Let's Chat: Permanent Contraception

Momversation's new format asks that we address (solo) what's bugging us. For me, this week, it's birth control. Specifically permanent birth control, which was my knee-jerk "Yes, I must do that" reaction to finding out I was carrying a third and fourth child. We always knew we wanted two and then we went back and forth for an entire year re: being a family of five. But six? Oy and eep. Exciting! But still very oy and eep.

Moving on.

I am positive that after this, I'll be very much finished with the babymaking portion of my life. Hal, on the other hand isn't convinced. (Hal doesn't want a vasectomy, which I totally support. We have a full-support zero-pressure system in our marriage so although compromise is what holds us together, so is our understanding of the other's free will and feelings. Also, if it was up to Hal we'd have 89890231 kids because he's an insane person.) Hencefoth! This shit is on me. Because unlike Hal, I am convinced that four is PLENTY of children to raise and adore.

Behold, a short one-minute vid where (once again) I appear to be pooping in the still:


I think its a really interesting conversation mainly because it's a huge deal to permanently alter your body in such a way. And there's a part of me that wonders "what if I change my mind in ten years?" I am only thirty. Then again, exactly. If I don't do something permanent I am at risk for having 981908903281390 children and subsequently my own reality show disaster. Then again, what if somewhere down the line a family member or close friend wants to have children, cannot, and needs to borrow my uterus? I am totally down for surrogacy and feel it's only fair for those blessed with fertile bods to assist (if they can) those who aren't so fortunate. It feels almost selfish to close my shop. Or maybe that sounds totally naive. I've gone back and forth so many times, my head is literally spinning. I told my doctor several appointments ago that if I end up with a C-section (it's looking increasingly likely I'll be able to deliver vaginally) I want him to tie my tubes. I have since changed my mind. Then changed it back. Then changed it again.

The (above) video went live on Tuesday and after conversing with various commenters both here and on twitter, I'm pretty sure I'm going to experiment with the ONLY form of birth control I haven't used: The ParaGard (copper) IUD. Even if it makes me cramp more during periods and bleed all over myself for the first six weeks or whatever, I'd prefer that to the hormonal non-period lose-my-hair-and-sex-drive alternative. (For more on my Adventures with Mirena, you can read here, here and here). If that doesn't work, I'm seriously considering undergoing the Essure procedure, which is non-invasive, very permanent and seems to be the safest, most effective way to cease procreation.

Anyway.

I would love to hear from you regarding whether or not you've closed Uterine Shop permanently and if so, what you chose to do. Have you had a permanent procedure? A tubal? Essure? Has anyone ever regretted their decision? Or on the contrary, has anyone regretted NOT doing something more permanent? (ED: Please don't tell me Hal should get a vasectomy. If the roles were reversed and he was pressuring me to do something that might compromise my reproductive system against my will everyone would agree that would be uncool. Same goes for him because he is also a human with feelings.) It's a very personal choice, birth control but I feel like sharing stories (much like with my Mirena debacle) is both enlightening and helpful for those of us on the fence. Like me.

Thanks in advance for sharing your thoughts on this. You rule.

GGC

172 comments:

lbswmom | 9:45 AM

I had my tubes tied after having two children at the age of 26. I had twinges of regret at the age of 36 when I wanted another child for at least an 18 month period. My husband never wanted more and is happy with our two. I am happy now as well... again... and enjoy the freedom of my choice. I would encourage you to read about post-tubal ligation sydrome prior to making your decision. Much luck.

Anonymous | 9:46 AM

ParaGard for sure! I got one about a year ago (largely based on the discussions here about mirena issues) to solve bc related migraines. It's worked like a charm. My partner has no issues with the string, and while I certainly have less "enjoyable" periods, they are FAR better than the monthly migraines. Hope it ends up being a good semi-permanent option for you!

Sally Wolff | 9:46 AM

Wow, what a debacle! I'm a marraigeless, childless 23 year old (though in a steady partnership), so after hating the pill I decided to go the IUD route. I got a copper one since I wanted only my natural hormones, and I'd recommend that. Obviously the insertion was uncomfortable (but I'm sure that a mom-pro such as yourself would think it's a breeze), but I've been really happy with it! I've had only positive results. My periods aren't insanely crampy like I expected, they are weirdly always on time, and it can stay in for up to ten years! To me it seems like a win-win longterm but not permanent solution.

Anonymous | 9:49 AM

Eeee that's a tough one... honestly, I'm secretly hoping my husband will step forward to have a vasectamy when we finish having kids (we haven't even started, so the conversation hasn't begun there). But I have a feeling that he's going to be against that... but I'm also not so keen on getting my tubes tied. On a selfish level, I feel that the vasectamy is less invasive, and I have to do all the child birthing, so fair is fair... but that's what my mom fed me growing up, so I have to take a step back and find my own view on that. Hmmmm

Lisa | 9:50 AM

Just had my Mirena pulled on Tuesday, so I may be the last person to discuss this issue. But for us, DH has always agreed to the vasec. once we were done done done with kids. I carry them all, he gets the snip.

Fingers crossed for one more healthy pregnancy in the next year.

My mom got a tubal after her last and never had any complaints.

Alexia @ Dimple Snatcher | 9:50 AM

I'm 23 and can't really comment on your situation, except to say that my aunt tied her tubes and STILL GOT PREGNANT!!!!! After she had my cousin, she cut her tubes.

Lisa | 9:51 AM

I should add, my mom was only 27 after her last child, so 30 would seem old for her (then again, I'm pressing 35 for my last fertility go round.

Jena Nicole | 9:52 AM

I'm not there, yet. Well, I mean - I may be done havin' zee beebees. But, I'm not ready to totally shut down production, either.
We only have the one - And, we kind of like our family of three.
But, I also have the exceptional joy of being unable to deliver vaginally. Because, my pelvis is small and I make 10 lb. babies. So, if we have another I will consider the tube-tying route. Until then, I'm ok with condoms and the pull-method. It works for us. And, no one has to get altered.

Anonymous | 9:57 AM

I have had terrible experiences with hormones and birth control so I had the Paraguard for the last 3.5 years. It's awesome! I had heavy periods for the first half year or so and then things evened out, my periods became moderate and (for the first time for me) quite regular. For the most part, I totally forgot it was there.

AngstyJen | 10:01 AM

I'm 33 and we have one child, a 4.5-year-old daughter. I don't think it's in the cards for us to have another kid, but like you said, it's hard to think of closing shop when you're in your early 30s. Right now I'm on the pill and not having many issues with it. So I'll probably stick with the pill for now and reevaluate at 35.

Anonymous | 10:01 AM

Give it time before you make a decision regarding permanent birth control. Right now your hormones are in overdrive and will continue wreak havoc for quite some time.

I've heard great things about the effectiveness, ease, and long-term viability of the copper IUD. I researched it thoroughly for myself and it is comparable to tubal ligation in terms of effectiveness. Yet, it is reversible. Always a good thing *in case* you change your mind.

Five years ago, if you told me that in 2011 I would be a married stay-at-home mother, I would not have believed you. (At the time, I was single, working on my PhD, and had no intention of breeding.)

