of this kind of decision. Not all of them are, and some of them actively discourage “letting” women of any age make this kind of decision. Matt not only supported me, but he actually refused to give me his opinion about the surgery because he wanted the decision to be entirely my own. From previous discussions I knew that he was not particularly attached to his genes and was happy to adopt if we decided to have children in our lives after all, but he was reluctant to express an opinion on my decision to have the tubal ligation. He reassured me that he would get behind whichever decision I made. Matt accompanied me to the hospital on the morning of the surgery and hung out in the waiting area all day until I was ready to be taken home. Matt and my friend came to greet me as I was wheeled out to one of the restricted waiting areas. Since I was the only patient left in the room, they allowed the two of them in to sit with me while my paperwork was processed. I was too groggy, nauseated, and in pain to really understand what was going on. I vaguely remember the nurse telling me that after a few days I wouldn’t need the hardcore painkillers anymore and would be able to just take a couple of Tylenol and Advil to manage the swelling and discomfort.

My friend drove us to a pharmacy to pick up some Statex, my prescribed pain medication, and then drove us home. I slept a lot for the next few days, and Matt spent a few days taking care of me until I was able to prepare my own food again and then all was pretty much back to normal. I found the Statex useless and unpleasant because it severely nauseated me, so as early as the day after my surgery I was already down to taking just Tylenol and Advil, which worked fine. The surgery was on a Tuesday, and by Friday I was able to run some errands and go out with some friends. I was moving very slowly as I felt pretty tender and exhausted and was worried I might tear something if I moved too quickly.

People have freaked out at me about the “risks” of this kind of procedure (it is surgery, after all). My response? Pregnancy is risky. Giving birth is risky. Abortions are risky. Driving a car is risky. Drinking alcohol, smoking cigarettes, eating bacon or sushi, and many of the other things my critics probably do are risky to themselves and sometimes to others around them. Life is risky. This surgery was not a big deal, and might have even prevented future risks. I won’t lie to you: recovery was not fun. Overall, though, I’d say the gas collecting in my left shoulder was probably the most painful thing I experienced after the day of the surgery. I can’t really explain the sensation but it was wretched (I’m pretty sure the gas in my abdomen was the main cause of my pain after waking from the surgery, too). It took at least a couple of days for that shoulder pain to be gone, about a week to walk normally again, and maybe two weeks until I felt pretty much back to normal. And, I was asleep for the entire procedure!

Persuasion

The following tips might help you convince your doctor or gynecologist to perform your tubal ligation. I don’t know if they will succeed in situations where your gender and/or sexual orientation are not easily recognizable or definable, but it’s still worth trying.

* Remember that the doctor probably sees the world very differently than you do, so you need to present them with a version of yourself that they will understand. The less they “get” where you’re coming from, the more likely they are to think you’re going through a rebellious “phase” that won’t last long. Similarly, I’m generally taken more seriously when a decision is seen as my “choice” or “obligation” rather than my “politics” (compare this to how vegans are taken less seriously than people with egg and dairy allergies or aversions when explaining dietary restrictions). This can take as many forms as there are people to try it, but I predict the most reliable approach is to try to seem “normal” or “average” when talking to your doctor about it. Alternately, if you’re patient, prepared, and ready for a possible uphill battle, or if you have an awesome feminist doctors, then by all means approach them as the gender warrior that you are!

* The doctor probably wants to hear that you are in a stable, long-term, monogamous relationship, that you’ve discussed your options with your partner, and that you’re both totally fine with the procedure and happy to adopt if you change your minds (whether or not any of this is true). Why? I think there’s a subtle underlying assumption in our culture that we must punish promiscuous women and defer to men’s approval for such big decisions. The easiest way to get what you want is probably to come across as straight-laced and “responsible”, but, of course, if you’re ready for the challenge then embrace your slutty self and take them on! (And let me know if your approach has any success!)

* Tell the doctor you’ve wanted this surgery for a very long time. If they think it’s a new/recent idea, they’re more likely to think you’ll change your mind and deny you the surgery until more time has passed. They don’t want to be blamed for “letting” you make “such a foolish decision”. Translation: Mainstream culture tends to characterize young women as flighty and changeable and thus unable to make sound decisions, so you must appear very determined.

* Do your research! Know that you might change your mind someday, that it’s a permanent procedure, that reversal procedures are expensive and unreliable, and know the risks involved (see following page). If you think it will help, try to bring statistics to back up your arguments. I recently came across stats about parents of adult children which indicated that nearly 70% of them, if they could live life over again, would have elected to not have kids at all. That sort of thing could potentially help your argument.

* Doctors are less likely and less willing to perform these surgeries on young people, but do not lie about your age. The doctor has access to all your medical information, so lying about this or anything else they can verify will only hurt your case.

