Women's Bodies, Women's Wisdom (90 page)

My husband and I made our decision together. Though the final choice was mine, we both realized that we didn’t really want more children. After that, making the decision to have a tubal ligation was not difficult. Even though vasectomy is technically easier to perform, in the event that I acquired another sexual partner one day through a change of circumstances, I wanted to be sure I would not get pregnant. Besides, I had performed many tubal ligations and felt comfortable with the procedure. (Other couples feel much more comfortable with vasectomy. It is safer and cheaper than tubal ligation.)

A tubal ligation changes the blood supply to the ovaries some what. There may even be a slight risk of an earlier menopause following tubal ligation if the blood supply to the ovary becomes severely compromised, but this is rare. Some women develop “post-tubal-ligation syndrome,” an ill-defined problem character ized by increased cramping, irregular periods, and heavier bleeding. (Many studies do not show this effect, so its existence is controver sial.) This is mostly a problem for women who have been on the pill prior to their tubal surgery and haven’t experienced natural periods for years. Indeed, they may have developed bleeding problems anyway when they went off the pill, not necessarily
because
of the tubal ligation. Tubal ligation may even be somewhat protective against ovarian cancer.
³³

Tubal ligation lowers progesterone secretion significantly, and even a year after the ligation, these levels may not recover fully to what they were previously. The menstrual pattern isn’t affected, however.
³⁴
These data certainly do explain, in part, why some women develop PMS following a tubal ligation.

E
SSURE
: N
EW
T
UBAL
B
LOCKAGE
P
ROCEDURE WITHOUT
S
URGERY

The first permanent method of birth control for women that doesn’t involve surgical incisions or general anesthesia, called Essure, was approved by the FDA in 2002. This office procedure is just as effective as tubal ligation and is performed in the doctor’s office in about half an hour. The doctor inserts a small scope through the vagina, cervix, and uterus and uses it to place a tightly coiled spring-like device 1 or 2 millimeters long into each fallopian tube. (They are about the size of the springs in a Bic pen.) Most women return to their normal activity the same day or the next day. The body then starts to develop scar tissue around the coil, which becomes thick enough to fully block the fallopian tubes in about three months (so an alternative method of birth control is necessary until the physician confirms that the scarring is sufficient).

In addition to the benefits of not requiring anesthesia and a hospital stay, Essure doesn’t block the blood supply in the tube or interfere with the blood supply to the ovary at all. Another plus is that it’s available to women who aren’t good candidates for tubal ligation, such as those who are obese, those with previous multiple abdominal surgeries, and those with heart disease or other contraindications to general anesthesia. (For more information, call the Essure Information Center at 877-377-8731 or visit
www.essure.com
.)

Though some ancient Taoist traditions feel that tubal ligation or vasectomy interferes with the energy flow of the body, my medical intuitive consultants say that the life energy around the body simply reroutes itself— that there is no permanent damage to the body after a so-called sterilization procedure. Caroline Myss says that the only problem with a tubal ligation or vasectomy is when the person is ambivalent about it and really doesn’t want it done. As with abortion, it’s not the procedure itself that can potentially cause problems—it’s the
meaning
of it.

I was very clear that the potential problems associated with tubal ligation were
nothing
compared with the disruption that an unplanned pregnancy would cause in my life. So I made an informed choice. Then I called my sister.

Moving into Greater Creativity

My sister Penny had her miscarriage a year before I decided to have a tubal ligation. (We’re eleven months apart in age—the doctor asked my mother if she had poked holes in her diaphragm.) After the miscarriage, I said to her, “Why don’t you have a tubal ligation and be done with the worry?” She said, “I’ll do it when you do.” So when I finally decided to do it, I called her up and asked her if she wanted to join me for the event and schedule them at the same time. She said she did. I made arrangements for both of us to have our procedures done in the office via a tech nique known as a minilaparotomy (small operation). After I made the appointments, I hung up and experienced about thirty seconds of sorrow about what I had just done. I vowed that if this feeling of loss continued, I’d cancel the procedure. But the feeling passed very quickly.

