Tubal Ligation - questions for my doctor, others who have gone through the procedure....

In My Humble Opinion
1

I am going to see a surgeon-type person in a couple of weeks to discuss having a tubal ligation.

Husband and I are old enough we know for damn sure we made the right choice not having kids, and I am getting old enough (early 40s) to start feeling uncomfortable remaining on hormonal birth control (nuvaring). I am fairly certain I won’t go for Essure because having an IUD inserted was one of the most horrifically painful things I have ever experienced.

I am in the process of figuring out what to ask the doctor when we meet.

What did/would you ask your doctor in this situation?

If you’ve had a tubal ligation, what kind did you get and what were your experiences with the surgery & recovery?

2

I have looked into this question. Last year we were deciding between IUD vs. Essure vs. tubal ligation.

The first thing you need to find out is, what will it cost you out-of-pocket? Essure is usually MUCH cheaper than a tubal ligation. Even if you have insurance, there are co-pays, co-insurance, and deductibles to consider. Essure would have been $250 OOP for me. The tubal would have been significantly more because it is surgery with general anesthesia. And I have excellent insurance. You may also want to shop it around to different facilities. Different providers may charge a different price.

Also, you need to find out what your doctor is willing to do. My doctor would not do a tubal if Essure was a possibility, because it was lower risk and lower cost for the patient.

It doesn’t have to be really painful. My doctor has a lot of experience with IUDs and Essure. When I chose an IUD, her skill allowed there to be little pain, even though I have never been pregnant. Finding a doctor who has done many Essure procedures can be worth it, comfort-wise.

3

I had my tubes tied Dec. 2012 for no out of pocket costs. The gynecologist I was referred to did indeed try to talk me into an Essure, I guess it was, but I didn’t want that - I was 45 then, and we also knew very well that we didn’t want to have any kids, and I wanted to be done with ever having to worry about birth control again.

The surgery itself was not a big deal at all - no food after midnight, wait around for a couple hours the day of, out like a light, wake up and it’s done, then recover in the hospital for a couple hours and go home and finish recuperating there. My biggest problem was nausea after anesthesia; even knowing that and giving me drugs for it, I was still pretty nauseated. I went home and recuperated for about a week, and that’s pretty much it.

The type of surgery? He clamped my tubes laparoscopically, which I believe is pretty standard.

4

Thanks for the replies so far.

I am pretty dead set against Essure. I’ve had two different doctors attempt IUD insertion (one successful, one not) and I am not willing to go through having someone open my cervix again. My current gynecologist (who was not one of the IUD doctors) said I have a very tightly closed os, which contributes to pap smears being painful for me.

In any case, out-of-pocket expenses won’t figure into our decision making process for which sterilization method to go with. We’re financially sound at the moment and have savings. And our out-of-pocket max under our insurance plan is $3000. We’re lucky right now. :slight_smile:

5

I got my tubes cauterized almost 15 years ago, when I was 24. Luckily, my doc had a childfree sister, so he didn’t give me any pushback. I recommend asking the doc how many he or she has done, and if there have been any spontaneous “reversals”. Also, ask if you can get some pics or video. Since they have a camera in there, they can take pictures of what they’re doing and show them to you later - it’s way cool.

At your age, you shouldn’t get any b.s. about “what if you change your mind”, so I don’t think you’ll need to have all of the arguments prepped that I had.

My recovery was pretty easy, I took a long weekend off of work and was back the next Monday with no trouble, though I did have some lingering shoulder pain from the gas they use to inflate your abdomen. Sex was OK after maybe a week or so - it’s a lot of jostling around for an area that just had surgery. A friend of mine only took about 24 hours to get back to normal from hers, so it varies from person to person.

6

When I was pregnant I was adamant about not ever being pregnant again. I love my little girl but holy cow did I hate being pregnant. My doctor was totally cool with it and asked me to sign some paperwork 30 days before and then again the day of the surgery (which she did after my c-section before she sewed me up) indicating that I knew what I was asking and that I was sure I didn’t want any more kids. I don’t remember what kind of surgery she did though, just that it was done.

