(no subject)
So, due to having had to mention this to multiple younger women in the various CF communities to which I belong, I figured I would write one centrally-located help post for all of you out there fighting desperately to be sterilized. PLEASE CIRCULATE THIS AS MUCH AS POSSIBLE. Link back or give credit as needed, but I really just want all the struggling, frustrated CFers out there to know that it's NOT as hopeless as it seems & that it can be done.
DISCLAIMERS:
* This is (naturally) drawn mostly off my personal experience and, to a lesser degree, those of my sterilized friends. Obviously, as such, your own results may vary. I had multiple factors working to my benefit that many of you likely will not have (which I will go over in detail). You should probably not use this as a literal checklist for that reason as it will probably not be completely relevant or apply entirely to your situation.
* Also, this will be written largely to aid childfree female-born folks as not only am I female, but it seems that CF men get a little less bullshit thrown at them during such pursuits & have a generally easier time obtaining induced infertility. So yes, while male-born folks can possibly benefit from some of my advice, this is female-centric for a myriad of reasons & I will not apologize for my otherwise uncharacteristic show of gender inequality.
* While much of this information can also be utilized by women who do have children but are still considered too young to have their wishes respected re: fertility, this is written primarily to benefit the childfree. This is necessary since it's well-known we generally have to jump through more hoops to get snipped and largely possess fewer networking resources to point us to sympathetic medical providers & facilities. TL;DR, no breeder-pleasing or apologetic attitudes here. Sorry, but that's how it is; we're trying to avoid being breeders, pure and simple.
* In addition, I am American-born and bred, and have not ever left this country. As such, I have only a vague knowledge of how the health systems of other countries work or their costs/limits of care coverage. Therefore, my insurance information & medical prerequisites will probably not apply to you if you are located outside the United States, and unfortunately I have no advice to give in that situation.
Basically, long story short, this is going to be very slanted for various reasons and I make no apologies. While it would've been delightful if I could've tailored it to everyone's situation, I lack that ability. Please mentally substitute and add info where relevant & helpful for your own personal situation. Furthermore, I am a very brusque & harsh person, and don't particularly care if anything I write causes butthurt. So don't waste your time causing wank about something pissing you off. Shut off your computer and take a walk instead.
Furthermore, I assume no responsibility for failure, health complications, estrangement of partner/family, loss of insurance coverage, financial loss, stress, regret, guilt, depression, anxiety, suicide, homicide, generalized butthurt/displeasure, acts of God/any other deity, or any other negative correlation/causation to you as a result of reading or heeding the advice written below to any degree whatsoever. By reading this list, you agree to release & indemnify me from any responsibility.
HOW TO GET NULLIPAROUSLY STERILIZED WHEN THE ENTIRE WORLD WANTS YOU TO BE AN INCUBATOR
~ Start a paper trail. And be as diligent as you can. From the very day you decide you don't want children, spend excessive amounts of time telling every doctor you see that you have no plans of breeding, ESPECIALLY at annual pap/pelvic exams & visits to renew any birth control you may be on, when your fertility/sexual health is at the forefront. Harp on it to the point where they'd be practically negligent NOT to note it in your chart. Make a point of asking THEM if they've changed THEIR minds about sterilizing you. Do it at least once a year. Ideally, next thing you know, you've got 5-10+ years of chart notes stating "Pt not interested in childbearing." It will serve as a wonderful weapon against the ever-dreaded "You'll change your mind!" bingo if you can point out to your doctor that, o hey, you really HAVEN'T changed your mind in all the time you've seen them.
But don't stop there. Pitch your idea to every doctor you see. You have no idea who may or may not be sympathetic. Even if your PMD (primary doctor) is adamantly opposed, maybe your GYN is more supportive - or vice-versa. Maybe your cardiologist's personal PMD is childfree himself & knows where to refer you. Or maybe your endocrinologist knows a doc in her practice's building who's open about sterilization. Even the nurses/medical assistants you see - maybe they're CF too and have some inside info (a title I'm proud to bear myself). You seriously never know. Think of it as networking!
Even in situations as seemingly irrelevant as an emergency room visit, when they ask you if you could be pregnant (and ye gods, they ALWAYS do), scoff and say, "Nope. And never will be, when I get my way." Seems silly and pointless, but with the way hospitals & health franchises are operated these days, doctors are rotated & constantly stretched thin. You never know when that ER doc might turn out to be your new primary care physician, who (if you make enough of an impression) might just remember how determined you were not to have kids. Which brings me to my next point...
~ Don't be afraid to be frank & open (or even vulgar) when you talk about pregnancy/childrearing. Yes, tact is all well and dandy in certain situations, but if done well, being over the top will work to your benefit in ways you can only imagine. Take, for example, these imaginary situation - you're told you'll change your mind by a doctor. What do you think is going to give them pause & stick with them more?
"Well, kids just aren't for me. I have a niece/nephew I love, but I just don't want any of my own."
-OR-
"Nope, not happening. My niece/nephew produces enough snotty shirts & shitty diapers to last me a lifetime."
A or B, gentle readers?
If one-liners aren't your thing or you're chronically shy/anxious about speaking up for yourself, practice them in the mirror or with a friend/partner until you get them down pat. Being able to deliver a zinger is not only a great skill to have in general, but will also serve you well if done properly within this context.
And speaking of...
~ LEARN TO SPEAK UP FOR YOURSELF. You are undoubtedly the only advocate you will have, and you are your own most powerful tool as such. That's not to say you have to pick fights with obstinate doctors/medical personnel, grant you (that certainly won't help make your case of being mature enough to choose nulliparous sterilization at a young age), but do not let them trample on your desires. If you really want this so badly, then by Jove, the entire fucking medical world should know and know it well! Don't be afraid to become that patient who talks way too much & whom they dread seeing. This CAN backfire, but it can also be your biggest asset (usually the latter). I'll go more into detail about little tricks and hints, but overall, do not give up. There is a huge difference between compromising for the sake of your paper trail (which I'll mention later) and allowing someone to completely shut you down about the entire idea; the latter is unacceptable. Don't ever lose hope. One dissenting doctor (or, shit, even a DOZEN of them) is not a death sentence for your dreams. Do not allow a doctor to stomp all over you & leave you shaken about your own resolve.
