Sunday, November 15, 2015

How to Consent for Tubal Ligation

There are two important things to discuss with patients when consenting for BTL: permanence and regret.

Only 50-56% of women can have a child after a tubal reversal (26% if you're trying to reverse it after age 39). The largest study done on tubal ligation was a prospective, multicenter piece of research done by the CDC, and was called the CREST study. It found that people under the age of 30 are 3.5 to 18 times as likely to request reversal than those over 30 (of those sterilized between 18 and 24, 40.4% requested information on reversal).

Not all insurance pays for the reversal, either. 

The CREST study found that 14 years after BTL, there is a large amount of regret, especially among patients with certain characteristics. Here are the numbers for regret at 14 years:
    • 20.3% of women who were 18-30 years old regretted their sterilization
    • 21.7% of black women
    • 20.4% of unmarried women
    • 17.6% of women who chose BTL within a year of their last child's birth
Regret develops in a linear fashion, meaning that around 5% regret at 3 years, then 10% at 7, then 20% by 14 years. It's difficult to extrapolate 14 years over a lifetime, especially a woman's lifetime, which has a natural time of infertility that can bring on or increase pre-existing regrets.

When women are under the age of 30, black, unmarried, or choosing BTL within a year of delivery, I counsel them that about 1 in 5 women like them regret their decision to get a tubal ligation. I also stress that the real world is not like Friends, and BTLs are permanent. I recommend on pospartum day 1 (or during prenatal care) that they talk about the decision with their loved ones and look into LARCs (and natural methods, of course), which are reversible and can be just as effective.

Friday, October 30, 2015

Two months in review (9-10/2015)

In the past two months, I've been on Labor and Delivery, and on the clinic service. During this time, I clocked my personal best and worst weeks in terms of duty hours. I logged 92 hours on week on L&D (when I worked two weekends on either side of a busy week), and I logged 30 hours on a (very average) clinic week.

I got a lot done during that month of 30 hour work weeks: doctor visits, dental appointments, making curtains, a car wash, moving forward on research projects (18 patients recruited for my survey study, phone calls towards one patent, drawings for a manufacturer on another, and signing on to another device study at my hospital), and moving forward on fun projects (contacted an illustrator on two children's books [was turned down but hey at least I contacted someone], and went live for beta testing on another [sorry I can't link or it'd compromise anonymity]). I also furthered some of the NFP projects, completing fundraising on a video project for NFP-only interviewees (now that's gonna compromise anonymity when the video comes I'll probably have to delete that later), completing a final version of new-evangelization-style NFP handouts for patients in our metroplex (and getting half of the funds for that!), and half-finalizing the manuscript of the pocket-Napro book that myself and another NFP-only resident are working on.

I have learned to do a discharge summary in ten minutes. I have learned to do dishes once every two weeks without inviting every bug in the metroplex. I have started walking to work more (because I hate scraping cars).

I'm still chronically exhausted. A major spiritual battle right now is how to deal with fatigue; it's actually the core battle of my life. At the same time, I am tempted to think I do not pray, sacrifice, or love God enough. But the reality is, that my prayer (outside the starvation rations of just MP, EP, and meditation) is the prayer on the Cross: complete obedience and self abnegation. And my penance is the penance of Christ's ministry: who needs flagellation when all personal time is lost in a 90 hour work week?

P.S. There are two additions that need to be made to OB/GYN Ethics 101: methotrexate for ectopics, and emergency contraception. I'm also working on elevator speeches and details on the post-fertilization effects of IUDs. Thank you for being patient! The next five months will be very, very hard for me and I have posts scheduled through that time, but new material will be slow to come out.