hey guys welcome back mama dr. Jones
OBGYN and mom 2 4 we're talking about
tubal ligation or getting your tubes
tied and having to have your husband's
consent for that this tweet is from
Hollie resist and it says my OBGYN just
said if I want my tubes tied electively
than my husband's signature is also
required on the release form I asked her
if that was a long she said it's not but
it's their policy my face has been stuck
like this for 15 minutes I'm pissed as
you should be Hollie resist that is
insanity let's talk about it a lot of
you guys were tagging me in this asking
me is this true do you do this is it
required what does the law say my
initial reaction was this is insane I've
never heard of this this must be just
some terrible physician the more I
started reading the more I was horrified
by everybody's experiences with
discussing tubal ligation with their
physician so I wanted to look more into
what are the laws surrounding requiring
a spousal consent for permanent
sterilization and then to talk a little
bit more just about tubal ligation or
getting your tubes tied in general so I
found an older article this is 1974
Journal of American Medical Association
which is JAMA a very popular
peer-reviewed research journal I can't
see the whole thing but I can see the
abstract and even then it seems like
there was some contention among
physicians whether this should be
required or not newsflash 1970s it
should not I'm calling you from 2020 and
we're apparently still having problems
with this and I don't know why and it's
blowing my mind it seems like this was
extremely common in the 1970s that was
legally challenged in a handful of legal
cases deemed inappropriate to require
spousal consent for permanent
sterilization however it never went to
the Supreme Court so it was never
actually made illegal it just was kind
of looked down upon that means nobody's
stopping any individual physician or
hospital system from having this as
requirement which is crazy it is worth
saying that there's a lot of really
insane regulations from both the federal
government and insurance companies and
hospital systems about permanent
sterilization for instance if a hospital
system is Catholic owned you can't do
permanent sterilization procedures in
that hospital at all patient comes in
they're pregnant they're having a baby
by c-section they want their tubes tied
doesn't matter you can't do it that
Hospital has deemed you can't tie tubes
in its facility in the town I live in
there are two hospitals one of them they
can't do any kind of permanent
sterilization procedures they also won't
place IUDs unless it's for something
other than contraceptive birth control I
don't work anywhere like that I would
have a very hard time with that it was
never made illegal and now what people
can just do it if they want I guess so I
live in trained in and work in the south
and have never been around this
personally there are plenty of people on
the internet who are saying that they
experienced this and I asked a group of
my OBGYN friends there were a handful of
them who said yeah I've worked with
someone who does that you guys why less
common but still written about is
spousal consent being required for
vasectomy I found a handful of places
where people were saying this but by and
large the men that I saw talking about
this were like no I just walked in and
got my vasectomy based on completely
anecdotal evidence because I don't have
any way to get any evidence other than
that it seems like it happens much less
frequently with vasectomy it needs to be
made illegal because that is not okay
you own a uterus but you're a person
with autonomy to make decisions for
yourself first and if you are in a
situation where you want your tube side
and your spouse doesn't want you to do
that the first thing you should do is
work it out with your spouse but I'm
saying that from the privilege of being
in a relationship that's not
manipulative and not one-sided
every person has autonomy over their
body and their decisions I didn't feel
like I had a ton to say about that other
than one it's abhorrent to it should go
away and three how do we get it to the
Supreme Court to make it a federal law
that you can't require spousal consent
for someone to get their tube side I
need a breather when I talk I don't know
the answer to that I don't know how to
make that happen it would be nice if
maybe someone watching this knew that
another
and I noticed it seems like people are
very frustrated in the process of trying
to get their tubes tied particularly if
they are young or don't have children
even people who didn't have a spouse
were being denied tubal ligation based
on a single factor or a couple of
factors there's a whole reddit thread of
people saying I couldn't get my tubes
tied because of my age because I hadn't
had any kids and so I wanted to talk a
little bit about the reasons I think
maybe this happens and how I think it
can be avoided and why I think it's
important to discuss this issue this is
a good segue into tubal ligation in
general what is tubal ligation tubal
ligation is taking a segment of the
fallopian tubes out or learning a
segmented fallopian tubes together it
essentially blocks the sperm from being
able to get through the tube to where it
would meet the egg they stay separated
no fertilization can occur no pregnancy
can occur tying the tubes is a misnomer
we don't tie the actual tube that's not
anatomically possible we need to have a
discussion about what is permanent tubal
ligations
are permanent and intended to be
permanent I made a tech talk about this
one time the comments were kind of
overtaken with people saying it's not
permanent my friend got pregnant after
getting their tubes tied my friend had
their tubal reversed
permanent does not equal fail-proof
there is a failure rate for any type of
contraceptive that you use including
tubal ligation it's very low weigh less
than 1% but it can't happen can you
reverse a tubal I would consider this to
be the same as a tattoo nobody says
they're not permanent my friend had
theirs removed tattoos are intended to
be permanent that doesn't mean that you
can't sometimes cover them up or get
them removed but they're intended to be
there forever and there are consequences
that come along with trying to reverse
that so the same goes for tubal ligation
it can be very difficult to have it
reversed sometimes it doesn't work it's
very expensive it's intended to be there
forever why does this happen why are you
guys telling me that you've been denied
tubal ligation because of your age or
how many kids you have I think this
probably happens for a variety of
reasons one of them being training
system of obstetrics and gynecology has
some very sick
we can't roots in paternalism we are
working really hard to get that
undercurrent completely wiped out but
there are still some of those things
