Q:
I've had two C-sections. This is my third pregnancy and I was told that if I wanted a tubal ligation the birth of my child would have to be a planned C-section, and that if I wanted a vaginal birth I would have to wait six weeks before I could have the tubal ligation done. I want to know if there's a medical reason for this or if it's just to get more money out of the insurance company.
A:
Tubal ligation is a permanent method of birth control requiring a surgical procedure to tie each fallopian tube. This prevents pregnancy by blocking the pathway between egg and sperm, preventing fertilization. Tubal ligations can be done soon after a delivery or planned for a later time, usually after a minimum six weeks following a delivery.
After delivery your uterus remains enlarged; it takes a full six weeks for the uterus to return to its pre-pregnancy size. For the first two days after delivery, the top of the uterus rests close to the level of your belly button. If a tubal ligation is performed following a vaginal birth and within 48 hours of delivery, your doctor can perform the procedure through a small incision adjacent to your umbilicus (belly button). Using a finger, the doctor can slide over the top of the uterus and identify each fallopian tube. The fallopian tubes are individually lifted through the umbilical incision, and a small section of each tube is tied off and removed. This surgery is more difficult in obese women, and when there is scar tissue present from previous abdominal surgeries.
In your case, your doctor may be concerned that the scar tissue resulting from your prior Cesarean sections would make it difficult to safely mobilize and perform surgery on your delicate fallopian tubes through a small umbilical incision. With a Cesarean section, it's much easier to identify and perform surgery on the fallopian tubes through the generous abdominal incision. If scarring is discovered around the fallopian tubes, these adhesions can usually be carefully removed in order to safely perform the tubal ligation.
Keep in mind that any tubal ligation requires careful advance decision-making. Many insurance companies require women to sign an informed consent form at least 30 days prior to the surgical procedure. Some insurance companies will allow you to use only a three-day waiting period. This waiting period is designed to protect women from making a rash decision about this permanent procedure. So understand that you will not be able to choose to have a sterilization procedure at the time of your delivery if you have not previously discussed this with your doctor and signed informed consent papers well in advance.
Laura E. Stachel M.D. Obstetrician & Gynecologist