Time changes our minds, our circumstances, and our needs. One never knows. I hate to quote something I saw on Oprah... but once, on Oprah, I saw a story of a couple whose 3 children died in an unbelievably tragic accident. Later on, she became pregnant with and gave birth to triplets. John Travolta's wife (in her 40's) had a baby after their son died. Life is unpredictable.

Sorry for being such a downer.

Happy baby growing, you look radiant in your photos!

Karen | 10:02 AM

I couldn't tolerate hormonal birth control, with the exception of the Nuvaring, which was better than most. After I had my son I got the Paragard. It's great except for two days of the month, which my husband and I refer to as the deluge. During the deluge, I have to wear ultra sized tampons and pads. After my next child, I'm probably getting my tubes tied.

My Bottle's Up! | 10:03 AM

no advice, my friend. just wanted to comment and wish you luck and peace in your decision making.

Erica | 10:03 AM

I have the copper IUD and it's fine. We're pulling it out soon to go for #2 and that is supposed to be pretty easy peasy. Yes your periods can be a little nutty but I don't find too much cramping.

Anonymous | 10:10 AM

I am in my early 30s and have not had any kind of permanent birth control done and neither has my husband. The whole "permanence" of it freaks me out. So much in life can change and you just never know what could happen to change your mind. A friend of mine was "positive" that 2 was enough for her and begged her doc to tie her tubes during her 2nd child's c-section. The doctor wouldn't do it because she was only 26 at the time. And it is a good thing because 5 years later she had a 3rd (planned) child and is planning on a 4th down the road. My brother had 4 children with his 1st wife and considered getting a vasectomy but then decided against it. Unfortunately his marriage did not last. On the positive side he remarried and was then able to have 2 more beautiful children with his 2nd wife. I cannot imagine life without all 6 of my nieces and nephews. So no matter how sure someone might feel, things can happen to change it. It is totally your decision but personally I will not consider anything permanent until 40 or so. Fertility is such a gift (one that I have struggled with-we have 2 children and have had 3 miscarriages) and I would hate to see anyone regret such an important decision. ☺sorry so long and congrats on your beautiful expanding family☺

Tamara | 10:13 AM

Have you read "Taking Charge of Your Fertility?" Because, you don't have to use birth control of any kind if you chart. Which sounds exactly like something crazy hippie earth mother with 3 accidental extra babies would say, I know, but check it out and see if it would work with your lifestyle.

Motherhood Uncensored | 10:14 AM

We're torn around my place, mostly because my friend Julie (The Mom Slant - you know her) got pregs on a copper IUD.

And well, with all 4000 women telling me (including you) that the Mirena is a little scary, that's not an option for me. Either is BCP, which usually make me a lunatic.

That doesn't leave much, and while I totally get your free will thing with the Vasectomy, I feel as though I had 4 babies all out my vag and will continue to have to deal with a period for who knows how long. A little snip snip isn't a big deal. Hell, he can DRIVE home from it on his own, and around here, they do it without a scalpel. My husband's refusal and avoidance actually really bothers me to nearly being offended.

Okay, I am offended by it.

If getting my tubes tied wasn't permanent, I'd probably do it, but the permanence does sort of freak me out. Not sure why since I'm done.

So there you go. I'm no help at all! WHEE!

Tricia | 10:18 AM

I have paragard (have had it for a year exactly as of this week), and am quite happy with my decision. Yes, periods are a bit more aggravating (especially the first couple), but none of the physical side effects has been more than a box of super tampons and daily use of pantiliners can't handle (sorry if that's tmi). Everything else about it is perfect for MY lifestyle, and that's really what you have to consider, right? No weight gain, easy loss of baby weight, no moodiness or skin problems, no loss of sex drive... I'll gladly deal with the minor annoyances of this hormone-free option until I KNOW I'm done (33 and only 2 kids right now). If I haven't gotten the baby bug again by the time this Paragard is due to be replaced (I'll be 42), then I'm guessing it'll be well past time for a more permanent option. Good luck with your decision!

A. J. | 10:21 AM

You can be a surrogate after you have your tubes tied, actually, as long as the pregnancy is using donor eggs (from the intended mother or from another donor). As long as you've still got a uterus, it doesn't matter if the ovaries are hooked up if you don't want to get pregnant with your own child! And surrogacy with your own biological child seems much more emotionally messy to me, although of course YMMV.

Kait | 10:23 AM

My mom had her tubes tied after her second child (that'd be me) and regretted it deeply.

Husband and I have agreed that we will never do a permanent measure of birth control because so many things could happen. Although we do not and likely will not have a biological child (we're working on adopting children 3 and 4 now) we still don't want the option completely taken away.

I just...can't imagine losing that forever. Even if I don't intend to use it, how could you ever shut yourself completely off to the opportunity? And how do you know that this decision is really one you could live with forever, especially since you mentioned previously that adoption is not an option in your family. That would mean you're saying it's done FOREVER. I just couldn't handle the weight of such a permanent choice.

boosmom10 | 10:23 AM

Can I just say I love you for defending your husband in advance.

My husband and I have used condoms for just about our entire marrage. The first year I was on the pill but that was not good.

My son is 19 and he is our only child. We have been married 21 1/2 years. However we have been dating since 3/1/1986. I'm 40 my husband is 42. So that is what seems to work for us.

Best of luck. I know it's a hard one to make. Esp. when both of you want to be happy and not change your bodies in the end.

Beth | 10:27 AM

Even if you have your tubes tied, I think you could still be a surrogate, would just need IVF, which you'd probably do anyway since the couple would probably want to use their own egg, and if they wanted to use YOUR egg, you'd still ovulate with your tubes tied, so (I think) it should be possible to harvest your egg for IVF w/father's genetic material.

Whew!

I am interested in what you decide, if anything, for permanent BC. Even though all four of your children are lovely, I can think of 1,547,856 reasons not to have any more of them. :)

alanna_migliacci | 10:29 AM

Six years ago, I got Paraguard. I was 22 and adamant that, as God as my witness, I will never mess with my hormones again. And most doctors didn't get that! All of them pressed me with the 'low dose' BC. Low dose bullshit, you are still messing with my body. I was pissed for a long time, that, as a woman, my birth control options are so limited. How can pumping us full of hormones be the go to options? (I was 16 on I started BC - that can't be good for us, as a society.)

I did my research and decided on the non hormonal IUD. It took SIX doctors to find one who would give it to me: a non married, no children having, 22 year old and I wanted an IUD, damn it.

The first year was hard! The cramps oh the cramps! And the blood! I went back to the doctor after four days convinced that the IUD had perferated my uterus. (They called it growing pains)

The penis poking happens too. It happened for the entire first year. I went in, not once, but twice to have the strings shortened. And I was terrified that I was going to have to have it removed because I didn't want sex to be miserable for my BF. And then what?

Six years in, my period is heavier than normal (but lighter than the first few years), I'm more crampy and my period last a hell of a lot longer (8 days on average, but only a few days being heavy,), but the poking has stopped. I haven't had a complaint in years.

