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Should I Get a Tubal Ligation?

To Tubal Or Not To Tubal

By Amalah

Amy,

I am almost halfway through my pregnancy with baby #4. My husband and I have always been on the same page, four kids are we are done. My husband is done done done. I feel the same, with a little less enthusiasm. We are both open to adoption or foster care in the future, so it makes the decision to do something permanent a little easier.

At my last OB appointment I discussed different options. I asked him what he would recommend, a tubal or a vasectomy. He said for a vaginal birth he recommends vasectomies and for C-sections a tubal. I will have a C-section. From everything I have read and talked about both options seem fine. I just keep picturing the end of my C-section with them handing me my baby and in the same minute I will also be permanently done with having kids. I’m afraid emotionally that will be hard. It would be silly to wait and have a tubal later. It is the easiest and most convenient option. My husband would be fine getting a vasectomy, it just seems like it would be much easier for me to get the tubal. I really don’t want to have to think about birth control again.

What do you think? Will it be too hard emotionally at the end? I don’t know anyone else who has been in this position that I can talk to. I have already had small moments of being sad that this is my last pregnancy (although very brief, because man I don’t enjoy being pregnant).

Any advice would be great.

Okay, so first of all, this is a very, very (veryveryvery) personal decision and situation, and what it is right for one person will be the exact opposite of right for another. But I think it’s a good thing for us all to talk about and share, and admit that there really isn’t anything “easy” about these sorts of decisions.

Personally, my experience is very colored by my mom’s. She was 36 when she had me (in the late 70s, when “older moms” were definitely not much of a “thing”), and she and my dad had SIX children between them from their previous marriages. She had a tubal the day I was born. She regretted it. A lot. Even though it technically made all the sense in the world — advanced maternal age! SEVEN children! on a high school teacher’s salary! etc.! — she and my dad ended up wishing they’d had just one more baby together. Ouch.

My OB/GYN also brought up this discussion during my pregnancy with Ike. Multiple times, actually. I was having a C-section so did I want a tubal? What about a tubal? He even asked one last time WHILE I WAS ON THE OPERATING TABLE. “Are we doing a tubal, you crazy baby-having person?”

My answer was always “no.” Like you, I just…I just couldn’t add that to my list of Things To Deal With While Newly Postpartum. I was probably just being a big chicken, but I was really, really scared of having it done and then immediately regretting it, and of not being able to look at Ike’s face without getting whalloped with the set-in-stone reminder that he would be My Last Baby Ever.

I told my OB/GYN that instead of permanent birth control, I would come in and get a copper IUD (Paraguard). That’s 10 years of not thinking about birth control (while also being hormone-free and safe for breastfeeding). But it’s also 10 years of knowing that I could change my mind at any time. 10 years would put me in my mid-40s, and I figured that by then, we’d either have decided to go nuts and have a fourth baby or actively decided against it, and Jason would get a vasectomy. (After three pregnancies and C-sections, I am all in favor of letting his parts bear the responsibility at that point.) I absolutely do not regret NOT getting the tubal when Ike was born. I am convinced it would have been the wrong call for me, at that exact moment.

And yet: the reality is that we are very probably likely done having children. Three children is…a lot, for us. It’s loud and complicated and draining and expensive and thoroughly, completely awesome. I am looking forward to the end of the baby/toddler phase. I am looking forward to life with three older children and trying not to freak out about the coming teenage years. I am giving away all our baby gear and clothing with wild abandon and dreaming of getting a tummy tuck. Maybe by now the tubal thing wouldn’t even faze me much at all.

(And yet: I still haven’t made that IUD appointment.)

Anyway, that’s MY story. It’s neurotic and probably not helpful, because your situation is yours and unique. Four children, possible plans to foster or adopt, a partner who is more emphatic on the DONE. Maybe an IUD would be a good compromise for you, rather than going straight to something permanent. And I don’t think there’s anything wrong with skipping the “convenience” of the C-section tubal if the decision isn’t sitting right with you for any reason or you’re worried about its impact on your postpartum emotions. (Which: Don’t mess with those bitches, no matter how many babies you’ve had. You know it’s always a slightly different set of loop-de-loops.) You’re having your fourth baby and that’s HUGE. There’s nothing irrational with putting a pin in another HUGE decision for a little bit, even if you’re just afraid of being a little tiny bit sad for awhile. 

On the other hand, you might always be a little tiny bit sad, no matter when you make the decision. Totally normal. Maybe getting the tubal done at the birth might have the opposite effect — you’re too busy being in love with your newborn to give it much thought! You have a special bond with your youngest because you know to savor every single last “first” from the get-go! We’re done and it’s okay because LOOKIT THIS BABY.

