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

What is permanent birth control? — 

This is a procedure to prevent pregnancy permanently.

This article uses the word "women" to refer to people with a uterus and ovaries. But not all people with these parts 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. Both involve the fallopian tubes, which are the tubes that carry eggs from the ovaries to the uterus (figure 1):

●Tubal ligation – This is also called "having your tubes tied." A doctor blocks, clamps, or seals the fallopian tubes.

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

After either of these, you should not be able to get pregnant. That's because once the fallopian tubes are blocked or removed, your eggs should not 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 you never want to get pregnant in the future.

If you think you might change your mind, you should probably consider a different form of birth control until you are certain. There are methods that can prevent pregnancy for months to years and work just as well, 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 it.

The 2 main types are:

●Laparoscopy – You will get this if you did not just give 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 will insert a tiny camera and tools through small cuts ("incisions") in your lower belly.

•The doctor will use 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 your tubes completely.

Most people recover from surgery after 1 to 2 weeks.

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

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

•First, you will typically get a "spinal block." The doctor will put a small needle in your lower back, into the fluid around your spinal cord. Then, they will inject medicines that block pain and relax your muscles so 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 will make a small incision below your belly button and take out a small section of each fallopian tube. Or if you are having a bilateral salpingectomy, they will remove your 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 it is permanent and doesn't require you to use other forms of birth control to prevent pregnancy.

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

What are the downsides of permanent birth control? — 

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 the wrong place in the body and starts to grow. This can be very dangerous. If you had a permanent birth control procedure and think you might be pregnant, call your doctor right away.

What if I change my mind and want to get pregnant? — 

Most people who choose permanent birth control do not regret their decision. But some people do change their mind and decide they want to get pregnant.

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

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

If you have a tubal ligation, it is possible to have another procedure to try to reconnect your fallopian tubes. But this often does not work and can be very expensive. If you had your tubes removed completely, this cannot be reversed.

More on this topic

Patient education: Tubal ligation (The Basics)
Patient education: Salpingectomy (The Basics)
Patient education: Choosing birth control (The Basics)
Patient education: Long-acting methods of birth control (The Basics)
Patient education: Ectopic pregnancy (The Basics)

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