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Tubal Ligation

Having a tubal ligation

A tubal ligation, or having your tubes tied, is effective contraception without having to remember to do anything to prevent pregnancy. There will be no more pills or shots or condoms, or anything else. It is done either during a cesarean section or through a laparoscopic surgery. In a laparoscopic tubal ligation there will be one small incision made in the belly button and the other made just above your pubic bone for the scopes to be placed.

The benefit of doing it immediately after delivery is no extra time in the hospital and no trip back to the hospital. Also, published studies suggest that postpartum tubal ligation is the most effective, least likely to fail, tubal ligation.

Arranging a Tubal Ligation After Delivery

We can often arrange for the tubal ligation procedure during the same hospital admission for labor and delivery. The surgery can be done as soon as 2-3 hours, and as long as 48 hours. The timing depends upon lots of things, including day of the week, time of the day, availability of staff, and other scheduled surgeries. These same factors exist in small hospitals as well as big hospitals. The goal is to get the procedure done, and done safely.

If you want your tubes tied after delivery and before you go home, here is what to do, and what to expect: At the time of admission the patient needs to tell staff: “I want my tubes tied after my delivery.” Then, after the baby is born, the patient needs to remind staff: “I still want my tubes tied.”

You will either use the epidural you had for labor, be given a spinal anesthetic (awake anesthesia, like an epidural), or possibly general anesthesia (going all the way to sleep) for this procedure. General anesthesia is rarely needed for this procedure.

When To Do It

If the delivery happens after 12 pm, the tubal ligation will probably be scheduled the for the next day. If the delivery happens between 12 am and 6 am, the tubal may be done either that day or the next. The surgery is typically done between 8 am and 3 pm Monday through Friday. We usually cannot offer the surgery on a Saturday or Sunday.

We should not do the tubal ligation sooner than 2-3 hours after a vaginal delivery. We should do the surgery within 48 hours of delivery and patients must have an empty stomach, which is no food or drink for 6-8 hours before surgery time.

Tubal Ligation Any Other Time

If, for any reason, the tubal ligation can’t be arranged during your hospital stay, we can do it as soon as 4-6 weeks after delivery. Call Dr. Mackey’s office to arrange tubal ligation. The sooner a patient calls, the sooner we can get something arranged. We will then schedule a laparoscopic tubal ligation, instead of the postpartum tubal.

If, during your labor or hospitalization, you are having difficulty getting things arranged, contact Dr. Mackey, directly. It is expected that hospital staff and/or the patient can/should/will call, if there is trouble or confusion scheduling this surgery.

Risks

The following information is very detailed, and is simply meant to be complete. This is a VERY safe surgery. The topic is complicated. All surgery has the risk of bleeding, infection and damage to internal organs. Anything that is damaged during the procedure will be fixed either by the doctor performing the operation, or by a specialist, if necessary. This is rare. Complications can extend the time you need to stay in the hospital OR slow your recovery.

Limitations

This is a PERMANENT and IRREVERSIBLE contraception. You should be ABSOLUTELY SURE about getting your tubes tied, because we can not take it back. The published failure rate of the surgery is around 1/100. That means, if the number is correct, that as many as 1/100 women can get pregnant even if their tubes are tied. The bottom line is that you should view tubal ligation as effective (not more effective) than any other Hormone/IUD method.

Fewer than 1/100 women get pregnant after tubal ligation. As many as 50% of those women who get pregnant after tubal sterilization will have a tubal pregnancy. This is called an ectopic pregnancy, and it can be very dangerous. If you miss a period OR you think you are pregnant, you must take a pregnancy test. If you find that you are pregnant you MUST contact us, or another gynecologist for special evaluation for ectopic pregnancy.

Recovery

Typical Time in Hospital: This is same day surgery. You arrive approximately 2 hours before the scheduled time of surgery. The surgery takes approximately one hour. Most women are ready to leave the hospital around 2 hours after the procedure.

Recovery Time: The day of surgery is a “lost day.” You may feel a little out-of-it the day after surgery. By 2 days after surgery you are pretty much recovered. You may need some pain pills… and I will give you a prescription for pain pills to have after the operation.

Back to Regular Activity/Work: Most women are able to go back to work between 3-7 days after surgery. If your recovery goes slower I can fill out papers to keep you home longer. You must be seen in my office if your recovery is not going as quickly as we expect.