~ But make sure it really IS what you want. Yes, yes, I know. "WHAT, hollowdoll??" you're surely howling. "HOW THE HELL CAN YOU DARE BINGO ME!? I thought you were one of US!!" Yep, I know you're probably pissed, and somewhat justifiably so. I also know a good many of you ARE about one-thousand percent sure that you don't want kids, as I am. Feel free to skip this part if you want! But for those of you reading who maybe AREN'T one-thousand percent sure you never want children, wait it out a little while longer. Just as one should never rush into childbearing without being completely sure, sterility goes the same way. I say this for more than one reason:
1. There are plenty of other reversible contraception options out there - hormonal and nonhormonal - that can work just as effectively as sterilization and can work around/with multiple health issues as well while you ponder what you ultimately want to do. And it's generally easier to access them anyway.
2. Giving yourself time to sit back and play devil's advocate ("Well, what if I DO want kids? What are my plans there?", etc.) will really give you some great ammunition if/when you do decide to remain childfree & get bingoed by doctors. Yes, that's right. BINGO YOURSELF! Even for those of us who've been staunchly childfree ever since we knew where babies came from, it can do you some good to question your own faith/resolve once in awhile. Ask yourself every possible "what-if" question & note your responses, as they'll be truthful, legitimate counterpoints to help build your case with a doc.
3. Just as it's drilled into your head from day one that you should never show fear when facing an angry animal, you should NEVER show any doubt or sign of wavering when up against a doctor, because they can smell it. And it smells a hell of a lot like "future malpractice suit" to them. Unfortunately, as a childfree woman, you ARE an anomaly. End of story; it is what it is. We are a minority, and one that the medical community (as well as society as a whole) is relatively new to and does not entirely know how to handle. Like ravenous wolves or malpractice lawyers with a student loan payment due, they will be waiting to pounce upon even the slightest insecurity of yours. And they will bleed it dry as proof that you cannot make this decision for yourself lest you risk their good name and practice twenty years down the road when you can't fulfill your biological imperative. Yes, that day will likely never come, but they don't know that. They can't. So they're covering their ass like mad.
4. Furthermore, if you do get snipped, change your mind and come back to them complaining about it, then you have dealt a HUGE blow to other childfree women down the line who are seeking the same services. Every one anecdotal case of regret will overshadow a thousand CF women who are legitimately happy (or would be) with their sterility, & that makes it all the more difficult for everyone else to attain the same goal. Yes, I know it can be a little daunting to think about the potential damage to millions of people you've never met (and probably put some of you off with all the talk of abstract morality and righteousness), but I'm a firm believer in the needs of the many outweighing the needs of the few. It's damn selfish to risk a bar's liquor license by sneaking in while underaged just because you want a drink, is it not? Out of decency, one should never abuse liberties like that.
~ Research, research, research. If they cite the studies stating the high level of regret in young women who've been sterilized, counter that with the point that the majority of the studies are not done on women who haven't had children prior to sterilization. If they point out the fact that failure rates for sterilization are higher in younger women, clarify that by mentioning that's simply a matter of statistics as younger women will obviously have more lifetime ovulatory cycles for such an accident to occur. If they throw in the mention of Post-Tubal Ligation Syndrome, destroy their idea by pointing out that PTLS has been wholly discredited & is linked to the body adjusting postpartum or from a woman stopping half a lifetime of hormonal contraceptives to allow her old issues of painful periods & heavy bleeding resurface without the hormones there to alleviate things. Be prepared - there is a litany of crap the doctors can throw at you. After all, it's their job to know the outcomes of health studies; unfortunately, too many of them still ALSO utilize the mindsets they obtained fresh out of med school 10-20+ years ago. It'll behoove you to out-research them.
~ Know your medical terminology inside and out. Whether they realize it or not, many doctors subconsciously let their God complex crack if you use some of their lingo. Bonus points if you study/work in medicine yourself or grew up around healthcare workers as this will be second nature to you. I have yet to figure out exactly why this is so effective, but I imagine it's got something to do with some sort of primal wiring identifying you as "FRIEND" if you have a major identifying characteristic in common, such as language. Now do exercise caution; this can (and does) sometimes backfire if the doctor is prone to insecurity and defensiveness. In all fairness, the wo/man did go to med school for how many years? And you come in, Joe-Ann Blow off the street, trying to pretend you know more than they do? Just who the hell do you think you are? Blahblahetc. So do be gentle with that approach. But it will do you WORLDS of good to become a mini-expert on birth control and women's health to the best of your ability. Check out the websites of places like Planned Parenthood, Go Ask Alice or other similar sites until you know enough to put the doctor and her/his drug reps to shame. Doctors are so used to steamrolling people & making the decisions for the generally ignorant populace (most of whom get their medical information from episodes of House & the "Ask your doctor" pharmaceutical commercial spiels in between showings of Matlock & Price is Right) & putting things in the simplest possible terms that, in my experience, they usually will treat an informed & assertive patient with at least a modicum of genuine respect (if not fear).
~ Do not be afraid to doctor-shop. I fought fiercely for my sterilization since I became sexually active at 18. As someone who has multiple chronic health conditions, the tally of doctors I've seen over the last five years is simply innumerable. And yes, I didn't take my own advice all the time by throwing it at every single doctor I came across, as it was simply too daunting. Plus, I was okay compromising for the time being (more on this later). But when my options - save for the very-unappealing "choice" of abstinence - completely dried up in March of this year, I increased my hunt. My PMD refused to concede that my health issues prevented me from carrying a healthy pregnancy. The GYN she sent me to was a very patronizing man from a different cultural background who flat-out refused to acknowledge that I, as a woman, could ever refuse children. I sought another GYN, who refused to proceed unless my PMD gave the OK re: my health issues not being conducive to breeding. A visit to another one left me with a tentative OK, provided I give records of a psychiatric evaluation by a doctor HE chose for me to see. I called multiple more GYNs in the area and was turned down by the receptionists before I even got as far as an appointment. Desperate, at this point I ended up turning to the family planning clinic within one of the most amazing hospital systems in the country, if not the world, and spent multiple-houred trips back & forth begging for approval from three MORE GYNs (AND an allergist) until I got one of them to agree to snip me.
