Tubal Litigation-Who's decision is it anyway? - VeggieBoards
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#1 Old 06-30-2004, 09:38 AM
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I've recently, within the past week, discovered something disturbing.



My friend at work thinks she may be pregnant. Her husband and her have been using b/c but she's 2 weeks late. Seems to think the b/c may have failed. Anyhow, their one and only baby just had his 1st birthday. Both of them know they don't really want anymore kids because they don't believe they can provide for another. They've decided before the first was born that one is enough.



So she discusses this with her doctor before she delivers the baby. He won't perform a tubal ligation because she's too young. My friend was 26 at the time. She then went to another doctor who explained to her that she may change her mind and that he would rather she wait awhile before making that decision. He wouldn't do the procedure either. Well, now she may be having another baby that they really didn't want to have.



I discussed this with my best friend last night and was floored to find out she had the same problem. She has 2 kids now. One is almost 11 and the other is 7. After her first child she wanted the tubal litigation. The doc wouldn't do it. Said to her his rule of thumb is that he'll do it if the woman is over 21 and has at least 2 kids. Other than that he won't. She went to someone else and got a hassle. Mind you, she was just 19 when she had her son and doesn't regret having her daughter (who's now 7). After her daughter was born she had no trouble finding a doc to do the procedure.



In discussing this with other women, I'm finding that doctors are hesitant to do this if the woman is young and doesn't have a house full of kids. I'm like, WTF? Where do they get off telling women how many kids to have?? This should totally be the individuals decision, not some doc who won't even be contributing to the cost and raising of the potential offspring. It just disgusts me that in this day and age, we still have men determining crap like this. It ain't right I tell ya. Ain't right.



Thoughts?? Anyone ever heard of women being denied the procedure???
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#2 Old 06-30-2004, 09:42 AM
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My cousin was denied the procedure. They told her she wouldn't be able to until she was at least 21. She wanted it at 18 after her first child was born. Four kids and thousands of diapers later, she's 26 and just now getting it done. I dont think it should be up to the doctors when a woman should have the procedure. As long as she's of legal age..its her body..her decision.
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#3 Old 06-30-2004, 09:46 AM
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It doesn't really surprise me that they make you wait until you're 21, but the idea that you're supposed to have a certain number of kids is absolutely ridiculous. What about women who don't want children at all? Ugh. It's like doctors are saying, "You might change your mind, and then it will never be the same, even if you adopt. No, there's nothing quite like popping out more kids into a world that's already incredibly overpopulated."



You're right, Ruthie, it's disgusting that doctors think that they can decide something like that. I feel sorry for your friend. I have a question though--can't her husband get a vasectomy?
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#4 Old 06-30-2004, 09:48 AM
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I'm not a body-ologist or anything, but can't a tubal litigation be reversed? If so, why should the doctors determine how many kids someone can have? If someone doesn't want kids, give em the procedure, and later on if they change thier mind, they can have it reversed. (if thats a possibility)
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#5 Old 06-30-2004, 09:49 AM
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Ahhh MRB, a very timely topic personally.....



I'm almost 34, no kids. I have a doc's appt. in a couple of weeks to discuss the very same issue. I have discussed it with other women my age, my mother, my aunt, co-workers, etc. I get these type of responses, "you may change your mind, blah, blah, blah." The only people that support my decision are my mother and aunt. They both feel that "some people just aren't meant for children and that's a decision you have to make, and we'll support you." I might add, since my 20's I've had very strong feelings on this subject.



I don't believe a physician should make the choice for a woman by denying this particular procedure. I certainly believe providing information/counseling is acceptable, but outright denying a procedure...nah, that doesn't sit right, especially if a spouse agrees to the procedure. I'll let you know if I find the same challenge.
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#6 Old 06-30-2004, 09:52 AM
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I heard of several stories from social workers. One woman who was in an unstable relationship and could barely support her 5 kids. They said since she wasn't married she might marry a different man and want a child with him some day.



She ended up having twins.