7

I had a tubal ligation back in 2002 or 2003, around then. So consider that it was more than 10 yrs ago and things might have changed.

I told my doctor I wanted a tubal. We were still pretty young (early 30’s) He asked us a few questions, including why we chose for me to have a tubal vs. my husband having a vasectomy. My answer was that I was 100% sure I never wanted to produce another child from my body ever again. (Yeah, pregnancy and delivery were awful for me). My other reason was that I wanted to be the one controlling my body, and not relying on someone else to change their body as a means of protecting mine. He seemed to like my answers.

My doctor did what he called the triple whammy: cut, tied, cauterized the ends.

I had it done on a Thursday, and was back at work on Monday. Recovery seemed pretty easy. Just a lot of discharge like a really heavy period for a day or two. I don’t remember any pain, more like some discomfort.

I had no out of pocket costs.

I can’t think of anything else off-hand to say, except I am very glad I did it.

8

Your husband needs to think about getting snipped. Easier, cheaper, less invasive.

9

Thanks for the input, but we’ve already ruled that out.

10

Quick update with more to follow - I had a tubal ligation this past Thursday. Things went well, and my only complaints right now are the bubbles and the fact that my incision has started to itch. Gah! I can’t sit around scratching my nether regions at work so I might go home early today.

11

I am glad you had the procedure and it went well. I had it a long time ago (maybe in 1975?) and the only bad part was I had to have ether as an anesthetic and I was heaving for hours. Otherwise no problems at all ever. Congrats on getting birth control out of your life!

12

Here’s all the deets.

I had two appointments with a surgeon, she asked all kinds of questions about my health and made sure I knew that tubal ligation was permanent, then scheduled the surgery. I was a bit surprised how straightforward the whole process was, and how little probing my doctor did about how sure I was. It probably had a lot to do with my age (early 40s) and that we’ve been married for 10 years and are still sure about no-kids. Because of my general good health they didn’t make me go in for any pre-testing.

Showed up at 6am at the hospital, they took my temp and blood pressure a billion times, started my IV. The surgeon, anesthesiologist, nurse anesthetist, OR nurse, and an anesthesiology student all cam by to see me and ask me the same questions over and over. I assume this was normal procedure to help make sure they weren’t tying the wrong person’s tubes. :slight_smile:

They stole my glasses, gave me some kind of happy medicine in my IV, let my husband kiss me and wheeled me off to the OR.

I woke up 2 hours later MISERABLE - lots of crampy pain and a good deal of nausea. I told the recovery nurse I thought I was going to throw up and she gave me one of those kidney shaped dishes and asked me my pain level. I said 7 and then she gave me a shot in the arm. I thought she said she was giving me dilaudid, and specifically for nausea, but when I look up dilaudid on the interwebz it doesn’t seem to be for nausea. So either it wasn’t for nausea or it wasn’t dilaudid, I guess. I never did throw up - yay! I woke up again about an hour later and the recovery nurse asked if I wanted something to eat and drink. I chose apple juice and saltines. I thought it was odd that the only choices were saltines and graham crackers, given the fact that I had a wicked sore throat from the breathing tube. So I spent the next hour sipping apple juice, taking a bite of cracker and then waking up 15 minutes later with the cracker still in my mouth. That shot was some interesting stuff!

Nurse asked a couple more times about my pain level. When I said it was a 4 she asked if I wanted to go home. I asked if I could have a percocet because my doctor had said they could give me one before I left (and I was lying slightly about my pain level because I wanted to go home). The nurse said I could have one but would need to stay for at least another 1/2 hour for observation so I said nevermind I’d rather go home.

They went and told my husband to fetch the car. He did and we drove home (about a 10 minute drive - so many potholes on Fresh Pond Parkway!!!). I went to bed and slept for about 7 hours. Woke up and ate pudding and apple sauce so I could have a percocet, and spent a few hours dozing on the sofa.

Next day I only took ibuprofen because there wasn’t much pain. Napped a lot. Taking a shower was really nice. Day 2 we took a walk to go vote and to CVS to buy Cheetos (don’t judge, man!)