...and this was all within the space of just over five months. So yes. Doctor shopping, while draining/tiresome AND sometimes illegal in the context of narcotic acquisition and other such questionable practices, is PERFECTLY acceptable when you cannot find a doctor who'll take you seriously. I doubt that if you had cancer & an oncologist who kept telling you that you were fine, refusing to treat you, that you'd continue to accept their word as fact & not seek care elsewhere. The same principles apply; health care is health care and one size does not fit all in this field. You're doing THEM a favor by allowing them to treat you; do not allow them to abuse that trust. Find a doctor who'll listen to you no matter what.
Now, I realize some of you may have hit a brick wall at this point in my spiel. I realize health care is expensive. I realize many of you may live in more rural/isolated areas that simply lack the type & sheer amount of providers my area boasts. I realize many of you lack insurance or the transportation/funds to see as many doctors as I did or to take the cross-state trips that I took in order to obtain my tubal. I was fortunate enough to have both a primary and secondary insurance plan that split the cost of my tubal without a hitch. I know not everyone has access to such things, and this can be a HUGE roadblock to reproductive freedom. But this brings me almost seamlessly to my next point...
~ Beat every resource you have to death. Believe it or not, there is an obscene amount of resources available. Yes, conventional/commercial insurances do often cover sterilization to some degree, but even those of you without insurance may have options available that you didn't know you had. As a Michigan resident, I'm intimately familiar with Plan First!, which is the state's family planning Medicaid waiver & covers family planning costs. It was the secondary insurance I had that covered the latter half of my tubal after my primary insurance picked up the first 50%, therefore saving me from being over $4K in debt. I also have a very dear friend who utilized PF! to pay for her tubal as well. The lovely part, of course? Michigan is not the only state who has a program like this. Courtesy of the good folks at Guttmacher, here's a rough list of family planning waiver information. Obviously, not having been a resident of any of these states within my childbearing years, I have no idea the extent of their services (as far as whether they cover sterilization or not) or what the qualifications are. But you can. Check out your respective state's websites or your county's Department of Health & Human Services to see what you qualify for, or call your local Planned Parenthood/other family planning clinic to see if they have information as well. Even if, for some reason, you do not qualify for one of these programs (or it lacks the coverage you need for sterilization), most family planning clinics work on a sliding fee scale basis & some of them even perform certain sterilization services. My tubal cost $9K because I was in a hospital with very generous insurers ($61 because I was too doped up to remember to return their threadbare gown; really?), but a family planning clinic with surgical services is no less effective or safe (and I've heard more glowing reviews about the care received at smaller clinics). Even at the top of a fee scale, it'll generally cost you less out-of-pocket than a hospital or private doctor's office would. You may qualify for discounted procedures, too, which is something a hospital really can't do for you. Furthermore, there are even some family planning clinics that have privately funded independent grants for sterilization. Basically, there ARE resources. Don't rest until you find them.
~ Compromising is okay. Temporarily. This goes back to establishing the paper trail that I mentioned before. If you waltz into a doctor's office at age 18/19 and say "Yep, I want my tubes tied" and refuse any other birth control, it's highly unlikely you're going to get very far whatsoever. But if, for now, you let your desires soften a little (instead of "MUST HAVE TUBAL", try "MUST NOT GET PREGNANT") and let the doctor think they've got the upper hand in your care (see the defensiveness mentioned above) by agreeing to try other reversible birth control they recommend, you'll only be doing yourself a favor. I promise. By being patient & willing to try other forms of birth control, you're creating the history of being agreeable as well as proving to the doctor in some years that, hey lookit there, you really HAVE tried everything else like s/he told you to and it's just not working for you! Looks like it's tubal time! Big plus if you have health issues that prevent you from using most hormonal birth control (migraines with aura, hypertension, hyperlipidemia, blood clotting disorder, etc.), as well; that'll save you some time and bargaining. I can't recommend enough the usage of IUDs as collateral. Some more old-school doctors still refuse to insert them into nulliparous women, especially young ones, but the tide on that is changing rapidly. Family planning clinics also tend to be a lot more liberal about this sort of thing. Use that to your advantage. And frankly, IUDs really are a great option, IMO. I've used them both, and despite having to have them removed for various reasons, I still recommend them. If I hadn't developed a freak issue with mine (Mirena worsened my hypertension which it is NEVER supposed to do, and with the Paragard I developed unrelated uterine polyps that went undiagnosed & were irritated by the presence of the Paragard; spotted for a year straight before yanking it in its third year), I'd still be using it. In addition, assuming you have no problems, when you go back to your doctors in 5-10 years to have it "replaced", you'll probably have a lot more leverage when you point out that you spent that entire time with it in place and STILL don't want kids, and you're older now so will THEY sterilize you NOW? Trust me, you will never have a better plan in place than when you walk into a GYN demanding a tubal & agree to bargain down to an IUD. Think of it as padding a resume. Sure, nobody wants to do that minimally-paid temp internship as a gopher for a senator, but won't that look delightful when you're applying for law school or running for office yourself? Bide your time, be open to their suggestions, make it look like you're complying, continue to inquire about getting spayed as often as possible so it's well-established you want it, and once you think you've got enough ammunition, BOOM. You'll be half-unstoppable.
Also, if the doctor is insistent you will change your mind and want kids someday, bargain with them. Play pretend just to put their troubled little mind at ease. Swear on [insert family member]'s grave that you will TOTALLY be open to the idea of surrogacy/IVF/adoption if you do change your mind. Especially the adoption one; anyone trying to argue this one against you is going to look like a selfish ass. "Oh, I just couldn't bear to bring a child into this world when there are so many poor unloved children in the foster system. One of my friends/family members/whatever is an adoptee! Etc.!" What are they going to say to that without looking like an utter monster of a self-absorbed cockmongrel? Lay it on with a freaking trowel if you have to - whatever you need to do to shut them up and assuage their panic that you might someday sue them. This is a form of compromise, somewhat, even if you are lying through your teeth. And speaking of...
