Tying the knot
For some women, tubal ligation is the only real way to avoid pregnancy
KATE LUNAU | October 31, 2007 |
On the morning of May 1, 25-year-old Lee Wing Hin got her tubes tied. After the surgery was over, and she could be sure she would never bear children, what Lee felt was an overwhelming sense of relief. Six months later, she's still feeling it. "Pregnancy is something I've been anxious about for a very long time," says Lee, a graduate student at Toronto's York University. "I felt this was right for me — this is how I want to live."
Tubal ligation is a surgical sterilization procedure(the WHO cites a failure rate of 0.5 per cent). It requires general anaesthesia and lasts about 30 minutes; recovery takes a week. With around one in 100 patients experiencing complications, tubal ligation is riskier than male sterilization(vasectomy). And while tubals can sometimes be reversed, to do so requires a difficult operation that's not always successful. For that reason, experts insist, it should be considered permanent.
That's exactly what appealed to Lee. And she isn't alone in not wanting kids: a 2001 survey found seven per cent of Canadians aged 20 to 34 felt the same. While many among them might not seek a permanent solution, some — Lee included — insist other birth control methods are too invasive, untrustworthy, and altogether temporary. For Laura, 33(who asked that her real name not be used), moral convictions would have dictated that she keep a child, rather than resort to abortion or adoption, should she get pregnant — something she wanted to avoid at all cost. Laura had her tubes tied last year. It was necessary, she says, for her "peace of mind."
While Lee's own doctor was "supportive," women who are young, single and childless frequently have trouble finding a willing doctor, reports Ottawa-based sex therapist Sue McGarvie: "The view exists that you don't do that to a single woman; they'll find a man and want to have babies. I find it incredibly patronizing." While young men seeking sterilization might encounter similar problems, anecdotally it seems to be more difficult for women. "[My wife and I] chose vasectomy because there would be much less arm-twisting of doctors," says Boston resident Vincent Ciaccio, now 30, who was sterilized at 23.
Some hospitals ask that childless women under 30 get a second(or third)gynecological opinion. Others might be sent to see a psychiatrist first. Catholic hospitals could even require the approval of an ethics committee — one young mother who was denied the surgery by a Catholic-run hospital in Saskatchewan recently received a $7,875 settlement after complaining to the province's human rights commission. It's a situation that's familiar to Maxine Cooper, 43. Ever since her childhood in rural Newfoundland, Cooper's been convinced she never wants kids of her own. At age 34, she underwent surgery to remove an ovarian tumour. "I told the doctor that since I'd be on the operating table anyway, I wanted my tubes tied," says Cooper. The doctor refused. "He told me I hadn't met the right man yet. I was shocked."
Last year, Laura struggled for months to find a gynecologist in Toronto who'd tie her tubes. At one point, she even considered looking outside the country for a doctor who'd do it. "There is a lot of stigma attached to choosing a life with no children, even [in Canada]," Laura says.
But Montreal-based gynecologist Cleve Ziegler says doctors have every reason to be cautious. "Certainly any wise, experienced gynecologist will turn down a young woman seeking a tubal ligation," he says. "It is in general a bad idea for women under 35." Up to one in five women sterilized before age 30 later express regret, while only one in 20 sterilized after age 30 regret it, according to one U.S. study. "We've all seen that woman who had two kids, had her tubes tied at 28, and at 29 [has] a new boyfriend and wants it reversed," Ziegler says.
Laparoscopic tubal ligation(the most common type)is the second-most frequent cause of litigation in gynecology, for reasons ranging from a failed procedure to injury. And when it comes to tubals(which are usually covered by provincial health care, although reversal isn't), physicians' remuneration is poor. "Tell a doctor, for $140, to take a patient into an operating room [and] take her life in his hands," Ziegler says. What's more, with a "crisis" in terms of patient access to Canadian operating rooms, elective sterilization surgeries remain low on Ziegler's priority list. Most importantly, he says, there exists a wider variety of safe, long-term birth control methods than ever before.