Patient education: Permanent birth control for women (The Basics)

What is permanent birth control? — Permanent birth control is a procedure that prevents pregnancy permanently.

This article uses the word "women" to refer to people with a uterus and ovaries. However, not all people with a uterus and ovaries identify as women. This information is also for transgender men and nonbinary people who wish to prevent pregnancy.

What are my options for permanent birth control? — There are 2 options. They both involve the fallopian tubes, which are the tubes that carry eggs from the ovaries to the uterus (figure 1):

●Tubal ligation – This is the most common permanent birth control procedure. It is also called "having your tubes tied." For this procedure, a doctor blocks, clamps, or seals the fallopian tubes.

●Bilateral salpingectomy – This is a procedure to remove the fallopian tubes completely.

After a tubal ligation or bilateral salpingectomy, you will not be able to get pregnant. That's because after the fallopian tubes are blocked or removed, your eggs cannot get into the uterus to be fertilized by a partner's sperm.

Is permanent birth control right for me? — This is a very personal decision. If you are considering permanent birth control, it's important to be sure that you never want to get pregnant in the future.

If you think that you might change your mind, another type of birth control might be a better choice. There are several options that work very well to prevent pregnancy but are not permanent. Your doctor or nurse can talk to you more about this.

How is the procedure done? — Permanent birth control procedures involve surgery.

The type of surgery depends on when you get the procedure. The 2 main types are:

●Laparoscopy – This procedure will be used if you have not just given birth:

•You will get medicines through a thin tube that goes into a vein, called an "IV." You also might breathe gases through a mask to make you unconscious. This is called "general anesthesia."

•The doctor inserts a tiny camera and tools through small incisions (cuts) in your lower belly.

•The doctor uses rings or clips to close your fallopian tubes. Or they might use heat to seal the tubes shut. If you are having a bilateral salpingectomy, they will remove the tubes completely.

Most people recover from surgery after 1 to 2 weeks.

●Postpartum procedure – This is when you get the procedure right after giving birth. Many people who are giving birth and do not wish to have any more children choose this type of procedure.

If you have a vaginal birth, the procedure is done after you have the baby, while you are still recovering in the hospital:

•First, you will get a "spinal block." For this, the doctor puts a small needle in your lower back, into the fluid around your spinal cord. Then, they inject medicines that block pain and relax your muscles so that you do not move. If you had an "epidural" for pain during labor, this can be used instead of a spinal block.

•Next, the doctor makes a small cut below your belly button and takes out a small section of each fallopian tube. Or, if you are having a bilateral salpingectomy, they will remove the tubes completely.

If you have a "c-section" (surgery to get the baby out), the doctor can do a permanent birth control procedure right afterward, through the same incision.

Getting permanent birth control after giving birth doesn't usually keep you in the hospital for extra time. This is true whether you have a vaginal delivery or a c-section.

How well does the procedure work? — It is very effective. Less than 1 percent of people who have a permanent birth control procedure get pregnant.

What are the benefits of permanent birth control? — The main benefit is that it is permanent and doesn't require you to use other forms of birth control to prevent pregnancy.

Besides preventing pregnancy, this procedure might also lower your risk of getting ovarian cancer in the future.

What are the downsides of permanent birth control? — Most people who choose permanent birth control do not regret their decision. But some people do change their mind and decide that they want to get pregnant.

It is very rare to get pregnant after having a permanent birth control procedure. But if this does happen, there is a high risk of an "ectopic" pregnancy. When this happens, the egg joins with a sperm to form an embryo. But instead of attaching to the lining of the uterus, the embryo attaches to a place in the body where it should not attach and starts to grow. This can be very dangerous. If you have had a permanent birth control procedure and think that you might be pregnant, call your doctor right away.

What if I change my mind and want to get pregnant? — If you have a tubal ligation, it is possible to have another procedure to try to reconnect the fallopian tubes. But this often does not work and can be very expensive.

People are more likely to change their mind if they:

●Were younger than 30 when they had the permanent birth control procedure

●Had relationship problems when they got the procedure

●Began a new relationship after having the procedure

●Have had pregnancy complications, lost a pregnancy, or had a baby or child die

Deciding about birth control is a personal decision, and the choice is yours alone. But if you are at all unsure, you might want to consider a different form of birth control until you are certain about your decision. There are methods that can prevent pregnancy for months to years and work just as well, but are not permanent.

More on this topic

Patient education: Choosing birth control (The Basics)
Patient education: Long-acting methods of birth control (The Basics)
Patient education: Emergency contraception (The Basics)
Patient education: Salpingectomy (The Basics)

Patient education: Permanent birth control for women (Beyond the Basics)
Patient education: Long-acting methods of birth control (Beyond the Basics)
Patient education: Birth control; which method is right for me? (Beyond the Basics)