~ Lying/omission/exaggeration is SOMETIMES okay. Now, this is basically tap-dancing in a minefield. You have to approach this with a care rivaling that of a bomb squad. Omitting facts on medical history forms & during visits is a good way to not only fuck up your care if you don't know what the relevance of what you're saying, but can sometimes even qualify as insurance fraud, depending on what you lie about & how you do it. So if you take this advice, YOU DO SO AT YOUR OWN RISK. What I'm emphasizing more, though, is exaggeration rather than outright lying. Doctors' motto tends to be that a family history is their most important tool for care, but it's yours too. Most doctors are not going to listen when you say "I just don't want kids" as your rationale for a tubal if you have no contraindications to conventional birth control or health issues that'd make breeding or pregnancy stupid or selfish. However, if there are certain unpleasant aspects of your health or that of your immediate family members that would really help them see why passing on your genetic line is undesirable, use that to build your case. And if it means you've got to fib a little, then do it. Mom had horrible postpartum depression? Bump it up from depression to psychosis (if it was that severe, it could've been psychosis for all you know, so it's not ENTIRELY untrue...). Grandma's had three heart attacks? Phrase it as "close to five". Entire family so damn fertile that not a holiday passes without some new baby there? Talk about the high rate of birth control failure in your family (even if it isn't necessarily entirely due to that), having multiple pregnancy scares of your own & how afraid you are your birth control might fail despite your diligence, given your family fertility. You get the idea.
Grant you, that doesn't mean you HAVE to lie. You shouldn't, really, assuming it can be avoided. At the very least, nothing should be a complete and total lie (like saying you have a family history of spina bifida when you don't, or something else drastic). Lying can be obscenely hazardous in this situation. I would recommend avoiding it as much as you can. Your excuses can - and whenever possible SHOULD - be completely valid. But make it the focal point of your argument if you have enough fodder to do so. Sometimes it's as simple as memorizing all the awful aspects of your family's health to the point where it sounds like you're all basically walking dead. Mom's gestational diabetes turned into full-blown Type 2 after she had you, and you're showing early signs of diabetes yourself (one I utilized myself)? God, push that shit like meth in a trailer park. Have a long history of hormonal fluctuations/tampering (e.g. by taking hormonal birth control) completely fucking you up? Talk in excruciating detail about just how miserable the moodiness/other symptoms left you. ANY family history of birth defects or genetic maladies (however common)? Make them finally be useful for once in your life. Personally, I had so many health issues of my own that my family history was practically irrelevant. However, one thing played out perfectly - the simple omission of a test that'd been run on me.
You see, my mother has hemochromatosis, a genetic disease that basically causes her body to accumulate excess iron without the ability to remove it. It seems relatively innocuous, but can actually be quite fatal if left undetected & is thought to be a cause of much heart disease, especially with strong family histories. She was diagnosed earlier this year, right around the same time I was beginning my sterilization fight. Obviously, as a potential carrier, why on earth would I want to pass that on? And that's one of the slants I used to argue my case for a tubal, as during my initial battle I was still waiting for my genetic testing to come back to determine whether or not I had the gene mutation & thus had no idea whether I was a carrier or not. And as I argued with doctors, I found it only seemed to lend weight to my case.
Then the results came back several weeks later - I tested negative for all the gene mutations. However, with all these doctors I was seeing (within multiple health systems), none of them knew about my results coming back since it was something unrelated to sterilization that my PMD ordered. By this point, I had legitimately mentioned it to at least four of those doctors, since I hadn't known the results. So I figured...why bother telling them now? And I didn't. I never mentioned being tested to the other doctors, therefore creating the illusion that I was a probable carrier. Naturally, I mentioned all her other health issues, especially the ones pertaining to her pregnancies, and I described in great detail exactly how many of these problems I was already known to have inherited, but I simply mentioned her testing positive for it & neglected to expound on the depth in which we'd investigated that particular condition in me. Yes, I probably could have done without even mentioning it at all, considering the ridiculous history I had with birth control alone (not to mention my other health issues), but I figured that little omission couldn't hurt. And, clearly, it didn't.
As I said, this can be tricky and dangerous. Exercise EXTREME caution if you decide to mention (or not mention) even little things like this as it really can bite you in the ass. I mean, I highly doubt that the doctors who did sterilize me would have refrained from doing so if they knew for sure that I wasn't a carrier for the disease; they were (rightfully) more concerned with my other legitimate/pertinent issues, especially how I was literally out of birth control options due to a multitude of nearly-fatal problems with ALL of them. So my real point is knowing your personal & family history, and not being afraid to play it up a little, will probably serve you well.
~ You will not be taken seriously for a long time. Know this. Accept this, however begrudgingly. Make friends with this. This goes back to the whole "biding your time" thing. Doctors are usually very logical people and medicine is a very linear science. It basically consists of "when A, B & C occur in the presence of D, someone has X, Y or Z affliction" & it's their job to figure out which one it is. So if someone presents with A, B & C within the presence of D and it isn't X, Y, or Z...yeah, hair is going to be torn out (figuratively, I hope). Many doctors apparently find it difficult to accept things outside of the norm; it seems to frustrate them as they evidently associate that with failure. Obviously this isn't ALL doctors and I am making a lot of assumptions here, but I think you get the idea. Couple that with the general idea that doctors are supposed to heal & not harm, and thus arises the issue. If a doctor views childfreedom as a mental deformity of some type, of course s/he isn't going to be open to the idea of helping to perpetuate that - ESPECIALLY for a younger woman. It may not be right, but it's something you'll have to accept - for now.
But be patient, bide your time & the time will finally come where all your puzzle pieces will fall into place, as mine did. As I've said before, no single factor that I've listed here was the one magical issue or action that made this happen for me. It was a combination of dozens of things that I had the gumption & wherewithal to force to work for my benefit. And yes, someday you'll do the same. Someday you'll be sitting in that hospital bed right before they come to take you away to the OR, best friend by your side trying to keep you cheerful, picking at the hem of your flasher gown & grimacing at the sight of the IV in the crook of your arm, and then you'll be rollingrollingrolling down the hallway with a good nine white-coated people around you, and they must've given you something because suddenly everything starts to look a little blurry and you feel very light and drained and wait you're lying down how did that happen? and you're absolutely terrified but despite that a tiny smile will flash for just a split-second, right before they put that oxygen mask over your face, because even though you're scared you know that when you wake up, all your hard work will have finally paid off in the form of two tiny scars on your abdomen and your life can finally begin.
