Postpartum Tubal Ligation

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What is a postpartum tubal ligation?

A postpartum tubal ligation is a procedure that blocks the fallopian tubes to prevent you from becoming pregnant. The 2 fallopian tubes carry eggs from the ovaries to the uterus. The procedure, called a mini-laparotomy, is done after delivery of a baby. The position of the uterus at this time makes it easy for your provider to reach the fallopian tubes.

When is it used?

This procedure is done shortly after you have had a baby, when you are still in the hospital. If you have a cesarean section, the tubal ligation may be done at the same time. Tubal ligation is only done if you have asked for it. It may not be 100% successful: About 1 in 250 women become pregnant after a tubal ligation. It is very difficult to reverse the procedure and make it possible for a woman to become pregnant again. Because of this, you should have this procedure only if you are sure you do not want to become pregnant again.

Healthcare providers generally recommend a permanent form of birth control, such as tubal ligation, only if:

• You have had as many children as you want.
• Being pregnant might be dangerous for you.
• You have a high risk of passing on a serious genetic disease.
• You cannot use other birth control methods.

Examples of alternatives are:

• trying other forms of birth control
• waiting 2 months after the birth of your child to have a laparoscopic tubal ligation
• having your partner get a vasectomy

You should ask your provider about these choices.

How do I prepare for a postpartum tubal ligation?

Plan for your care and recovery after the operation. Allow for time to rest. Try to find other people to help you with your day-to-day duties.

Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. Also, your wounds will heal much better if you do not smoke after the surgery. For these reasons, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit before you become pregnant.

Follow any other instructions your provider gives you. Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?

You are given a local, regional, or general anesthetic. A local or regional anesthetic numbs part of your body while you remain awake. It should keep you from feeling pain during the operation. A general anesthetic relaxes your muscles, puts you to sleep, and prevents you from feeling pain.

Your healthcare provider makes a cut (incision) in your lower abdomen. This may be done just below the belly button or lower, just above the pubic bone. Your provider then is able to reach your fallopian tubes so that they can be cut, tied, burned, or clamped. The incision your abdomen is then sewn closed.

What happens after the procedure?

Because this procedure is done soon after you have given birth, it will add very little to any discomfort you may have. Having this procedure usually does not keep you in the hospital any longer than if you had not had this procedure. Take it easy and avoid heavy activity, such as lifting, for a few weeks. You should ask your healthcare provider how much you can lift.

Ask your healthcare provider what other steps you should take and when you should come back for a checkup.

What are the benefits of this procedure?

• Closing of the fallopian tubes almost always results in lifelong sterilization. It is a very reliable form of birth control.
• Blocking of the tubes may also help to prevent a serious infection called pelvic inflammatory disease (PID).
• Lovemaking does not need to be interrupted by the insertion of a birth control device or spermicide. You do not have to take a daily pill or get shots for birth control.

What are the risks and disadvantages of this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your healthcare provider.
• A local or regional anesthetic may not numb the area quite enough and you may feel some minor discomfort. Also, in rare cases, you may have an allergic reaction to the drug used in this type of anesthesia. In most cases local or regional anesthesia is considered safer than general anesthesia.
• The abdominal organs, glands, intestines, or blood vessels may be damaged. You may need abdominal surgery to repair them. However, these are very rare events.
• The lining of the abdominal wall may become inflamed.
• A blood clot may break off, enter the bloodstream, and clog an artery in the lung, pelvis, or legs. Rarely, a clot may break off and clog an artery in the heart or brain, causing a heart attack or stroke.
• Scar tissue (adhesions) may form on the pelvic organs.
• You may develop an infection or bleeding.
• Even though tubal ligation is considered permanent sterilization, there is a slight possibility that a woman who has had a tubal ligation could get pregnant. If you have had a tubal ligation and you get pregnant, the chances are very high that the pregnancy is outside the uterus. You will then need surgery to remove the pregnancy.

Tubal ligation does not protect you against sexually transmitted diseases, such as AIDS. Latex or polyurethane condoms are the only safe way to protect against sexually transmitted infection.

You should ask your healthcare provider how these risks apply to you.

When should I call my healthcare provider?

Call your healthcare provider right away if:

• You have a fever over 100°F (38°C).
• You are bleeding around the surgical site.
• You notice a green or yellow discharge from the surgical site.
• You develop redness or tenderness around the surgical site.
• You have nausea and vomiting.
• You become short of breath.
• You become dizzy or faint.
• You have chest pain.
• You have abdominal pain or swelling that gets worse.

Call during office hours if:

• You have an unexpected vaginal discharge.
• You have mild abdominal discomfort.
• You have questions about the procedure or its result.
• You want to make another appointment.

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