We decided to make this a meaningful event for both of us. Penny has no daughters; I have no sons. Each of us had to make peace with that. We named our operations and the ceremony we had beforehand “Moving into Greater Creativity” because we saw our lives after childbearing as rich with potential to develop ourselves further and to use our fertility in the outer world more fully. (By the way, that is exactly what has happened for both of us.) I’ve always hated the word
ster ile
because of its negative connotations— “barren” women are sterile; a bare, cold room is sterile; hospitals are sterile. I didn’t consider myself sterile before the tubal ligation, and I certainly didn’t see how having my fallopian tubes cauterized would change how I felt about myself. I had simply chosen to be proactive about avoiding future pregnancy.

Our operations were scheduled at nine and nine-thirty on a Friday morning in May. Springtime—a perfect time to celebrate newfound fer tility and also, according to Caroline Myss, a good time to have surgery, as the energies associated with spring bode well for healing and new growth. The night before, Penny and I participated in a beautiful ceremony—one prepared for us by Judith Burwell, a friend who guides people via ritual through significant life changes. Another friend, Gina Orlando, had made us two exquisite spring flower wreaths to wear on our heads during the ceremony. I felt like a bridesmaid—virginal in the true sense of the word, a woman complete unto herself.

Each of us spoke in turn about how she felt taking this step—and about how, when we make a conscious choice, there’s always grieving for the choice not taken. Yet we must fearlessly go forth and consciously work with our circumstances to the best of our ability, working to manifest our dreams. In the ritual Penny and I made space to grieve aloud our unborn children—me for my unborn sons, and Penny for her unborn daughters—knowing full well that Mother Earth doesn’t really require more people right now, that that part of the earth’s history—the order to go forth and multiply—is over. “For now,” I said, “may we go forth and multiply many spiritual children and give birth to ourselves.”

The next morning we arrived at the doctor’s office, three miles from my house. We had brought a special music tape with us to listen to during our surgery, which was to be performed under local anesthesia with a very light intravenous sedative. My sister went first. I held her hand and checked to see that her tubes were cauterized in just the right way—not so much that the blood supply would be com promised.

Penny walked into the recovery area, and then it was my turn. It was all quite painless. The doctor at one point said, “Do you want to see your tubes? They are very long and perfect.” I said, “No, I’d just as soon have a mind-body split right now.” I didn’t like the idea of actually burning nice healthy fallopian tubes, something that so many women would love to have. But I had made my choice. If I had changed my mind even
during
the procedure, though, I would have told the doctor to stop.

Afterward, my husband drove us home and fed us lunch and dinner while we rested on the couch, kept ice packs on our lower ab domens, and watched all the episodes of
Anne of Green Gables
on videotape. We developed shoulder pain, which often results when the abdominal cavity is opened and excess gas from room air or carbon dioxide gets trapped under the diaphragm and then is “referred” to the shoulder because the nerves that supply the diaphragm are connected to the nerves that innervate the shoulder. This gas gets reabsorbed after a day or two, and the pain goes away. The intensity of our shoulder pain was unexpected, but we were very happy with our choice.

The following morning we gathered spring flowers from the yard and floated them in the bathtub while we sat on the side, soaked our feet, and talked about our parents, our childhoods, and how happy we were to be celebrating this momentous event together. While lis tening to the singing of Susan Osborne, we gave each other a foot massage. Then we rested some more.

Later that afternoon, we drove into Portland to a special store called the Plains Indian Gallery. I bought a piece of art called
Tree Momma,
a magical figure of a woman made out of a weathered wooden branch, fur, and some clay. Penny bought a painting that had deep meaning for her of two Sioux warriors riding away from a bur ial platform. These purchases were personal symbols of our conscious choice to shape our destiny by clarity and intent— not chance.

Neither my sister nor I had any regrets. One chapter of our lives closed, but we each opened an entirely new one. At a family reunion in which we watched our then teenage children have fun together, we remarked on the wisdom of our decision.

TABLE 6

C
OMPARING
C
ONTRACEPTIVE
M
ETHODS

The rates shown in the table assume perfect use every time. Effectiveness rates of actual use may vary significantly from those shown.