DISCLAIMERS:
* This is (naturally) drawn mostly off my personal experience and, to a lesser degree, those of my sterilized friends. Obviously, as such, your own results may vary. I had multiple factors working to my benefit that many of you likely will not have (which I will go over in detail). You should probably not use this as a literal checklist for that reason as it will probably not be completely relevant or apply entirely to your situation.
* Also, this will be written largely to aid childfree female-born folks as not only am I female, but it seems that CF men get a little less bullshit thrown at them during such pursuits & have a generally easier time obtaining induced infertility. So yes, while male-born folks can possibly benefit from some of my advice, this is female-centric for a myriad of reasons & I will not apologize for my otherwise uncharacteristic show of gender inequality.
* While much of this information can also be utilized by women who do have children but are still considered too young to have their wishes respected re: fertility, this is written primarily to benefit the childfree. This is necessary since it's well-known we generally have to jump through more hoops to get snipped and largely possess fewer networking resources to point us to sympathetic medical providers & facilities. TL;DR, no breeder-pleasing or apologetic attitudes here. Sorry, but that's how it is; we're trying to avoid being breeders, pure and simple.
* In addition, I am American-born and bred, and have not ever left this country. As such, I have only a vague knowledge of how the health systems of other countries work or their costs/limits of care coverage. Therefore, my insurance information & medical prerequisites will probably not apply to you if you are located outside the United States, and unfortunately I have no advice to give in that situation.
Basically, long story short, this is going to be very slanted for various reasons and I make no apologies. While it would've been delightful if I could've tailored it to everyone's situation, I lack that ability. Please mentally substitute and add info where relevant & helpful for your own personal situation. Furthermore, I am a very brusque & harsh person, and don't particularly care if anything I write causes butthurt. So don't waste your time causing wank about something pissing you off. Shut off your computer and take a walk instead.
Furthermore, I assume no responsibility for failure, health complications, estrangement of partner/family, loss of insurance coverage, financial loss, stress, regret, guilt, depression, anxiety, suicide, homicide, generalized butthurt/displeasure, acts of God/any other deity, or any other negative correlation/causation to you as a result of reading or heeding the advice written below to any degree whatsoever. By reading this list, you agree to release & indemnify me from any responsibility.
HOW TO GET NULLIPAROUSLY STERILIZED WHEN THE ENTIRE WORLD WANTS YOU TO BE AN INCUBATOR
~ Start a paper trail. And be as diligent as you can. From the very day you decide you don't want children, spend excessive amounts of time telling every doctor you see that you have no plans of breeding, ESPECIALLY at annual pap/pelvic exams & visits to renew any birth control you may be on, when your fertility/sexual health is at the forefront. Harp on it to the point where they'd be practically negligent NOT to note it in your chart. Make a point of asking THEM if they've changed THEIR minds about sterilizing you. Do it at least once a year. Ideally, next thing you know, you've got 5-10+ years of chart notes stating "Pt not interested in childbearing." It will serve as a wonderful weapon against the ever-dreaded "You'll change your mind!" bingo if you can point out to your doctor that, o hey, you really HAVEN'T changed your mind in all the time you've seen them.
But don't stop there. Pitch your idea to every doctor you see. You have no idea who may or may not be sympathetic. Even if your PMD (primary doctor) is adamantly opposed, maybe your GYN is more supportive - or vice-versa. Maybe your cardiologist's personal PMD is childfree himself & knows where to refer you. Or maybe your endocrinologist knows a doc in her practice's building who's open about sterilization. Even the nurses/medical assistants you see - maybe they're CF too and have some inside info (a title I'm proud to bear myself). You seriously never know. Think of it as networking!
Even in situations as seemingly irrelevant as an emergency room visit, when they ask you if you could be pregnant (and ye gods, they ALWAYS do), scoff and say, "Nope. And never will be, when I get my way." Seems silly and pointless, but with the way hospitals & health franchises are operated these days, doctors are rotated & constantly stretched thin. You never know when that ER doc might turn out to be your new primary care physician, who (if you make enough of an impression) might just remember how determined you were not to have kids. Which brings me to my next point...
~ Don't be afraid to be frank & open (or even vulgar) when you talk about pregnancy/childrearing. Yes, tact is all well and dandy in certain situations, but if done well, being over the top will work to your benefit in ways you can only imagine. Take, for example, these imaginary situation - you're told you'll change your mind by a doctor. What do you think is going to give them pause & stick with them more?
"Well, kids just aren't for me. I have a niece/nephew I love, but I just don't want any of my own."
-OR-
"Nope, not happening. My niece/nephew produces enough snotty shirts & shitty diapers to last me a lifetime."
A or B, gentle readers?
If one-liners aren't your thing or you're chronically shy/anxious about speaking up for yourself, practice them in the mirror or with a friend/partner until you get them down pat. Being able to deliver a zinger is not only a great skill to have in general, but will also serve you well if done properly within this context.
And speaking of...
~ LEARN TO SPEAK UP FOR YOURSELF. You are undoubtedly the only advocate you will have, and you are your own most powerful tool as such. That's not to say you have to pick fights with obstinate doctors/medical personnel, grant you (that certainly won't help make your case of being mature enough to choose nulliparous sterilization at a young age), but do not let them trample on your desires. If you really want this so badly, then by Jove, the entire fucking medical world should know and know it well! Don't be afraid to become that patient who talks way too much & whom they dread seeing. This CAN backfire, but it can also be your biggest asset (usually the latter). I'll go more into detail about little tricks and hints, but overall, do not give up. There is a huge difference between compromising for the sake of your paper trail (which I'll mention later) and allowing someone to completely shut you down about the entire idea; the latter is unacceptable. Don't ever lose hope. One dissenting doctor (or, shit, even a DOZEN of them) is not a death sentence for your dreams. Do not allow a doctor to stomp all over you & leave you shaken about your own resolve.
