Getting my tubes tied

Content note: contains frank discussion of bodily functions.

Once up on a time there was a little girl who realised she did not want to grow up to be a mummy. She was not alone in this realisation, but she was a bit anxious because lots of little girls did want to grow up to be mummies. And as she got older she read some scary stories about how difficult it would be to be a grown-up girl who didn’t want to have children. There were lots of ways she could make sure she didn’t have children, and she used these for many years. But these methods had side-effects that started to annoy her. So when she was ready, she decided to ask her doctors if she could permanently make sure she would never get pregnant. And she remembered all the scary stories, and she wondered if it would be really hard to convince the doctors this was what she wanted.

But it wasn’t hard. This is her non-scary story.

The decision

I realised I would never want children when I was a teenager. As luck would have it, the man I fell in love with felt the same. We may have been young, but I fancy we were pretty emotionally mature, and this was a conversation we had early on. We were categorically both on the same page – procreation was a state to be avoided at all costs.

I’d been on the combined pill from age 17 to 25, had an IUS for 5 years, and then switched to implants lasting 3 years apiece. As far as preventing pregnancy goes I can’t fault these methods. But coming to the end of implant #3 I was acutely aware that I’d typically get two pretty good years, then one year of irregular bleeding, skin breakouts & mood swings. Plus I’d been told that if I went for a 4th implant they’d have to switch to my right, dominant arm as the scar tissue was getting too built up in my left. Enough was enough. I wanted a permanent solution.

The referral

Unfortunately, just at the point I’d made a decision to ask my GP to refer me to a surgical consultant, the pandemic hit. So we went into lock-down in March 2020, and waited to see how events unfolded. Watching friends and colleagues struggle with the additional stressors of childcare & home-schooling was yet another reminder of why this was the right decision for us.

I finally managed to arrange a phone call with my GP in July. I wrote up my list of reasons, and prepared to do battle with the forces of the patriarchy. I’d read the horror stories of women getting refused this procedure, and to be honest those stories had put me off from asking for this sooner. But my worries were allayed immediately. My GP was friendly, professional, and showed zero inclination to talk me out of my decision. He put the referral in, and I waited.

The waiting list

A couple of weeks later I had another phone call, this time with the surgical consultant. Again, I was prepared to argue, persuade, beg, or whatever was needed to convince this chap that I knew my own mind. And again, my fears were unfounded. He was perfectly accepting of my happy, child-free situation, my desire to secure that permanently, and my frustration with alternative methods. So I was added to the waiting list – simple as that. Of course as the pandemic raged on, I was warned the procedure wouldn’t happen until at least 2021. Several months later – after I’d seen my GP for an unrelated matter and he’d given the hospital a nudge – I was finally scheduled for a pre-op appointment.

The preamble

The pre-operative appointment consisted of a 4 page questionnaire asking about my medical history and habits with regard to self-medication. I admitted to drinking alcohol in what I considered to be non-problematic quantities, and the occasional CBD capsule for anxiety. I was weighed, measured, swabs taken to test for MRSA, blood drawn to test for something else, blood pressure checked (a little high – but it had been quite a stressful journey there) and then sat down to have the procedure explained. I’d be given two weeks notice, and for that period I’d need to follow comprehensive social distancing and hand washing protocols (which obviously we should all be doing anyway). Then 3 days before the op I’d have to go for a Covid test, and then fully self-isolate until the day of the procedure.

I was also told it could take a further 16 weeks to schedule the procedure date, so was resigned to yet more waiting. But just a week or so later I was rung up with a date for mid April. Which meant the two week countdown started almost immediately. I’d managed to avoid having a Covid test throughout the entire pandemic (on account of basically going nowhere) so this was a fun new experience! I dutifully got a taxi to the test site (the instructions specified not to use public transport), had a long stick poked far enough up my nostrils to make my eyes water, and then got a taxi back home to officially self-isolate.

