I was 29, unmarried, and childless the first time I asked to have my tubes tied. My doctor pursed his lips and piffled my request away. I'd most likely, he assured me, want kids when I grew up and grew older. In my mid-30s, I asked a different doctor, a woman this time. She suggested I go home and discuss my fertility with my husband or partner, even though I had neither at the time.
I have wanted to get sterilized for most of my adult life. It took nearly a decade and a half for someone to take me seriously. Earlier this month—at age 42, single and with no children—I finally underwent laparoscopic tubal ligation.
In theory, I should have been able to get my surgery when I originally requested it. There is no law that prohibits a woman from getting voluntarily sterilized, and the procedure is commonly used as a form of birth control in the United States. In practice, however, things weren't quite so simple. The doctors who refused to tie my tubes echoed my friends and family members who assumed I was too immature to decide that I didn't want children. Over the course of 13 years, I've consistently heard that I shouldn't act rashly, that I would later regret it. Most of the people who cautioned me against getting the procedure would end the conversation with a patronizing, figurative pat on the head. They would reassure me that I could still have the tubal ligation after I experienced the joy of having a kid or two. Some would add an insidious coda: When I was done having kids, I could reasonably pressure my husband into having a vasectomy, since I had already done all the hard labor.
I've never had any desire to have kids. When I was younger, an aunt told me this was because I hadn't met the right person yet. That might have been true, but I've dated many men who would have made great fathers, and I was once married to a man with whom I could have led a long and happy two-child, two-car garage type of life. I didn't want that lifestyle, however, and we eventually divorced. I have no regrets about the door I closed behind me.
For most of my sexually active life, I've been struggling to find a form of birth control that doesn't cause me constant discomfort or pain. I experience a slew of negative side effects when I'm on the pill: daily headaches, the occasional migraine, and a constant, slightly upset stomach, as well as a longer, irregular period and mood swings. I've been told that my cervix is too small for an IUD (one doctor described it as "the size of a pinhole"), and because I'm so sensitive to hormones, even in low doses, getting a contraceptive implant isn't a viable option, either. Tubal ligation has seemed like a sensible solution, being both hormone-free and permanent. For a while, it seemed impossible to find a doctor who agreed with this.
In February of this year, after my Pap smear came back with an abnormal result, I made an appointment with a specialist, a well-respected OB/GYN in my town. Expecting nothing, I told him I wanted a long-lasting form of birth control with fewer hormones. Instead of dismissing me, he responded, "Well, you can try Norplant, though that has hormones—or you can have your tubes tied. That's permanent, but it is something to consider." I walked out of the office elated, knowing I'd finally found the holy grail of my contraceptive quest: a doctor who listens, who was willing to tie my tubes.
A month later, at a follow-up appointment, I told him that I wanted the tubal litigation. He took a step back and, though he seemed surprised, went on to calmly walk me through the specifics of the surgery. He did not ask me if I had consulted with my partner; he did not tell me to go home and consider it thoroughly. He did make sure I understood that it's a permanent and irreversible option, and then he had me read and sign a consent form.
My insurance approved the surgery within a week of the doctor's initial request. I easily scheduled the pre-op exam and a litany of accompanying examinations: an EKG, chest x-rays, and various blood tests. The only difficult part was telling my mother, who firmly believes and has stated multiple times that a woman's highest calling is motherhood. I approached her about it sideways, while we were both sitting on the couch, mocking the telenovelas we obsessively watch together.
"My second Pap smear came out okay," I said, trying to sound casual. "I'm thinking about getting my tubes tied."
Surprising me, she took it fairly well: She sighed, then pointed out that, since I'd never wanted children in the first place, this would be a propitious time to have this surgery. The procedure is relatively un-invasive and risk-free. My health insurance would cover the cost. Most importantly, I was single, and this was my own decision. My mother hesitated then. I was single, right? This was my own decision?
It has taken me 13 years, several doctors, and a few bad Pap smears to get this far. I'm sure in my decision.
There's an obvious reason for my mother's concern: America has a long, shameful record of involuntary sterilization. In 1927, the Supreme Court ruled in Buck vs. Bell that states had the right to forcibly sterilize men and women they considered unfit to breed. According to Alexandra Stern, a professor who specializes in the history of eugenics and justice, doctors in the state of California sterilized about 20,000 men and women in the mid-1900s. Their main victims were patients they considered sexually transgressive or promiscuous, as well as the children of Mexican, Japanese, and Italian immigrants whose families were too poor to care for them. In the 60s and 70s, the Los Angeles County-USC Medical Center forced Mexican and Mexican-American women to sign documents consenting to medical sterilization before they would be treated for emergency cesareans. Earlier this month, a judge in Tennessee came under fire for offering a 30-day sentence reduction to inmates if they either get a vasectomy or Norplant implant.
As a Mexican-American woman, I understand that I'm a historical anomaly for seeking out and voluntarily undergoing a tubal ligation procedure. And even among women who choose to get their tubes tied, my case is exceptional: According to the CDC, only 1.7 percent of women who choose female sterilization as a form of contraception do so because they've chosen not to have children and find other forms of birth control to be a problem.
About two weeks ago, the night before my surgery, I looked at these statistics once again and experienced a flicker of doubt. The thought of raising a child has always bored me, but I'm in currently in a great position to have one—my job is child-friendly and I could, with some adjustments, "afford" to have a baby. My sisters and mother have repeatedly said that if I ever had a son or daughter, they would be happy to pitch in and help in whatever way was needed. I should be grateful for these circumstances, but as I laid in bed and imagined what it would be like to carry a pregnancy to term and raise a child, my stomach curled and a sensation of anxiety rose in my throat. I love my nephew and nieces, but motherhood is not something I want for myself. As I fell asleep, I reminded myself: It has taken me 13 years, several doctors, and a few bad Pap smears to get this far. I'm sure in my decision. This is what I want.
The day of my surgery, my procedure was delayed an hour and fifteen minutes because my doctor was delivering a baby. A nurse told me this after placing a heating blanket on top of me and inserting my IV. As I sat cocooned in my bed, I thought about the woman giving birth a few floors above me. I wished her well. I hoped that she was having her baby, just like I was having my surgery, in the best of circumstances.
I was about to fall asleep when my doctor popped into the room and asked me if I was ready and sure I wanted this. I told him yes, and then I was wheeled into the operating room.
A tubal ligation procedure is simple: The surgeon makes one or two small cuts in the patient's stomach, then pumps gas into the abdominal cavity, expanding it. This enables her to see the uterus and fallopian tubes more clearly. Then, a diminutive camera is inserted into the patient's belly, and the tubes are severed; afterwards, the surgeon will either burn the ends or clamp them closed. The surgeon then pulls the camera out and stitches then patient up. That's it.
I don't know which method my doctor used—cauterizing or clamping—because I never asked him. I woke up two hours after the 30-minute surgery, feeling drowsy and serene. My stomach and belly button felt sore, but I wasn't worried because the nurse had told me to expect this. She assured me that the pain wouldn't get any worse, and the following days proved her right.
It has been slightly over a week since the surgery, and the stitches and the two-inch bruise below my belly button are the only physical reminders of my surgery. Thirteen years is a long time to think about tubal ligation, and I was sure in my decision. Post-surgery, I feel neither regret nor joy at what I've done—just a constant, reassuring sense of security. Being sterile is my choice, and it is what I wanted.