Tubal Ligation Health Article

Definition

Tubal ligation is a permanent voluntary form of birth control (contraception) in which a woman's fallopian tubes are surgically cut or blocked off to prevent pregnancy.

Purpose

Tubal ligation is performed in women who want to prevent future pregnancies. It is frequently chosen by women who do not want more children, but who are still sexually active and potentially fertile, and want to be free of the limitations of other types of birth control. Women who should not become pregnant for health concerns or other reasons may also choose this birth control method.

Demographics

Tubal ligation is one of the leading methods of contraception, having been chosen by over 10 million women in the United States—about 15% of women of reproductive age. The typical tubal ligation patient is over age 30, is married, and has had two or three children.

Description

Tubal ligation, or getting one's "tubes tied," refers to female sterilization, the surgery that ends a woman's ability to conceive. The operation is performed on the patient's fallopian tubes. These tubes, which are about 4 in (10 cm) long and 0.2 in (0.5 cm) in diameter, are found on the upper outer sides of the uterus. They open into the uterus through small channels. It is within the fallopian tube that fertilization, the joining of the egg and the sperm, takes place. During tubal ligation, the tubes are cut or blocked in order to close off the sperm's access to the egg.

Normally, tubal ligation takes about 20–30 minutes, and is performed under general anesthesia, spinal anesthesia, or local anesthesia with sedation. The surgery can be performed on either hospitalized patients within 24 hours after childbirth or on outpatients. The woman can usually leave the hospital the same day.

Tubal ligation should be postponed if the woman is unsure about her decision. While the procedure is sometimes reversible, it should be considered permanent and irreversible. As many as 10% of sterilized women regret having had the surgery, and about 1% seek treatment to restore their fertility.

The most common surgical approaches to tubal ligation include laparoscopy and mini-laparotomy. In a laparoscopic tubal ligation, a long, thin telescope-like surgical instrument called a laparoscope is inserted into the pelvis through a small cut about 0.5 inches (1 cm) long near the navel. Carbon dioxide gas is pumped in to help move the abdominal wall to give the surgeon easier access to the tubes. Often the surgical instruments are inserted through a second incision near the pubic hair line. An instrument may be placed through the vagina to hold the uterus in place.

In a mini-laparotomy, a 1.2–1.6 in (3–4 cm) incision is made just above the pubic bone or under the navel. A larger incision, or laparotomy, is rarely used today. Tubal ligation can also be performed at the time of a cesarean section.

The tubal ligation itself is performed in several ways:

• Electrocoagulation. A heated needle connected to an electrical device is used to cauterize or burn the tubes. Electrocoagulation is the most common method of tubal ligation.
• Falope ring. In this technique, an applicator is inserted through an incision above the bladder and a plastic ring is placed around a loop of the tube.
• Hulka clip. The surgeon places a plastic clip across a tube held in place by a steel spring.
• Silicone rubber bands. A band placed over a tube forms a mechanical block to sperm.

Tubal ligation costs about $2,000 when performed by a private physician, but is less expensive when performed at a family planning clinic. Most insurance plans cover treatment costs.

Diagnosis/Preparation

Preparation for tubal ligation includes patient education and counseling. Before surgery, it is important that the woman understand the permanent nature of tubal ligation as well as the risks of anesthesia and surgery. Her medical history is reviewed, and a physical examination and laboratory testing are performed. The patient is not allowed to eat or drink for several hours before surgery.

Aftercare

After surgery, the patient is monitored for several hours before she is allowed to go home. She is instructed on care of the surgical wound, and what signs to watch for, such as fever, nausea, vomiting, faintness, or pain. These signs could indicate that complications have occurred.