Never had a yeast infection!

Oh, one other thing: sex in the ten days or so before my period, usually results in expected bleeding. This is how I understand it: Penis is banging away and making contact with cervix (which moves lower during this time of the month), cervix is then bumping into IUD, IUD is ramming into my uterine wall, which is currently filled with blood in preparation for implantation. The first several times it happen, I a) thought I got my period b) was pissed about the sheets c) was scared. Now, I figured, I've probably done some damage to my uterus, but overall I still think the IUD is the best option out there.

It's not perfect, penis poking happens.

Having had kids or not, I would still be extremely reluctant to do anything permanent or have my tubes tied. It's too dangerous.

Suzie | 10:29 AM

After having three kids (one set of twins) I decided to close up shop. The conversation went along the lines of ME not wanting to have kids, so I wanted to do something on MY end. If my hubby wanted to close up his shop that was up to him (your conversation sounds so familiar!!!). So, had the tubal a few weeks after the twins were born and haven't looked back. However, a few years later we decided that we wanted another child. I never regretted my decision to have the tubal though, as I was 100% sure that i never wanted to be pregnant again. So, fast forward to now where we have FOUR kids, one set of twins, a darling little girl that we adopted along the way. I am still 100% sure about my decision. I knew that for me, being pregnant again was not a good option. I grew healthy, BIG babies in my belly, but was miserable and uncomfortable the whole time (no glow for me sister). Thus my decision was easy. I suggest that you hold off on a tubal, however, until you are settled with it. I like your idea of a more semi-permanent procedure - I didn't even look into those however as I knew in my mind that I was done. Best of luck on this one, and I commend you for not having the attitude that your hubby needs to "sacrifice something too" since you carry the babies - I get that all the time and it drives me nuts!

P.S. - Had to do my tubal a few weeks after the c-section (Baby A flipped over and was jamming his foot down in my cervix so we couldn't do the natural delivery in the end) as the only NICU in town was at a Catholic hospital that didn't allow tubals, and we had to deliver there as it was considered high risk back then to have twins. After a c-section it was a very simply procedure though - practically painless.

Sally | 10:38 AM

I commented yesterday on the Momversation site, but I just checked and it looks like my comments didn't clear moderation. I hope it's not because I offered a pro-vasectomy opinion. Way to stifle the convo, Rebecca. :(

Anonymous | 10:40 AM

hub agreed to a vasec long ago, but now that it's time to get down and dirty he is waffling a bit. it's a no pressure situation here too but i've said from day one that i don't want a tubal...i know lots of people who had complications after tying their tubes. my sis had Essure done and was very happy but subsequently had to have a hysterectomy (unrelated) at 36. we're using condoms right now and have always used them for non-baby-wanting times of our marriage because hormonal bc makes me a colossal beyotch! it's a conundrum for sure...looks to me like if you're up for the copper IUD that's the way you should go...then again, opinions are like a-holes - everybody's got one!

Tricia | 10:46 AM

Please forgive this second comment, but regarding the "penis-poking" (and I'm remembering the "IUD in her Hurt Locker" line, which still cracks me up)-- if you go the Paragard route, ask for the strings to be left long and tucked up behind your cervix. Eliminates the poking problem.

melani rae | 10:47 AM

Almost same sitch as ldswmom, but I was 23/28 when my 2 girls were born. Had an urge at 32, but I knew it was only biology telling me thas is it.

Logically I know having more children is not the best choice for us. I'm glad I'm fixed because I know if I wasn't I would have 'accidentally' got my self knocked up, and that is not at all what we want.

GIRL'S GONE CHILD | 10:48 AM

Sally,

I do not moderate comments on Momvo. Nor do they. So please don't tell me I'm stifling the conversation because it's not the case. You're entitled to your POV here and on Momvo. Xx

Anonymous | 10:51 AM

OK. I watched the video when you first linked it and I took issue with the whole what if Hal wants to knock up someone else down the line. It sort of felt like a throwaway argument that I see with moms and circ'ing their boys - let dad decide because he has the same equipment. To which my response to both of those would be that a marriage is shared, decisions about your child are shared, and it's not any kind of right to let one person be the decider (ironically enough both those decisions have to do with penises).

But then you posted this:
"ED: Please don't tell me Hal should get a vasectomy. If the roles were reversed and he was pressuring me to do something that might compromise my reproductive system against my will everyone would agree that would be uncool. Same goes for him because he is also a human with feelings."

BAM!

And I think that was a bridge between what I was thinking and that (I know, I know, very sarcastic and funny albeit hopefully not ever true possibility) idea of him banging someone else later. Because I kept thinking "but you are in the marriage NOW! It's ok to have that on the table for discussion!"

But adding that edit...well, yes. Absolutely.

I have nothing to offer wrt birth control. My husband would gladly get the snip, but I'm probably going to have baby fever until I'm dead. Surrounded by a billionty children. Sigh.

~Leah

Josey | 10:54 AM

I agree with Tamara - have you read Taking Charge of Your Fertility? That book totally changed my life. It basically teaches you about your body and your cycles... and how your cervical mucus and your temp can be used (either as a contraceptive or a TTC aid). My Mom started temping in the late 70s and was able to plan/prevent pregnancies for the next 20 years that way. It might be a good alternative for you, at least while your hormones are still jumping all over the place. I hope to never go back on hormonal birth control for the rest of my life thanks to that book!

Glenda | 10:59 AM

When I was pregnant with my second my husband was all for getting a vasectomy. That was until I met a lady that her husband had one and it was botched and she ended up getting pregnant. At that time we discussed and I offered to get my tubes done because I didn't want to be on the pill indefinitely and didn't want to worry about birth control indefinitely. At that point I had a son and when I gave birth had a daughter. I had one of each and felt that being a military family with two children was plenty with the having to move every three years and hubby being away for a given amount of time due to work. I had my tubes tied, cut and burn when my daughter was three months. I was 25 at the time and I don't regret my decision.

We both come from a large family of siblings six on his side and eight on my side. Knowing we were moving every three years we knew we didn't want more than two.

I've heard of people getting them tied and getting pregnant. I didn't want to take that chance and why the reason I had them cut and burned.


Prior to having a tubal I never suffered from cramps and once I had it done I did suffer from cramps for a few years. Nothing out of this world to regret the tubal.

Best of luck!

Anonymous | 11:03 AM

I've been on the regret side of sterilization and was unable to reverse it. Mega bummer. I used a copper-T IUD for six years before ever becoming pregnant though and highly recommend it. It did make my craps a little worse and made my periods heavier but it was totally worth it. I'd imagine things would be easier if I'd had kids before using it as well.

Allison | 11:13 AM

We have 3 kids. One is my husband's from a previous marriage & the other 2 are mine from a previous marriage. But they are our kids. We decided not to have any children together as our kids range in age from 15-5. We also feel that the balance is right & that we didn't want to throw it off. My husband offered to get a vasectomy. He actually had the procedure before we were married. Honestly, I had a hard time thinking about permanent birth control (tubes tied)because it is just so permanent. He was fine with having a vasectomy & in a weird way I was too because it wasn't me. Sounds harsh, I know & I truly don't mean it that way. We will both fully admit that we are sad that we aren't having any babies but not quite sad enough to actually go through with it. You have beautiful children & I am really excited to "meet" the twins when they arrive!

