Tubal ligation, or “having your tubes tied,” is a surgical procedure that provides permanent birth control for women. A tubal ligation involves surgically cutting or blocking both fallopian tubes so a man’s sperm cannot reach a woman’s egg and fertilize it to begin a pregnancy. The fallopian tubes are located in the lower abdominal (pelvic) area. They connect the ovaries to the uterus and provide a passage for sperm to move to a woman’s egg and for a fertilized egg to move into the uterus. When the fallopian tubes are blocked, sperm cannot reach the egg and fertilize it to begin a pregnancy. Tubal ligation is a common but significant surgery with risks and potential complications. Other methods of birth control are less invasive than a tubal ligation and are not permanent. Ask your doctor about all of your options to understand which are best for you before having a tubal ligation. Types of tubal ligations Methods of blocking or disconnecting fallopian tubes during a tubal ligation include: Clamping or banding involves applying a small clamp, clip, or band to each fallopian tube to shut it. Cutting and tying involves making one cut in each fallopian tube so that they are no longer connected and tying shut the open ends. Sealing with electrical current involves making one cut in each fallopian tube so that they are no longer connected then using a small amount of electrical current to seal the open ends. Your doctor may recommend a tubal ligation for permanent sterilization and birth control. You should not consider a tubal ligation until you are finished having children or you are sure that you never want to have children. A tubal ligation is sometimes reversible, but it carries risks and is not successful for many women. Talk with your doctor about all permanent and temporary birth control options, such as an intrauterine device (IUD), condoms, the birth control pill, hysteroscopic sterilization, and vasectomy. An obstetrician-gynecologist (Ob/Gyn) performs tubal ligation. An Ob/Gyn is a doctor who specializes in women’s health and pregnancy. An Ob/Gyn is trained in medical and surgical treatments. Your tubal ligation will be performed in a hospital or surgical center. It is performed as an open procedure requiring a five-to-seven-inch incision in your lower abdomen, or as a minimally invasive laparoscopy or minilaparotomy procedure. Laparoscopy and minilaparotomy, as compared to an open procedure, generally entail a faster recovery time, less pain, and a lower risk of some complications, such as infection. Your doctor will advise you on which procedure is best for you and how long you need to stay in the hospital or surgical center based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different tubal ligation procedures and ask why your doctor will use a particular type for you. Surgical approaches to a tubal ligation A tubal ligation may be performed using one of the following approaches: Laparoscopy is a minimally invasive method of tubal ligation that involves making a few small incisions in your abdomen. A small tube, fitted with a special camera and other surgical instruments, is inserted through the incisions to cut, tie or clip your fallopian tubes. Laparotomy (open tubal ligation) involves making a five-to-seven-inch incision in the lower part of your belly. The incision may be vertical or horizontal. A horizontal incision (bikini cut) is placed very low on the abdomen so it is not easily visible. Mini-laparotomy involves making one small incision in the lower abdomen, pulling the fallopian tubes through the incision, and cutting, tying or clipping them shut. Types of anesthesia that may be used A tubal ligation may be performed using either general anesthesia or regional anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain. Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable. What to expect the day of your tubal ligation The day of your surgery, you can generally expect: To talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form. To remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth. To talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have A surgical team member will start an IV. A tube may be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen. Your vital signs and other critical body functions will be monitored throughout the procedure and during your recovery until you are alert, breathing effectively, and your vital signs are stable. As with all surgeries, a tubal ligation involves risks and possible complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery. General risks of surgery The general risks of surgery include: Anesthesia reaction, such as an allergic reaction and problems with breathing Bleeding or hemorrhage (heavy bleeding), which can lead to shock Blood clot Infection Potential complications of a tubal ligation Complications of a tubal ligation include: Increased risk of a future ectopic pregnancy (a pregnancy occurring outside your uterus) Incomplete blockage or cutting of the fallopian tubes which could result in a pregnancy Damage to your urinary tract, bladder, rectum, or other pelvic structures during surgery, which may lead to problems such as urinary or fecal incontinence that require further surgical repair Reducing your risk of complications You can reduce the risk of certain complications by following your treatment plan and: Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery Notifying your doctor immediately of any concerns such as bleeding, fever, increase in pain, or wound redness, swelling or drainage Informing your doctor if you are nursing or if there is any possibility of pregnancy Taking your medications exactly as directed Telling all members of your care team if you have any allergies You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome. You can prepare yourself for a tubal ligation by: Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times. Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed. Losing excess weight before the surgery through a healthy diet and exercise plan Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia. Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process. Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. You may also need to take a laxative to clean out your bowel the day before surgery. Questions to ask your doctor Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments. It is also a good idea to bring a list of questions to your appointments. Questions can include: What are my other options for birth control? What type of tubal ligation procedure will you perform? Is a laparoscopic, minimally invasive tubal ligation an option for me? How long will the procedure take? When can I go home? What restrictions will I have after the surgery? When can I return to work and other activities? What kind of assistance will I need at home? When will it be safe to have intercourse without using another form of birth control? How should I take my medications? Is this procedure covered by my insurance? Do I need pre-authorization? If it is not covered, how much does it cost? Is there financial assistance available to cover the cost? How will you treat my pain? When should I follow up with you? How should I contact you? Ask for numbers to call during and after regular hours. Knowing what to expect can help make your road to recovery after a hysterectomy as smooth as possible. How long will it take to recover? You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable. You will probably be able to go home the same day unless you received your tubal ligation during a cesarean section (C-section). Most women stay in the hospital for a few days after a cesarean section. Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. Full recovery takes a few days to a few weeks. Will I feel pain? Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication. When should I call my doctor? It is important to keep your follow-up appointments after a tubal ligation. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have: Bleeding Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing Change in alertness such as passing out, unresponsiveness, or confusion Chest pain, chest tightness, chest pressure, or palpitations Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever. Inability to urinate or have a bowel movement Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot Pain that is not controlled by your pain medication Unexpected drainage, pus, redness or swelling of your incision When can I stop using birth control after my tubal ligation? Your doctor will tell you when you may stop using another method of birth control after a tubal ligation. Women who have a tubal ligation can typically stop using birth control after they have had their first period after the procedure. How might a tubal ligation affect my everyday life? A tubal ligation provides permanent birth control. This means that you will never again need to use contraception to prevent pregnancy. Women who still desire to have children should not have a tubal ligation. In terms of your everyday life, you will have: An increased risk of ectopic pregnancy or miscarriage in the unlikely event that a pregnancy occurs Continued need to have routine gynecological screenings, including PAP smears and pelvic exams, because you still have a uterus and cervix Continued need to use condoms to protect against sexually transmitted diseases when you have intercourse with new partners Your monthly period. You may experience changes to your menstrual cycle and menstrual bleeding after a tubal ligation. This is not due to the procedure, but to the hormonal changes involved with discontinuing hormonal birth control such as the pill or the patch.