All about sterilisation

Don’t want to have any more children? Read on

Sabrina is pregnant with her second child. She and her husband have been discussing sterilisation. They do not want to have any more children and would like to adopt a permanent method of family planning. Sudha is undergoing a second caesarean section. She and her husband have also decided on sterilisation.

What does sterilisation in a woman involve? Sterilisation is a surgical procedure that is done to prevent a woman from getting pregnant. It is a very effective method. Fifty per cent of women who undergo sterilisation have it immediately after the birth of a baby. If sterilisation is being considered, the decision is best made well before the birth of the baby. This gives enough time to plan and discuss the procedure with the obstetrician. The couple should be absolutely certain that they do not want any more children in the future. If there is any chance that they may want to have children in the future, reversible forms of birth control, like an intrauterine device or birth control pills, would be a better option.

What is female sterilisation?

Tubal ligation (also known as “tying the tubes”) is a safe and permanent method of family planning which for most women is free from problems.

The fallopian tubes arise from both sides of the uterus. The egg and the sperm meet in the tube and fertilization occurs there. If both the tubes are blocked by the process of sterilisation, the egg cannot enter the tube and the sperm cannot reach the egg. Many women are concerned that the eggs will collect inside them and will make them fat! This is just a myth: remember that the human egg is microscopic and disintegrates in 48 hours.

The surgery does not affect either partner’s ability to have or enjoy sex. Many couples say that sex improves after sterilisation because there is no fear of an unwanted pregnancy.

When is sterilisation done?

Usually, postpartum sterilisation (sterilisation immediately after a vaginal delivery) is done within 1-2 days of birth. It is best to have a paediatrician assess the health of the baby before the procedure is done.

When the sterilisation is combined with a caesarean section, the tubal ligation is done at the same time as the caesarean. This does not add any extra complication to the caesarean and there is no increase in recovery time.

Interval sterilisation is performing the tubal ligation when a woman is not pregnant. This can be done anytime but is usually done immediately after a period to ensure that the woman is not pregnant at the time of the procedure.

How is sterilisation done?

Tubal ligation is done under anaesthesia. This could be general anaesthesia or regional (spinal or epidural) anaesthesia.

After birth, it takes the uterus about 2-3 days to contract down. So when the sterilisation is done immediately after a vaginal birth, the uterus is still enlarged and is usually at the level of the umbilicus. A small, 2- 2.5 cm incision is made just below the umbilicus. The tubes are then located through this incision and they are ligated. During a caesarean section, the abdomen is already open and the tubes are easily accessible.

Each fallopian tube is tied and cut. After the tube has healed, the two cut ends will be far from each other and the egg cannot reach the sperm. After the tubes are tied and the procedure is complete, the skin incision below the umbilicus is closed with stitches and dressings applied. The operation takes about 15-30 minutes. The hospital stay will be extended by 2-3 days after the procedure.

When the procedure is done on a woman who is not pregnant, it is done through a minilaparotomy (a small cut just above the pubic hairline) or through a laparoscopy. The tubes are usually blocked with a Falope ring or by an electric current.

Chances of pregnancy after sterilisation

Though small, there is a risk of getting pregnant even after a tubal ligation. Four to six women out of a thousand can get pregnant. This happens because the tubes regenerate and bridge the gap that was created. This is usually a spontaneous process and does not mean that a poor technique was used.


(The author is a Chennai-based obstetrician and gynaecologist with a special interest in women’s health issues.)

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