My Bilateral Salpingectomy

Content warning: sexual assault, abortion, fertility, medical misogyny, medical racism, surgery

 My Abortion

The only time I ever entertained being a parent was when I was a lot younger, and only because my mother wanted lots of grandchildren. When I was 20 I got pregnant because I was stealthed by someone I met at a Tower Records and never took me on a real date. I was lucky to be living in a place where there were no institutional barriers to abortion. My doctor was matter-of-fact but understanding and said, “So you are pregnant, and as I remember you were not trying to be pregnant”. We agreed I didn’t want to be pregnant and he put in the request for an abortion. 

The staff at the clinic were kind, and the procedure was fairly painless even though I bled and cramped pretty badly afterward. When I look back on the experience, the traumatic part of the process wasn’t the abortion itself, but the societal stigma I had so deeply internalized. I was hesitant and afraid to tell people, and have still never told my parents. The feelings of isolation and fear that stemmed from my inability to seek support drove me into a deep depression for over a year. When I did open up to friends about the experience, I was surprised how many shared their own experiences, or that someone close to them had also had an abortion. There’s a part of me that feels bad for the 20-year-old who cared so much. She cared about what other people thought about what she did with her own body. I think about my abortion all the time, and it is always with gratitude, even when I was in my lowest and saddest place. I am so grateful I was able to have agency over my life in that way, and it is also sad to have to be so grateful. Nobody should have to give birth if they don’t want to or cannot do so safely.

Journey Through Birth Control

After my abortion I asked my doctor if I could be sterilized instead of pumping my body full of birth control. This time, he wasn’t as understanding. He said I was too young and that I’d regret it. After all I had been through I was apparently still too young, too stupid and naive, to understand what I wanted out of life. I was told I would regret my decision, like there aren’t other ways of being a parent or parenting within a community. As if I hadn’t already had nearly 10 years to think about it – all my mother wanted from me, from a very young age, was grandchildren. I felt so confused and so angry – this medical system which had granted me a life-changing degree of reproductive choice was now stifling this same choice and bodily agency.  There are so many people that want to be parents and for myriad reasons have a really difficult time – shouldn’t we focus on their needs? What do we achieve by denying a 23-year-old, who knows they do not want to be a parent, agency over their reproductive future? I know that the continued use of contraceptive medications, devices, or prophylactics is not the same type of binding responsibility as having a child, however it is so bizarre that the system could assume so much about my goals in life.

I think the medical system also underestimates the pain, trauma, and complications associated with contraceptive medications and devices. They all have side effects, some of which can be debilitating for many users. I think many people who menstruate can attest to experiencing migraines, heavier periods, debilitating menstrual cramps, mood swings, acne, loss of sex drive, bloating, tender breasts, and dangerous ovarian cysts as a result of birth control. Not to mention that installing some contraceptive devices is insanely painful and traumatic. Installing or replacing an intrauterine device (IUD) involves a practitioner PRYING OPEN THE CERVIX, CLAMPING IT, PULLING OUT THE OLD IUD, AND SHOVING IN A NEW ONE. It looks and feels exactly like you would imagine, and the removal and replacement are done with brute force. I’ve had this done three times and had awful cramps for days. No pain management beyond ibuprofen is typically advised for this procedure. Over the last twenty years I’ve tried birth control pills, which are not only less reliable than condoms due to user error, but gave me mood swings. I tried the non-hormonal IUD and had debilitating menstrual cramps for six months until I asked my doctor to replace it with a hormonal IUD. The hormonal IUD worked decently well for me until I was in my thirties and I started to experience really intense breast pain. I then switched to NuvaRing which helped the breast pain a little, but also tanked my sex drive and made my periods last nearly twice as long with random spotting throughout the month. After my abortion, being denied sterilization, and beginning to use contraceptive medications, I really took these side effects for granted. In the past, I have been dismissive of my friends who didn’t want to participate in the futile exercise of finding a contraceptive medication that had the fewest side effects for them. However, some people recognize it’s not worth it for them and would rather use other methods that don’t ravage their bodies.

It speaks volumes about the global cult(ure) of misogyny that people who can get pregnant bear the physiological and psychological brunt of family planning. How many contraceptive methods do you know of (beyond condoms or vasectomies) that have been developed for people with penises and testes? I think people would opt for this type of contraceptive were it widely available, but it is simply not there. So not only are the people who can get pregnant expected to undertake family planning, but they can also experience shame if the method fails; or are prevented from terminating pregnancies through legal, social, and spiritual conditions. If they do give birth, the United States has some of the highest birthing mortality rates in the world, and the birthing mortality rate for Black people is THREE TIMES that of other races. If they have a healthy birth, parenting triggers an entire other set of judgments and pressures. If you don't want to be a parent, there’s no thriving in this circuitous maze of shame and control.

