17 August 2016

So I was sterilized


I don’t have to explain why I don’t want children. I never did. My reasons are numerous and private, and they don’t really matter just now.

That’s a fairly mild revelation. I don’t want children. Like saying I don’t like cauliflower, or I feel uncomfortable at dance clubs. Maybe you don’t agree, but surely you can see my point of view. Some can’t or won’t. But they’re less interested in my happiness than in maintaining their own ideas of womanhood, femininity, and social order.

For me, the question was never if I should get sterilized, but when. How old would I have to be? When would I meet a doctor who would be willing to do it for me?

It turns out, I only had to stop listening to people who told me it would never happen and reach out to one. I don’t know what any other particular gynecologist would have said, but I do feel lucky to have picked mine. I’ve read too many stories from women who face paternalistic refusals from doctors who think that because most women want kids, all women must.

Because women aren’t individuals, right? We’re pretty much one-size-fits-all tube tops. Right?

I could argue that a significant number of parents have kids because it’s expected of them, or they have an accidental pregnancy, or they’re pressured by partners. But what I really want to do is talk about myself. Because that’s what I know best. Maybe then people will stop questioning my decision. Or at least, they’ll leave me alone and stop asking out loud.

Trigger Warning: A photo of my clipped fallopian tubes follows this article.

ONE – THE FEELS

What if you meet someone who wants kids?

This has happened twice, actually. My two biggest relationships, with people I loved intensely, ended in large part because of conflicting views on parenthood.

The Saint

My ex-girlfriend, E., with whom I was in a polyamorous relationship, became pregnant by her boyfriend four months after we met. It was as unreasonable for me to expect her to change her mind about the baby as it was for her to think I could learn to accept it. I’m not proud of the way I acted, but she was saint-like in her patience.

When she told me and her other girlfriend, M., that she was pregnant, we were both stunned, but M. was more gracious, politely congratulating E. I knew I was supposed to do the same, but the congratulations stuck in my throat, I couldn’t get the words out. How could I? It meant our breakup was coming, but I wasn’t ready to lose her.

We stayed together for another six months. Most of the issues that arose in that time were changes linked to her pregnancy. I didn’t know where I would fit in her life once the embryo became a fetus and then a person. She’d bring the baby and a diaper bag to my apartment for sleepovers? I’d go to hers and share a bed with her and her boyfriend, waking up at various intervals in the night when the baby cried?

I picked fights and grew irritated over small things. I was not as kind as I should have been. I resented the changes to her body, not because I thought she was less beautiful, but because of what they meant. Her swelling belly meant the birth was approaching. Her growing breasts meant she’d be feeding the baby soon. Her lack of energy meant she had to spend more time caring for it than running around with me on vacation.

I eventually stopped loving her because the negative feelings drowned the positive. Though we’re friends now, I still wish her demon baby didn’t exist.

E., who knows me better than anyone ever has, told me she was happy for me that I was finally being sterilized. Which is generous, given how often I express revulsion toward her spawn.

The Dreamer

For a while, I was in a monogamous civil union with my ex-boyfriend, C. I considered pursuing sterilization through his mother, a gynecologist, but before I could ask, he told me she loves children and would never sterilize her son’s pacsée. I wonder if that was true or if he was simply hoping I’d change my mind.

He was terribly unhappy about it. He didn’t always want kids, but when he realized he did, I felt him growing distant, knowing there wasn’t any flexibility in this on my end. I was always certain of things; he wavered. We still loved each other, though, and when I prodded him to talk about us, he said he didn’t want it to be over yet. But, he said, if I wanted to leave, that was my choice. I thought that was unfair and cowardly.

Once, C. said people must have children at our age because they’re bored and need a hobby. I remember thinking, 1) I’d love to entertain you if you’d only stop pushing me away, and 2) that is the worst reason to have a child. As if we merely needed to be distracted from all the ways we were wrong for each other. As if it was a child’s job to fix a broken couple.

Finally I decided to leave on my own. It wasn’t that I didn’t love him, only that I refused to hang around until he decided it was time to have babies. Besides, I was as bitter about his monogamy as he was about my aversion to children, so we fought constantly, made each other miserable. The countless reasons to split rendered love irrelevant.

Because I think of him as one of my best friends, I told him about my sterilization. He felt sad and didn’t support me, crushingly. I can’t imagine why, given how bitter and painful our breakup was – getting back together was never a serious question. Beyond that, I don’t know what he feels because he isn’t ready to be friends. Harder than anything was when he told me he had nothing to say to me, because if I could’ve had anyone in the world with me the morning of my surgery, it would have been him.