Anonymous | 11:16 AM

I also am not sure you should make a permanent decision now - pregnancy hormones can make anyone not think straight : ). I would also not go for something permanent - for all of the other reasons that have been mentioned.
Good luck making a decision - it's not an easy one.
Just out of curiosity - why go on an iud instead of the pill?

MB | 11:16 AM

I've had for a year now Paragard and I love it. The first few cycles were whoa, but after that it tapered off. Cramps still happen but they're never intense, just sort of, there occasionally.
What really helped me was talking through everything with my friends who had IUDs before, during and after insertion. Since they're still not a supercommon option, it helped to have a base of feedback for what I was experiencing/going to experience.
Also, oddly, more than one doctor tried to push me towards Mirena but I knew better! Stand your ground!

FaithWalker | 11:21 AM

I refuse to use any type of hormonal birth control again, because I've tried 'em all and they all make me fat and crazy. I can deal with one or the other but not both at once. My body works best without any more hormonal tweaks than occur naturally.
That being said, I have the CopperT and I love it. None of the side effects are as bad as having another child would be for me. I'm 30 and this will last me until I'm 38 and my son is ten. By which time I will probably need a partial hysterectomy as every other woman in my family has. I can't wait until that happens, hoenstly. If I were able to have the whole kit and caboodle removed now, I would.
I have never in my life wanted children and while I love my son, I do not even want the option of having another.

Mandy Thompson | 11:28 AM

I'm a firm believer that if you're on the fence regarding a decision that will change you forever, you're not ready. When making a decision this huge (and possibly irriversable) you need to be very sure of the decision you've made. You should stick it out a while longer, (def post pregancy hormones) and give it some serious thought!

All the best, its a tough decision to make!!

Rosie | 11:30 AM

I'm 41 years old and am currently 28 weeks pregnant with my second child. We underwent fertility drugs to get this pregnancy and also had two miscarriages. Despite our ages, how difficult it was to become pregnant, and the fact that we're fairly sure this will be our last child, when the nurse asked last week about birth control after this child is born, we looked at each other and agreed, "Nothing permanent." Neither of us wanted to close and lock that door (yet).

Anonymous | 11:43 AM

I had my tubes tied at the age of 24 after my second child was born. I've experienced pangs of regret here and there, especially the closer I get to 30 but I know that we currently cannot afford anymore children and I don't see that changing anytime soon. I am glad that I chose to have my tubes tied because I tend to be a little impulsive and I have no doubt in my mind that if I hadn't decided to do something permanent that I would've had another child and we would be financially strapped and I would be overwhelmed as I work from home without daycare or nannies (not that I have a problem with that, I would gladly get help if we could afford it). I'm sure that I will continue to have regrets every now and then but on particularly stressful days or hard financial times I am *so* glad that I did what I did.

Sammy | 11:46 AM

Rebecca.... do NOT get your tubes tied. I have heard a hundred horror stories from women I know that have had complications from the procedure years later. There has to be a better way!!!

Sally | 11:53 AM

Thanks for the response, Rebecca, but they most certainly do moderate comments over there at Momvo. After I submitted my comment, I got a msg stating my comment would appear after approval from moderation. So maybe it was a fluke? IDK, but don't think I'll spend time making comments over there in the future if it just gets lost in cyberspace.

LBC | 11:57 AM

You can't go wrong with Socrates: "know thyself." Rebecca, in your case, I'd say that means you would regret a permanent alteration to your fertility. Life has a way of changing course. Who's to say that years from now you guys would decided a "caboose" was needed for your family train? In my relationship, I hate being pregnant. My husband was game for a vasectomy. He got the V and we decided our next kids would be adopted. (We have adopted one and are just starting the process for another.)

Abbykins | 11:57 AM

I have a friend on the Non-Hormonal IUD and she thinks its amazing! I am not sure about getting your tubes tied - but that is definitely something worth thinking about if you are SURE that you are done... If the only thing holding you back is the Uterus-for-Hire possibility later -- I think that your tubes wouldn't even be a part of that. You would still have a Uterus and that's all you need to grow someone else's baby! Either way -- I'm sure you'll make the choice thats right for you... If it were me - I would go 5 years on the IUD (if it works with your body) and make the call then on tubes. A lot can happen in 5 years!

L.L. | 11:59 AM

My body, my choice - his body, his choice! I was surprised how many commenters over at Momvo were railing against Hal's choice not to snip snip. Pro-choice goes both ways, IMHO. If I want a man to respect my right to choose how to handle my lady bits then I need to respect his right to choose not to alter his boy parts. The whole "I had to be pregnant and go through childbirth" and "Vasectomys are less invasive" sound like guilt trips to me, which does not seem like a good basis upon which to make such a monumental decision. If I could make all those choices for my husband, then I would start with him scratching his nuts less but alas, that is not for me to govern.

Molly | 12:22 PM

I agree with many of the commenters here that if you're anxious about such a big decision, that means that you're not ready. There seems to be some kind of pressure surrounding the potential "opportunity" of doing the tubal ligation in the event of a c-section. Just scratch that. That's just too much change at once, if it's a fraught issue!

It sounds like the copper IUD might be a good thing to try once your body has recovered. And speaking of pro-choice, if whatever BC method you choose fails in the future, there's always the option of a safe and legal abortion. There's no need to pressure *yourself* into a permanent procedure right now when you're so young. You will always have options at any time, they don't get foreclosed if you don't do it now.

VlogMom | 12:23 PM

Def look in to charting. Even if you are irregular it can become your best friend. It has been amazing to get to know my body so well, and prevent pregnancy naturally simply by tracking my temps and symptoms every day! It literally takes 3 minutes with the help of a free online tool. If you want more info I can help you, but just know that until you get enough data you should use a condom EVERY time if you don't want to get pregnant. An organization that tries to help women who want to prevent preg and don't want to use birth control tried to break it down simply between 'wet days' and 'dry days'. When you are fertile you will have more discharge, 'wet days' and you are most fertile when the discharge is an eggwhite consistency. I know that wasn't exactly the case when the twins were conceived, but I have hope for you that you can easily and naturally do this for the rest of your life and never have to permanently shut down until your bod wants to! If you want to talk more nichole.hinton AT gmail.com Love you!

Molly | 12:25 PM

P.S. About Hal, I completely respect what you said. It would also be great though if he (and all of us) could remember that there might be a contraceptive pill for men developed, if more people started clamoring for it!