~ But make sure it really IS what you want. Yes, yes, I know. "WHAT, hollowdoll??" you're surely howling. "HOW THE HELL CAN YOU DARE BINGO ME!? I thought you were one of US!!" Yep, I know you're probably pissed, and somewhat justifiably so. I also know a good many of you ARE about one-thousand percent sure that you don't want kids, as I am. Feel free to skip this part if you want! But for those of you reading who maybe AREN'T one-thousand percent sure you never want children, wait it out a little while longer. Just as one should never rush into childbearing without being completely sure, sterility goes the same way. I say this for more than one reason:
1. There are plenty of other reversible contraception options out there - hormonal and nonhormonal - that can work just as effectively as sterilization and can work around/with multiple health issues as well while you ponder what you ultimately want to do. And it's generally easier to access them anyway.
2. Giving yourself time to sit back and play devil's advocate ("Well, what if I DO want kids? What are my plans there?", etc.) will really give you some great ammunition if/when you do decide to remain childfree & get bingoed by doctors. Yes, that's right. BINGO YOURSELF! Even for those of us who've been staunchly childfree ever since we knew where babies came from, it can do you some good to question your own faith/resolve once in awhile. Ask yourself every possible "what-if" question & note your responses, as they'll be truthful, legitimate counterpoints to help build your case with a doc.
3. Just as it's drilled into your head from day one that you should never show fear when facing an angry animal, you should NEVER show any doubt or sign of wavering when up against a doctor, because they can smell it. And it smells a hell of a lot like "future malpractice suit" to them. Unfortunately, as a childfree woman, you ARE an anomaly. End of story; it is what it is. We are a minority, and one that the medical community (as well as society as a whole) is relatively new to and does not entirely know how to handle. Like ravenous wolves or malpractice lawyers with a student loan payment due, they will be waiting to pounce upon even the slightest insecurity of yours. And they will bleed it dry as proof that you cannot make this decision for yourself lest you risk their good name and practice twenty years down the road when you can't fulfill your biological imperative. Yes, that day will likely never come, but they don't know that. They can't. So they're covering their ass like mad.
4. Furthermore, if you do get snipped, change your mind and come back to them complaining about it, then you have dealt a HUGE blow to other childfree women down the line who are seeking the same services. Every one anecdotal case of regret will overshadow a thousand CF women who are legitimately happy (or would be) with their sterility, & that makes it all the more difficult for everyone else to attain the same goal. Yes, I know it can be a little daunting to think about the potential damage to millions of people you've never met (and probably put some of you off with all the talk of abstract morality and righteousness), but I'm a firm believer in the needs of the many outweighing the needs of the few. It's damn selfish to risk a bar's liquor license by sneaking in while underaged just because you want a drink, is it not? Out of decency, one should never abuse liberties like that.
~ Research, research, research. If they cite the studies stating the high level of regret in young women who've been sterilized, counter that with the point that the majority of the studies are not done on women who haven't had children prior to sterilization. If they point out the fact that failure rates for sterilization are higher in younger women, clarify that by mentioning that's simply a matter of statistics as younger women will obviously have more lifetime ovulatory cycles for such an accident to occur. If they throw in the mention of Post-Tubal Ligation Syndrome, destroy their idea by pointing out that PTLS has been wholly discredited & is linked to the body adjusting postpartum or from a woman stopping half a lifetime of hormonal contraceptives to allow her old issues of painful periods & heavy bleeding resurface without the hormones there to alleviate things. Be prepared - there is a litany of crap the doctors can throw at you. After all, it's their job to know the outcomes of health studies; unfortunately, too many of them still ALSO utilize the mindsets they obtained fresh out of med school 10-20+ years ago. It'll behoove you to out-research them.
~ Know your medical terminology inside and out. Whether they realize it or not, many doctors subconsciously let their God complex crack if you use some of their lingo. Bonus points if you study/work in medicine yourself or grew up around healthcare workers as this will be second nature to you. I have yet to figure out exactly why this is so effective, but I imagine it's got something to do with some sort of primal wiring identifying you as "FRIEND" if you have a major identifying characteristic in common, such as language. Now do exercise caution; this can (and does) sometimes backfire if the doctor is prone to insecurity and defensiveness. In all fairness, the wo/man did go to med school for how many years? And you come in, Joe-Ann Blow off the street, trying to pretend you know more than they do? Just who the hell do you think you are? Blahblahetc. So do be gentle with that approach. But it will do you WORLDS of good to become a mini-expert on birth control and women's health to the best of your ability. Check out the websites of places like Planned Parenthood, Go Ask Alice or other similar sites until you know enough to put the doctor and her/his drug reps to shame. Doctors are so used to steamrolling people & making the decisions for the generally ignorant populace (most of whom get their medical information from episodes of House & the "Ask your doctor" pharmaceutical commercial spiels in between showings of Matlock & Price is Right) & putting things in the simplest possible terms that, in my experience, they usually will treat an informed & assertive patient with at least a modicum of genuine respect (if not fear).
~ Do not be afraid to doctor-shop. I fought fiercely for my sterilization since I became sexually active at 18. As someone who has multiple chronic health conditions, the tally of doctors I've seen over the last five years is simply innumerable. And yes, I didn't take my own advice all the time by throwing it at every single doctor I came across, as it was simply too daunting. Plus, I was okay compromising for the time being (more on this later). But when my options - save for the very-unappealing "choice" of abstinence - completely dried up in March of this year, I increased my hunt. My PMD refused to concede that my health issues prevented me from carrying a healthy pregnancy. The GYN she sent me to was a very patronizing man from a different cultural background who flat-out refused to acknowledge that I, as a woman, could ever refuse children. I sought another GYN, who refused to proceed unless my PMD gave the OK re: my health issues not being conducive to breeding. A visit to another one left me with a tentative OK, provided I give records of a psychiatric evaluation by a doctor HE chose for me to see. I called multiple more GYNs in the area and was turned down by the receptionists before I even got as far as an appointment. Desperate, at this point I ended up turning to the family planning clinic within one of the most amazing hospital systems in the country, if not the world, and spent multiple-houred trips back & forth begging for approval from three MORE GYNs (AND an allergist) until I got one of them to agree to snip me.
