Podcast: Play in new window | Download
Thelma Dow is a 32 year old G-4, P-3, who delivered uneventfully earlier today. She is awaiting a postpartum tubal ligation.
She had a normal pregnancy, labor and vaginal delivery, utilizing a continuous lumbar epidural anesthesia technique.
She is content with her four children and wants no more.
Prior to labor, she was counseled about contraceptive options. A postpartum tubal ligation is an excellent method of contraception with a little less than 1% failure rate. It is permanent and considered irreversible. Once performed, it is free to maintain and will last a lifetime. It is a relatively simple surgical procedure that can make use of the epidural anesthetic that is already in place during labor and delivery.
There are some drawbacks to postpartum tubal ligation. The main problem is that it is normally performed within the first 24 hours following delivery. There are uncommon but serious problems with the newborn that may not be apparent at the time the tubal ligation is done. In the event of such a development, the woman may regret having terminated her future childbearing capacity.
Although this is an elective procedure, it is performed shortly after delivery and significant blood loss, not the optimal timing for an elective procedure.
There are alternatives, of course. An IUD can provide comparable contraception, albeit reversible, without the surgical and anesthetic risk. An Essure procedure can provide permanent sterilization in an office setting. A vasectomy can be performed on the male partner in an office setting with fewer risks of serious complication. These are in addition to all the commonly-used contraceptive techniques, such as birth control pills.
All of that said, postpartum tubal ligation is still an excellent choice in the right patient.
