Thursday, March 26, 2015

Tied in a bow

I'm having my tubes tied tomorrow! Below is a Q&A responding to the most common questions I've received. Some are inquisitive, some are rude. Some are specifically about the procedure, and some are about the stigma that comes with not wanting children.

Why are you having your tubes tied? How did you decide this was the right choice for you?

I have to be honest here. I don't like children. I don't want children. I love my nephew, L., because I can give him back after a hot minute, and he's finally old enough that he has a personality. Between the stress and anxiety of missing a pill and the fact that I'm now at a point in my life where I feel that I can make a fully informed decision, this feels like the right time and right procedure for me.

There's no way to be 100% certain that you don't want children, but I'm about as sure as I can be. When it comes to health, I'm a serious researcher. There's no reason to trust your doctor blindly, and I've had more than one say that they appreciate an informed patient who knows his or her options. And since this is such a big decision* to most people, I did a lot of research. The deal was sealed for me when I read this post on the Childfree subreddit. Although I had read a lot about not having kids and felt comfortable with it, hearing from someone who had actually been convinced to have a child against his wishes really upset me and made it a lot more difficult to believe that I could ever make it okay for me to have a kid. Reading that post is like a punch in the gut to me, and that's when I really knew.

*Part of why I know this is right for me is because so many people think this is a big decision to make, but for me and my body, it's always been the one that made sense. It doesn't feel like a big decision, it just feels like another doctor's appointment. That's the biggest sign that sterilization is the right path for me to go down.

Why now? Why not wait to make sure?

I've always found it odd that women who want to have their tubes tied are looked at askew for a permanent decision such as this one, while women who decide to have children--an equally permanent decision--are hailed. Why do I have to wait to make sure but they don't? It's bizarre.

I have been considering a tubal ligation for a long, long time. While hormonal birth control has worked well for me, I am very anxious if/when I miss a pill, and then I spend all month freaking out and thinking oh god, I might be screwed. I don't want that anymore, and from day one I've felt that this has been the end result. It was just a matter of when. Especially now that I'm in a relationship, I don't want to have to be running for Plan B every month, which I've had to do more than once. I'm sick of the fear of possibly being pregnant, and I have better shit to do with my time than panic.

What did your doctor say?

I am very, very lucky to have a doctor who, unbeknownst to me when I chose her out of a phone book nine years ago, is extremely supportive, open minded, and knowledgable. She also, again unbeknownst to me, specializes in minimally invasive gynecological surgery. I went to my annual exam in December expecting serious pushback, because I've heard horror stories about doctors who refused to give a woman a tubal because she's "too young", "hasn't had children", or "might change her mind". Let me be clear that this is not the doctor's choice, and no person should be told, within reason, what one should do with his or her body, by a doctor or anyone else. So when I went to my doctor, I was armed with a list of reasons why I should have this procedure, or Essure (a form of nonsurgical permanent birth control). Turns out I didn't even need the list. She asked a few questions, we talked, and in the end, all she had to say is "you've done your research and you know what you want. Let's do it." It took a few months to get to this point, because my doctor is busy (isn't that true of all OB/GYNs though?), but my surgery was scheduled back in January. This past Monday, when I went for my pre-op appointment, her only question regarding my decision was "not considering changing your mind, are you?" Nope. Not at all.

How does the procedure work? Is it permanent?

The type of tubal ligation I'm having is laparoscopic, which means there will be two small incisions made, one in my belly button and one at the base of my stomach. My doctor will go in with a tiny laser and camera and sever each Fallopian tube, then cauterize each end to ensure nothing can get through one way or the other. I call it the "slash and burn". (My doctor thought that was pretty funny!) Because the procedure is so minimally invasive, I'll be discharged from the hospital the same day, and after a couple days of chillin, I'll be ready to return to my regular activities. I might not be able to lift a lot of weight at first, but it's not like I'm a pro weightlifter anyway.

Tubal ligations are a permanent form of birth control. In rare cases they can be reversed, but medical professionals absolutely do not recommend a tubal ligation as a temporary form of birth control. There are many other options for long term reversible birth control that do not require surgery. This is a lifelong choice, much like getting a tattoo. There are ways to take it back, as it were, but they're painful, expensive, and difficult.

How much will it cost?

Thanks to reaching my deductible and out of pocket max from my back surgery in October, the procedure will be completely free. Even if I hadn't reached my insurance plan's maximum payment, I would still pay nothing, as health insurance plans are now required to fully cover female sterilization as a version of birth control under the Affordable Care Act. Some people, including politicians, believe that this is more dangerous and costs Americans more than just the pill, but it also offers women who can't take hormonal birth control another option, and laparoscopic procedures are very safe.

What if you change your mind?

It's always insulting to ask if I might change my mind. It's quite rare for someone to ask a pregnant woman if she might change her mind about having kids, so why is it so okay to ask me if I might change my mind?

I've considered what might happen in the very slim possibility that I do change my mind--because after all, people do change. One of my core beliefs has always been in the power of adoption; I think it's so important to support the children of this world who don't have families or the love that they deserve. I haven't ruled out the possibility of adopting an older child, but even if I were able to have my own children, I would much rather adopt. So that's what would probably happen if I changed my mind. I would never blame anyone--my boyfriend, my doctor, or even myself--for changing my mind, because that shit happens.

But what about your boyfriend and his legacy?

What about my legacy? I'm always flabbergasted by this question. As though legacies can only be male. Regardless of my boyfriend's legacy (just so we're clear, my boyfriend fully supports this decision), my legacy involves some nasty diseases--PCOS, of course, but also breast cancer, heart disease, diabetes, stroke, and depression. I don't want to pass this on to anyone. The burden of disease is a heavy weight to bear, and I wouldn't share that lightly. And although I plan to be with my boyfriend for a very, very long time, what if something happens? I want to always be in full control of my own reproductive health, and this is the best way to ensure that I will always have that power. In a time when the control that women have over choices regarding their own bodies is constantly under attack, I want to protect myself whenever I can and however I can.

Why don't you want children? That seems selfish.

I have always felt extremely uncomfortable around children. Even when I was a child myself, I was precocious and preferred to be around adults rather than others my age. I am also very uncomfortable--sometimes to the point of panic--around pregnant women, although of course I can't tell them that, because what an insult. I've always feared being stuck in a situation where I was pregnant, and where I would have to make a very difficult decision to either have a child that I would not love or to have an abortion. If wanting to avoid bringing a child into a lifelong relationship with a mother that did not want to be a mother is considered selfish, then call me selfish to the end of the moon.

Not having my own children means that I'll be able to be a beneficiary for L.'s college savings plan. I'll be able to pay off my student loans and support my boyfriend and myself while he works his way through college. I will be able to buy a house someday and help care for adopted pets. I don't think of any of this as selfish--I just think I have different priorities, and that's a good thing. Someone has to do the things that other people don't, and that's true of many things, not just parenthood.

How will this affect your PCOS?

It won't, which is both good and bad. I will have to remain on birth control for the rest of my reproductive life, which is a pain, but it will be strictly used to control my symptoms and regulate my periods, which without birth control are nonexistent. I won't have to concern myself with a super specific schedule, and missing a pill won't mean a month of anxiety.

Do you have any questions that I haven't answered? Feel free to ask!

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