If you think your current baby may be your last, you're not alone. Over 150 million people worldwide have undergone tubal sterilization or vasectomy. Most couples find that permanent birth control adds spontaneity and
Alexandria Powell

If you think your current baby may be your last, you're not alone. Over 150 million people worldwide have undergone tubal sterilization or vasectomy. Most couples find that permanent birth control adds spontaneity and freedom from worry to their sex life. Unfortunately, recent studies show that about six percent of women feel regret five years after their or their male partner's procedure. How do you know if you're really ready? The answers may surprise you.A permanent solution
Sydney Holton* and her husband had carefully planned their first four children, and didn't plan to have more.

At age 39, she found she was expecting again. "To think that we were in the middle of an unplanned pregnancy," says Holton, "with a 13 month old, was a reality check on our fertility." Holton, from Seattle, had a tubal ligation performed minutes after her fifth child was born.

"I no longer pray that my period will start, or have to abstain from intimacy due to ovulation," says Holton. "I am thrilled with having it done and we are freer as a married couple now."

When your family is complete, permanent birth control can be an excellent option. However, permanent birth control should be considered permanent -- a serious drawback if regrets arise. "Tubal ligation is covered by insurance, reversal usually isn't. Reversal costs thousands of dollars, and only works about 50 percent of the time," says Marjorie Greenfield, MD, associate professor of obstetrics and gynecology at University Hospitals of Cleveland and the Case School of Medicine, and author of Dr Spock's Pregnancy Guide. The story for vasectomy reversal is a similar one.

Risk factors for regret
A recent study conducted by the Centers for Disease Control and Prevention (CDC) examined the probability of regret after tubal sterilization. Using data from the US Collaborative Review of Sterilization, researcher Susan D. Hillis, PhD, and her colleagues found that while the majority of women studied were comfortable with their decision, 6 to 7 percent did express long-term regret.

Several risk factors were identified. Major risk factors for regretting tubal sterilization included being age 30 or younger at the time of sterilization, and, for women under 30, having the procedure performed postpartum. The older the youngest child was at the time of sterilization, the lower the risk of regret. In addition, says Dr Hillis, "women who reported significant conflict with their husbands were three times as likely to express regret; women who were unmarried at the time of the procedure also had a significantly increased risk of long term regret."

In another study conducted by the CDC, regret statistics were about the same for women whose partners have had a vasectomy. Marital conflict was the most significant risk factor for vasectomy regret.

The right choice, right now?
Dr Greenfield suggests that couples considering permanent birth control ask themselves, "Is there any chance we're going to want another child? What if we're in new relationships? What if something were to happen to the kids? It's crummy to ask these kinds of questions, but you have to think about them". Of course, if you're already wondering about reversal, "that's a big red flag."

Sterilization, adds Dr Greenfield, is "not a decision to make in a moment of crisis." For that reason, couples should proceed with caution when making permanent birth control decisions during pregnancy. Pregnancy can be an overwhelming time, physically and emotionally. While you may think you'll never want to be pregnant again, you may feel differently after your baby is born.

Jennifer Purvis had planned to schedule a tubal ligation along with a repeat c-section. Purvis, from Louisiana, was 34 at the time and considering permanent birth control due to her age and previous high-risk pregnancies. "I thought, if I was blessed enough to get that one here then that would be it," However, says Purvis, "it seemed so final." She decided against tubal sterilization. "If I'm even questioning, then I'm not ready."

Before deciding on any permanent birth control procedure, discuss the risks, benefits and alternatives with your physician. "Alternatives, especially, sometimes fall short when patients are being counseled," says Dr Greenfield, "but there are good, long-term [birth control] methods available for people who don't want a surgical procedure or are not ready for permanent birth control."

Moving forward
Although it's important to understand all the risks involved in permanent birth control procedures, including the risk of regret, "women considering sterilization should be assured that the majority of women, in fact, do not regret this decision," says Dr Hillis.

Ginger Green, from Louisiana, had a tubal ligation three years ago. She couldn't use hormonal birth control methods due to health concerns, and she knew her family was complete. "My age was a factor. I didn't have the energy with my second pregnancy that I had with my first," Green says. "Also, we couldn't afford any more kids."

At the time, knowing her second son would be her last was bittersweet. "It was the thought that I couldn't [have another baby], even if I wanted to. I didn't want to, of course!" Today, she's happy with her choice. "I like not having to worry about birth control."

*Name and location have been changed to protect privacy. PregnancyAndBaby.com

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