DEAR DR MITCHELL,
I am a 40-year-old mother of three, and I have had four miscarriages. I am currently 28 weeks pregnant and when I give birth, I want to have my tubes tied at the same time.
However, my husband says he will not give his consent, and I was told that this is required by the hospital before I can do the surgery.
What are my other options? I do not want any more children, or any other pregnancies!
Congratulations on your pregnancy!
So sorry to learn of your recurrent pregnancy losses. It is important for you to follow your doctor's advice and keep up with your antenatal visits to ensure a good outcome for both you and your baby.
Women of advanced maternal age (above 35 years) are at increased risk for high blood pressure and diabetes mellitus in pregnancy. There is also an increased risk of birth defects and premature ageing of the placenta, resulting in poor nutrition and failure of the unborn baby to grow properly. This can result in low birthweight or death of the baby before the expected delivery date.
It is also important for the visits to be more frequent as you become more advanced in the pregnancy, so that if there are any problems with the mother or baby, delivery will be expedited by Caesarean section.
Tubal ligation at the time of delivery is not advised if you are having conflict with your husband about the decision. It is a permanent procedure and should only be done if you are both absolutely sure that you will never want to have another baby.
There is no hospital regulation that demands that the husband signs and gives permission to do the tubal ligation. It is entirely the woman's decision and the only signature required is yours.
However, in the interest of a good relationship you should both agree, since this can potentially cause a breakdown in the relationship moving forward.
There are other methods available which will give you effective and safe contraception, and afford you the opportunity to have another child if you decide to change your mind. Long-term methods that are safe include the intrauterine contraceptive device, subdermal implants, and contraceptive injections (Depo-Provera). These are safe options which do not contain any oestrogen and can be used until menopause.
The intrauterine device lasts for 10 years and is very effective. This is the Copper T 380 device.
This will take you to age 50 years old. The average age of menopause is 51 years old. This will be ideal for you and is completely reversible.
It can be inserted at the six-week, post-delivery, check-up visit with your health centre or doctor.
Best wishes for a safe delivery.
Consult your doctor who will advise you further.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to firstname.lastname@example.org ; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 876-968-2025. All responses are published. Dr Mitchell cannot provide personal responses.
The contents of this article are for informational purposes only, and must not be relied upon as an alternative to medical advice or treatment from your own doctor.