* Be clear that you are familiar with other methods of birth control, and make a clear case for why these will not do for you (i.e. they are not permanent, accidents can happen, maybe you have a medical condition that makes abortion or hormone pills or pregnancy a bad idea, etc).

* Make it very clear that you won’t change your mind, but also be clear that you have other options (in vitro fertilization, adoption, etc) if you do. Also, have an answer prepared for when the doctor asks you why your partner doesn’t just get a vasectomy, which is far less invasive or risky.

* Finally, do not back down. Make it clear that you want this procedure and that you will do whatever it takes to get it. Do not come across as uncertain or hesitant, because they will probably use this to turn you down. Keep on pushing!

The risks

When trying to convince your doctor that you know what you are “getting yourself into”, it’s good to demonstrate your awareness of the possible risks of this surgery. This list is not exhaustive by any means, but it should help. The risks of a tubal ligation via laparoscopy include:

* You might change your mind. It sounds ridiculous, but many sources actually list this as a “risk” for this surgery. I wonder if anyone tells pregnant people or people who are trying to become pregnant that they run the risk of changing their minds? The procedure is technically reversible, but reversal procedures are expensive, not usually covered by any insurance, and have relatively low success rates. That’s why a tubal ligation is referred to as “permanent”.

* Pregnancy and ectopic pregnancy. That is, the egg and sperm sometimes find each other in spite of the surgery. Rarely is the surgery unsuccessful, but when it is pregnancy can occur. For various reasons, however, the zygote occasionally gets implanted too far into the fallopian tube, and this results in an ectopic pregnancy. To be clear, ectopic pregnancies can occur in any female, but the risk is slightly elevated for people who have undergone a tubal ligation. As the implanted zygote grows it can be painful and damage your tubes. This is actually really dangerous and can lead to death if not treated. Ectopic pregnancies are very rare and usually only happen 7-10 years after the procedure was performed. When it does happen, it’s usually because, over the course of several years, the fallopian tube found a way to fuse itself back together.

* Like any surgery, there’s always a risk of complications. For example, if the laparoscope is old and has a specific kind of defect or malfunction that I don’t quite understand, it can actually burn a tiny hole in your intestines while they’re operating on your fallopian tubes, which could cause you problems for years to come. It’s extremely rare, but it has happened.

* Other complications can occur as well. Some people have a hard time waking up from anaesthesia, or simply don’t react well to it, which can sometimes lead to various problems. Sometimes the incisions don’t heal well and you wind up with infections. Also, doctors are only human, so they make mistakes. Because all your organs are crammed in there together, there’s a small chance your intestines or bladder might get nicked during surgery. These are potential risks involved with any surgery, but they are very rare.

* Like any surgery, there is a small chance that the complications will be so severe that they cause death. To be clear, though, pregnancy and giving birth carry the same risk, but to a much greater degree. There’s a statistic that 4 in 100,000 tubal ligations result in death, while there were 13 reported maternal deaths per 100,000 live births in the US in 2004 (and 12 in 2003). Even so, no one challenges the women who get pregnant about whether it’s “worth the risks”. I think I’ll take my chances!

Don’t just take my word for it, though—do your research! When I first began thinking about the procedure, I was fairly unaware of the risks. When I became aware, however, I still felt the risks were far more tolerable than having to worry about pregnancy for the rest of my life. I felt the peace of mind granted by the surgery was well worth the risks, and you might, too.

[click here for part 4 of 6]

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~ by artpoped on July 30, 2010.

One Response to “ZINE: Ask me about my tubal ligation (part 3 of 6)”

  1. Hello Sarah,

    I just googled the phrase “My doctor doesn’t take me seriously about tubal ligation” and your blog came up. Thanks for such a well written, informative, insightful, fact-filled commentary on this subject.

    I’m 32 years old (33 in October), and have asked several doctors about this very subject. Usually I get laughed at and treated like a child being rebellious. My man, Ryan, is totally supportive of me in this and he himself has no desire to have children. We’ve been together for over 10 years now. He’s willing to get a vasectomy but my view on that is, if we ever break up (you never know lol) I don’t want to have to still worry about getting pregnant in any future relationships.

    I’ve known since I was still a child myself that I did NOT want or need children. I remember playing “house” with my baby dolls and thinking “thank goodness I don’t have to have kids in real life”. I think that people automatically think you hate kids and therefore they basically shun you, consider you a deviant or something. You have the parts, they work, so why not use them is the mentality that seems to be their mantra.

    Also there’s that “You will change your mind.” I don’t even get the “You MIGHT change your mind.” I find it excruciatingly rude, dismissive and totally disrespectful to be treated like a flighty, slutty woman when broaching the subject with ANY doctor, male or female.

    Anyway, thanks so much for your blog. I think I might keep perusing it. I will definately get my arguements all lined up and all of my reasons for wanting the surgery ready for my doctor and will fight for it as you have. Hope you are well and had no complications from your surgery.

    Much respect and thanks,
    Eva

    Like

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