What Does It Take To Get A Tubal Ligation?
Navigating Gynecologists’ Resistance to Permanent Birth Control
You Can’t Just Walk In To The OBGYN Office and Ask For It.
I was 14 when I told my mother I didn’t want kids. At the time, I’m sure she hoped I would grow out of it, but no such luck. I will be forever grateful to my brothers for making her a grandmother and me an aunt.
Granted, 14 years old is definitely too young for permanent birth control. You can’t get a tattoo or vote or go to war. But you can get pregnant, so just over a year later, when I fell in love with the boy who lived two doors down, she took me to get the pill.
It took me about a decade to figure out that hormonal birth control makes me clinically depressed. That was a rough ride.
My mother had been through her own ordeal trying to get a tubal ligation when I was four. She’d left her abusive husband while she was still pregnant with me. Although he was already re-married, her gynecologist refused to call him her “ex-husband,” when he laughed and told her definitively that when she went back to her husband and couldn’t give him any more babies, she’d sue the doctor who rendered her infertile.
He literally laughed in her face. I almost wish I’d been there to witness her chewing him out. I’m willing to bet everyone in the waiting room that day heard exactly what she thought of the good doctor and his precognitive abilities.
She had to go through a few surgeons before she found one who would give her the procedure. Doctors are reluctant to permanently end the fertile chapter in a woman’s life.
Ok, but that was in the early 80’s. Surely now, doctors respect their patients’ rights to choose whether and when they have children?
Spoiler: No. Not generally.
I can’t tell you how many times I’ve been in conversations with groups of women sharing tips on which gynecologists in town might be open to granting someone a tubal ligation. It’s a hot topic because I don’t know anyone who has been able to get one the first time they asked.
ProTip: Don’t think that because a doctor gave a tubal ligation to your friend, they are going to give you one. Your friend stumbled upon the secret knock that opened the hidden passageway. They discovered the magic words that particular doctor needed to hear. Or maybe they caught the doctor on a good day. More likely, they presented in some way that fit the doctor’s personal bias about who should be allowed to have this procedure.
At the end of the day, the gynecologist is in the position of playing amateur psychologist to determine what you really want, despite what you say you want.
It’s patronizing. It’s frustrating. It recapitulates every type of prejudice within our larger society. And there is jack shit you, as a patient, can do to change that, which is why we whisper tips and recommendations to each other at parties. That’s why we cycle through doctors with our fingers crossed. We’re pulling levers on the slot machine of our reproductive health, until we finally get lucky.
To pass your unstructured, unofficial psychological assessment with your OBGYN, you’re in for a fight. You’re going to have to answer a ton of personal questions that have no right answers. You’re going to have to get good at justifying yourself. Were you on the debate team? That would help.
If not, I’ve garnered some tips over the years.
Ask For Recommendations
I still support getting recommendations. Some doctors are categorically opposed to tubal ligation. If your doctor or their hospital is Catholic, they might be against any form of birth control. It’s not worth trying to change their minds. Just move on.
Ask around, not just among your friends. If you have a doctor you especially love, ask them to recommend a specialist who might be agreeable to a tubal ligation. I find exemplary doctors tend to recognize merit in each other, and likewise, they can spot mediocrity when they see it.
Standing Your Ground
Expect pushback. Even a doctor who is willing to perform the procedure is going to test your resolve. Don’t let that throw you. Be adamant. Do not blink.
If you have a conflict avoidant personality, you might struggle with advocating for yourself, especially with an authority figure, like a doctor. Practice.
You have to stand your ground, but take care not to over compensate by getting aggressive. The doctor can always dig their feet in, if they feel threatened. Consider bringing a friend, if you know someone who is good at stating a case without making people defensive. Remember, in the end, you still have to have enough of a rapport with the gynecologist to trust them to perform surgery on you.
Being A Grown Ass Person
Being old enough to get a tattoo or fight in a war is not enough. Some states set the legal age somewhere in the mid 20s. Your insurance might try to impose age minimums, as well. Even if they don’t, chances are you’re in for a fight against your doctor’s discretion.
If you’re under 38, it’s likely to be a very hard sell. If you’re under 30, you’re unlikely to win unless you already have several kids, but I hope you keep trying anyway.
If you’re over 39, you could end up with the opposite problem. Suddenly, doctors find your reproductive planning less important. Nature will be taking its course soon enough.
I recommend you think about how to respond to that in ways that don’t involve your middle finger. Best to go in prepared.
Being a Parent
It’s harder to get a doctor to give you a tubal ligation if you’ve never had kids.
If you have kids, you can make the case that infertility is the best choice for your children’s sake. Screw your needs, but medical complications and financial burdens could negatively impact your family. We are sometimes forced to play the martyr because it’s more expedient than advocating on our own behalf.
