Tubal Ligation

If you are considering a tubal ligation, talk to your gynaecologist. Your doctor will discuss the procedure, what it entails, risks associated with it, and possible side effects. It is important that you understand and give informed consent before the procedure is done, as tubal ligation procedures are permanent.

• Consultation – Your consultation session may be the most important part of the procedure. Among the things your doctor will discuss with you include:
  • Risks and benefits of tubal ligation surgery, and what other reversible birth control methods are available
  • Type of surgery recommended for you
  • Details of the surgery
  • Possibility of an unsuccessful surgery, and the contributing risk factors
  • When to do the procedure, which may be during vaginal/cesarean delivery, a few weeks after labour, or any time outside of labour
    
• Prior to your surgery – If you are planning for a surgery outside of pregnancy, your doctor may suggest other forms of birth control before your surgery. On the day of surgery, your doctor may require you to take a pregnancy test to make sure you are not pregnant.
  
• During the surgery – You will be given anaesthesia during the tubal ligation procedure to minimise pain and discomfort. The choice of anaesthesia may vary according to the doctor’s preference, your preference, and whether you are having the procedure postpartum or outside of pregnancy [6].
  
  
  • Epidural – If you are having the procedure done right after delivery, epidural can be used for both delivery and tubal ligation.
  • Regional – Regional anaesthesia is given to the area that the doctor will operate on. This keeps you awake during the procedure. Regional anaesthesia can be used in procedures after vaginal birth or cesarean birth.
  • Spinal – Spinal anaesthesia involves injecting the anaesthetic drug into the spine to block off pain. Spinal anaesthesia has a quick onset and short duration of action.
  • General – General anaesthesia involves putting the patient in an unconscious state for the procedure, this is typically used in cases of tubal ligation several weeks after birth, or outside of pregnancy.
    
• After the surgery – Depending on the type of surgery, you may be required to stay in the hospital for a few days. More invasive procedures such as mini-laparotomy or laparotomy, as well as procedures done postpartum, may require several days of hospital stay. The doctor will monitor your condition and prescribe medications to manage pain and inflammation, such as acetaminophen or ibuprofen. Several precautions during this period include:
  • Avoid taking showers for the first 48 hours
  • Avoid taking baths, hot tubs, or swimming for the first 2 weeks
  • Avoid lifting heavy objects for the first 2 weeks
  • Avoid sexual activity for 6 weeks after vaginal birth or cesarean delivery
    
• Recovery – As you recover, you can slowly return to your daily activities. It is important to follow postoperative care instructions given by your healthcare provider to ensure optimum healing. You may also be asked to come in for a follow-up appointment. Contact your doctor if you experience any of the following throughout your recovery period:
  • High fever
  • Fainting spells
  • Redness, swelling, bleeding, or discharge from the surgical incision
  • Abdominal or pelvic pain
  • Persistent nausea or vomiting 
  • Heavy or abnormal uterine bleeding

Although rare, side effects or complications of the surgery may occur. Among these are:

• Pain around the pelvis
• Pain during sex
• Cramping during periods
• Abnormal bleeding, or irregular periods
• Failed contraception, in cases where clips or bands used in the ligation may fall off

Although not typically contraindicated to any group of patients, several factors can increase the risk of complications for tubal ligation procedures, these include [3, 7]:

• Allergies to anaesthesia
• Obesity
• Significant comorbidities such as heart, lung, or kidney conditions
• A history of previous laparotomic, abdominal, or pelvic procedures
• A history of endometriosis
• Chronic pelvic conditions or infections

Normally, your doctor will inform you, or give you instructions on what you can do to prepare for your surgery, these may include:

• Stop taking certain types of medication such as blood thinners or aspirin
• Have someone to take you home after the surgery, or arrange your transportation accordingly
• Inform your doctor of any health supplements or medications for other conditions that you are taking
• Prepare a care plan for your recovery at home’

A tubal ligation is considered a permanent form of birth control or sterilisation. Other alternatives similar to a tubal ligation can include:

• Vasectomy – A vasectomy is a male sterilisation procedure. Similar to a tubal ligation, the vas deferens, which are the tubes that carry sperm, are sealed off or cut to prevent sperm from being ejaculated.
  
• Hysterectomy – A hysterectomy is a procedure that removes part or all of the uterus, and is indicated for uterine conditions such as cancer or fibroids. However, in some cases, hysterectomies are also done as a form of sterilisation [8].

Informed consent and patient awareness is of utmost importance before undergoing sterilisation procedures. If you are unsure if a tubal ligation is for you, consult your doctor for other non-permanent forms of birth control.