Adventures in Sterilizing

It was all so perfect in my head.

During one of my first prenatal appointments for this pregnancy, I discussed with my ob/gyn the possibility of getting my tubes tied shortly after delivering baby number three. I already knew that the hospital where I had Kara and Nathan wouldn't allow this procedure during the c-section, being a Catholic institution and all, and I was okay with that because I loved both of my stays there and how I was treated by the staff. Plus, Luke has always been willing to man up and get The Snip, so there was no reason to give it any more thought.

Until recently, when I gave it some more thought.

The idea came up again during talks with a coworker who is expecting her first child in May; I learned that she was delivering her little guy at a neighboring hospital, and it reminded me that when I first signed up with my practice some four years ago, right before I became pregnant with Kara, my doctor told me she had privileges at that very facility, in addition to the one I eventually chose. Let's call my current hospital Scrubs A and this second one Scrubs B.

Scrubs B has no religious affiliation but maintains an equally stellar reputation.

The wheels in my head started turning.

Originally, I didn't even want to think about switching to another hospital because my experiences with Scrubs A up to this point have been wonderful, and I had no desire to throw unnecessary wild cards into the mix with this last baby. However, Luke and I have been doing an awful lot of talking about the whole getting fixed issue lately, and since my personal deductible will be all paid up as a result of the charges associated with this pregnancy, any procedures that are covered by insurance would be free of charge for me. You never want money to play a factor in determining which spouse gets sterilized, but when you are already pinching pennies and you are searching for a permanent resolution to ending the reproductive chapter of your life, it is what it is.

So I changed my tune. It wouldn't be the worst thing in the world to switch things up a little, especially since Scrubs B is so well known for its maternity services and especially since, to the best of my recollection, my doctor could just as easily deliver there as she could at Scrubs A. Then I could kill two birds with one stone - one baby, one tubal, one surgery for the win!

"Let me just make sure the practice still delivers at this hospital," I told Luke a couple of weeks ago. "My next appointment is soon. I can't imagine they wouldn't deliver there anymore."

That appointment was today, and guess what? They don't deliver there anymore.

Well, that's not exactly true. As it turns out, privileges are maintained by physicians on an individual basis, and of the now eight ob/gyns currently with my practice, only two might possibly still retain privileges. This is largely due to the practice's close proximity to Scrubs A - we're talking right-across-the-street close - and of course, as fate would have it, my own doctor is not one of those two. She explained that she stayed affiliated with Scrubs B for quite a while but that her patients always chose to deliver at Scrubs A, so she finally decided there was no need to maintain her ties with Scrubs B. MINUS ONE FOR FREMA.

On the up side, though, the two doctors she mentioned are ones I really like, so while I didn't particularly enjoy the idea of having someone other than my primary physician perform the c-section, that's exactly what happened with Kara and everything went swimmingly, so the switch was still on the table, until she reminded me that if a complication accelerated my delivery and one of those two doctors weren't on call, I'd end up having Baby Brother at Scrubs A, anyway. And as long-time readers may recall, I did have a complication with Nathan that caused me to deliver earlier than planned, so even though my scheduled c-section removes a good chunk of the guesswork from the actual birth, the pregnancy itself is still very much up for grabs, and the last thing I want is to spend my remaining gestating months fretting over how this will all play out.

All of that to say: no two-in-one for me.

Still desperately wanting to take advantage of having a paid-in-full deductible, I talked to my doc about having a tubal after the fact and learned I could schedule it within a week or two of my six-week postnatal follow-up, if I wanted. Which at first I did, because hello with still trying to kill two birds with one stone. Two surgeries within the same recovery period can still be considered a win, right?

My findings: It's a standard outpatient procedure, my ob/gyn can do it, I'd have to be sedated, and someone would have to drive me home afterwards, but recovery time is short at roughly one to two weeks. However, during that time, I would be prohibited from any strenuous exercise: no running, no 30-Day Shred, etc. You know, all the things I planned to do to get into shape before returning to work. Of my anticipated 12-week leave, I would be able to maybe use three of those to actively lose any baby weight.