Again, nothing is foolproof. It didn’t work for my mom. She basically just threatened that she was going to keep trying doctors until someone tied her tubes. I picture her, younger than I am now, with my same piercing wide eyed stare, her brows raised, battle-ready in her don’t-mess-with-me tone of voice, saying pointblank, “Someone’s doing this procedure. Do you want it to be you or the next guy?” She was never one to blink first. I have her to thank for my moxie.
Establishing a Pattern
Any evidence you can offer to establish that you’ve been sure of this decision for a long time would be helpful.
ProTip: Most doctors are only going to listen to the first few sentences you say. Tell them what you need them to know quickly, and don’t throw in extemporaneous details that they might color with undo importance.
Don’t talk about a romantic break up. Don’t say you want to go to college or focus on your career. Don’t talk about situations that are inclined to be different 10–15 years from now. You don’t make a permanent change to your body for temporary reasons.
Talk about all the years you’ve been asking your doctors for this. Point to any evidence that will demonstrated that you are not going to change your mind.
Some places actually have a mandatory waiting period, just to make you prove you’re not being an impulsive hot head.
FunFact: Medicaid makes you wait 30 days from signing the informed consent form, longer than you have to wait to buy a firearm anywhere in the U.S.
Permission From Your Man
Yeah, it’s gross but I absolutely knew someone whose doctor finally relented after six years only on the condition that she marry her partner and the groom agreed to it. That is absolute trash, but she did it, and in her place, I probably would have done it, too.
In my friend’s case, it worked out. She wanted to marry the guy anyway. But what if she didn’t, or was unsure, and this doctor tipped the scales by dangling a surgery in front of her like a carrot to entice her into a marriage? That’s completely manipulative and unethical.
Also, you can see how prerequisites like this favor heterosexual monogamous couples. Pansexual sluts need birth control, too, Doc!
Keeping It Personal
Keep the focus on why pregnancy is not the right choice for you personally. Avoid listing all the generic down sides to giving birth and being a parent. Your doctor went all the way through med school and decided to specialize as an OBGYN, so they probably think babies are pretty ok. They spend their days watching families overcome all kinds of hardships in order to make new humans, so they can counter your reasoning all day long.
Don’t get into a philosophical debate on the merits of pregnancy with an OBGYN. They’ve trained their whole lives for that. This is your personal choice that you have the right to make for yourself, and it is not a judgement on anyone else’s choices.
Other Medical Issues
There are certain medical issues that will help make the case that you would benefit from a tubal ligation. Think about what applies to your situation and how to best present it.
Examples:
- Many doctors are more amicable to it if you have a history of complications during pregnancy.
- You can also mention any mental health problems that are relevant. Doctors vary wildly how on much they value mental health, but that is a topic for a different essay.
- You can discuss problems you’ve had with hormonal birth control, but that, by itself, is unlikely to be convincing.
- If you have a chronic pain condition, something like fibromyalgia, then bringing a baby to term could wreak havoc on your health and may disrupt your quality of life in irreparable ways. It’s not a golden ticket to self-determined infertility, but it’s worth arguing.
- There are also a number of chronic conditions that can be made worse by IUDs, especially conditions involving generalized pain and inflammation. Additionally, some medications, such as muscle relaxers, increase the likelihood of an IUD coming out.
- If you’ve ever had an abortion, definitely bring that up. A lot of doctors would rather you have a tubal ligation than an abortion.
- If you’re a transgender man using masculinizing hormones, then hormonal birth control is not an option, and IUDs, in addition to other problems, can trigger dysphoria. The medical profession has a tragically long way to go towards offering trans men equitable reproductive care.
PSA — Only bring these things up, if they apply to you. Never lie to your doctor about your medical history. You cannot predict all the ways that could seriously harm you.
No Promises
If you go in ready to advocate for yourself and prepared to counter the intrusive questions with unwavering confidence, then you have a better shot at convincing a doctor that you are competent adult who can decide upon your own birth control and not a 14-year-old eschewing motherhood for the first time. If you know from the jump that you are running head long into a mine field of someone else’s prejudices, then you won’t be as easily knocked off target by them. However, it could still take years or even decades to get your tubal ligation, and you might have to go through several doctors to find the right one.
Vasectomy
Most straight couples I know have given up on gynecologists and opted instead to pursue a vasectomy. Friends who’ve had vasectomies tell me they didn’t go through all of this strife.
There are still requirements, of course. You have to be at least 18. The urologist can refuse if they think you’re not mature enough, but my friends are plenty mature. They are exactly as mature as their female partners who can’t get a doctor to sterilize them.
They tell me their doctors don’t seem at all concerned that they might be doing this just to throw a tantrum after a bad break up. Apparently vasectomy doctors are not super worried about the patient’s spouse freaking out, either. It sounds like there’s just generally less supercilious debate about their competence to decide not to have children.
Of course, not everyone who wants a vasectomy can have one. Doctors do say no, but around here, it’s a thousand times easier to get permanent birth control if you have a penis.
