Tubal Ligation

What is Post-Partum Tubal Ligation?

• Tubal ligation is permanent sterilization (irreversible birth control) by cutting and tying your fallopian tubes.
• Post-partum tubal ligation is permanent sterilization or irreversible birth control done after delivery of your baby.
• It can be done at the time of C-section or after vaginal birth.

How is Post-Partum Tubal Ligation Done?

• You and your baby must be stable after delivery.
• A postpartum tubal ligation usually does not extend your hospital stay.
• Your obstetrician will discuss with you again the birth control options and their risks & benefits to ensure that you still understand your options and continue to want permanent sterilization.
• He or she will also go over the surgical risks that are associated with tubal ligation.
• If you are still 100% certain that you want to use tubal ligation as a permanent birth control, then the tubal ligation will be done.
• You are taken to the operating room.
• The existing epidural or with local injection & intravenous sedation will keep you comfortable throughout the procedure.
• A 2-3 centimeter (approximately 1 inch) cut is made under the belly button.
• Your belly is entered and the fallopian tubes are located, tied with absorbable sutures and a segment of it cut.
• The incision is closed with absorbable sutures or skin glue.
• You will recover in 1-4 hours and go home on pain pills.

Will I Always Have the Tubal Ligation Before Going Home?

• If your have a -section, postpartum tubal ligation is done after the uterus is sewn together, there is no significant bleeding and you and your baby is stable. This additional procedure adds another 5-10 minutes to the C-section.
• If you have a vaginal birth, the tubal ligation is done immediately, the day of discharge or about 2 months after the delivery.
• This is an elective procedure; it is done on a time and resource availability basis. If Labor and Delivery is full or if there are multiple urgent cases in the main operating room, your postpartum provider will discharge you to go home.

I Did Not Get My Postpartum Tubal Ligation. What is Next?

• If time and resources do not permit doing your postpartum tubal ligation, your discharge provider will offer you a reversible method of birth control (pill/patch/Depo-Provera/IUD) depending on your breastfeeding status.
• When you come back for your postpartum exam, your provider will place a formal consult for an Bilateral Tubal Ligation.
• Remember, there are other as affective and reversible birth control methods (i.e. pills, patch, uterine systems / devices, Depo-Provera, rhythm, condom, spermicides, cervical caps, diaphragm).
• Many of these reversible methods (i.e. pills, patch, or progesterone impregnated uterine systems ) offer other benefits aside from birth control. They can regulate your menstrual cycles and/or decrease menstrual cramping.
• Don’t forget, vasectomy is still the safest form of permanent sterilization

Interval Tubal Ligation

• Are you a Tubal Ligation Candidate?
• Interval tubal ligation is perform at any time not associated with delivery of the baby.
• If you had just given birth and were unable to get your postpartum tubal ligation, you must wait at least 6-8 weeks as interval tubal ligation is very different than postpartum tubal ligation.
• Two types of interval tubal ligation
  • Laparoscopic Tubal Ligation
  • Hysteroscopic Tubal Ligation

Laparoscopic Tubal Ligation

• You will be under General Anesthesia
• A small cut will be made under the belly button.
• A small camera will be inserted to survey your abdominal/pelvic organs. (Laparoscopy)
• One or two more small cuts will be made in the pelvis area to insert laparoscopic instrument to perform the tubal ligation.
• The fallopian tubes can be disrupted with:
  • Rings
  • Clips
  • Burning
  • Removal, through cutting the entire or a segment of the tube.
  • The skin is closed either with glue or absorbable sutures.
  • You go home after 2–4 hours of recovery.

Hysteroscopic Tubal Ligation

• This is a novel way of performing interval tubal ligation.
• It is as effective as laparoscopic tubal ligation.
• You are either under General Anesthesia, IV Sedation with Local Injection of the Cervix, Oral Pain Medication, or Spinal Anesthesia.
  • Most people are very comfortable with IV or Oral sedation.
  • A few choose spinal anesthesia.
  • There is rarely any need for general anesthesia for this procedure.
• Your gynecologist will discuss with you Surgical Risks associated with this procedure.
• A camera is inserted into the uterus (hysteroscopy).
• Two very small Titanium coils are placed in the opening of the Fallopian Tubes. This will not interfere with going through metal detectors.
• You have to use birth control for 3 months.
• After 3 to 4 months, a dye test (Hysterosalpingogram) is done to confirm occlusion of your tubes.
  • After confirmation of occlusion of the tubes, you can have sex without protection.
  • If the tubes are still open, you will continue to use birth control and repeat the hysterosalpingogram in 2-3 months. This rarely happens.

Tubal Ligation Candidate

• You are a candidate for tubal ligation if you are:
  • 100% certain you do not want anymore children the rest of your life. This is regardless of marital situation (i.e. remarried to a man who wants children) or death of a child.
  • Want to be sterile (unable to bear children) for the rest of your life—permanent sterilization.
  • If you have medical conditions that makes pregnancy dangerous to your health.
  • You do not want other forms of birth control.
  • Accept the surgical risks.
• Your husband does not want a vasectomy. Of the two procedures, vasectomy is much safer than tubal ligation.
• Understand that there is a 1 in 150 - 200 chance that the tubal ligation may fail and you may end up pregnant. Abstinence is the only 100% birth control method.
• Understand that there is a high risk of tubal pregnancy (ectopic) pregnancy if you conceive after a tubal ligation. Ectopic pregnancy has the potential of causing internal hemorrhage and even death.
• You voiced your request to an OB Provider and was counseled at least once before your scheduled tubal ligation.