The gas bubbles were really painful the first 2 days, when they were in my chest and shoulders. Now they seem to be working their way out through the “correct” channel. My intestines feel bruised and quite sensitive, but everything is moving along so I am assuming all is well.

Some things I was surprised by

  • I didn’t poop for 2 days. Probably a combo of not eating for 24 hours and the drugs for general anesthesia apparently temporarily shut things down. One of the things the recovery nurse kept checking for was “gut sounds.”
  • I didn’t realize one of my incisions would be INSIDE my belly button. that freaks me out for no good reason
  • the steri strip that’s still on my lower incision itches a lot, but everything I’ve read says don’t pull it off, it’s ok where it is and will fall off on its own
  • on day 3 I started showing some bruises on my abdomen, already looking like old bruises when they appear
  • I have some little bruises elsewhere which I assume is from them moving me around. I bruise fairly easily tho and they don’t hurt so I don’t think they were being rough with me. It must be a pain to move someone who is unconscious though.
  • I don’t like percocet. I only took 2 - one each on the first two nights. On night two my sleep was very disturbed and I felt yucky.
13

Yay! Those gas bubbles are the worst - they hurt me a lot more than any of my tiny little incisions. The relief when they finally do come out - sublime.

One word of caution (and you might be past the danger zone already) - even though you might be feeling pretty good, take it easy for at least a week afterwards. Surgery takes a lot out of you (no pun intended :slight_smile: ).

14

What are the gas bubbles you’re talking about? A factor of the sedation or something to give them room to operate inside?

15

It’s been a long time (almost 20 years) so I don’t’ recall what kind, apart from the fact that it was done with a laparoscope.

What I recall very vividly, however, was becoming aware before they were done. Fortunately it was not very long before they were done, so I was only trapped in a living nightmareI still find impossible to adequately describe for a relatively brief time, compared to others.

16

Two kinds of gas- one is the CO2 with which your abdomen is distended so the surgeon can work through those leetle teeny scopes. That causes the shoulder pain, which is actually referred from the diaphragm. We work hard to press it all out, but there’s always a little left. It is absorbed by tissues, not expelled through the gut.

The other gas is your intestine waking up. It’s pretty standard to have intraoperative antibiotics, which lill off the normal flora in the gut. First poops in two days is great:). They are pretty stinky too, due to the whole procedure. It takes a couple of weeks to normalize, during which time some sort of probiotics is a good idea (yogurt, if you eat it). Cheetos belong to one or more of the Basic Four Food groups- salt, sugar, fat, and beer. They will cheerfully encourage gas production, as you probably already know.

It’s a pretty simple operation, the BTL. It is still highly invasive, and do follow CW advice- give yourself time to heal, and to recover from the dam anesthetics. We are lucky to have them, but sorting them out of your system takes a bit of Tincture of Time.

I’m missing tonsils, appendix, uterus, breast mass, and gall bladder…not willing to give up anything else at present. Had my tubes tied at second C/S, so don’t remember much about that, what with the new baby, the toddler, and my oldest child (aka spouse)

17

I was lucky (IMO) that my surgeon does not do prophylactic antibiotics for this procedure for healthy women, so I didn’t get any unnecessary antibiotics. My intestinal flora is intensely grateful. I hope. I haven’t actually spoken with them in a while. I should friend them on FB.

Thanks for the validation! :smiley:

I’m easing my way back into my usual diet which tends to be fiber and vegetable intensive. I don’t want to unduly stress the system, so I have a great excuse to eat pudding as a dietary supplement.

18

Ugh. Nothing like that happened to me, I’m happy to say.

19

I’m struggling with that. I don’t feel sick, so I am very impatient with the notion that I have to take it easy. I’m not a patient patient. I’ll have no truck with malingering! I did go home early yesterday though and if I’m tired again this afternoon I’ll do it again.

20

The Holdsworth Effect answered that pretty well. The painful part is the CO2 working its way out. It made breathing pretty painful at a couple of brief points. And now things just feel kind of “bruised” which is annoying.