Subj:   Tubal ligation

In response to Sheri:

In my previous career when I worked in hospital as Nursery and PP staff nurse I
had a great deal of contact with women having postpartum tubal ligations.  In
those days, all women were in hospital for 3-4 days and they were encouraged to
have the surgery before discharge.

The sterilization procedure is probably more traumatic to the woman when done
immediately post partum than when the surgury is delayed several months.  The
entire procedure is entirely different because of the great difference in the
internal organs at the two different times.

In these days of universal early discharge, I am even more uncomfortable with
the disruption this surgery would put into a very crucial adjustment period.
The effects of the medications does not seem very important.  But the women I
cared for felt pretty lousy and were not much interested in their newborns.  We
encourage delaying circumcisions (if done at all) because of the disruption to
the usual attachment and learning period.  Doing surgery on the mom is even
more disruptive.

The excuse for early TL is the fear that the woman will not schedule the later
procedure in a timely manner and will end up pregnant again.  This is a very
demeaning attitude toward women and hopefully not something any of us would
subscribe to.  The seemed to be a bias expressed by the OB's to maximize the
provided services while they had the client in their hands.  Maybe this is just
a negative impression of a Maternity nurse, take it for what it is worth.

My guess that now with early discharge, the surgery is done VERY soon after the
birth.  It was bad enough when it was done a day or two later, but earlier
would have an even greater disruption on mother/baby contact.

I would encourage my clients to consider scheduling a later procedure.

I don't know if there is published info on this.  My opinions are based on what
I saw and on information I received from more experinced PostPartum and
Labor/Delivery Nurses.

Ruth Sweet, RN, MS, IBCLC