Why this key chance to getting permanent birth control is often missed. Following the momentous Roe v. Wade decision by the U.S. Supreme Court, doctors report a rise in the number of women seeking to have their “tubes tied” in order to avoid more unexpected births.
However, many patients never actually have this operation because a crucial window of opportunity — the hospital stay immediately following childbirth — is frequently overlooked.
The causes range from overcrowded operating rooms to administrative issues. This has long been a cause of frustration, but it has now become even more urgent as a result of the court’s ruling, which has sharply raised demand for this long-lasting, highly effective type of birth control.
Why this key chance to getting permanent birth control is often missed. The most often used method of contraception for women in the US is tubal surgery, which includes cutting, obstructing, or destroying the fallopian tubes that deliver eggs.
However, research indicates that between 40% and 60% of women who had previously wanted to have their tubes tied during a postpartum hospital stay actually do not receive it then. The likelihood of a future pregnancy is high for these women.
According to Dr. Rachel Flink, an obstetrician and gynecologist in upstate New York, “almost half of women who don’t have their desired postpartum sterilization operation will get pregnant in the next year.”
According to Flink, women might potentially visit the hospital again, but those without insurance, those with low incomes, and those with less education usually ask for this kind of birth control: “They’re more likely to belong to a later population that has trouble gaining access to the healthcare system.”
“Someone is able to monitor their baby, they’ve already made other child care arrangements, there’s no transportation concerns,” Flink says of people who are already in the hospital for the birth of a baby.
Therefore, from the perspective of the patient, this may be the ideal time for tubal ligation, particularly if they will soon lose their public health insurance because of their pregnancy and childbirth. However, a variety of obstacles may get in the way.
Sometimes it’s because the hospital’s operating rooms are overflowing, making it impossible to fit in an elective surgery that doesn’t appear urgent before a patient needs to be discharged.
Why this key chance to getting permanent birth control is often missed. Even while data says obesity doesn’t offer an additional risk to surgery, sometimes surgeons believe the patient is too overweight for the procedure. Younger patients may occasionally be discouraged by a doctor by being told that they might alter their minds. The surgery can simply be outlawed if the hospital has a religious association.
Difficulties with Medicaid
One more piece of paper presents particular difficulties.
It is a consent form needed by Medicaid, which covers over half of all hospital births in the US. Dr. Sonya Borrero, a researcher and clinician affiliated with the University of Pittsburgh School of Medicine, adds that this paperwork must be signed at least 30 days before tubal surgery is performed.
According to Borrero, who points out that the waiting period is not mandated by private insurance, “basically what this accomplishes is create a forced 30-day waiting period for people who rely on public support for their health care.” So, undoubtedly, a two-tiered structure is created.
Medicaid will not cover the cost of the procedure if the patient on the program signs the consent form after the deadline, delivers unexpectedly early, loses the paperwork, or fails to keep it on file.
According to Borrero’s findings, removing Medicaid-related barriers to undergoing tubal surgery might prevent more than 29,000 unwanted pregnancies annually. “This does effect a considerable number of people with Medicaid,” she adds.
Dr. Kavita Shah Arora, an obstetrician and gynecologist at the University of North Carolina, clearly recalls learning about Medicaid’s rules for the first time while she was a medical student.
“I was genuinely upset by what I witnessed. Patient after patient expressed a strong desire for permanent contraception but failed to sign the form “she claims. “We had intentionally erected this barrier to wanted care,” the patient said, “and it simply left me feeling powerless and angry.”
However, she quickly discovered that the consent form and waiting period were instituted in the 1970s as a reaction to the country’s repulsive history of forceful sterilizations, which frequently targeted the poor and people of color.
She came to the conclusion that just getting rid of the consent form and the waiting period wasn’t always the best course of action after speaking with patient advocacy groups. After all, there have been recent allegations of discrimination, and the possibility of reproductive abuse still exists.
But according to Borrero, the Medicaid rules as they currently stand don’t appear to be the greatest method to safeguard the weak because “a lot of research shows that they are creating barriers for the people they were designed to benefit.”
New methods for describing the process
New strategies are being tested in some regions. A few years ago, West Virginia made the decision to begin paying for this surgery using state money in the event that a patient wanted it but Medicaid wouldn’t cover it since they hadn’t waited the minimum 30 days.
Additionally, performing tubal surgery is a top focus at one institution in Texas. Wow, a lot of women can have this surgery done here, Dr. John Byrne thought to himself when he first started working at Parkland Hospital in Dallas.
According to Byrne, who is currently working at the University of Texas Health Science Center in San Antonio, Parkland Hospital operates as a “safety net” county hospital for patients with little financial resources. Hospital administrators established a method to benefit from the brief hospital stay following childbirth since they were aware of the burdens their patients would experience if it wasn’t done then. According to Byrne, the hospital really wanted to make sure “that we do all in our ability to supply that” if a patient requested this form of contraception.
Anesthesiologists and surgeons were assigned to work in the tubal surgery operating room at Parkland Hospital, which also made the decision to pay for the procedure whenever Medicaid did not.
According to a research newly released by Byrne and colleagues, approximately 90% of women who requested that their tubes be tied after childbirth actually underwent the treatment.
In addition, if an operation wasn’t performed at this facility, it was virtually invariably because the patient had opted against it.
Flink, who calls this technique “not a practical alternative for most hospitals,” notes that this study “took place in a very specialized patient population, in a hospital with dedicated staffing for these treatments, and that is willing to bear the cost of procedures.”