The operation

For a morning procedure under general anaesthetic, eating and drinking is permitted until midnight the night before. A snack before bed is encouraged, rather than just an evening meal. Then a small glass of water no later than 6am, and nothing further to eat or drink. I have to ‘check in’ at 7, which sounds like I’m off for a fancy spa treatment. I’m shown to a single-sex waiting room with half a dozen other women, who mostly seem to talk about their children and how hard parenting has been during the pandemic. Clearly the universe does not intend to try to change my mind at the last minute!

After a few minutes’ wait I’m taken to a room to meet the anaesthetist. And so begins the first of several safety checkpoints where they make absolutely sure who I am, what I am having done, what I am allergic to, and whether there are any issues which could cause problems with the anaesthetic, eg loose teeth, crowns, undeclared body piercings etc. The risks of the procedure are explained, and I sign my consent.

Then I meet a nurse who provides me with the obligatory paper knickers, hospital gown & surgical stockings which I change into, and I am directed to provide a urine sample for a pregnancy test. This is followed by a discussion with the surgical resident (who I gather will be doing the actual work under the supervision of the consultant) who again makes sure that I fully understand what’s going to happen and what risks are involved.

I’m summoned to a corridor where I relinquish my belongings into the custody of the hospital. I just about have time to send a hasty text to Terry to say I’m being taken down. I am given a pillow to hold, which puts me in mind of the companion cube from Portal, though I assume it will have a practical purpose to become clear in due course.

I’m deposited in another waiting room. This one has a telly and I watch half an episode of Fraser. Another member of the anaesthetic team calls me into a yet another room, and we go through the identity/procedure/allergy/risk call-and-response yet again. I have to say I’m impressed with their commitment to the Checklist Manifesto, or, as a former colleague once put it, Not Being at Home to Mr and Mrs Cock Up! Then we’re on the move for the last time and arrive at the ante-room outside the theatre, with me still clutching what I now think of as my emotional support pillow. There is a bed, and lo, my pillow gets its moment to shine. So up I hop, and the process of putting me to sleep begins. There’s a deal of squeezing and gentle slapping as apparently my veins aren’t playing ball, but eventually the cannula goes in to my left hand. I’m hooked up and feel a very slight dull ache as the liquid is drawn into my body. Then a soft falling sensation, and then nothing.

The recovery

I come round slowly, disorientated and bleary, but not too freaked out. I hear myself mutter “oh right, the operation” which seems like a very witty and urbane comment to make in the circumstances. A nurse asks me about my pain levels and if I need anything. I decline, and then change my mind about 45 seconds later as sensations in my abdomen start to register as quite substantial discomfort. I get a syringe of something sweet and syrupy which I dimly remember being told was opioid based. Whatever it is, it dulls the gnarly feelings well enough. I’m wheeled up to a shared ward with space for 5 patients, and manage to shift myself onto the bed.

I’m told I’ll be hanging out there for the next three hours, assuming nothing untoward happens. It’s around 11 ish in the morning, so I decline offers of tea or coffee (I’m kind of caffeine sensitive) but greedily sip water, then orange squash, to re-hydrate. My blood pressure and temperature are checked regularly, and don’t seem to be causing anyone any concern. After imbibing a good litre or so of liquid I finally need to pee, but am under instructions not to attempt to stand up unsupervised. I have a button to summon assistance, but with 4 other patients in the room the nursing staff are in and out fairly frequently anyway. I use the facilities without incident, although I am bleeding a bit (no different from a light period) which is entirely normal. I receive a standard-issue NHS maxi-pad to assist with that situation.

Throughout the entire process I have felt protected, cared for and respected. At no point have I felt like a number, or a piece of meat, but rather that my comfort and safety have been of paramount importance all the way through. The one small administrative mistake is in my favour – as a day patient I’m only meant to be offered drinks, and toast and/or biscuits. In error I have a lunch order taken and delivered, which shouldn’t have happened. I eat it gratefully, although I do get a sudden wave of nausea the next time I stand up a bit too quickly. This is completely normal as the anti-emetics used as part of the anaesthesia wear off. Fortunately no vomiting occurs, and I have learned my lesson that I’ll need to move slowly for a while.

