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debirlfan
09-21-2010, 08:12 AM
A question for the resident doctors...

I know that doctors are generally unwilling to "tie the tubes" of a young woman who has not had children. However, I'm wondering if special circumstances might change that.

In this case, (set in 1991), the young woman (I don't have an exact age, but probably late 20's to 30) has been diagnosed with ALS (Lou Gehrig's disease) and doesn't want to chance becoming pregnant. Do you think she could find a doctor who would agree to the procedure?

(If it matters, she has a long time boyfriend/fiancee who she has tried to chase off, but who is determined to stick by her. He is in agreement with her in regard to having the tubal ligation.)

Thanks much.

Wiskel
09-21-2010, 07:31 PM
She'd probably find someone without too many problems.

She has four good reasons:

Some ALS cases are familial so there may be a risk to the child
If she has any symptoms, then pregnancy and birth carry an increased risk for her.
If she has any symptoms, then abortion would carry an increased risk for her.
Her ability to care for any children may be compromised.

There are two factors against her:

Any operation or procedure carries an increased risk to her. The more symptomatic she is, the higher the risk. Any surgeon would probably want to do it under local anaesthetic and avoid high doses of sedatives.
She might change her mind and even if she knows she won't, she'll have to convince the surgeon.

I suspect it would be a pretty cold hearted surgeon who'd say no, but a good one will want to make sure that she's sure.


Craig

stitchingirl
09-21-2010, 10:46 PM
I know when an ex-friend tried getting a tubal done after her second pregnancy, they refused to do it. She was like 18 or 19..somewhere around there. But the doctors told her that she could change her mind in two years and then she couldn't have any more kids. That if she would have been like 21 or something, then they could do it.

I thought that was complete bullshit. It was almost like they were trying to encourage her to have more kids. Of course she did end up having two more kids, but that was their choice.

debirlfan
09-21-2010, 10:52 PM
She'd probably find someone without too many problems.


Thanks - that's pretty much what I figured. Luckily I don't need much in the way of details re the procedure or how she convinced the doctor to do it, just needed it to be reasonable that she DID have it done.

Thanks again.

GeorgeK
09-23-2010, 10:11 PM
It's mainly the insurance companies dictating that, not as much the doctors. If someone showed up with cash in hand and filled out the informed consent forms, I doubt that they would have to go to more than 2 offices to find someone.

Aerial
09-24-2010, 01:59 AM
No, I think most doctors are primarily concerned with making sure that the patient won't regret the choice somewhere down the road. Anyone who's old enough to think back on their twenties nostalgically knows that how you see the world at that age is radically different from how you'll see it at 30 or 40 or 50.

I had a tubal done when I had my third child (at age 30). The baby was unplanned (and arrived almost five years after my husband's vasectomy). Even so, the doctor asked the question about having the procedure several times, until he was personally satisfied that I had thought through the choice and the consequences and would not change my mind later. I'm sure it helped that we'd already taken one step toward permanent birth control (the vasectomy). And though the doctor probably had lawsuits somewhere in the back of his mind, I don't think that was his primary concern by a very wide margin.

Finally, just because life is always unpredictable, we ended up adopting a 4th child a couple of years after I had the tubal. :)

Aerial

thethinker42
09-24-2010, 03:49 AM
It's mainly the insurance companies dictating that, not as much the doctors. If someone showed up with cash in hand and filled out the informed consent forms, I doubt that they would have to go to more than 2 offices to find someone.

In my experience, it really is the doctors. I contacted dozens - yes, dozens - of doctors about one, and all but one refused to even consider it. The one who was willing to consider it did everything he could to scare me out of it, and finally said he wouldn't do it unless I wore an IUD for 6 months first, even after I said an IUD was out of the question.

I'm covered under military insurance and had documentation that the procedure would be covered. Military doctors wouldn't consider it either. Would it have been different with civilian doctors if I'd had cash in hand? Maybe. All I know is the attitude was very much "oh, no, you're entirely too young to make this decision" (but I wasn't too young to make the decision to HAVE children?).

Now, when my husband asked for a vasectomy? Done, no questions asked. Okay, the doctor ran us through a few routine "have you thought this through?" questions, but it was entirely devoid of the attitude I got when I tried to get fixed.


No, I think most doctors are primarily concerned with making sure that the patient won't regret the choice somewhere down the road. Anyone who's old enough to think back on their twenties nostalgically knows that how you see the world at that age is radically different from how you'll see it at 30 or 40 or 50.

I had a tubal done when I had my third child (at age 30). The baby was unplanned (and arrived almost five years after my husband's vasectomy). Even so, the doctor asked the question about having the procedure several times, until he was personally satisfied that I had thought through the choice and the consequences and would not change my mind later. I'm sure it helped that we'd already taken one step toward permanent birth control (the vasectomy). And though the doctor probably had lawsuits somewhere in the back of his mind, I don't think that was his primary concern by a very wide margin.

Finally, just because life is always unpredictable, we ended up adopting a 4th child a couple of years after I had the tubal. :)

Aerial

This was what we ran into also. Ironically, they have no qualms about dishing out fertility treatments to a 23 year-old, but won't sterilize a 27 year-old. My point to them was that I had already changed my mind about having them, and having a child is a hell of a lot less reversible, you know?

Fortunately, my husband was able to get a vasectomy with no trouble. Trying to get a tubal was a nightmare and a half.