Anonymous | 12:28 PM

I have the copper IUD. I'm actually on my second (the first was pulled for a planned pregnancy). I will do it again after what will likely be our last child (TBD - I still have an IUD in, after all!), but my husband says he wants the snip, snip. I won't tie my tubes, it's simply too permanent. And I love hearing that you're open to surrogacy - I've offered my womb to my best friend and hope she takes me up on it when she and her soon to be hubby are ready!

kristi | 12:35 PM

Three months ago I had my Mirena replaced with the Paraguard. Mirena was giving me heart palpitations (among other annoying side effects). I have had three Paraguard periods and, holy cow, am I hemorrhaging? These are periods that no tampon can stop. But last month after some googling, I decided to try the Diva Cup to contain the flow and now I just couldn't be happier. No cramps (before kids I used to have serious, stay in bed all day cramps, after kids, nothing). Also, yes, if you do go with the IUD, leave the strings a bit longer and they'll just tuck themselves up around your cervix, no poking.

Carrie | 12:49 PM

I really liked the Paraguard BUT I actually got pregnant with my son while I had it...we decided to make a baby, made an appointment to have the IUD pulled on Monday, had lots of, "yay, we're going to make a baby next week" sex...but apparently I was ovulating that weekend because we discovered a few weeks later that we already had. Made the baby, that is. It kind of freaked me out about all those heavy periods and cramping...was there something else going on all that time?

Despite that, I tried to have one inserted after my son was born, and the OB told me that the shape of my uterus involves some kind of acute angle, so the IUD just goes up and around the corner to hang out, where it may not prevent pregnancy, so much.

I'm old and my husband's older, but I still feel a little sad about considering permanent options - there's something tragic about the end of our fertile years. He, of course, can't stand condoms and I can't stand hormones, so maybe we're on track for having 32423434 more before the clock runs out.

Arnebya | 12:53 PM

I've had a Paragard IUD for nearly two years now. We weren't comfortable going the permanent route since we aren't yet sure that three's enough. I KNOW I'm not sure, so IUD was the easy choice. I could never remember the pill (had a horrific experience with Seasonale where I had a period for four months NONSTOP -- not light, not spotting, but full on BAM! every day). Now, although the flow is like Kristi says - no known tampon can handle it (super PLUS my ass!) cramps are gone whereas they had me on the floor even after kids when on the pill. I also didn't want any hormones and it is working great (aside from the friggin' monthly deluge). Best of luck in your decision, whatever it may be. I'm confident the two of you will make the best decision for your family.

Becky | 12:54 PM

We were both fairly satisfied with three children (I have since decided I could totally gone for a 4th), but after #3 was born in a way that was hugely traumatic for my husband, he was sure he was DONE. We had already discussed him having a vasectomy, and he was fine with that, but slow to actually have it done until I reminded him that *I* wasn't going to be responsible for future birth control, and he was failing miserably in the heat of the moment. He moved quickly after that.

Strangely, in spite of the fact the the husband is obviously done, and I have no intentions of ever sleeping with any other man, I can't bring myself to permanently end my fertility, even as a way to solve some other reproductive issues of mine. I really can't explain why.

Hilary B | 1:01 PM

Like a couple others have noted, I'd like to give you a high-five for defending Hal at the start. You guys are a really cool couple. I have no children but wish you all the best in whatever you both decide!

Anonymous | 1:01 PM

All OBs that I've gone to (who are women) have the Paraguard themselves. I plan to get one after this pregnancy (my first), leave it in for a few years to be sure we're one and done, and then hand off the BC responsibility to my husband, who has agreed to have a vasectomy.

Also, Wired magazine recently had a super fascinating article about an researcher who has found a way to do reversible vasectomies (they think that it could be applied to tubes as well) using a compound to block the pipes rather than physically cutting them. In 10 years, who knows what might be available?

Linden | 1:08 PM

We are lucky in that my husband and I were both D-U-N after baby #2. He agreed to a vasectomy, but there was a lot of complaining about it. I can't say I was too sympathetic considering the toll the babies had already taken on my body.

If he hadn't agreed to the big V, I think we would have just used condoms for a while until he was sure (that is what we did between baby #2 and the all clear). I felt like I had done enough already, and the ball was now in his court.

My doctor's office does have a lot of materials about the Essure procedure, and it sounds like a good option. I don't know anyone who has done it, though.

Arnebya | 1:08 PM

Oh, and this might be slightly selfish, but I don't think I could be a surrogate. I know myself. I would get too attached to the baby while it was cooking. I've always adored the idea of being able to be the vessel for someone else's parenthood happines, but since having my own children I know emotionally I am not their best option. No one wants to wait for their baby being born through their sister only for her to say sorry, I'ma takin' mah baby home.

annabelvita | 1:11 PM

Yeah. My periods on the copper IUD are pretty brutal - not more painful just like... whoah, that's a lot of blood. (Because I use a mooncup I know that in one day last month I bled twice as much as a heavy average menstruater does in a whole period). But... you deal with it, you know? Like I said on momversation, there's no perfect contracaption, this is the one that works for me.

GIRL'S GONE CHILD | 1:29 PM

You guys are awesome. Thank you. And I feel like a total bonehead for thinking that by tying up my tubes my uterus would suddenly break. So thank you to those who pointed that out! While I think I could absolutely be a surrogate/vessel, I wouldn't have it in me to biologically mother someone else's child. Far too difficult.

I do think the Paragard is probably the way to go. Because I totally agree with those of you who said "you never know!?" ... Because, really, in life, one never does.

Natalie | 1:33 PM

First off, I have paraguard and don't mind it. The only downsides for me are the 2 weeks of bleeding (ugh!) And the metallic taste in my mouth. I recommend it to anyone looking for an easy birth control solution.

Asfor closing up shop? Never, but only because I'm paranoid. My motherwas taking care of 3 children (my two half brothers and my older sister) when I was born. Convinced 4 children were plenty, she had her tubes tied. Fast forward 4 years, my two half brothers were taken out of the state by their mother and my older sister was killed in a car accident. My mom was devastated and really regretted her decision to get her tubes tied. I think its a great option for people who are completely sure, but I just don't think ill ever escape those "what-if" feelings, ya know?

KateFitz | 1:33 PM

It's a toughie fo so...and you are completely right about the vascetomy talk we ALL should be the end all final word with what happens with our bodies.

I also think you should give yourself a grace period to let your hormones settle down. Table the issue for a bit then strike it up again once you're settled into your new-ish life. It probably won't be any easier but at least you will know what a family of 6 is like and it might ease some potential regret. I was told repeatedly by my sister to not make any big life decisions while pregnant if possible. I thought it was really good advice.

Hope you are having a good day!

Anonymous | 1:46 PM

After popping out four kids he won't volunteer for a vasectomy? Wow. This makes me feel like a lucky girl. After 10+ years of being on various methods of birth control, being poked, prodded, ect. and birthing two rather large children I made it abundantly clear I was DONE taking the brunt of the responsibility in the family planning department. I've used Paraguard in between babies and I love it. You can keep it in for up to 10 years, which is a plus.

Molly D | 1:48 PM

Completely respect and agree with your views about Hal and his bodily autonomy/choice, but just curious: if you are certain you never want more children, and will take steps to ensure that's the case for you, what does Hal gain by retaining the ability to reproduce? (unless he intends to do so with someone else.) That's the only ick factor in it for me and my relationship, especially given that we agree that while all decisions are up for discussion and compromise, neither of us will ever push if the other insists "no more kids."