Towards the end of the three hours I’m visited by the lovely surgical resident who informs me that the procedure was uneventful with no transfusions or any such drama occurring. I’m also de-briefed by a nurse who talks me through what to expect over the next few days. This is mostly a repeat of information I was given prior to the op. Air is used to expand the lower abdominal cavity, which usually doesn’t fully dissipate when you’re stitched up. This can result in referred pain, particularly around the shoulders, as the gassy pockets try to disperse around the body, pressing on various nerves as it does. Sure enough I feel pretty bloated, although it’s weird knowing this isn’t standard trapped wind in the alimentary canal, so I’m not just one good fart away from relief.

I’m also instructed to keep the dressings as dry as possible, to keep the surgical stockings on day and night unless bathing, and to make sure I am supervised for the next 24 hours. I’m issued with various bits of literature on these points for later perusal, my cannula is removed, and after a final blood pressure check I am discharged.

The aftermath

By 4pm I am back home safe and sound, feeling a bit grimy, dozy, and kind of beaten up. As a priority Terry gives me a sponge bath to remove as much of the remaining iodine and bits of dried blood as possible. I take some paracetamol and have a little nap.

Over the next couple of days I rest, with occasional naps between rest periods. The official advice is to take appropriate steps to manage pain levels. Now is not the time for misplaced displays of machismo. I use paracetamol as directed, which gets me through the first 48 hours. The most distressing effect I have to endure is constipation, probably caused by that first opioid based painkiller. I finally get relief from that state of affairs on the Sunday morning after a rare 2nd coffee, which leaves me jittery but slightly more comfortable.

There are two specific advantages of doing this during the pandemic. The first is that I am currently working from 100% of the time. As part of my discharge I am given a sick note which would sign me off work for two weeks. But by Monday I realise this won’t be necessary and I am perfectly capable of working, albeit taking things a bit easy. If I’d had to commute in on pubic transport and sit in an office I’d have taken the time off no question. But current WFH arrangements enable a more flexible approach to employment by default. And the second is that as I don’t share an office (or train carriage or bus) I can adjust my attitude to personal cleanliness (apparently I’m not the only one according to this Guardian article). Which means in practical terms I can continue with the sponge-bath approach to washing for the next 5 days. Ideally the dressings covering the incisions should stay sealed for that long, unless they get wet or there is any sign of infection. So I hot water and flannel it until the following Wednesday, safe in the knowledge no-one can tell over Zoom how greasy my hair has become.

By Monday I am off the painkillers, and taking gentle exercise each day. On Wednesday I finally have a proper shower and gently remove the two dressings. The incision points are healing up beautifully with no indication of any infection. I swab the areas with antiseptic liquid and re-dress with some of the spare dressings I was issued at the hospital. The stitches are designed to dissolve away, although the one in my belly button where the laparoscope was inserted is still just about visible.

On Thursday Terry and I go for a walk. This is the first time I have left the house since the op, and the first time I’ve left the house not for a medical appointment in months. Tomorrow it will be one week since the operation. I’m still being fairly gentle with movement, and avoiding lifting anything. I also get a bit fatigued in the middle of the day – again quite normal. But the recovery so far has been textbook.

Checking my privilege

I am fortunate to be in a committed relationship with an emotionally literate partner who shared my life preference for not having children. I am lucky to have had support and encouragement from friends and family. I am grateful to live in a country with a decent healthcare system, and lucky to be able to bear the incidental costs, such as taxis, without struggle. I had a wholly positive experience with the medical practitioners all the way through, and never once felt like I had to justify my choice to someone with pre-conceived notions of what a woman should want. I’m profoundly grateful for the care I received, and have written to the NHS Trust’s PALS team to pass on my positive feedback and for making this a non-scary story.