Another story I heard was similar. The woman took the kids in to the doctor and wanted him to pay for their college. (perhaps facetiously)
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#7 Old 06-30-2004, 09:53 AM
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i don't neccessarily agree with this but i have to say i've known several people, personally , who changed their minds about having (more) kids after being surgically sterilized.



to be fair, the doctor that performed my husband's vasectomy wanted to know his age and how many kids he had before doing the procedure...so i don't know if it's neccessarily a thing only women seeking sterilization face.
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#8 Old 06-30-2004, 09:54 AM
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i had my tubal at 26. my doctor did everything but deny me the surgery. i was pregnant with my 2nd child at the time i decided. he made me watch movies. he made me read literature. he tried to talk my (ex) husband out of it. like it was his decision.



and it wasn't like i hadn't thought about it. my first son (who is now almost 6) was conceived while i was on depo provera. you know, the once every 3 months shot you can't screw up???



my second son (who is now almost 5) was conceived while i was on ortho-tricyclen. and no i didn't miss any pills or take them late or anything. i'm just fertile myrtle.



in the end i got my wish. but even in the middle of my c-section, while i was drugged, he confirmed it with me again. if i had hesitated he wouldn't have done it he says. men are just pigs sometimes.
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#9 Old 06-30-2004, 10:00 AM
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Please do let us know what your doc tells you, dawngirl. I requested one at age 20 and was told no way. Even though I'd already been married for a couple of years and my husband and I were very definite that we did not want kids. Ever. Since then (I'm 27 now), I haven't pursued it all, because I was quite happy with my birth control shot (no periods!). But now that is starting to worry me - all those unnecessary hormones. (Someone once told me you need to still take hormones if you've had a tubal ligation, but I'm not sure if that's true. Doesn't make sense to me.) Anyhoo, my husband and I are still very definite that we don't want kids, so having a tubal at age 20 would not have been a "mistake" at all.



I agree that a certain amount of counseling wouldn't hurt, but a doctor should not be able to deny a woman the procedure. I also don't understand why they would make you wait until you're 21. In the U.S., we're considered to be legal adults at 18 years of age.
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#10 Old 06-30-2004, 10:07 AM
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i don't disagree with women being informed that it is really is a permanent firm of bc. it rarely fails and it is nearly impossible to reverse. but it's your body, it's your decision.



you don't have to take anything after a tubal. i had to have another procedure done, but that was for near-hemorrhaging periods, not the tubal.
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#11 Old 06-30-2004, 10:56 AM
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Quote:
Originally Posted by rincaro View Post

i don't disagree with women being informed that it is really is a permanent firm of bc. it rarely fails and it is nearly impossible to reverse. but it's your body, it's your decision.



Exactly. And I think doctors need to recognize that as adult women, we're fully capable of understanding the permanency of this issue.
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#12 Old 06-30-2004, 11:17 AM
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First, men are often refused vasectomies for the same reason.



Second, just as it is a woman's decision, it is a doctor's decision whether he/she wishes to perform such a treatment. Don't like it, then get another doctor.



A high % of young people do change their mind, and yes, they would have said they were certain at the time. A doctor who refuses is a.) realistic in their assessment that the patient may regret this procedure in the future, and b.) protecting themselves against possible litigation in the future.
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#13 Old 06-30-2004, 11:19 AM
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Regardless if you like it or not, lots of young women change their minds. And doctors are tired of being sued for it. Want to blame someone? don't blame the doctors; blame the women who changed their minds and want to punish someone other then themselves.



edit: Tame beat me to it.
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#14 Old 06-30-2004, 11:36 AM
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I suspect the doctors are just being cautious; I think it's silly, but you really cannot account for the stupidity of other people that make hasty decisions. I have no idea about vasectomies - I've known of men who had them but they always had kids and were over 25. I've never heard of any man younger than that having one. However, I know a lot of women that want to have a tubal and they're annoyed to no end that they have to keep taking BC etc. because this is what they've wanted for *years*. I think it sucks but I don't automatically assume that all the doctors are sexist because of it.. I do agree asking the husband/boyfriend (or using that as excuse) is kind of insulting, though.



