Changing the Culture Around Child-Free Family Planning
Jan 06, 2023 Cassie Tomlin
Recent research shows that a growing number of U.S. adults who don’t have biological children say they plan to remain child-free forever. For women (and nonbinary or transgender people with uteruses) who know they don’t want kids, Cedars-Sinai provides options, including surgical permanent contraception.
Tubal ligation—surgical removal of the fallopian tubes to prevent pregnancy—has long been offered immediately following childbirth to people who don’t plan to have more children. But the procedure (commonly known as getting one’s “tubes tied,” because it used to involve the cinching of the organ with clips or bands) is historically less available for women who intend never to become pregnant.
Because tubal ligation is irreversible, unlike oral or implantable birth control methods, physicians may be wary to provide it to women of child-bearing age who haven’t had kids.
“Most OB-GYNs don’t do these surgeries because they worry about the risk of regret”
“Most OB-GYNs don’t do these surgeries because they worry about the risk of regret,” says Dr. Natasha Schimmoeller, a surgical gynecologist at the Cedars-Sinai Family Planning Program, which aims to provide permanent contraception to anyone. “This is the only field in all of medicine where regret is so emphasized—it’s very gendered."
“For our team, offering permanent contraception to anyone who seeks it is a principle-based practice of medicine," Dr. Schimmoeller says. "I can give objective scientific data in my role as a doctor and surgeon, but the ultimate sign of respect is that I believe that you know your life the best.”
Here, Dr. Schimmoeller answers frequently asked questions about permanent contraception.
What does the permanent contraception procedure entail?
Dr. Natasha Schimmoeller: Tubal ligation is the most common form of contraception worldwide. When it is not performed immediately after someone has given birth, it’s a 30-minute laparoscopic surgery, during which we make incisions as small as 3 millimeters—two on either side of the abdomen near the hips, and one inside the belly button—to remove the fallopian tube. Removing the fallopian tube eliminates the “bridge” for sperm to reach the ovaries.
Unlike a hysterectomy—the removal of the uterus—or other gynecologic surgeries, we don’t touch the uterus or the ovaries. So, following the procedure, a person still gets their period, and their hormones remain the same.
Most people take over-the-counter pain medication for a few days and are back to work and normal activities in a week.
Who is an appropriate candidate for this procedure?
NS: Anyone who is sure they don’t want to have kids can consider permanent contraception. Medicaid requires people to be at least 21 years old, and private insurance requires people to be at least 18. About a quarter of my patients who consider this procedure are nonbinary or transgender.
What are common misconceptions about child-free family planning?
NS: Sometimes people think there are rules or laws governing this procedure—there aren’t, besides a federally mandated three-day waiting period for people with private insurance, and a 30-day waiting period for Medicaid patients, which is standard for a vasectomy as well.
People sometimes think there is a certain number of children you must have had first, or that a woman’s partner needs to have a say, and neither of those things is true.
What if someone has this procedure and changes their mind about wanting to become pregnant?
NS: If people change their mind, they can still do in vitro fertilization to try to get pregnant. This field—women’s reproductive health—is the only one in all of medicine in which the possibility of future regret is so heavily emphasized.
The American College of Obstetricians and Gynecologists suggests that physicians should counsel women about the permanence of the procedure, but even more so must respect women’s right to make decisions about their bodies when they’re confident it will benefit them.
What is Cedars-Sinai doing to change the culture around child-free family planning?
NS: Cedars-Sinai is one of the only places in the country that prioritizes this procedure for people who never want children. When you come to our office, you can feel safe, from the moment you walk in the door, that you won’t be judged.
Everyone on our team is on board with taking care of you, absent any bias—from the telephone operators who make the appointments to the nurses in recovery. Everyone you encounter will support you.