Give it a little more thought and decide which scenario seems more likely for YOU, for YOUR unique situation. Don’t let yourself feel pressured for being “silly” or whatever. This is a decision that involves the heart (and let’s be honest, the HORMONES), and there’s nothing wrong with being a bit Scarlett O’Hara and saying “I’ll think about that tomorrow” instead.

(Just uh…be very careful and don’t rely on breastfeeding as birth control in the meantime.)

Amazon Mom

Amalah
About the Author

Amy Corbett Storch

Amalah

Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy’s daily mothering adventures at Ama...

Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy’s daily mothering adventures at Amalah. Also, it’s pronounced AIM-ah-lah.

If there is a question you would like answered on the Advice Smackdown, please submit it to [email protected].

Amy also documented her second pregnancy (with Ezra) in our wildly popular Weekly Pregnancy Calendar, Zero to Forty.

Amy is mother to rising first-grader Noah, preschooler Ezra, and toddler Ike.

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Susan
Guest
Susan

I know that statistically it’s safe, but I’m looking at my sweet five-month-old boy conceived a few weeks after I got an IUD. I had been asking my husband to get a vasectomy for the last year, but we settled on the IUD in the meantime. After spending the pregnancy quite cranky about the whole thing, my baby boy is my sweet love and I can’t imagine life any other way. 

But my husband IS getting that vasectomy this summer. (data points- we’re 36 & 37 with 2 kids)

A different Susan
Guest
A different Susan

Ah, and here I was coming to rave about my Mirena IUD, which I got as soon as humanely possible after pushing out baby #2 (6 weeks, I think).  What I love the most (besides not having any more kids because we are DONEDONEDONE at age 37 and 41) is that I haven’t had a period since before I got pregnant with him (he’s now 2.5 yo, so that’s like 40 months of WHEEEEEEE).   There is a difference between the Paraguard and the Mirena so do your research before you decide.  I was all for DH getting the snippity-snip… Read more »

Stephanie
Guest
Stephanie

Lucky! I’ve had my Mirena IUD and while I didn’t have a period for the first six months or so, now I get them every four weeks like clockwork. Just saying it doesn’t end those pesky periods for everyone…

Sarah
Guest
Sarah

Every family’s situation is different, but I have made this very decision only it was with our second.  My husband and I had always said after two we would be done….so much so that with our first, we viewed it as a “test drive”.  Either we would have an only OR after seeing how it went, we would have a second.  And it went well enough, so we re-upped and had that second baby. I need to have a scheduled C with both babies because of cardiac issues (fine to gestate, just not fine to push).  And so since I… Read more »

AB
Guest
AB

After a history of infertility and a very difficult and risky second pregnancy, I KNEW I didn’t want any more children, but I also was terrified that something would happen to my baby. I just couldn’t bring myself to do anything permanent until I knew for sure and certain that I could bring him home from the hospital. I opted not to have a tubal as part of my CS, and tentatively planned to get Essure after a couple months.  As it happened, fate intervened in the form of a postpartum infection. I had a lap to remove my left… Read more »

Jackie
Guest
Jackie

In addition to deciding if you are done or not, I would also consider the other consequences to having a tubal.  The blogger linked below experienced this and after reading about her experience I personally won’t consider it as an option now.  

http://extraordinary-ordinary.net/category/ptls/

C
Guest
C

This is super depressing and heartbreaking, but this made sufficient impact to affect my decisions 25 years later: When I was ~12 my mother had surgery and shared a room with a woman having her tubal reversed because her children and sister will all killed in a house fire and she and her husband wanted to try and have another child. From a superstitious, don’t tempt fate point of view, it’s the first thing I think about when considering permant birth control, and the reason that I could never consider it.

Kacie
Guest

Ditto this. Tubals aren’t perfect (nor are vasectomies). I have seen plenty of tubal horror stories around the interwebs, and it’s frightening me, personally!

Not sure what we’ll do when it’s time to be done…but I’m not getting a tubal.