Also, it's "ligation" not "litigation".
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#15 Old 06-30-2004, 11:44 AM
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The issue I'm upset about is the fact that the one doctor is demanding she have two children. Sure, she can find another doctor, but it's still ridiculous to have that kind of rule.
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#16 Old 06-30-2004, 11:45 AM
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Quote:
Originally Posted by DuckThatWasn't View Post

The issue I'm upset about is the fact that the one doctor is demanding she have two children. Sure, she can find another doctor, but it's still ridiculous to have that kind of rule.





Her body, his practice. Them's the breaks.
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#17 Old 06-30-2004, 11:46 AM
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Her body, his practice. Them's the breaks.



I know. That's why I agreed that she can just go somewhere else.
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#18 Old 06-30-2004, 12:00 PM
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Men asking for vasectomies are given similar run-arounds, but there seems to be more variability among doctors on the vasectomy issue because vasectomies are much more easily reversed than are tubal ligations.



I agree that it SHOULD be the woman's decision, but the truth is doctors are so lawsuit-phobic these days (as some here have already pointed out) that they're not going to do anything that could lead to prosecution (kind of similar to the abortion issue; the more intimidating the pro-life movement in your town, the harder it is to find a safe abortion). Sucks, but that's the greedy money-sucking world we live in.
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#19 Old 06-30-2004, 12:08 PM
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Originally Posted by Tame View Post

First, men are often refused vasectomies for the same reason.



Second, just as it is a woman's decision, it is a doctor's decision whether he/she wishes to perform such a treatment. Don't like it, then get another doctor.



A high % of young people do change their mind, and yes, they would have said they were certain at the time. A doctor who refuses is a.) realistic in their assessment that the patient may regret this procedure in the future, and b.) protecting themselves against possible litigation in the future.



I've heard of doctors being sued for malpractice for complications or for neglecting to tell the woman about its permanence or side effects, but I've never heard of a case being brought where the woman knew it was permanent but simply changed her mind. Could you give me some more info about it?



Quote:
Originally Posted by DuckThatWasn't View Post

I know. That's why I agreed that she can just go somewhere else.



Not necessarily. Insurance companies often have strict regulations about what doctors they do and don't support. In non-major-urban areas, that means they may only cover one or two doctor who performs certain proceedures.



Terra
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#20 Old 06-30-2004, 12:22 PM
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my mom was denied the procedure 24 years ago, right after she had me. she was 24 years old and knew she didn't want more children but the doctor told her he wouldn't do it for anyone under thirty even tho he also told her she should never have anymore children because she almost hemoragghed to death having me!



when she was 30 she went back and got it done.
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#21 Old 06-30-2004, 12:32 PM
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Quote:
Originally Posted by Tame View Post

First, men are often refused vasectomies for the same reason.



Second, just as it is a woman's decision, it is a doctor's decision whether he/she wishes to perform such a treatment. Don't like it, then get another doctor.



A high % of young people do change their mind, and yes, they would have said they were certain at the time. A doctor who refuses is a.) realistic in their assessment that the patient may regret this procedure in the future, and b.) protecting themselves against possible litigation in the future.

If I were a doctor I would be hesitant to perform these procedures on very young people who've had not children. Many people do change their minds and contrary to popular belief, they are not as reversible as people like to think.



On the other hand, are doctors really being sued successfully for performing these procedures? Couldn't they also be sued for refusing them, like in the stories I mentioned above? From what I was told at the hospital, physicians have become much more liberal in allowing these procedures, they used to be much more paternalistic. And paternalism is perhaps the main issue here.



Some interesting info:



Quote:
Despite pre-vasectomy counseling, up to 10% of men who undergo voluntary sterilization will subsequently request vasectomy reversal. Surgical reversal is costly and has a variable success rate, ranging from 30% to 76%, depending on the amount of time that has elapsed between procedures.

Quote:
It was not surprising to find that the most common reason for reversal was divorce and remarriage. Although there were fewer men between the ages of 20 and 29 years who underwent vasectomy, vasectomy reversal occurred 12.5 times more often in this age group than in others.

http://www.clevelandclinic.org/urolo...misc/vol6f.htm

(it also says on this page that the patient and his partner must sign a form acknowledging that it may not be 100% effective.)



