Tubal ligation: Pros and cons of getting your tubes tied

Eva Nakanwagi had heard of the procedure and after her second born, seeing that she was soon clocking 40 asked her gynaecologist to go through with the procedure after the C-section delivery.

“You are not yet 40,” he said. “Why don’t you try and have one more child and then if you are really sure, we perform the surgery then?” The previously determined mother was given something to think about and after discussing the options with her husband, the couple decided to follow the doctor’s advice.

Dr Vincent Karuhanga, a general practitioner at Friends Poly Clinic, says tubal ligation is an ideal procedure for a woman in their 30’s or 40’s who has had the number of children they desire and would like to stop. He adds that it is also ideal for those with medical issues.

Dr Franklin Wasswa, a general practitioner, says although it is a minor surgery, it should only be performed in a well-equipped medical facility by medical personnel.

Uses

Save for working as a family planning method, Dr Karuhanga says it can be done for other reasons:

It helps to avoid conception for one who has complications such as Rhesus factor which can lead to death either of the mother or the child during pregnancy or birth. “Other conditions include high blood pressure and diabetes,” he shares.

It helps to prevent certain pelvic inflammatory diseases seeing that these come from the vagina, to the womb through the tubes and then the ovary. “However, with the tubes cut, the infection will never reach the ovaries,” he says.

It can also be done for medical reasons such as when one has cancer of the ovaries. “Breast cancer gene 1 and breast cancer gene2 can cause one to get ovarian cancer. So, when the tubes are removed, the chances of women who are genetically predisposed to getting the cancers are reduced. That said, sometimes even the ovaries are sometimes removed,” he shares.

Methods

Tubal ligation can be done right after a vaginal birth by making a small incision under a woman’s navel, during a caesarean-section birth or whenever desired. That said, there are various surgical methods used to carry out the procedure. Some of these include:

Hulka clip technique or tubal clip. Here, a clip is applied on the tubes. They are, therefore, bent hence avoiding the transfer of the sperm to the ovary.  “This method accounts for the one per cent failure rate because if a woman is younger and still fertile, chances of the tubes opening up and one getting pregnant are high,” Karuhanga says.

Rings. With this method, a tubal ring is used to double over the fallopian tubes. However, just like the clip, pregnancy can happen should it be that just a small part of the tube is affected by the ring at the time of intercourse.

Tubal removal. Here, the whole tube is removed from the area that accepts the egg to near the womb. With this, Dr Karuhanga says, it becomes very difficult to reverse the process.

Occlusion method. With this method, clips are used to make obstructions on the fallopian tubes thus creating a blockage for the flow of ovaries down to the womb. “It could be multiple occlusion method or one part can be occluded. That said, mono-occlusion is not as efficient as having multiple occlusions done,” Karuhanga warns.

Disadvantages

Dr Karuhanga shares that the procedure may have its pitfalls which include:

Formation of scars on the abdomen as is with a C-section operation for one that goes to a medical facility just to have this procedure done.

Allergic reactions to the anaesthesia or to the medicines given to aid recovery is a possibility.

One may also experience pain owing to the operation as is with other surgical procedures.

At times, it may require one to remove the womb in cases where a woman experiences excruciating pain. This usually happens because partly, the medical personnel cuts up to the womb yet adhesions occur which could be painful.

Moreover, when burning or cutting is done, some of the ligaments holding the womb are removed thus descending of the womb. “That said, uterus prolapse could also be due to other conditions such as giving birth multiple times, age, operations, and body weight.”

Some people go for the procedure quite early yet it is not common among Ugandans to have just one or two children. Some do it because they are only able to take care of a specific number of children. “However, when either party wants to conceive again, reversal is not easy,” Karuhanga says.

Ectopic pregnancies may also occur in cases where the sperm escapes and fertilises the ovary yet there are no tubes to transport the fertilised egg to the womb. Although rare, Dr Karuhanga says the condition is dangerous and could lead to death.

Legal battles

Dr Wasswa says in Uganda, women’s rights are ambiguous owing to the issue of decision-making because constitutional rights clash with cultural gender-based decision-making roles.

“You may find that while the woman wants to go ahead with the procedure, the man is against it. Additionally, in some hospitals, the woman cannot completely decide on this without the man’s approval. This is not technically constitutional, as we know a woman should have a right to her body and anything done to her body. Such scenarios put the doctor in a difficult spot,” he says.  Dr Wasswa adds that they have had a few lawsuits by husbands because the doctor carried out the procedure without their consent. 

Dr Karuhanga adds that women should be counselled before they go through with the procedure since it is permanent and reversal, although possible, is costly and not always efficient. “Therefore one should be aware of what they are getting into,” he says.

By Joan Salmon

There are many things to get done this year, many life-altering decisions that we desire to make. If picking and applying a family planning method is one of them, more so for women, we share the pros and cons of one of them.

