Few decisions are more personal than whether or not to have a child. For some of us, the answer is an easy yes or no. For others, it requires a bit more soul searching. When the answer is no, there are a number of birth control options. Most allow a woman to delay having a child by preventing pregnancy temporarily. Another option, tubal ligation, is a much more permanent solution.

Tubal ligation is a viable option both for women who've never had children, and never want any, as well as women who've had children and don't want anymore. Yet while we've all heard about "getting your tubes tied," what exactly does it mean, what's involved and what are the risks associated with this procedure?

What is tubal ligation, and how does it work?

Tubal ligation, or getting your tubes tied, is a surgical procedure which involves a few small incisions near your belly button, and perhaps on your lower stomach as well. Your doctor will then locate your fallopian tubes, cutting, clamping or otherwise blocking them, and then close up your incisions. This is generally a one-day surgery that won't require you to stay overnight.

Getting your tubes tied is also sometimes referred to as female sterilization, since it permanently prevents pregnancy. Cutting or sealing your fallopian tubes stops sperm from ever meeting egg. No fertilization: no baby. While you will still have your period, you will essentially be sterile.

How effective is tubal ligation?

Getting your tubes tied is a very effective method of permanent birth control. According to the Johns Hopkins website, only about 1 in every 200 women may still become pregnant after the procedure. This might happen if the fallopian tubes weren't fully closed during the procedure (since sperm can wriggle through even the smallest of openings), or if an egg was released before the procedure, and becomes fertilized (an ectopic pregnancy). Overall, however, tubal ligation, or female sterilization, is one of the most effective methods of birth control, period.

Is it safe?

Getting your tubes tied is relatively safe. In fact, the biggest risk is associated with the fact that it involves a surgical procedure. As with any surgery, there are certain risks of infection or a poor reaction to your anesthetic. Pre-existing conditions such as diabetes might increase your risks as well. Your doctor will go over specific risks and things you need to consider when you discuss the procedure with her. 

What to expect from a tubal ligation

Even if you're definite about not having children, or not having any more children, getting your tubes tied can still be a scary procedure to face. Here's what to expect:

Before

Like any other surgical procedure, your doctor will have specific instructions about when to stop eating and drinking the night before. Arrange for transportation home from the hospital afterwards, as well as someone to stay with you until the anesthesia has worn off, just in case.

During

You'll either receive a general anesthetic, which sends you to sleep, or a more localized anesthetic, in which case you'll either be completely awake or in a light twilight state. You won't feel any pain during the procedure, and it takes less than an hour.

After

You'll have specific instructions about caring for your incisions, such as how long to keep them dry, as well as what kind of activities can be resumed when. You will be a bit sore, and perhaps groggy from the lingering effects of your anesthetic.

How to best prepare for getting your tubes tied

You can take a few days from work, or at least give yourself a long weekend, to recover. And don't schedule any social events within a few days of your procedure, in order to give your body time to rest and recover. However, the most important preparations you make should be mental.

While this procedure can be reversed, it dramatically decreases your chances of actually becoming pregnant. Be sure you've discussed this choice with your doctor, and with someone whose opinion and feedback you trust.

If you're with a partner, even if you've both agreed previously not to have children, or not to have any more, another discussion about the procedure and its ramifications is still a good idea. Better to address any doubts before your procedure than to have to deal with regrets afterward.

Pros and cons of getting your tubes tied

Below is a general list of positives and negatives associated with tubal ligation, but you'll no doubt be able to add some of your own personal reasons or concerns. Factor these in when you discuss the procedure with your doctor, your partner or a trusted friend.

Pros

• relatively simple procedure: a one-day surgery, and no major incisions
• chances of becoming pregnant are very low
• "reversible," should you experience a change of heart
• peace of mind: knowing you don't have to worry about a contraceptive

Cons

• surgical risks, such as infection, are still a consideration
• ectopic pregnancy (an egg becoming fertilized inside the fallopian tube) is still a possibility
• "reversible," but with a lowered chance of conceiving afterward
• regret if you later decide to have a child, and are unable to conceive

Other methods of birth control

There are, of course, other methods of birth control: the pill, the patch and IUD implants. All of these, barring one IUD (intrauterine device, if you opt for the copper type), utilize hormones to varying degrees to prevent pregnancy. All of these are also short-term preventatives, and you can become pregnant not long after removing or discontinuing use. Bedsider has an awesome rundown of every birth control option, and tons of other info too.

FAQs

1. Can a tubal ligation be reversed?

Yes, your tubes can be reattached or unblocked, but with varying success rates in terms of being able to become pregnant afterward. In fact, according to some studies, your chances of conceiving can dip as low as fifty percent.

2. How soon can you have sex after getting your tubes tied?

Most doctors will advise about a week, in order to let yourself heal. However, everyone heals and recovers (physically and mentally) from a procedure differently, so you can take as long as you need.

3. How much does a tubal ligation cost?

If you don't have insurance, getting your tubes tied can cost a couple thousand dollars. This will include your initial consultation, the procedure itself and also any follow-up appointments, including having your incision stitches removed. If you do have health insurance, check your policy to see how much of this cost your plan will cover.

4. How long is the recovery period?

You'll have to consult your doctor for timelines on specific activities, but within a month most women are back to about their regular routines. 

5. What are the side effects of getting your tubes tied?

The sides effects are predominately those associated with any surgical procedure: pain around your incision areas, possible infection, adverse reaction to anesthetic. However, since it involves such a sensitive area, it may also affect your desire to have sex, for a while.

6. What happens if you get pregnant with your tubes tied?

There is a possibility of becoming pregnant even after getting your tubes tied. In fact, the younger you are when you have the procedure, the higher the chance your fallopian tubes may even grow back together. In this case, a woman could have a perfectly normal pregnancy. Other times, a fertilized egg might end up in the fallopian tube. This is called an ectopic or tubal pregnancy and is a health concern you'll need to go to the doctor to address.

Final thought

When you come down to it, the biggest issue with tubal ligation is the decision to have it at all. We don't get to talk much about the social pressure aspect of motherhood, do we? But we should. Just because you can have a child doesn't mean you actually have to, or want to. If you're already a mother, talking about getting your tubes tied is a little less stigmatized, since you've already experienced those "joys" of maternity. Yet even so, removing the possibility of experiencing that again can be a heavy topic. Make sure you think about it, and talk about it with people whose opinions you trust, before you decide what's right for you.

Overall, however, tubal ligation is a short, simple procedure that can ease your mind about unwanted pregnancy almost completely. While there are risks, and it can be a tricky thing to reverse in terms of actually conceiving, getting her tubes tied has put many a woman's mind at ease. Whether you've had all the children you want to have, or have simply decided motherhood just isn't for you, getting your tubes tied can be the next logical step to putting the issue aside, and moving on with your life.

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Heather Adams is a writer, and the creator of the speckled note.