Quote:
What is the success rate (for tubal reversal)?

The success of this operation depends on many factors:

The length and health of the remaining fallopian tube segments to be rejoined

Skill of the microsurgeon (a surgeon experienced with microsurgery)

The womans age at the time of reversal surgery

Method of tubal sterilization

Scar tissue in the pelvis

The sperm test results of the partner and other infertility factors



Re-opening of the tubes provides a high chance (but not a guarantee) for pregnancy if the womans tubes are healthy and there are no other infertility factors. Under optimal conditions, the pregnancy rate is 75 to 80 percent.

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#22 Old 06-30-2004, 12:33 PM
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Wow. I never knew that it was that high of a pregnancy rate. Thanks Thalia!



I used to live in Dayton (airforce town). None of the insurance companies would pay for reversals. But the airforce medical would. I thought that was strange.
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#23 Old 06-30-2004, 01:11 PM
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I will never get one because of my intense phobia of medical treatment.



However, if I wanted one it would piss me off if someone tried to tell me they wouldn't do it because I would change my mind later. OK I get it that people change their minds, but not only do I dislike children and have no interest in having one, my medical phobia would be a pretty huge deterrent as well. Who is anyone else to think they understand me and my priorities better than I do? I'm not exactly your "typical" person, I reject most of the things society values.



I can see the lawsuit concern but it ticks me off that because some people are flaky and litigious that it should impact my access to a tubal, should I want one.
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#24 Old 06-30-2004, 01:42 PM
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Originally Posted by Terra View Post


Not necessarily. Insurance companies often have strict regulations about what doctors they do and don't support. In non-major-urban areas, that means they may only cover one or two doctor who performs certain proceedures.



Terra



Good point. I hate insurance companies.
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#25 Old 06-30-2004, 01:43 PM
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I can see the lawsuit concern but it ticks me off that because some people are flaky and litigious that it should impact my access to a tubal, should I want one.



Right on, sister
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#26 Old 06-30-2004, 05:31 PM
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Has it been posted that the younger the patient, the higher chances of failure?



I had to wait four weeks to have the procedure done after signed a waiver at age 22. My tubes were burned one inch, and then clipped one inch on either side of the destroyed tube the day after my 23rd birthday, six weeks after my first child was born. I was 24 when I became pregnant again, and have been pregnant three more times since then (though I have only one other living child)



I was given the literature, warned of the consequences, and even warned of the failure rate. My doctor at the time even said he didn't like to do them on women as young as I was then.
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#27 Old 06-30-2004, 05:43 PM
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My stepdaughter wanted to have one after her first child, and the doctor refused. She had another unplanned pregnancy, and after my second granddaughter was born, the doctor agreed to perform the procedure.



I discussed having a tubal ligation with several doctors when I was in my mid thirties, but they wouldn't perform the procedure because I had not had any children.
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#28 Old 06-30-2004, 07:58 PM
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They gave me a hard time about having one even though I had two children and I was 30...but they did it. Did I ever regret it...yes, but it was the decision I made, so I'm very OK with it
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#29 Old 06-30-2004, 11:43 PM
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I can't believe women are denied this. I think women are smart enough to know it's a permanent procedure. It's the womans body & right to have one if she chooses. It's rediculous for the doctor to tell a woman she should have a certain amount of kids. That's not the doctors business! What if she doesn't want kids ever? Does the doctor really believe her or just think maybe she'll change her mind. Some women never change their mind. Children are a choice. Not a requirement! I am 31 & I don't want children. I have never actually tried to have this done, but if I wanted to, I hope I would be able to. I mean I'm 31, not 21. I think I know by now if I want kids or not. I'm old enough to know for sure! It's a crazy world. GRRRRRRR .....lol
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#30 Old 07-01-2004, 12:14 AM
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At 31, you won't meet nearly as much resistance to it.



Furthermore, just because it's your body does not mean that the doctor has to perform an optional surgery. You can make your choice, but the doctor doesn't have to help you with it.
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