KJ | 2:09 PM

I love reading your blog as an almost thirty woman who's just starting out as a doctor...i.e. I do not have any kids yet and it would be !bad! if I got pregnant with my 80+ hr weeks but I like playing dress-up with your blog and thinking about the alternative...
My advice to you is 1. I hope that the pull method comment was a typo; that one's a good way to conceive 2. Maybe reconsider the pill. There are some new very low estrogen options out there with fewer side effects. I've always had super bad reactions to the pill but am doing well with an uber low estrogen option. 3. If you're nervous about the permanent options, hold off on them until you're completely ready.
Good luck (and congrats on the present)

Anonymous | 2:14 PM

I had my tubes tied after baby number 2. I was 28. This was baby number 4 for my husband. his boys came to live with us shortly after baby number 1 (of mine) was born. I cant say I totally regret the decision, as there was a strong chance we would've ended up with a jillion kids. 4 kids in full time day care was KILLING us. BUT I'm positive that we could've made it work financially with more. I just would've had to quit my job sooner than I did. And that was our true motivation for not having more. My husband regrets the decision as well. But paying to have my tubes untied and it not being a sure thing anyway; so not worth it. Now that I'm 6 days away from turning 32 and my almost 4 year old is getting bigger by the minute...I wish she wasn't my last baby! I guess if that big guy upstairs feels we should be blessed with more, it's truly up to him any way. Good luck on your newest babes!! Congratulations, also. I'm a blog lurker..coming out. I have not read up on tubal ligation syndrome, but I'm fairly certain I had/have it. Definitely not what I expected. K in NC

Muffin Cake | 2:19 PM

I always find it confusing when people think the man 'should' be the one to get the snip. That's not fair. I'm assuming most women made the choice to get pregnant and carry a baby, so shouldn't he have a choice too??

Anyhow.

I have Paraguard (actually, some generic version of it?) and had the monster periods, but no other symptoms. I love that I don't have to force hormones into my system every month to stay baby-free.

When I was pregnant with my son (2nd baby, and got the IUD after his birth) my hubby was SURE that was it, and talked about getting a vasectomy. I urged him to take more time deciding because of all the what-ifs. For months, he kept saying he was DONE with having babies and wanted to have it done.

Now that my son's 2, he's talking about our third kid as if it's a foregone conclusion, not a 'maybe someday'.

So, yeah...you never know.

PLUS....I am my parents' 4th child. My dad got a vasectomy in September, the Friday before my older brother was born. I came along 16 months later, and I am most definitely his.

Whitney W | 2:22 PM

After having difficulty getting pregnant, trying for a year and using clomid we are currently 32 week along with twin boys! I am not much help here either. I am 25 years old and would love to have more children in the future, hopefully add 2 more kids to our growing family. At that point I have no idea what I would do. I completely understand what you mean, anymore than 4 kids is kind of daunting, but I also would have a hard time permanently altering my body. What if I changed my mind in the future and decided to have just one more? I definitely would wait until after you have the babies and your hormones have leveled out, especially as your pregnancy progresses. I know right now I am so big and uncomfortable that permanently altering my body so I never have to feel this way again seems pretty good! LOL! But what a blessing my two boys are going to be, and at this point in my life permanent contraception is just not for us. But you never know what the future may hold.....

Lilla | 2:38 PM

Knowing my whole life I never wanted kids, I got Essure two years ago and so far I've had no problems. You get scans to make sure your tubes are really blocked, which you don't with tubal ligations. Before that I used condoms 100% religiously (most people don't) and never got pregnant. I think you don't really know if a non-permanent method is right for you until you try it because bodies react differently to different methods. I tried the pill one time and quit because it gave me horrible vaginal odor.

I think if you're even slightly open to children in the future, don't get anything permanent. Maybe it will be easier to make your decision once you have your twins for a while. It sounds like you get pregnant easily though, and I know someone who got pregnant using Paraguard. In any case you are and will be a great mom whether you have 4 children or more!

Ames | 2:44 PM

I have four kids. Neither my husband or I wanted to do something permanent like a vasectomy or tying tubes. It just kind of grosses us out. After baby #4 I got the Paragard based on my OB's recommendation. I got the IUD about 8 weeks post-partum, I didn't get my period back because I was nursing until baby was 15 months old. He is 17 months now and I have had my period twice. It is not at all crazy bleeding like people (including my OB) warned. It is almost exactly the same as it was before IUD (which I can barely remember since it was 2002 when I was last not-preg/not-bf), about 4 days, the second day is heaviest (maybe a tad heavier than before but like I said - can barely remember) and I have had no cramps. I definitely used to have some. Nothing crazy, nothing that 2 Advil didn't take care of, but I haven't had to take Advil at all these 2 times!
So, I just wanted to highly recommend the Paragard - it lasts for 10 years, so I got my first one at age 34, I'll get another at 44, to last until I am 54 (!!) and then I probably won't need contraception anymore! Also, you can have it taken out anytime and get pregnant immediately if for any reason you decide to. It is just a win-win in my opinion! The permanent stuff is just so...permanent!

Lacey Jane | 2:46 PM

My mom had her tubes tied after her 4th baby, but had so many vivid dreams about a baby girl for years and years afterwards that her and my father went to have it reversed. It was too expensive to have it reversed, and now even 20+ years later she has dreams about her 5th child.

That story seems super sad- but my mom was never upset about the fact that she got her tubes tied :)

Lacey Jane | 2:48 PM

Ah yes I must also comment about my dearest friend Jamie, who beat the odds and was born years after her mothers' tubes were tied. That girl is here for a reason :)

Anonymous | 2:53 PM

Such a great discussion. So glad i am not alone. I have 3, with my 3rd csection my husband voted for a tubal since I was already in the OR. I..just...could...not. Don't know why. I kind of want 4, husband said he was done after 2-HA. I keep waiting to feel, done. One thing that made me feel better. My mom told me she, at 62, post hyster, still feels like she is not "done". Maybe I won't ever feel complete. I just can't go the perm route. Much kudos for respecting Hal- my husband did the same for me- easy peasy to have a tubal post c section- but he did not push because I could not commit. You are an awesome couple and would be super parents to those fifty trillion babies. Also, you look so beautiful, truly a lady who glows. Much love, and thanks for sharing your journey with strangers.

Nikki | 3:16 PM

I have the non hormonal IUD (paraguard.) LOVE IT. LOOOOOOOVE IT. I had some strange schedule stuff going on but I, personally, didn't have any bad cramping or anything. And honestly, I feel like terrible cramps for a couple days are better than all those scary side effects I hear about with Mirena.

I'm completely against any form of hormonal anything for birth control after being on The Pill for 15 years (from age 16). I spent a very, very long time thinking I suffered from debilitating anxiety along with all my other issues... but I went off the pill and VOILA. Anxiety disappeared. I never knew what I was like NOT on the pill, so it never occurred to me that I might have any side effects.

