Ohhhh God, I can feel the chunks a-rising already. Here it comes... False alarm. We're okay. So, from what self-destructive urge is the brave and noble doctor saving this woman? Suicide? Alcoholism? Marrying Kevin Federline?
Earlier this year, a patient of mine in her early 20s who was expecting her third child asked to have her tubes tied. A mother of two, with a full-time job and part-time school classes, she saw a fourth child as an impossible burden.
Wow. Yes. Yes, that is a, um, terrible, awful, irresponsible decision that could harm her in the future, as she continues to... not have more kids than she has the money or time to care for. Go for it, doc.
I acknowledged to my patient that the surgery was effective in preventing pregnancy. In terms of making her life better and her happier, though, the prognosis was poorer.
Because if anyone would know, it would be her male gynecologist.
The best study done on surgical sterilization followed more than 10,000 women who had the procedure. Women under 30 felt regret much more often than those over 30, the researchers found. Other studies suggested that my patient, younger than 25, might be at even higher risk for regret.
This is actually true. As a commenter at Pandagon points out, the frequency of regretting a tubal ligation is two percent overall, but for women under 30, it's - wait for it - four percent. That's twice as many. How good of the kind doctor to save this woman from a 96 percent chance of being satisfied with the procedure.
My patient could change her mind and have children after sterilization. A subsequent surgery could reconnect her tubes. She could undergo in vitro fertilization, removing the eggs directly from her ovaries, fertilizing them and placing them back in her uterus. But both options carry risks and are very expensive, and if my patient did not have the money, she would be out of luck.
And obviously she wouldn't have the money, since she's already said that she doesn't even have the money to raise more kids. Oh, good doctor, show her the error of her ways!
I wanted her to understand the implications of her decision.
“What if your children died in a fire? Would you want more children?” I asked, a horrible to question to put to a pregnant mother.
If one of your wholly interchangeable children were to die horrifically, wouldn't you want to immediately pop out a new one? A horrible question, indeed, but a crucial one. Who would finish all of those Lunchables in the fridge?
No, she said.
“What if the relationship you’re in now ended and you met someone else? Would you change your mind?”
After your current man leaves you, you baby-hating slut, won't your new man want to plant his sperm flag on Mount Uterus? Don't you care about your new hypothetical man?
My patient’s request wasn’t unreasonable. She was choosing a form of birth control favored by millions of other American women. For her, I just felt it was a bad choice because in 15 years, much could change: her children might go off to college, she might be remarried, she could have a higher income. She might want a fourth child by then, and with excellent reversible birth control options like the intrauterine device, there was no need for her to take a risk with a tubal ligation.
She might be homeless and on the streets. She might be reveling in an empty nest and considering starting her own business. She might be remarried, with a higher income, and looking forward to a cruise around Mexico with her new hubby. And who wouldn't want another baby at that point? The important thing isn't that we take care of her needs now; the important thing is that we prepare for an infinite array of hypotheticals a decade and a half in the future. When medical science will not have progressed at all.
“Treating people as rational adults means letting them do things they may bitterly regret later,” wrote Piers M. Benn, a medical ethicist at Imperial College London and the lead author of a paper on sterilizing young, childless women, published last year in The British Medical Journal.
If society let a person ruin her health by drinking a bottle of whiskey a day, Dr. Benn wrote, “it might be reasonable to ask what is so special about voluntary sterilization.”
Because drinking a bottle of whiskey a day is, of course, perfectly comparable to having full baby-making capacity and choosing not to use it.
In the end, I decided my patient’s request was reasonable. I hope the surgery gives her a feeling of control in her life and relieves some anxiety. If years from now she decides she wants more children, I’ll tell her what I think her best options are and try to talk her out of any bad ideas.
O blessed doctor, thank you for being there and rescuing this woman from the horrors of making her own decisions. Autonomy is such a stress on women, delicate and fragile as we are, and having someone browbeat us into submission about our own bodies is such a relief. Thank you for taking the time out of your busy day to impart your wisdom upon us. Now, if you'll only tell me whether or not I should toast my turkey sandwich today, and if Swiss cheese is the wisest choice, I'll let you get back to the helpless, deeply stupid women in need of your care.