I went back to work after eight weeks with Nathan, and I looked and felt terrible. I do not care to repeat that experience with baby number three, when the length of time off is one of the benefits I now have at my disposal.

So, all of THAT to say: no tubal during maternity leave for me.

After my appointment, Luke and I did some more talking, and  we came up with a plan. We decided that he would reschedule the urologist consult he cancelled back in October to get more information about The Snip and to find out how much of it would be covered by insurance. If our portion is minimal - as in, a few hundred dollars or less - then Luke will take care of things before I deliver, and we'll write off the bill as money well spent. If the cost outweighs the benefits for us at this particular moment in time, I will schedule a tubal for myself around the holidays, at which point I'll have been back at work long enough to use up some vacation time. Either way, somebody in the Frema-Useless Clutter household is getting sterilized in 2011.

I smell a new reality show for next season. We can call it The Amazing Race: Tubes versus Testes!

Comments

[Brandy]

Any chance your c-section will cover the entire family deductible and he could do the surgery once you're back on your feet? That's something Gabe and I have considered if we have a third. I'm sure you'll get it figured out.

[Liza]

Good luck!

I think in our economy, many people make these kinds of choices based on factors beyond the strictly medical. Who knows if I would have chosen a scheduled c-s with Josie, if I had not been given a layoff notice effective 2 weeks into maternity leave, with short term disability granting a higher payout for a c-s than a traditional delivery.

[Bren]

Had I known I was having a c-section with baby #2 I would have totally asked for a tubal right then and there. Unfortunately it was an emergency c and I was put under. I almost got another procedure done (Essure) but chickened out right before. It stinks to have to base medical decisions on things like deductibles and out of pockets but that is the world we live in. We actually set aside FSA money this year just so my husband can get snipped!

[Katie]

My husband's snip cost us nearly $800 after insurance! A month after he had the procedure I found out that our county health department does them FREE OF CHARGE with no income requirements to meet. Not only that, they contract with the same urologist that he ended up using for the procedure. Ugh, hindsight is 20/20! Worth checking in to if that is the route you guys decide to take.

[AJU5's Mom]

We are still up in the air as to which method to go with. If I do end up with a c-section, it will be easy. And I will make sure my OB/GYN has that in my chart in case they forget to ask me (although they asked with our first which I thought was REALLY weird). But, if this baby isn't a problem and comes naturally, it is a debate. I don't want to have surgery while caring for three kids - especially while breastfeeding. But, my husband hates doctors, etc and hence doesn't want his body touched. And waiting until this one is weaned isn't an option, as well, we get pregnant before then...

I do think it would be a good reality show :)

[Jen L.]

Aw, maaaaaaaaaan! That's stinky. But it would make an awesome reality show.

I paid $500 out of pocket for my tubal, which was just for anesthesia, since we have a stupid separate deductible for anesthesia. (Isn't that dumb?) It was worth every penny, though. 2 days of moderate bed rest and a few percocet later, I was back to my old self!
.

[Erica]

I had my tubal right around 7 weeks after baby. It wasn't a big deal at all. I now would like to have ensure, and that is done in the doctors office! Score.

[Molly]

I laughed out loud at your last line. Funny stuff, my friend.

[Jamie]

Have you looked into the Essure procedure? Iy has been something I've been thinking about for about two years.

With our last baby I also considered having my tubes tied with c-setion but fate had other plans for me (no c-section and no tubes tied) and we are currently 7 weeks pregnant with our -assuming I am able to carry this pregnancy to term- last baby. I'm really considering the Essure procedure over Tubal for many reasons.

[Melissa]

The total cost of vasectomy is usually $500-1000 dollars before insurance.

My husband paid $50 with insurance to cover co-pays and specialist fees which covered an initial consult and actual procedure. He had it done on a TH afternoon, took F off work, rested Sa and Su and was totally fine by Monday morning. As is, no pain, minimal discomfort. He followed instructions and after so many emissions (with condom; it isn't instantaneous) dropped off a sample. It is much less complicated for him, much less risky (no sedation or general; less risk of infection).

That was 2.5 years ago. After birth control side effects and worries about condom failure, it is truly great to enjoy sex without worry.