I do think men should step up to the vasectomy plate, though. While I admire your open mindedness, marriage IS supposed to be forever and I think you're well within your rights to say no more after 4 kids? Though vasectomies are actually reversible, too. (I don't know the success rate, but I know of two people who reversed theirs and had another kid.) Anyway. I hope that doesn't sound judge-y, I don't mean it to be.

But Paragard! Yes!!

Nikki | 3:19 PM

PS The risks after a tubal litigation are greater than any risks associated with a vasectomy (such as an ectopic pregnancy), plus, a tubal litigation ("tubes tied") is a much more invasive procedure with a longer recovery period.

Wendy | 3:54 PM

I LOVE my Paraguard! Only the first two or three periods were heavier and crampier. At this stage, 4 years after putting it in, my periods are actually shorter and lighter than they were before I had my IUD. I also stopped using tampons in favor of a Diva Cup, which I would also highly recommend. Good luck!

Lilybett | 4:07 PM

My mum fell pregnant with me while using a copper IUD. But this was back in the 70s, so perhaps the technology/techniques have improved since then.

Anonymous | 4:15 PM

Um... PS, the ParaGard gave me 3 week long periods for over a year, yeast infections AND made my hair fall out... FUN!

Lilybett | 4:17 PM

Do you guys have Implanon in the US? I know you weren't keen on the hormone contraception, but Implanon is actually a small matchstick sized rod that you get inserted on the inside of your arm, it's not an IUD. It has its own risk factors of course but I'm fairly sure it lasts up to three years and then you have it removed and a new one put in.

I know a few people who've used it here in Australia and they're very happy with it. ONly one had issues and that was with a buildup of scar tissue around the device which made it difficult to remove. But she still had another one inserted.

Kate | 4:56 PM

I had a tubal after my 4th pregnancy. I have two of my own children and I carried two as a gestational surrogate. I was not convinced that I was done, but 4 c-sections dictate otherwise. I definitely don't regret it and feel thankful not to have to worry about birth control again! I will admit feeling a wee sad upon seeing the post-op report and the term "sterilized" in reference to myself. But it's okay. Good luck in whatever choice you make for you and your family.

Amy | 5:12 PM

I believe in doing whatever you want to do or not do to your own body. Certainly, it is easier if the dude chooses to get snipped--which can even be reversible if he wants to breed with a twenty year old when he is sixty and going through an old life crisis.

I will be 38 this year so time and age may well become my form of permanent birth control. And that makes me a little sad, to be honest.

Amanda | 5:35 PM

I have one son, and he's three. After he was born, I had intensely heavy periods, so my doc talked me into Mirena. After one awful year with it, I had it removed. Same deal as you, Rebecca: I'd been yeast-infection-free my whole life, and then I couldn't shake the effers once I went on Mirena. My hair didn't thin, but I couldn't lose those pesky last five pounds of baby weight. Just an awful contraceptive all around. So, I went back on the Pill, but I'm not entirely pleased with it either. (Sex drive? What sex drive?) This discussion (so helpful, by the way) has me thinking about Paraguard. I'm looking forward to hearing what you decide/how it works out for you.

Baby in Broad | 5:39 PM

First off, I really, really hope you get to have your twins vaginally! Obviously, everyone's health and safety is numero uno, and if it works out, that would just be so friggin' sweet!

Second, I'm having birth control problems of the non-permanent variety. (What does a hormone-adverse, latex-allergic girl with a wonky-shaped uterus do for a couple of months while things are "closed for repairs.") So I'm all, "Yay! I love talking about birth control! Woo!"

Third, I'm not in favor of permanent birth control for myself. Rob has said that he wouldn't mind getting a vasectomy, and obviously that's his decision to make. But if it were up to me, he wouldn't. Permanent birth control just seems so...well, permanent.

Fourth (Longest. Comment. Ever!), I've had two Paraguard IUDs. The first one was fine: much heavier cycle, badass cramps (which went away as I got in better shape), no unplanned pregnancies. The second one, after Westley was born, was trouble from the start—which makes me suspect my body, and not the IUD, was at fault. (I blogged the whole saga.) Still no unplanned pregnancies, though, so it did its job! And Rob never felt a thing, poking-wise. My strings were quite long, and they wrapped themselves around my cervix. Also, I checked the strings regularly, and after a few months, they seemed to "soften" up.

~ Noelle

Anonymous | 5:48 PM

Oh geez, this is the PERFECT convo for me. I just (seriously, JUST...aka Tuesday) had my ParaGard removed. Loved the idea of it and had it for about a year. But it went from giving me super-crampy, semi-irritating cycles (which I can handle) to I-bleed-20-days-out-of-the-month "cyles", I had to throw in the towel. Ugh. My husband and I are feeling pretty complete with our brood of two but we are also only 30 and don't want to do anything quite so permanent yet. P.S. He also loathes the idea of a vasectomy. Alas, I find myself back on the pill. But I am still struggling with this decision that seems to be looming over me. Best of luck to you...maybe the ParaGard would work for you :)

Jessi | 6:15 PM

I'm 28 and have 3 children. Towards the end of my last pregnancy, my husband had a vasectomy. I was supportive because he KNEW he was done. But I still am sad. Our last is only 6 months old, but I wish we had done one more(and then just one more and then just one more knowing me lol).

I've used just about every birth control out there, including the copper IUD. Just be aware that if you had issues with the Mirena, you may have issues with the copper. I bled so heavily I was soaking through a super tampon and a pad every hour for 8-10 days. I had cramping outside my period. The strings poked my husband so that have sex was incredibly painful for him. We only managed once every couple weeks because he'd be so raw from the strings. I used it for a year because my doc said it would get better. It didn't. Some people have that reaction.

My husband would like me to get permanently altered as well to prevent the "grow back" pregnancy from happening since we all know people who've had that happen. I would strongly recommend AGAINST having your tubes tied. Every single woman I know who's had it done, their periods got closer together, they developed fibroids and had to get a hysterectomy. My own mother even got pregnant 14 years after her tubes were tied. I would go with Essure. Less risk and you aren't interrupting blood flow. Whatever you decide to do, I'd wait until the baby love has worn off. The hormones need to stabilize.

Whether you use rhythm method or get the copper IUD, I'd wait to do something that can't be undone. Things change in that first year, and you don't want to have regrets.

Jeanne | 6:19 PM

I had my first child, two months before I turned 18. I was married and it definitely wasn't an accident. Anyhoo... I've been a mom since I was 17. I had my last child when I was 21.

When my youngest child was 14, I was a single mom. I was dating, but definitely didn't want to have any more kids. Being a mom pretty much my whole life, I realized that I would only be 40 when my youngest turned 18; and I could smell freedom!

I decided that neither Prince Charming nor his white horse could convince me to want to give up the freedom that I had earned by keeping my children alive into adulthood. I got my tubes tied when I was 34 years old.

I've never had any regrets about choosing permanent birth control. Right after my last was born, I had Norplant put in and I was one of the very few people that could tolerate it for the full five years. Then they took it off the market; but in the meantime, my husband had a vasectomy done, so it was a non-issue. Until we divorced.

