I think I missed the first post, but would like to add a comment.  I agree
that this is not the best time to have a tubal.  (Now that I work in a
Catholic hospital, it's not even an option!!)  However, it has a few
advantages:  The uterus and tubes are bigger and higher in the abdomen, so
it can be done with a small peri-umbilical incision without a laparoscope.
Many family physicians are trained to do this procedure.  This may be
significant for moms in rural areas who would have to travel some distance
and/or disrupt their schedules to have access to a gynecologist with a
laparascope. (It's also less expensive, important for some patients with
no/poor insurance.) I've had some moms with several children who were
*sure* they were done, and who chose to have a pptl because they had
grandma or someone around to watch the older kids for a few days around
the birth of the new baby.

PPTL can be done with minimal disruption to breastfeeding if someone is
willing to make the effort and provide the advocacy.  Like most things
medical, it has its place but sometimes gets used inappropriately.

--
Anne Montgomery, M.D.
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St.Peter Hospital Family Practice Residency
Olympia, WA