Everything you need to know about getting your tubes tied.

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From time to time, my friends will joke about getting permanent birth control. We'll walk past a toddler who's kicking and screaming as their parent tries to drag them down the street, and one of my friends will laugh and say, "Remind me to schedule that appointment to get my tubes tied."

It wasn't until recently, when I was writing an article about a woman who did get her tubes tied in her 20s, that I learned the proper term for the procedure is tubal ligation. Then I realized that all those times my friends joked about getting their tubes tied, I never knew what the term actually meant. Do they actually go in there and tie your tubes? Do they tie them in knot? In a bow? (Kidding...kinda.)

I called Christine Greves, MD, ob-gyn at the center for obstetrics and gynecology at Orlando Health in Florida, to find out everything I didn't know about tubal ligations. Here's what she had to say.

What is a tubal ligation?

A tubal ligation is basically permanent birth control, says Dr. Greves. The procedure prevents an egg from traveling from the ovaries through the fallopian tubes (hence the name) and blocks sperm from swimming up the fallopian tubes to the egg. There are a few different ways a tubal ligation can be done, but the most common is via laparoscopy, she says. Getting it done after vaginal childbirth and after C-section are also popular.

During laparoscopic surgery, women typically get local anesthesia, though some may also have general anesthesia to knock them out. The doctor will make one or two small incisions near the belly button and inflate the abdomen with gas to better see the organs. They'll then insert a laparoscope (a tool with a light and a lens) to locate the fallopian tubes. Next they'll insert tools through the second incision and use them to seal the tubes by either destroying parts of the tubes or blocking them with plastic rings or clips. The entire operation usually takes about 20 to 30 minutes.

If a woman gets the procedure after vaginal childbirth, the doctor will likely make a small incision under the belly button to access to the uterus and fallopian tubes. For those who get it after a C-section, the doctor will simply block off the fallopian tubes by going through the abdominal incision used to deliver the baby.

What is recovery like?

Recovery depends on the type of tubal ligation you get, explains Dr. Greves. If you get it done after a C-section, it probably won't feel any different than recovering from the C-section alone. The same goes if you do it after vaginal childbirth, though you might have some discomfort near the incision site.

Women who get a laparoscopic tubal ligation may notice more discomfort. You can usually go home a few hours after the procedure, though Dr. Greves says you should take it easy for about a week or so. Other possible symptoms include dizziness, nausea, cramps, and belly pain.

Anyone who gets a tubal ligation, regardless of the type, will also need to avoid heavy lifting and sex until their doctor gives them the go ahead.

Are there risks?

Every surgery has risks, Dr. Greves says. With tubal ligation, these include damage to the bowel, bladder, or major blood vessels; continued pelvic or abdominal pain; reaction to the anesthesia; improper wound healing or infection; and failure of the procedure, resulting in a future unwanted pregnancy.

And of course, a tubal ligation can fail to prevent pregnancy. But Dr. Greves says the failure rate can be as low as one unintended pregnancy per 1,000 women. If you do get pregnant after getting your tubes tied, you have a higher risk of an ectopic pregnancy, when the fertilized egg implants outside the uterus, usually in a fallopian tube. (An ectopic pregnancy requires immediate medical treatment and cannot be carried to birth.)

Another very important risk to consider: regret. "Go through every possible scenario that you could possibly face in life and make sure you're okay never being able to have children again," advises Dr. Greves. That includes divorce, the loss of your spouse, the loss of a child, and more.

Is it covered by insurance?

There's a good chance a tubal ligation will be covered by your health insurance. The Affordable Care Act (or Obamacare) has made it so that most insurance plans must cover all methods of birth control, including some permanent contraception procedures. Medicaid and other government programs may cover it as well. Be sure to contact your insurance provider before getting the procedure to confirm what's covered.

Is it reversible?

Dr. Greves has the best answer: "If you're asking that question, you should not have this procedure."

Depending on the method used to seal the tubes, it may be possible to have a tubal ligation reversed. But reversal is expensive, complicated, and not guaranteed to work. If you think you might possibly want the operation reversed, you're better off going with a long-term birth control option that is easily reversible, such as the copper Paragard IUD, the hormonal Mirena IUD, and the hormonal contraceptive implant, which are effective for 10, five, and three years, respectively.

When making a decision as big as this one—to end your possibility of having children—ask your physician to lay out all of your options and go through the pros and cons with you. Take time to think about it. And take some more time if you need it. This is one life choice that you can't overthink.

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