Hmmm… I wonder if it’s having 3 kids and two newborns that had me thinking about this topic. All kidding aside, my hubby has had a vasectomy AND I have had my tubes tied (you can never be too sure… kidding… kind of…), but I was curious about other options as well. Breezy Mama turned to a favorite Go-To expert, Dr. Rothbart (who was famously flown to Namibia to deliver Angelina Jolie and Brad Pitt’s daughter Shiloh) to get the pros and cons of the different procedures when you are absolutely, 100% finished having children (ahem).
1. Tubes Tied
a. I recently had my tubes tied, but was told to use birth control for the first 3 months because I could STILL get pregnant. How is this possible?
It is really difficult to answer this question without knowing how the tubes were tied. Was it Laparascopic? Post Partum? Was it Hysteroscopic and through the vagina (Essure)? But IF the tubes were actually tied, or burned and cut, then waiting three months is not necessary at all, as true “tying” of the tubes blocks them completely, and the egg and sperm cannot meet. And this protection begins immediately.
b. What is involved in tying the tubes?
There are several methods for tying the tubes. Basically they all accomplish the same result, to physically obstruct the fallopian tubes, making travel through them by sperm or an egg impossible. Basically if you imagine cutting a hose somewhere in the middle of it and tying off both new ends. water could not get from one side to the other.
c. I had mine done during my C-section. If a woman opts for this after having kids but not having a C-section (or giving birth at all for that matter) what is involved in this procedure?
During a C-section tubal ligation (tying tubes) is very straight forward, as the tubes are right there and accessible. If tubal ligation is desired after a vaginal delivery, then a small incision is made underneath the belly button. The uterus is still enlarged immediately postpartum and access to the tubes through a very small incision is possible. When not performed around a pregnancy, a tubal ligation is most often performed laparoscopically, with a camera and small instruments through 1-3 small incisions in the abdomen.
d. Why do you still get a period when your tubes are tied?
Tying tubes only physically blocks the tube. The ovaries aren’t touched at all, and thus a woman still ovulates normally and has regular menstrual cycles. The difference is that the released egg cannot travel down the obstructed tube, and sperm cannot swim up it.
e. Are there downsides to having your tubes tied?
Overall, and via any method, tubal ligation is a very safe procedure. One downside is simply the surgical risks, if it is being performed any other time than during a C-section. Another is that there is an increased risk of ectopic pregnancy (a pregnancy in the tubes). The overall pregnancy risk after tubal ligation is less than 1%. But within that 1%, the ectopic pregnancy risk is higher.
a. When Breezy Mama interviewed former Bachelorette Trista Sutter, she said she was no longer having kids because she had this procedure which is non-surgical and hormone-free. Sounds like a dream – what’s involved?
That is a little misleading, as it is a surgical procedure, but can be performed in the office setting. Essure involves going through the vagina and cervix, visualizing the openings in the uterus where the tubes begin, and placing a copper coil in that opening to obstruct the tube. This is the method that requires the three month waiting period as it involves the copper coil to react with the tubal lining to effect complete blockage, and this takes time.
b. Will women who choose this option still get a period?
Yes, because again, the ovaries aren’t involved, and thus ovulation and menstrual cycle are unaffected.
c. Are there any downsides women should be aware of?
The main downside to this procedure is the waiting period. As well as a need for an X-ray dye test (HSG or hysterosalpingogram) at the three month mark, in order to demonstrate complete tubal blockage.
a. Would a woman ever opt for a hysterectomy to ensure she never gets pregnant again or are these only in the event of illnesses such as Cancer?
For sterilization alone, a hysterectomy would probably be too aggressive. But this must be individualized. If a woman is finished with childbearing, and has painful or heavy periods that affect her quality of life, then a hysterectomy might be an option.
b. Does a woman still get a period?
After a hysterectomy, there is no more period, as the uterus has been removed. Depending on age, the ovaries are most often not removed, so there will be ovulation and menstrual cycle symptoms. They simply don’t result in bleeding.
c. What is involved in the procedure?
A hysterectomy may be performed in many different ways: Through an incision in the abdomen; Through several small incisions with a camera (laparascopic hysterectomy); And through the vagina (vaginal hysterectomy). The best procedure varies from woman to woman and is always based on several factors, always discussed with her doctor.
What exactly is Uterine Obliteration and is it an option?
The actual term is uterine or endometrial ablation. This involves surgically cauterizing or burning the entire lining of the uterus. This is usually a treatment for heavy vaginal bleeding and is not a method of sterilization.
a. What is involved in the procedure?
This procedure is typically done in the operating room, though it can be done in the office. under direct visualization, an instrument is placed inside the uterine cavity and through cautery or heat or cold, the lining is burned.
b. This eliminates a woman from having her period altogether, correct?
Ablation can result in complete absence of bleeding, but not always. And the menstrual cycle persists (though often with little to no bleeding), because the woman is still ovulating.
c. Are there any downsides to this?
This is a very effective procedure to treat intractable bleeding with heavy periods, especially in the perimenopausal woman, but it never really is used as a sterilization technique.
Finally, are there any other options other than the above if a woman is done having kids?
Yes there are. If a woman is finished with childbearing but does not want a surgical procedure, she may opt for an intrauterine device, or IUD. These are placed into the uterus by a physician and can be used for five to ten years, depending which one is chosen (there are two.) They effectively cause sterilization while in place, yet are completely reversible and can be removed at any time. They are placed in the uterus in the office and removed in the office.
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About Dr. Rothbart
Famously flown to Namibia to deliver Brad Pitt and Angelina Jolie’s baby Shiloh in 2006 as well as appearing on Tori Spelling’s reality show, Jason A. Rothbart, M.D. is an Obstetrician/Gynecologist in Los Angeles. He attended college at the University of California at Davis, and medical school at The Chicago Medical School. He was trained in obstetrics and gynecology at the University of Southern California in the Los Angeles County Medical Center. He is back home practicing minutes from where he grew up, and has a wonderful practice with all ages, and is currently on the surgical and obstetric staff at Cedars-Sinai Medical Center.