the hard sell

The doctor was a short, rotund black woman with a friendly smile, and she kept eye contact with me as she asked me why I wanted to consider sterilization.

I told her, starting with never wanting children, never melting around babies, BF and I getting engaged and talking thoroughly about the non-kids thing. I went on to describe my experience watching the womb video, and my discovery that what I had was a phobia. I told her that I’d considered getting my tubes tied for some years, but the experience with the video had made me see that I wanted to go on and do it for my own peace of mind. I said I realized that I was young and it was a hard sell, but I was certain it was what I wanted.

She understood. She really, really did. She was warm and intelligent and she told me that no, she couldn’t tie my tubes for me, not right away. She explained that although certainly, as a doctor the lawsuit thing worried her, she was more concerned as a person about whether I would be happy and healthy if she did it – more worried about whether doing this would be a life mistake for me, rather than a medical mistake for her. She cared about her patients, she explained, and she didn’t want to agonize over the decision about whether to tie my tubes when I was so young. (I believed her.) She wanted to know that it would make me feel better rather than, eventually, worse.

Her conditions were two. First, that BF would have to come in to see her with me and tell her for himself that he was okay with this decision, that I wasn’t making it alone, and that it was something he supported fully. This made good sense to me. He will soon be my husband, and tying his life to an infertile woman would be a big and perhaps difficult decision for most men.

The second was that I would have to see a head doctor to talk about my tokophobia, to make sure I was certain and healthy before I had the procedure half-cocked. She said it sounded like I had a genuine phobia, and she wanted to see if psych help would assist me in getting over it. If that was the case, then maybe the tube-tying* would be a mistake. (I think I failed to emphasize that the phobia is about 1/3 of the not wanting children thing, and that most of my mind is made up about tube-tying because I don’t want to raise children. The phobia realization just kicked me in the side with spurs to get to this appointment.) Again, her explanation here was that she was thinking of my health; if I could be happier mentally, not paralyzed with terror at the idea of pregnancy or birth, then so much the better. She wanted a doctor to sign off on the fact that this wasn’t a fly-by-night decision and that I truly understood the ramifications of this choice.

This seemed sensible to me. I was worried that she would ask for therapy because if I didn’t want kids, I must be crazy, but that didn’t seem to be the aim at all. She said at one point that she thought it was a choice, and she wasn’t going to argue with the choice not to have kids. Her concern all the way around appeared to be my health, which honestly is a refreshing change from all my experience in the medical world for the last three years or so.

She also told me that if I wasn’t willing to meet her two conditions, that was fine and she could refer me to a doctor who would be able to sterilize me right away. I thought “Oh, great, so you’ll refer me to an unethical doctor. That’s exactly what I want!” Any doctor who wouldn’t be sensibly cautious in the way she was is not a doctor I want performing a procedure with potentially bad side effects on me.

She advised me about Mirena, which is just a hormone-drenched IUD, an option I’ve known about since I became sexually active. Since it lasts five to seven years, she thought this was a good midway procedure for me to do, because I might change my mind by 35. If I didn’t, then the tube-tying could move forward. She had a good point there, which I acknowledged; I thanked her but respectfully declined. I’ve heard that the hormones in Mirena can be wonkier than the ones in the pill, even leaving aside all the horrid anecdotal side effects I’ve read about, and I don’t want something in there, the way an IUD would be. Might as well just stay on the pill for five to seven more years.

So, the next step is for me to find a head doctor who can listen to me about why I don’t want kids. I have not taken this step yet. Part of the reason is that I know I have a stressful year ahead of me, planning the wedding, and I don’t feel that it’s necessarily a great idea to be trying to find a good therapist in and amongst that. And then, moving forward, having the procedure before the wedding is a terrible idea, because if something God forbid goes wrong, the wedding will have to be moved or cancelled, and that is the absolute last thing that I want. I’m also continuing to feel the spirit of moving slowly, and taking this journey one little leg at a time: taking time to think about it, and then taking a step, and then thinking about it some more, and then taking another step. What’s my hurry? I’d like to be off the pill, but it’s not as if I’m allergic to progesterone.

And, after all, I Could Change My Mind.

To be continued…in a few months.

*I’ve continued to speak of this procedure as “tube-tying” for the sake of convenience. In fact, I haven’t fully decided between Essure and tubal ligation. Essure seems like it would be a simpler, less expensive choice (it’s doubtful that my insurance will cover either procedure, although BF’s might after we’re married), but because I’m young, there’s more potential for it to be ineffective after some years, and I’m a little worried about my potential sensitivity to the nickel in the Essure coils. I don’t really want the invasiveness and anesthesia and recovery time aspects of a tubal, and its risk of pregnancy anyway is approximately the same as Essure’s. It’s just another decision I’ll have to make in the months ahead.