GeorgeK
09-24-2010, 03:34 PM
I am a retired surgeon. I took care of some people who medically would obviously not survive a subsequent pregnancy. Convincing the OB of that was not the problem. It was the insurance company that was the problem. It was only when I threatened to report them to the Senate insurance oversight committe that they agreed. The patients never see that aspect of it and most physicians are very resistent to admitting to patints just how hobbled we have become by the insurance industry and unwilling to spend hours a day several days a week arguing with a bean counter who only can read an algorithm. Also the surgeon's fees are a pittance compared to the facility fees. Since the patient would be bypassing insurance, they'd have to pay them up front as well. I'd be surpised if the final tally was less than 10 grand.

scarletpeaches
09-24-2010, 03:40 PM
Anyone who's old enough to think back on their twenties nostalgically knows that how you see the world at that age is radically different from how you'll see it at 30 or 40 or 50.Uh, no. I'm in my mid-30s and would have a tubal tomorrow if it was offered.

I felt exactly the same in my early 20s when I asked about being sterilised and was refused.

thethinker42
09-24-2010, 03:43 PM
I am a retired surgeon. I took care of some people who medically would obviously not survive a subsequent pregnancy. Convincing the OB of that was not the problem. It was the insurance company that was the problem. It was only when I threatened to report them to the Senate insurance oversight committe that they agreed. The patients never see that aspect of it and most physicians are very resistent to admitting to patints just how hobbled we have become by the insurance industry and unwilling to spend hours a day several days a week arguing with a bean counter who only can read an algorithm. Also the surgeon's fees are a pittance compared to the facility fees. Since the patient would be bypassing insurance, they'd have to pay them up front as well. I'd be surpised if the final tally was less than 10 grand.

Why does that not surprise me? *eyeroll* Grargh. I could rant about insurance for hours.

I'm not sure how much of an issue that is with military medical facilities, but the attitude is certainly the same.

GeorgeK
09-24-2010, 03:57 PM
No, I think most doctors are primarily concerned with making sure that the patient won't regret the choice somewhere down the road. Anyone who's old enough to think back on their twenties nostalgically knows that how you see the world at that age is radically different from how you'll see it at 30 or 40 or 50.

I had a tubal done when I had my third child (at age 30). The baby was unplanned (and arrived almost five years after my husband's vasectomy). Even so, the doctor asked the question about having the procedure several times, until he was personally satisfied that I had thought through the choice and the consequences and would not change my mind later. I'm sure it helped that we'd already taken one step toward permanent birth control (the vasectomy). And though the doctor probably had lawsuits somewhere in the back of his mind, I don't think that was his primary concern by a very wide margin.

Finally, just because life is always unpredictable, we ended up adopting a 4th child a couple of years after I had the tubal. :)

Aerial

That too is a big part of the problem, fear of lawsuits. The last time I looked it up, about as of 10 years ago. 75% of lawsuits against Urologists revolved in one way or another around vasectomies. If I remember cases like your husband, where there is a pregnancy later like that accounted for about a third of them. The question that the physician needs to ask the patient is the "What if, your spouse and children were killed in a car wreck tomorrow? 5 years later you are remarried and your spouse wants children. Infertility is still (or was back then) still consistently in the top 3 reasons for requesting a divorce. So are you positive that even then, you'd still want to be sterile?

You're right in that a lot of physicians simply stopped doing sterilizations altogether. IF that is what you mean by the doctors refusing, I understand your point, but I don't think that it is fair to blame the doctors as being the ones behind it.

For the OP, I would not be surprised if the cash paid Dr or facility required a permission slip attesting to sanity from a psychiatrist or the patient's primary care person. If there was clear documentation of a life threatening problem that might not be an issue, but "because the patient wanted the operation," is not a defensible position in court. There needs to be medical justification.

scarletpeaches
09-24-2010, 04:02 PM
The question that the physician needs to ask the patient is the "What if, your spouse and children were killed in a car wreck tomorrow? 5 years later you are remarried and your spouse wants children. Infertility is still (or was back then) still consistently in the top 3 reasons for requesting a divorce. So are you positive that even then, you'd still want to be sterile?I don't see the relevance of that question.

Firstly: who the hell marries someone who wants children, if they don't?

Secondly: who the hell marries someone who wants children, if they don't?

I mean...entering into a marriage without being upfront about that sort of thing? Huh? I don't get it.

If I ever get divorced it sure as hell won't be because I kept my unwillingness/inability to have children a secret. That's one of the first things you mention when you enter into a relationship.

And I'm not a woman who has kids and doesn't want more. I'm a childfree woman who never wants any.

GeorgeK
09-24-2010, 04:21 PM
And I'm not a woman who has kids and doesn't want more. I'm a childfree woman who never wants any.

And that's why we all like you (not because you don't want to have kids, but because you aren't trying to deceive anybody). Unfortunately there are a lot of people who are not so up front about that kind of stuff. Add to the fact the brain chemistries are a bit wacko during intense states of love, they may not be thinking straight. Sometimes people also do just change their minds about things. I was raised by (probably a closet gay, thinking back on it) a guy who was among other things an extreme homophobe. (I remember one of his more blood curldling rants about how Hitler's only problem was that he was too soft...but anyway) I was taught that it was symptomatic of almost demonic possession, that they were all pedophiles and tax evaders and secret communists bent on overrunning the world except on the days of their perverted disease spreading orgies.

In a bizarre way, his ignorance and ranting at least encouraged me (by the reverse barometer effect) to get a real education and I eventually learned that he was wrong, that it is simply an epigenetic phenomenon and therefore simply a normal variant. Sometimes things happen, or you learn things that make you change your mind. That's why the question I posed to patients is relevant.