...and this was all within the space of just over five months. So yes. Doctor shopping, while draining/tiresome AND sometimes illegal in the context of narcotic acquisition and other such questionable practices, is PERFECTLY acceptable when you cannot find a doctor who'll take you seriously. I doubt that if you had cancer & an oncologist who kept telling you that you were fine, refusing to treat you, that you'd continue to accept their word as fact & not seek care elsewhere. The same principles apply; health care is health care and one size does not fit all in this field. You're doing THEM a favor by allowing them to treat you; do not allow them to abuse that trust. Find a doctor who'll listen to you no matter what.
Now, I realize some of you may have hit a brick wall at this point in my spiel. I realize health care is expensive. I realize many of you may live in more rural/isolated areas that simply lack the type & sheer amount of providers my area boasts. I realize many of you lack insurance or the transportation/funds to see as many doctors as I did or to take the cross-state trips that I took in order to obtain my tubal. I was fortunate enough to have both a primary and secondary insurance plan that split the cost of my tubal without a hitch. I know not everyone has access to such things, and this can be a HUGE roadblock to reproductive freedom. But this brings me almost seamlessly to my next point...
~ Beat every resource you have to death. Believe it or not, there is an obscene amount of resources available. Yes, conventional/commercial insurances do often cover sterilization to some degree, but even those of you without insurance may have options available that you didn't know you had. As a Michigan resident, I'm intimately familiar with Plan First!, which is the state's family planning Medicaid waiver & covers family planning costs. It was the secondary insurance I had that covered the latter half of my tubal after my primary insurance picked up the first 50%, therefore saving me from being over $4K in debt. I also have a very dear friend who utilized PF! to pay for her tubal as well. The lovely part, of course? Michigan is not the only state who has a program like this. Courtesy of the good folks at Guttmacher, here's a rough list of family planning waiver information. Obviously, not having been a resident of any of these states within my childbearing years, I have no idea the extent of their services (as far as whether they cover sterilization or not) or what the qualifications are. But you can. Check out your respective state's websites or your county's Department of Health & Human Services to see what you qualify for, or call your local Planned Parenthood/other family planning clinic to see if they have information as well. Even if, for some reason, you do not qualify for one of these programs (or it lacks the coverage you need for sterilization), most family planning clinics work on a sliding fee scale basis & some of them even perform certain sterilization services. My tubal cost $9K because I was in a hospital with very generous insurers ($61 because I was too doped up to remember to return their threadbare gown; really?), but a family planning clinic with surgical services is no less effective or safe (and I've heard more glowing reviews about the care received at smaller clinics). Even at the top of a fee scale, it'll generally cost you less out-of-pocket than a hospital or private doctor's office would. You may qualify for discounted procedures, too, which is something a hospital really can't do for you. Furthermore, there are even some family planning clinics that have privately funded independent grants for sterilization. Basically, there ARE resources. Don't rest until you find them.
~ Compromising is okay. Temporarily. This goes back to establishing the paper trail that I mentioned before. If you waltz into a doctor's office at age 18/19 and say "Yep, I want my tubes tied" and refuse any other birth control, it's highly unlikely you're going to get very far whatsoever. But if, for now, you let your desires soften a little (instead of "MUST HAVE TUBAL", try "MUST NOT GET PREGNANT") and let the doctor think they've got the upper hand in your care (see the defensiveness mentioned above) by agreeing to try other reversible birth control they recommend, you'll only be doing yourself a favor. I promise. By being patient & willing to try other forms of birth control, you're creating the history of being agreeable as well as proving to the doctor in some years that, hey lookit there, you really HAVE tried everything else like s/he told you to and it's just not working for you! Looks like it's tubal time! Big plus if you have health issues that prevent you from using most hormonal birth control (migraines with aura, hypertension, hyperlipidemia, blood clotting disorder, etc.), as well; that'll save you some time and bargaining. I can't recommend enough the usage of IUDs as collateral. Some more old-school doctors still refuse to insert them into nulliparous women, especially young ones, but the tide on that is changing rapidly. Family planning clinics also tend to be a lot more liberal about this sort of thing. Use that to your advantage. And frankly, IUDs really are a great option, IMO. I've used them both, and despite having to have them removed for various reasons, I still recommend them. If I hadn't developed a freak issue with mine (Mirena worsened my hypertension which it is NEVER supposed to do, and with the Paragard I developed unrelated uterine polyps that went undiagnosed & were irritated by the presence of the Paragard; spotted for a year straight before yanking it in its third year), I'd still be using it. In addition, assuming you have no problems, when you go back to your doctors in 5-10 years to have it "replaced", you'll probably have a lot more leverage when you point out that you spent that entire time with it in place and STILL don't want kids, and you're older now so will THEY sterilize you NOW? Trust me, you will never have a better plan in place than when you walk into a GYN demanding a tubal & agree to bargain down to an IUD. Think of it as padding a resume. Sure, nobody wants to do that minimally-paid temp internship as a gopher for a senator, but won't that look delightful when you're applying for law school or running for office yourself? Bide your time, be open to their suggestions, make it look like you're complying, continue to inquire about getting spayed as often as possible so it's well-established you want it, and once you think you've got enough ammunition, BOOM. You'll be half-unstoppable.
Also, if the doctor is insistent you will change your mind and want kids someday, bargain with them. Play pretend just to put their troubled little mind at ease. Swear on [insert family member]'s grave that you will TOTALLY be open to the idea of surrogacy/IVF/adoption if you do change your mind. Especially the adoption one; anyone trying to argue this one against you is going to look like a selfish ass. "Oh, I just couldn't bear to bring a child into this world when there are so many poor unloved children in the foster system. One of my friends/family members/whatever is an adoptee! Etc.!" What are they going to say to that without looking like an utter monster of a self-absorbed cockmongrel? Lay it on with a freaking trowel if you have to - whatever you need to do to shut them up and assuage their panic that you might someday sue them. This is a form of compromise, somewhat, even if you are lying through your teeth. And speaking of...