Samantha
Guest
Samantha

Don’t do permanent sterilization unless you are POSITIVE about it. My husband was DONE DONE DONE. I wasn’t quite as sure, so I started with the IUD, and then our second was born with a congenital heart defect. I still wasn’t positive, until we had been through her surgery and the aftermath. I couldn’t do that again, so I became as done as my husband, and he got a vasectomy. I kept the IUD for a while longer because I loved the no periods. But, then I started getting monthly bacterial vagenosis (not fun!) and got it removed. I’m just… Read more »

Helen
Guest
Helen

i was all gung-ho to have a tubal when I had my second c-section, but then we discovered that there were some potentially serious issues with my son’s health, and it didn’t seem the right time to be making a decision about the possibility of never having another child. Fortunately his health issues were resolved very quickly, and *then* I went ahead with the tubal: but it’s a lot more hassle to get it done when they’re not already rummaging around in there for something else, plus I had to take a break from breastfeeding because of the anaesthetic. In… Read more »

Debra
Guest
Debra

I had an Essure device implanted after my third but about a year after. I did a ton of research and thought it had the fewest side effects of any of the permanent choices. I’m so glad I did. I knew I was done at that point given the progressively worse time my body had with each pregnancy and I haven’t had a single problem with it since. 

Debra
Guest
Debra

Oh, I forgot to mention that many doctors can perform this under local anesthetic in their office and it’s not anything like the hassle of the tubal. My doctor prefers to do it under general for the patient’s comfort but it was still a quick outpatient procedure.

Kelcey Kintner
Guest

Great answer to this question. I did consider one after my 3rd and 4th (twins) were born but I feared the emotional impact. I have known others who have had a very difficult time with getting their tubes tied despite the fact that “it totally made sense at the time.” I decided against it and I’m about to have my surprise 5th so…..

Just because you’re having a c-section isn’t necessarily reason enough. Follow your gut on this. It’s so personal. Keep in mind, a vasectomy is relatively easy procedure these days.

Marci
Guest
Marci

I second the Essure device.  It is permanent birth control and my doctor called it a tubal.  I had it done a few years after my third child.  It was a quick and easy outpatient procedure that I was awake for.  I was out and about later that day with my kids.  I highly recommend it.  Also, it’s safer than a vasectomy because there is no cutting involved…nothing to get infected.

Dayna
Guest
Dayna

I’ve seen too many heartbroken women who have gotten tubals and then had a surprise! pregnancy, only to find out the fertilized egg was stuck in the tube. Some had to have surgery to remove it. That would KILL me. I’m for vasectomy all the way 🙂

Hannah
Guest
Hannah

I had my first (and most likely only) child as a result of IVF, because I am the carrier of a particularly nasty genetic defect, and that was the only way (combined with PGD) that we were assured (as much as statistically possible), that our kid wouldn’t have massive mental and physical problems. About 5 months after she was born, I had the Mirena implanted. It worked well for about 8 months. Then, I started getting two periods a month, with horrible accompanying migraines. Out it came. After a lot of thought, I went in for a tubal. Because of… Read more »

Kim
Guest
Kim

I think if you have doubts, you should wait.  I signed up for a tubal during my second pregnancy, in the event that I needed a c-section. (I didn’t, and the OB on call showed up the next day very confused about doing a tubal on a postpartum woman.) But – I was 44, we were absolutely certain that 2 was it (2 was a bonus!,) and I had a conversation with my husband that even if something went terribly wrong, we were not going to try again. 3 years and no vasectomy later (that’s a whole ‘mother question, isn’t… Read more »

nagehan @ contemporary mother
Guest

Vasectomy is a 5 minute procedure and it’s less invasive than tubal. Sometimes I wonder why men think that women should take on this emotionally harming procedure when they also have the option of putting an end to future pregnancies.

I’d say think about it long and hard. Again, vasectomies take very little amount of time and less harmful of a procedure than tubal.

Maggie
Guest
Maggie

We were sure that we were done with one. I needed to have a scheduled c-section because of prior removal of several large fibroids. It made the most sense to have the tubal during the c-section. I was going to be open anyway and it only took a few extra minutes. The doctor confirmed it on the table before he did it, but other than that I didn’t think about it at all. I was too busy trying to see my new baby. I never thought twice about it during the hospital stay. There have been a monent or two… Read more »

Ashley
Guest
Ashley

If you’re on the fence, I wouldn’t do anything permanent during the c-section.  I was in the same place as you with my last pregnancy.  When my youngest was a year old, my husband had a vasectomy and was completely fine with it.  The only thing I’ll add is that when you start to have perimenopause symptoms sometime in your 40’s you will have at least one or two “scares” where you are 2 or 3 weeks late and you are sure the vasectomy reversed itself!   Thankfully it hasn’t, it’s just my hormones out of whack!

Ashley
Guest
Ashley

Oh this topic is very much on my heart right now. We just had our second and it took a lot for me to even want to try for him. I had very bad PPD with my first and it’s a whole new world this time. Instant bonding and love which makes me question being done. My husband is done done done though. We had agreed for the longest time that he would get a vasectomy. He got it last week and the reality of it has been devastating for me. I had questions leading up to the procedure but… Read more »

Kate
Guest
Kate

Hormonal birth control works by suppressing ovulation therefore there is no egg to be fertilized and no conception occurs. 