Tubal ligation, also referred to as tubal sterilisation is a permanent surgical procedure of either blocking or removing tubes to ensure that pregnancy does not happen.

Eva Nakanwagi had heard of the procedure and after her second born, seeing that she was soon clocking 40 asked her gynaecologist to go through with the procedure after the C-section delivery.

“You are not yet 40,” he said. “Why don’t you try and have one more child and then if you are really sure, we perform the surgery then?” The previously determined mother was given something to think about and after discussing the options with her husband, the couple decided to follow the doctor’s advice.

Dr Vincent Karuhanga, a general practitioner at Friends Poly Clinic, says tubal ligation is an ideal procedure for a woman in their 30’s or 40’s who has had the number of children they desire and would like to stop. He adds that it is also ideal for those with medical issues.

Dr Franklin Wasswa, a general practitioner, says although it is a minor surgery, it should only be performed in a well-equipped medical facility by medical personnel.

Uses

Save for working as a family planning method, Dr Karuhanga says it can be done for other reasons:

It helps to avoid conception for one who has complications such as Rhesus factor which can lead to death either of the mother or the child during pregnancy or birth. “Other conditions include high blood pressure and diabetes,” he shares.

It helps to prevent certain pelvic inflammatory diseases seeing that these come from the vagina, to the womb through the tubes and then the ovary. “However, with the tubes cut, the infection will never reach the ovaries,” he says.

It can also be done for medical reasons such as when one has cancer of the ovaries. “Breast cancer gene 1 and breast cancer gene2 can cause one to get ovarian cancer. So, when the tubes are removed, the chances of women who are genetically predisposed to getting the cancers are reduced. That said, sometimes even the ovaries are sometimes removed,” he shares.

Methods

Tubal ligation can be done right after a vaginal birth by making a small incision under a woman’s navel, during a caesarean-section birth or whenever desired. That said, there are various surgical methods used to carry out the procedure. Some of these include:

Hulka clip technique or tubal clip. Here, a clip is applied on the tubes. They are, therefore, bent hence avoiding the transfer of the sperm to the ovary.  “This method accounts for the one per cent failure rate because if a woman is younger and still fertile, chances of the tubes opening up and one getting pregnant are high,” Karuhanga says.

Rings. With this method, a tubal ring is used to double over the fallopian tubes. However, just like the clip, pregnancy can happen should it be that just a small part of the tube is affected by the ring at the time of intercourse.

Tubal removal. Here, the whole tube is removed from the area that accepts the egg to near the womb. With this, Dr Karuhanga says, it becomes very difficult to reverse the process.

Occlusion method. With this method, clips are used to make obstructions on the fallopian tubes thus creating a blockage for the flow of ovaries down to the womb. “It could be multiple occlusion method or one part can be occluded. That said, mono-occlusion is not as efficient as having multiple occlusions done,” Karuhanga warns.

Disadvantages

Dr Karuhanga shares that the procedure may have its pitfalls which include:

Formation of scars on the abdomen as is with a C-section operation for one that goes to a medical facility just to have this procedure done.

Allergic reactions to the anaesthesia or to the medicines given to aid recovery is a possibility.

One may also experience pain owing to the operation as is with other surgical procedures.

At times, it may require one to remove the womb in cases where a woman experiences excruciating pain. This usually happens because partly, the medical personnel cuts up to the womb yet adhesions occur which could be painful.

Moreover, when burning or cutting is done, some of the ligaments holding the womb are removed thus descending of the womb. “That said, uterus prolapse could also be due to other conditions such as giving birth multiple times, age, operations, and body weight.”

Some people go for the procedure quite early yet it is not common among Ugandans to have just one or two children. Some do it because they are only able to take care of a specific number of children. “However, when either party wants to conceive again, reversal is not easy,” Karuhanga says.

Ectopic pregnancies may also occur in cases where the sperm escapes and fertilises the ovary yet there are no tubes to transport the fertilised egg to the womb. Although rare, Dr Karuhanga says the condition is dangerous and could lead to death.

Legal battles

Dr Wasswa says in Uganda, women’s rights are ambiguous owing to the issue of decision-making because constitutional rights clash with cultural gender-based decision-making roles.

“You may find that while the woman wants to go ahead with the procedure, the man is against it. Additionally, in some hospitals, the woman cannot completely decide on this without the man’s approval. This is not technically constitutional, as we know a woman should have a right to her body and anything done to her body. Such scenarios put the doctor in a difficult spot,” he says.  Dr Wasswa adds that they have had a few lawsuits by husbands because the doctor carried out the procedure without their consent. 

Dr Karuhanga adds that women should be counselled before they go through with the procedure since it is permanent and reversal, although possible, is costly and not always efficient. “Therefore one should be aware of what they are getting into,” he says.