~ Lying/omission/exaggeration is SOMETIMES okay. Now, this is basically tap-dancing in a minefield. You have to approach this with a care rivaling that of a bomb squad. Omitting facts on medical history forms & during visits is a good way to not only fuck up your care if you don't know what the relevance of what you're saying, but can sometimes even qualify as insurance fraud, depending on what you lie about & how you do it. So if you take this advice, YOU DO SO AT YOUR OWN RISK. What I'm emphasizing more, though, is exaggeration rather than outright lying. Doctors' motto tends to be that a family history is their most important tool for care, but it's yours too. Most doctors are not going to listen when you say "I just don't want kids" as your rationale for a tubal if you have no contraindications to conventional birth control or health issues that'd make breeding or pregnancy stupid or selfish. However, if there are certain unpleasant aspects of your health or that of your immediate family members that would really help them see why passing on your genetic line is undesirable, use that to build your case. And if it means you've got to fib a little, then do it. Mom had horrible postpartum depression? Bump it up from depression to psychosis (if it was that severe, it could've been psychosis for all you know, so it's not ENTIRELY untrue...). Grandma's had three heart attacks? Phrase it as "close to five". Entire family so damn fertile that not a holiday passes without some new baby there? Talk about the high rate of birth control failure in your family (even if it isn't necessarily entirely due to that), having multiple pregnancy scares of your own & how afraid you are your birth control might fail despite your diligence, given your family fertility. You get the idea.
Grant you, that doesn't mean you HAVE to lie. You shouldn't, really, assuming it can be avoided. At the very least, nothing should be a complete and total lie (like saying you have a family history of spina bifida when you don't, or something else drastic). Lying can be obscenely hazardous in this situation. I would recommend avoiding it as much as you can. Your excuses can - and whenever possible SHOULD - be completely valid. But make it the focal point of your argument if you have enough fodder to do so. Sometimes it's as simple as memorizing all the awful aspects of your family's health to the point where it sounds like you're all basically walking dead. Mom's gestational diabetes turned into full-blown Type 2 after she had you, and you're showing early signs of diabetes yourself (one I utilized myself)? God, push that shit like meth in a trailer park. Have a long history of hormonal fluctuations/tampering (e.g. by taking hormonal birth control) completely fucking you up? Talk in excruciating detail about just how miserable the moodiness/other symptoms left you. ANY family history of birth defects or genetic maladies (however common)? Make them finally be useful for once in your life. Personally, I had so many health issues of my own that my family history was practically irrelevant. However, one thing played out perfectly - the simple omission of a test that'd been run on me.
You see, my mother has hemochromatosis, a genetic disease that basically causes her body to accumulate excess iron without the ability to remove it. It seems relatively innocuous, but can actually be quite fatal if left undetected & is thought to be a cause of much heart disease, especially with strong family histories. She was diagnosed earlier this year, right around the same time I was beginning my sterilization fight. Obviously, as a potential carrier, why on earth would I want to pass that on? And that's one of the slants I used to argue my case for a tubal, as during my initial battle I was still waiting for my genetic testing to come back to determine whether or not I had the gene mutation & thus had no idea whether I was a carrier or not. And as I argued with doctors, I found it only seemed to lend weight to my case.
Then the results came back several weeks later - I tested negative for all the gene mutations. However, with all these doctors I was seeing (within multiple health systems), none of them knew about my results coming back since it was something unrelated to sterilization that my PMD ordered. By this point, I had legitimately mentioned it to at least four of those doctors, since I hadn't known the results. So I figured...why bother telling them now? And I didn't. I never mentioned being tested to the other doctors, therefore creating the illusion that I was a probable carrier. Naturally, I mentioned all her other health issues, especially the ones pertaining to her pregnancies, and I described in great detail exactly how many of these problems I was already known to have inherited, but I simply mentioned her testing positive for it & neglected to expound on the depth in which we'd investigated that particular condition in me. Yes, I probably could have done without even mentioning it at all, considering the ridiculous history I had with birth control alone (not to mention my other health issues), but I figured that little omission couldn't hurt. And, clearly, it didn't.
As I said, this can be tricky and dangerous. Exercise EXTREME caution if you decide to mention (or not mention) even little things like this as it really can bite you in the ass. I mean, I highly doubt that the doctors who did sterilize me would have refrained from doing so if they knew for sure that I wasn't a carrier for the disease; they were (rightfully) more concerned with my other legitimate/pertinent issues, especially how I was literally out of birth control options due to a multitude of nearly-fatal problems with ALL of them. So my real point is knowing your personal & family history, and not being afraid to play it up a little, will probably serve you well.
~ You will not be taken seriously for a long time. Know this. Accept this, however begrudgingly. Make friends with this. This goes back to the whole "biding your time" thing. Doctors are usually very logical people and medicine is a very linear science. It basically consists of "when A, B & C occur in the presence of D, someone has X, Y or Z affliction" & it's their job to figure out which one it is. So if someone presents with A, B & C within the presence of D and it isn't X, Y, or Z...yeah, hair is going to be torn out (figuratively, I hope). Many doctors apparently find it difficult to accept things outside of the norm; it seems to frustrate them as they evidently associate that with failure. Obviously this isn't ALL doctors and I am making a lot of assumptions here, but I think you get the idea. Couple that with the general idea that doctors are supposed to heal & not harm, and thus arises the issue. If a doctor views childfreedom as a mental deformity of some type, of course s/he isn't going to be open to the idea of helping to perpetuate that - ESPECIALLY for a younger woman. It may not be right, but it's something you'll have to accept - for now.
But be patient, bide your time & the time will finally come where all your puzzle pieces will fall into place, as mine did. As I've said before, no single factor that I've listed here was the one magical issue or action that made this happen for me. It was a combination of dozens of things that I had the gumption & wherewithal to force to work for my benefit. And yes, someday you'll do the same. Someday you'll be sitting in that hospital bed right before they come to take you away to the OR, best friend by your side trying to keep you cheerful, picking at the hem of your flasher gown & grimacing at the sight of the IV in the crook of your arm, and then you'll be rollingrollingrolling down the hallway with a good nine white-coated people around you, and they must've given you something because suddenly everything starts to look a little blurry and you feel very light and drained and wait you're lying down how did that happen? and you're absolutely terrified but despite that a tiny smile will flash for just a split-second, right before they put that oxygen mask over your face, because even though you're scared you know that when you wake up, all your hard work will have finally paid off in the form of two tiny scars on your abdomen and your life can finally begin.