Some women come to a point in their lives where they are certain that they no longer want to have children.
But accessing permanent birth control methods is proving arduous for some seeking tubal ligations, also known as “getting your tubes tied.”
By law, women do not have to have spousal consent or any children prior to having the procedure done, said Life’s Cycle medical director and gynecologist Dr. Pamela Kimbrough. If the patient is covered by Soonercare or Medicare she must be at least 21 and go through extensive counseling.
“We do extensive counseling to be sure that they’re absolutely certain,” Kimbrough said. “Because we don’t want someone later on down the line to have those regrets of ‘I wish I had not’.”
Under private insurance, Kimbrough said women face less rules and regulations. “If you don’t want to have children or don’t want to have further children then it’s your call,” she said.
However, physicians sometimes make their own rules, Kimbrough said.
“I’ll be transparent, there are some — I’ve had patients come to me and say ‘I didn’t want to have to children and doctor X told me that since I haven’t had children before he or she wouldn’t do it’,” Kimbrough said. “But that’s not a law or a requirement, that’s just an individual physician.”
Southern Oklahoma Women’s Health OBGYN Dr. Henry Ramirez said there are several things physicians take into consideration. This includes variables such as if the patient is below the age of 25, if they have a minimal amount of children, if they just had a traumatic birthing experience and if they’re in a bad relationship.
“You have to do a really good job of keeping everything realistic,” Ramirez said. “Those are all things that you have to take into consideration with the idea that ‘If we tie this lady’s tubes, then five years down the road she could be very upset’.”
The procedure is an outpatient surgery preventing the woman’s egg from entering her uterus or coming in contact with sperm by sealing the fallopian tube. Tubes may be sealed, cut or tied depending on the doctor’s preferred method.
“Recovery is pretty fast but you have a risk of injuring bowel, bladder, uterus,” Ramirez said. “The other big risk during any tubal is the risk of regret, which is terrible.”
If a woman is certain that she is permanently done having children, however, having the procedure done can be beneficial to her health in a variety of ways. Past the age of 35, Ramirez said women on birth control are at a higher risk of having blood clots, which can sometimes lead to death in severe cases.
Some women also face severe hormonal changes while on birth control pills. “We consider them noninvasive, but very much so taking over their entire hormonal situation. Some of them do really well and some of them don’t,” Ramirez said.
But local policies on the procedure make it difficult for Ramirez to offer women care in some cases, he said.
Often times, women opt to have a tubal ligation performed right after they give birth. This makes it easier and safer for the doctor to perform the surgery while the individual is already in the operation room, Ramirez said.
“The fact that we practice in a system that’s Catholic, we have plenty of times where we’re sitting in the operation room and this patient wants a tubal and I’m doing a c-section  — I’m right there,” Ramirez said. “All I have to do is tie it, but that goes 100 percent against our policy.”
Instead, Ramirez said patients sometimes have to wait up to six weeks before they can have a tubal ligation. “That to me is insane,” Ramirez said. “It makes zero sense to me. I don’t understand it, I’ve fought it, I’ve been in trouble for it.”
If he were to perform a tubal ligation subsequent to a c-section he could lose his privileges, Ramirez said.
Because of this policy, Ramirez said he has told some of his patients considering the procedure to think about delivering their babies in another town. “That’s not a myth — it’s the real deal,” he said.
While access to tubal ligations for women in Ardmore is limited due to various policies, there are only two urologists in town that perform vasectomies. “Is it better for the guys? I don’t know,” Ramirez said.
Oklahoma law on vasectomies and tubal ligations is very similar in writing and many times Ramirez said women would rather their husbands have a vasectomy because it is a less invasive surgery. Although their is minimal pain involved, men often don’t understand the procedure, he said.
“Most of the time, the guys for whatever reason don’t want to do a vasectomy,” Ramirez said. “If they think that they’re going to go through some pain, they don’t want to do it. And I know it’s terrible, but it is what it is.”
Regardless of the availability to men, women face additional problems that obstetricians are familiar with when it comes to accessing permanent birth control, especially in Ardmore, Ramirez said.
“There is a real problem that is overlooked and should be answered for and it’s one of the things that makes my practice hard,” Ramirez said. “There’s nothing worse than telling a patient ‘I’m sorry, I can’t tie your tubes, even though it’s safer for you to do it — I just can’t do it’.”