The possibility of falling in love with someone in the future who wants children can’t matter. I will not lease my time, my energy, or my body to fulfill a partner’s desires when in direct opposition to my own. It’s the wrong reason to do it anyway.

Don’t your parents want grandchildren?

They do. My mom’s cold anger burst my elated bubble. I don’t know why it surprised me so much. I knew she didn’t approve. She thought it was selfish. Selfish not to give her the grandchildren she wanted, not to share the experience of motherhood with her, not to sacrifice my life and independence to a baby – I don’t know exactly.

She gave me the cold shoulder for days. I was wounded and angry. I expected she would at least respect my right to make the decision. Surprisingly, it was my dad who was supportive. Well, supportive is a bit of a stretch. He didn’t agree but held his tongue because it wasn’t his call. He isn’t exactly a champion of gender equality or the idea of women stepping outside of traditional roles. Still, he didn’t question me or try to change my mind.

My mom is still quite sad about it, and I don’t like that she’s hurt. But if I won’t have children for a partner I’m madly in love with, I certainly won’t do it for my parents.

Most of the people in my life have been incredibly supportive – my friends, my ex-girlfriend E., the hospital staff, my Aunt B. My mom is trying to support me now, too.

TWO – CHOOSING STERILIZATION

What if you regret it?

Well then that’s just how the cookie crumbles, isn’t it?

Two weeks before the surgery, my mom asked me if I thought perhaps I made “self-sabotaging” decisions – dropping out of UC San Diego to attend the University of Bordeaux in France, engaging in polyamorous relationships, having (protected) loveless sex, and of course, being sterilized before my 25th birthday.

All I have to say about the decisions she’s deemed “self-sabotaging” is that they were incredibly liberating. Though she’s told me on multiple occasions that I seem to know myself extremely well, she forgets this whenever she disagrees with my choices. It’s typical, she’s no worse than any other parent, and I love her immensely in spite of it.

I’m not saying I’ve never regretted anything.

I regret spending $500 in two years on Threadless.com. I wish I hadn’t lapsed from veganism into vegetarianism for six months in 2013. I wish I’d been brave enough to tell a French friend that I was in love with him before we lost touch. I wish I’d slept with my ex-pacsé on our first date so that night would have been that much better.

If those regrets sound minor, it’s because I know myself well enough that my big decisions have always been exactly right for me.

Why don’t you use reversible birth control?

Hormonal birth control methods – pill, IUD, patch, implant, ring, injection – are impressive little tools that I support wholeheartedly. However, I no longer use them because I find their side effects intolerable: diminished libido, mood swings, weight gain, nausea, irregular bleeding, and hormonal dependence, to name only a few.

I am unwilling to deal with such severe side effects. I shouldn’t have to.

As for non-hormonal birth control, I don’t care for devices like the diaphragm and the sponge. They’re inconvenient and less effective. The hormone-free copper IUD frequently causes heavy, painful bleeding, sometimes to the point of anemia. Greater menstrual pain isn’t something I could handle. It also tends to cause spotting between periods, and its insertion has been described as agonizingly painful.

So when I sleep with men, that leaves male condoms as my only form of birth control. And they’re great! I will continue to throw my money at Durex in exchange for protection from STIs and STDs with partners who haven’t been tested. However, condoms leave room for human error.

I remember a terrifying moment with a guy when we sort of – well, the condom let us down. THINGS HAPPEN, OKAY. I made him accompany me to a walk-in clinic the same day for emergency contraception. It was his sperm that made the mess, so I didn’t see why I should wait alone in the lobby for an hour while he lounged at home. Despite being careful, condom use is often inadequate. Over the course of a woman’s fertile period, long-term risk accumulation results in a 50% chance of accidental pregnancy, according to my gynecologist.

Now, there are a few permanent surgical options. One is hysteroscopic sterilization (Essure), which uses implants that cause tissue growth to block the fallopian tubes. However, it’s a little new and not as reliable as it ought to be. Endometrial ablation isn’t necessarily permanent or foolproof. Hysterectomies cause drastic hormonal changes, which I do not want. I like my cycle, even the messy part.

That leaves laparoscopic tubal ligation as the Goldilocks of sterilization options.