Sarah
Guest
Sarah

Some (most if not all of the more commonly prescribed) birth control pills also thicken the mucous lining making it harder for a fertilized egg to implant. To have a pill completely suppress ovulation the hormone level has to be so high it can have bad side effects. I would have an open conversation with your doctor and not all doctors are experts at how different pills work. I don’t know about any of the more permanent birth controls because I’m not there yet so have not researched them.

Jess
Guest
Jess

That’s such a tricky one! My husband had a vasectomy when our second was about six months old because we were both *so* sure we were done even though we’re both only 32 years old. We weren’t sure what else to do birth control wise; our first was conceived while I was on the birth control pill, my cycles have always been so wacky that I didn’t trust NFP, and my best friend had recently nearly died after having an ectopic pregnancy (caused by her IUD), which burst and caused major internal bleeding, so I really wasn’t comfortable with the… Read more »

betttina
Guest

Swistle.com had great information about how she and her husband made the decision to be done (he was DONE DONE DONE; she didn’t enjoy pregnancy but was only sort of maybe done) and while I was looking for that series of blog posts, I also found:
http://lifeinatinytown.blogspot.com/2010/09/why-four-is-magic-number.html

Here are some of the (EXCELLENT) Swistle articles:
http://swistle.blogspot.com/2007/07/birth-control.html
and
http://swistle.blogspot.fr/2007/09/why-i-stopped-taking-mini-pill.html

Kat
Guest
Kat

Oh – how timely! My son was a surprise (as much as that can be – oh, you forgot to take the pill a few times? Yeah, that equals a pregnancy in my case). My pregnancy was extremely unpleasant (sick the whole time, bedrest for the last two months, non stress tests and ultrasounds several times a week for the last 6 weeks), and my husband was worried about me and the baby the whole time. We were so miserable during that we decided while I was pregnant that he would get snipped. He did, about 3 weeks after our… Read more »

Kate
Guest
Kate

I had baby #2 3 months ago and was asked if I wanted a tubal during my planned section. We are 99% sure we’re done but it just didnt seem like a decision I should make while pregnant. I mean when you’re pregnant it sure sounds nice to make sure you never will be again. But then you have this sweet little baby, and you think..maybe one more? I went ahead and got the Paraguard IUD (no hormones) and so far I LOVE it. I haven’t had a period yet, but just knowing I’m covered without having to take hormones… Read more »

Call Me Jo
Guest

Most of the time vasectomies work great, but remember there is always a chance. I have a little brother who is proof of that!
That said, vasectomies are a much simpler procedure than a tubal with better outcome rates related to infection, etc. 

Autumn
Guest
Autumn

I would hold off on the tubal at the time if you are that worried about it now.  If you are a candidate and IUD would be a great option for you.  I wish I was an IUD candidate, but my OB warned me that my really heavy periods could get worse.  I’ll stick with the magic pills.  We have a 20 month old, and the concept of #2 isn’t as scary as it used to be.  Timing will be tricky since a spring baby would not be career enhancing for Mr Autumn. THe question I keep asking myself is… Read more »

Heather
Guest
Heather

I made this decision 7 months ago, while pg w/ my 3rd. I would keep having children (up to 6, I think!) but my husband is done (feels great about our 3 kids, worried about putting 3 kids through college, our retirement, etc). I am 41, though, so I feel like being AMA is a big consideration. I love being pg, would love to have a large family, and get very sad about this part of my life being over. I also worried about seeing other pg women and being envious about their pregnancies! The first time I brought up… Read more »

Susan
Guest
Susan

“After three pregnancies and C-sections, I am all in favor of letting his parts bear the responsibility at that point.” Amen, sister, Amen. I knew I would never be able to have a tubal at the time of birth – it definitely wasn’t right for me. And I had absolutely no problems with telling the hubby, “after 4 kids, it’s your turn”. We never got that far, sadly. I had to have a complete hyst prior to us getting things done, so to speak. But yeah. I would not have had any problems not having a tubal at delivery and… Read more »

Terri
Guest
Terri

I am currently 30 weeks pregnant with my third, and I knew even at 6 weeks pregnant she would be my last. I have never had one moment of being unsure if it was the right move for me. I still remind my OB every appointment that at my C-section not to forget to tie my tubes. I’d opt for even more than a tubal, but I’ve read that it is risky to do that right after a baby… so I will wait. My husband was “done” after our first, but I knew I wasn’t so he had a vasectomy….… Read more »