Now at 34, I still don’t want to be a parent. When I was dating it was on my dating profile, and was always something I addressed when messaging new people and on the first date. I am with a partner who is also not interested in being a parent, and when I asked him if he would consider getting a vasectomy he wasn’t completely sure. Therefore, I needed to explore sterilization for myself. I approached my doctor and proposed a radical hysterectomy – complete removal of the uterus and cervix. She told me it’s an invasive procedure that is not recommended as an elective surgery, and removal of the cervix is usually performed by specialized oncological (cancer) practitioners. However, she connected me with an obstetrician/gynecologist (OB/GYN) who could talk through my options. The OB/GYN I talked to was sweet and sincere, and wanted to carefully explain each of the birth control options available. I told him politely that I had tried everything, it’s all awful, and I wanted something permanent. He seemed relieved to be able to skip the recitation of every birth control method available, and recommended a bilateral salpingectomy – removal of both fallopian tubes. The procedure is 100% effective at preventing pregnancy, and can be done laparoscopically in a 30-minute procedure. I started crying when he said he would put me on the surgery scheduling list. No more stress of remembering a pill or ring, traumatic procedures to remove and replace devices. No more worrying if a late period means failed birth control and another abortion.

The Surgery

I was put on a waitlist for surgery scheduling in January 2022, as elective surgeries were put on hold due to COVID-19. The scheduler let me know I would likely be scheduled in March and to be ready for a last-minute opportunity. I got a call from the scheduler on a Thursday, was scheduled for my pre-op appointment the following Monday, and had my surgery that Friday. My doctor, partner, family, and friends asked me if I was nervous and I only felt euphoria and disbelief. I literally could not process what happened until after the surgery.

We arrived at the hospital at 1pm as instructed, and I was taken back to the pre-op area fairly quickly. I was so excited  and couldn’t help but tell everyone I encountered how excited I was. Most of the medical professionals looked at me with blank faces because they were too busy to deal with my toddler-like energy. I hadn’t had anything to eat or drink since the previous evening so I fell asleep pretty soon after being hooked up to an IV. However, every hour or so a new doctor would come by, wake me up, and introduce themselves as part of the surgical team. I was finally taken into surgery around 4:30pm and woke back up less than an hour later.

The procedure is fairly simple and involves three small incisions – one in the bellybutton for the laparoscopic scope, and then two in the hip creases for the instruments. The surgeon cuts and cauterizes the fallopian tubes to remove their connection to the uterus and ovaries, and removes the tubes. Wham bam, I’m sterile! They even put a cute heart bandage on the big bellybutton incision. They didn’t give me any pain killers before the anesthesia wore off, so for the first two minutes I was awake, it felt like there was a crater collapsing into my abdomen. I started yelling about the pain, and the nurse pumped some vicodin and fentanyl into my system, and then rolled me out to the discharge area where I woke up some more.

Recovery

I was so fortunate to have my partner by my side during and after the procedure. He drove me to the hospital, waited for 6 hours until I was discharged, was grilled by the discharge nurse (she made him repeat back her instructions, and even quizzed him to be super sure), and made sure I had water, snacks, and medicine for the drive back to Kitsap County where I was taking care of a friend’s farm. He stayed the weekend and took really good care of me by cooking, entertaining the friends that showed up, feeding the farm animals, and doing all the chores so I could relax and recover. I am so grateful to the friends who visited, made me food, and kept me company on the lovely (but lonely) farm. Thanks to these sweethearts I only had to plop food on a plate and into the microwave for the whole week.

The worst part of the recovery were the cramps and pain from the incision in my belly button, and they really were not that bad. I managed the cramps with ibuprofen, and the doctor sent me home with seven small vicodin tablets (for incision pain), of which I only took six over three days. The incision pain made it tough to bend over or move around a lot; between the exhaustion and vicodin I didn’t have much endurance for farm chores or sitting upright for the first three days. I would use an ice pack on my belly button when it wasn’t bad enough for vicodin. Cramping was most painful for me in the mornings since the ibuprofen from the night before had worn off, and I think that whenever the body changes position after a prolonged period sometimes muscles freak out. I am writing about this more than a month after the procedure and I still experience random cramps in my abdomen (that are not menstrual cramps). My doctor said it was part of the healing process, but it’s still unnerving. I had some tenderness and bruising around the incision in my hip creases, as well as swelling in my abdomen for about ten days. I had some bleeding and spotting, but nothing bad, especially since I had read that vaginal bleeding can occur for a month afterward. 

5 days post-op

Processing

Since I was by myself with only farm animals to talk to and nothing to do for a week, morbid thoughts crept in. It all happened so fast, it felt unreal it had happened at all. What if I was in some kind of surreal fantasy? What if the surgeon put me under and made cuts in my abdomen but didn’t actually perform the procedure – they just laughed at me in the operating theater and I’m going to get pregnant again? I had been wanting something like this for more than 10 years, why did it take so long? 

In talking about the procedure, many friends were amazed that a person with a uterus could ask to be sterilized. Many thought it was only available if medically necessary, and I suppose I did too. I figured that if I demanded a radical hysterectomy I would likely be told no; I did not expect to be offered a more reasonable alternative. I don’t think that a bilateral salpingectomy is the right type of birth control for every person with fallopian tubes, but I do think it is a pretty great option if it is available to you (physically, emotionally, spiritually, and financially).