THREE  THE PROCEDURE

How did you find a doctor willing to sterilize a young, childless, unmarried woman?

A mix of luck and strategy, I suppose. I requested a referral from my general practitioner for a sterilization consultation. I chose Dr. Rachel Perry because of her affiliation with the UCI Women’s Options Center in Costa Mesa, which handles pregnancy terminations. A pro-choice doctor who recognizes a woman’s right to her own body may be more inclined to perform the procedure than some others.

Still, from the moment I stepped into her waiting room, I was defensive, ready to argue ferociously for my right to remain childless. But my defensiveness wasn’t necessary. Dr. Perry, who had just returned from maternity leave, merely introduced herself with a smile, shook my hand, and said politely, “So you’re here because you’re interested in having a tubal ligation?”

We discussed my previous methods of birth control and the reasons I no longer use them. She also emphasized that tubal ligation is essentially irreversible and made sure I understood that. She described different forms of sterilization, but like me, she preferred laparoscopic tubal ligation.

She then illustrated what the procedure was, exactly. My fallopian tubes would be closed off with clips to prevent sperm from fertilizing my monthly egg, though my eggs would still be there should I ever want them. She informed me of the potential risks. Twenty percent of young women feel regret later in life. Other than that, the risks are typical of any surgery with general anesthesia.

Surgery itself doesn’t scare me. I’m young and healthy, so the risks are minimal. I hate open-backed hospital gowns, being wheeled into the operating room, fog-inducing pain medication. But American doctors spend a lot of time and money on their training, so I trust they won’t kill me.

Dr. Perry gave me a few options to consider. I could have had my tubes removed entirely to drastically reduce my risk of ovarian cancer (salpingectomy), which I decided against to minimize scarring. She allowed me as much of a choice as possible for the incisions’ placement. I could even choose between silicone and silicone-titanium clips, though I had no preference and left it to her judgment.

I scheduled my surgery for three weeks after the consultation. I was ecstatic. I’d wanted this for years, thought it’d be nearly impossible to find a doctor who would do it for me, and there I was with a surgery date less than a month away.

On a side note, if your regular gynecologist is unwilling to perform the surgery, request a referral to a more open-minded physician. This is an international list of childfree-friendly doctors. Depending on your insurance, you may have a longer waiting period than I did. But once you’re over 21, you have a legal right to sterilization in the U.S.

Preparing for surgery

The rules are similar to any other surgery. I couldn’t take blood thinners for a week prior, and I was instructed not to eat or drink after midnight the day before. I also had to shower using a foul-smelling antiseptic soap.

My mom drove me to the hospital, where she works, because my surgery time coincided with her shift. My outpatient co-pay was a whopping $100 even with insurance, making me miss free French healthcare. Then I was brought back to a small curtain-enclosed square of space with a bed that allowed me a modicum of privacy as I changed into my hospital gown and socks.

Nurse M., who prepped me, was exactly what I needed: talkative and happy to describe every little step of what she was doing. I peed into a cup for the required pregnancy test. Then she wrapped compression devices around my legs to prevent blood clots and taped a pulse oximeter to my finger. She tied two bands around my wrist, one indicating my allergies, the other containing my patient information and a barcode the nurses would scan every time they administered pain medication after the surgery.

Then Nurse M. began my IV. It sounds ridiculous, but this was the worst part of the surgery. I’d never had an IV while conscious because of my intense anxiety. Needles don’t scare me much, and it hurts less than a cat scratch, but knowing that a huge needle is being slid into my vein makes my stomach turn. It isn’t a quick little poke, either, it takes a few minutes to get in. While she worked, I grew nauseated. My breathing became shallow even as I reminded myself to take deep breaths. I was on the verge of tears by the time she finished.

And I never grew unaware of the IV. I always felt its constant mean pinch. She drew blood through it to test my blood type, then withdrew the needle, leaving behind thin plastic tubing to administer fluids and medications. Later, she would also poke my hand to do another test of my blood type. I tried to talk her out of that one by waving around my blood donor card, to no avail. American medical professionals are very thorough because the populace likes to sue.

Unfortunately, the IV was done right before I met the surgical team. I couldn’t calm down after that, I was a ball of tension. And when I’m nervous, I talk incessantly.

First I met the two friendly residents who would be assisting, as well as the medical student, S.F., who spent a long time waiting with me. She told me about the cervical cancer screening work she’d done with women in Haiti, successfully distracting me and helping me feel less anxious about the tube in my vein. She also agreed to take pictures of my clipped fallopian tubes. Soon after, Dr. Perry came to see me. She answered my last-minute questions and didn’t mind my odd request for pictures.