there and I don't know that there are
always things that are recognized overly
I don't think that means that every
physician who has said no to someone is
paternalistic I think there are
multifactorial things that go into this
this conversation especially in somebody
who is young is really really important
to be had in a way that is extensive and
two-way like me talking to you and you
talking back to me you own a uterus but
you are a person with the ability to
make decisions regarding your body first
and I cannot ignore that and still be a
good doctor time with our patients is a
huge factor in why this conversation
isn't given the right amount of
attention and the correct discussion
there also are probably physicians out
there who just kind of suck at talking
about things like this I can't fix that
but I can have the conversation here
with you guys in there how I would in my
clinic ACOG has a whole committee
opinion on permanent sterilization some
of the things they really stress in that
committee opinion are respecting
autonomy for the patient discussing the
risks of the procedure discussing
alternatives to the procedure discussing
benefits of the procedure this is kind
of the process we go through with any
risk benefit discussion or at least I do
and I think anyone should inform consent
includes risks benefits and alternatives
and it's a two-way discussion I don't
just give you a paper and have you sign
it it requires both of us to be open
minded and listening what are the risks
the risk that we always hear talked
about is the risk of regret in my clinic
I always start this conversation with
I'm going to talk to you about the risk
that you will regret this procedure and
I say the first thing you think is I'm
not going to regret it nobody brings up
getting their tube side if they think
they're going to regret it every single
person who ended up in the regret group
thought they would not end up in the
regret group you can't approach this
like I will never be the person who
regrets it you have to approach it as
sharing the data and understanding it so
that if you ever
you get to a point where you regret it
you go yeah I knew this was a
possibility I didn't think it would
happen to me but here we are
this is understandably hard to fully
study and assess because you can't
really quantify regret like how much it
interferes with someone's lifetime I
could regret it but then it's like well
yeah I wish I hadn't done it but oh well
and then someone could regret it so much
that it completely destroys their life
moving forward and that's hard to
quantify a very common misconception
that I see is that you're more likely to
regret a tubal ligation if you don't
have any kids that is a myth and it
continues to be propagated by the
medical community over and over and over
if someone is child free by choice or
has had a lot of miscarriages and
decides they don't want to go through
that again they actually fall into a
low-risk regret category so stop telling
people they can't get their tubes tied
because they don't have kids most of the
data that I'm gonna go through comes
from a crest study I'm going to link it
I recognize that this data is relatively
old I am unaware of any data that is
newer or any data which goes against
what I'm about to say so if someone
knows of better data which is more
recently published or data which is
decent and disagrees with this please
let me know the risk for regret if
you're less than 24 is around 40% that's
not insignificant that's a lot of people
between 24 and 30 is about 20% wide a
few people but a lot lower than 40 for
ages 31 to 35 is about 8% and risk for
over 35 is about 2% what do we do with
these numbers it's important to think
about them in a sense of most people if
you look at those numbers most people in
all age groups don't regret their
decision so in a patient who is well
counseled on the risk and still wants a
procedure done I feel like they
shouldn't be told no surely based on age
no discussion about permanent
sterilization is complete without
talking about the alternatives that
includes long-acting reversible
contraceptives like IUDs and Nexplanon
which is the implant that goes in the
arm
they have failure rates equal to tubal
ligation and they are reversible as well
as vasectomy which is a permanent option
for
a person who's in a relationship with a
single male partner that's obviously the
only time that would be something that
worked
it is both cheaper lower risk and as
effective as tubal ligation I think it's
worth noting than in someone who's in
that really high risk of regret group
there are things that maybe they can
consider for a year or two and see if
they still feel the same maybe they get
an IUD for a few years and then decide
to get there to decide it's just an
option it should be discussed in
practicality it's really hard I think
for some people to have this discussion
without seeming like they're ignoring
the patient's autonomy and so you'll
notice in the discussion as I have it I
continue to reiterate I want to give you
the information so that you're fully
aware but at the end of the day if you
go through it and you still want your
tube side you get to make that decision
you have the autonomy to do that you
know which categories you fall into you
know if you're more likely to have
regret or not based on your age and then
there are other factors that come into
it too but that's the biggest one and
you also know what your life situation
is and what your motivations for seeking
this procedure are now what are the
benefits I think this is something
that's largely ignored the benefits also
include avoiding the risk of undesired
and unintended pregnancy which includes
things like seeking abortion having a
baby you don't want all these things
should be included in the risk I have
taken care of patients who have had
their tube side and regretted it and
it's really really terrible at the same
time that should not be done at the
expense of denying someone their
autonomy to choose to do what they would
like with their body although I
understand and have been in the position
of wanting to avoid potentially
contributing to sterilization regret we
also have to avoid paternalism - holly
resists and everybody else who has been
through something like this and shared
your story thank you you sharing your
story helps me to see that this is
happening and to speak up and try to be
a voice of reason and also kind of bring
some clarity to the situation for anyone
who needs to bring this up with their
physician do you feel like you're not
being listened to find anyone I know
that's not always easy but that's the
one if you're not subscribe hit that
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Monday be kind to yourself to each other
to me in the comments be kind and I will
see you next time
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