Finally I met the anesthesiologist and his resident. The resident, M.P., would be the one who remained in the operating room throughout my surgery. I found it was easier to relax with him than most male doctors, though this could easily be due to the drugs.

Surgery and recovery

Trigger Warning: A picture of my fallopian tubes is right around the corner. Scroll slowly if queasy.

When it was time to operate, M.P. administered Versed through my IV. The residents called this “happy juice.” It didn’t make me feel especially happy, but I certainly didn’t feel stressed, which is probably as much as can be expected for someone like me. Then M.P. and S.F. wheeled me into the OR, where everyone else was getting ready.

I couldn’t see who was there because I’d taken out my contact lenses. Dr. Perry semi-jokingly asked if I needed my hand to be held. One of the residents offered to let me choose the music. With the exception of the anesthesiologist and his resident, the team was entirely female, which I liked. I’m sure males can be equally competent, but I feel much better about having my body poked, prodded, and cut by women.

An oxygen mask was placed over my face, and I talked to M.P. while we waited for the anesthesiologist to return so they could begin the surgery. I vaguely remember M.P. telling me he would begin administering the anesthesia. And then, nothing.

It seemed like only a few minutes later that I was waking up in the same room with what felt like menstrual cramps from hell and a groggy head. My throat was sore from the breathing tube they’d removed. The surgery had only lasted an hour or so. I can’t remember who was there or who wheeled me to the recovery room. They gave me pain medication that didn’t act quickly enough. Later, Dr. Perry told me I seemed to be in more pain than most people. It’s unsurprising, given my low pain threshold and high medication tolerance.

With laparoscopy, you benefit from minimal scarring and invasiveness, but it also means the surgeon must fill you with air to get a visual and to create space for her tools. While she did remove most of the air before stitching me up, it was impossible to remove all of it. Until the body can absorb the excess air, it irritates a nerve linked to the shoulder, producing a sharp pain that’s worse than the incisions.

The medical student, S.F., held my hand as I struggled to become alert. I started crying, in part because of the pain, but also because I thought of my ex-boyfriend, C., and how he hadn’t offered even a “bon courage” before my surgery. I started blabbering about this to S.F., who said mean things about him to make me feel better. It worked.

Two residents came in and asked to look at my incisions. I groggily murmured, “If you must.” I wasn’t able to see the incisions myself and later realized why. The one in my belly button, where the laparoscopic camera had been inserted, was miniscule and hadn’t required stitches, only skin glue. The second wasn’t on my stomach, as expected, but rather on my pubis, as I’d wanted. This isn’t doable for all women, but the placement of my organs allowed for it. I was delighted, even though it meant more pain. It was sealed with stitches and glue that would dissolve and peel on their own.

Dr. Perry came to let me know how everything had gone. There hadn’t been any complications, injuries to neighboring organs, or need for a blood transfusion. She asked about my pain, which had skyrocketed as soon as she woke me. It was only that I kept falling asleep, and every time someone needed to speak to me, I’d wake up and remember the pain. She asked my new nurse, J., to give me more pain medicine, including an oral tablet. Nurse J. also wrapped me in toasty blankets when she saw I was cold and to ease the cramping in my pelvis.

I wanted to eat before taking the oral tablet, but forcing down the two crackers they gave me was a chore. I had no appetite, didn’t feel hungry, and my mouth was dry despite the fluids they administered. Supposedly the pill would be efficacious, but not long after, I needed more medicine. By the time I was discharged, I had maxed out my IV medications and would have to wait three hours until I could take the hydrocodone and ibuprofen Dr. Perry had prescribed.

A new nurse wheeled me out to the front of the hospital, and the valet brought my car around. My mom drove me home, where I immediately crawled into bed, and my cat came to cuddle with me. A little while later, I forced myself to eat so I could take my medicine. The next day, the pain had largely subsided with the exception of the pain in my shoulder, which lasted four days.

As far as surgeries go, this one was stellar. It was elective. I had an amazing doctor whose team made the whole experience as pleasant as I could have hoped for. And the incisions are so small and well-placed, you’d never know they were there.

I do have one complaint: What is “pelvic rest”? I can’t have sex for one month? One whole month? I feel like this rule was invented by sadists.

My clipped fallopian tubes. I warned you.