I tried Mirena (right before making the decision to get the tubal ligation) and it was awful. I had cramps all the time. A couple of years ago (three years post-Mirena) I was diagnosed with adenomyosis and I'm not convinced that the IUD didn't have anything to do with it.

The constant pain caused by the adenomyosis made a hysterectomy neccessary. But that's okay, I had no desire to make babies, so losing the monthly periods was fine with me.

You're 30 and you will have four kids. I don't think there's anything wrong with wanting to shut down production. You aren't too young and it's not like you only have one kid...

I knew a gal whose OB wouldn't tie her tubes, even though she was 35, had six kids, and was pregnant with #7, because they were all girls. He told her "You might want to try for a boy." I told her to find another doctor.

So, you need to do what you feel is right for you.

katiep913 | 6:30 PM

I had a Mirena experience, too! Had it put in after my 2nd kiddo. I was batshit crazy on it. They told me repeatedly it wasn't the Mirena. I had it out and was sane and normal in about 48 hours.

After my 3rd baby (30 months after my first!) I "knew" I was done, and had Essure coils put in. The procedure was easy, painless. That said...I changed my mind. 15 months after the procedure, we did IVF, and my twins are now 16 months old! (Yup, 5 kids 5 and under).

For me, the permanence of the sterilization caused a reverse psychology effect. I can't imagine my life without every one of my children, but I do wonder if I would have stopped after 3 if I hadn't felt such a panic deep in my core that I COULDN'T have more. It made me want more kids more than anything.

As far as the procedure and effectiveness, though, Essure was a great choice.

I have been reading for a few months, since just before you learned you were carrying two. I am loving following along with your twin pregnancy!

Anonymous | 6:52 PM

Wow, I am totally riveted by this conversation. Over 23 years I have tried numerous hormonal BC options = all horrendous, made me psychotic. Then successfully used condoms + charting for 10 years, no problems at all until I got pregnant (surprise!) at 40. I wasn't planning to have kids at all. I now have a 5-month-old whom I love beyond reason, no regrets about that, but the pregnancy and birth were so traumatic for all of us, I know I could never, ever go through it again. Her daddy agrees and initially volunteered for a vasec., but now he is...well, procrastinating. Not because he wants more kids, he's just having cold feet about the procedure and altering his body. Which I can relate to, 'cause I'm even more scared of going w/ tubal or Essure, for a lot of the same reasons (plus, I have major medical-phobia). We feel stuck. I have been feeling a lot of pressure (from friends, healthcare providers) to "push" for the vasec., but that doesn't feel right to me. So I was glad to read Rebecca's take on all that, along with some of the other "men are people too" comments, 'cause I agree. If he were pressuring ME, there would be an outcry, so why is it different? But it leaves us in a major conundrum (in the meantime, we just don't have intercourse -- an effective method, though kind of a sad one.) Eventually we will have to figure it out, but how?

amanda | 7:03 PM

I have to second and third (or fourth?) the comments about the book Taking Charge of Your Fertility. Check out the reviews on Amazon! Truly life changing information! I wish this form of birth control was more present in modern women's healthcare. Even if you choose another form of birth control, the book itself provides a wealth of knowledge on all things fertility. Interesting stuff!

Dani | 7:28 PM

I have a friend who had her tubes tied after 2 children with the wrong man (her exact words "I was TERRIFIED (emphasis hers) of having any more children with him). The marriage has since ended, she's moved on with a better guy and is happily remarried. She's serving in Afghanistan right now, but they have plans once she's back in good ol' Canada to have the procedure reversed and try for her third/his second/their first. These procedures are and aren't permanent at the same time. (yes, I know, it is possible that upon deciding to reverse it you may not be able to conceive anyway, but infertility can strike anyone at any time, regardless of the number of children previously conceived). So I say, IF you are pretty damn sure that number 3 and 4 are it for you, and you're not happy with other options you've tried, and tend to have babies pop up a little unexpectedly (like me lol), get it done. it will just relieve SO MUCH worry/what if, and can (usually) be reversed if you so desire. (:

that was longer than I thought it would be.

P.S. you are beautiful. I hope you hear that often because it's true (:

Kana | 7:29 PM

Just wanted to say that I really appreciate this discussion. It seems like everyone in my circle is stuck on "a few kids, then vasectomy, no questions asked" treadmill. I had never considered an alternative!
Not to be a bummer, but for me the tragic possibility of losing a child really does require some thinking about non-permanent options. And if, god forbid, my husband loses me, I'd want him and his next love to be able to build a family.
I'm currently surprise-pregnant for the SECOND time (never.trusting.condoms.again!!!!) (son is only 10 months) and we've always felt 3 was our magic number. I'd never heard much about the copper IUD but now I'm definitely going to look into it for between 2 & 3 and for the long haul. Anyway, thanks for this eye-opener everyone and especially Rebecca The Great Facilitator (And Gestator)!

silverfinofhope | 8:34 PM

I think most of us know folks who either were conceived or did conceive after a "permanent" solution had been put into place (one of my best friends got pregnant with a copper IUD, and her son is the cutest little guy ever, ever, ever...).

My husband and I have not used anything for birth control since I gave birth to my son over six years ago. I know my cycle, I know when I'm ovulating, and usually just don't have intercourse during that time. And other times he does not climax inside of me (when I'm not ovulating). Now that we're trying for another, it's no holds barred. I don't know, part of me thinks so much is up to the Universe that even our very human permanent solutions have very little to do with the inevitable.
I personally don't want my tubes tied, and my husband doesn't want a vasectomy, either. Just too freaky.

molly | 9:07 PM

le sigh.

I could talk about this subject until I become blue in the face.

I have 2 boys who are 21-months apart. My youngest is nearly 15-months-old and I'll be 33 soon. Time is a tickin' if we want to have a third.

I went into my second pregnancy pretty much knowing it would be my last.

And then I gave birth knowing it would not be my last.

But my husband is adamant about not having any more. So we discuss the IUD and the Vasectomy, which I think he would be open to getting, all while having unprotected sex. It's just the STRANGEST thing. I saw him hold a newborn a couple months ago and the smile on his face killed me.

I find myself thinking up names and staring at families with three kids. I am so surprised that I still feel like something is missing.

I am starting to think that this whole mother thing is what I'm good at and what I'm meant to do full-time (I work outside the home now).

It's just this feeling that we're not done. That there is one more, ya know? You must have felt that too.

Anonymous | 9:16 PM

I was a heavy bleeder and cramper my whole life so I cringe at the thought of you brave women who willingly take on the increased bleeding and cramping from the ParaGard. This is somewhat a sidestep from the original topic but due to my heavy bleeding I was struggling with chronic anemia and was just a basket case from dealing with my uber-heavy flow each month. I ended up a few months ago at age 39 having an endometiral ablation (removing the lining of the uterus) to stop the heavy bleeding, effectively closing up my shop in a different way. I've been mourning the loss of my "factory" ever since (even though we have one child and knew we didn't want any more), however, the new found freedom I have from no more menstrual bleeding is amazing and empowering in its own right. You just might want to think about what, if any, impact the extra bleeding and cramping will have on your ability to care for two more little ones. I also share the opinion of a few other readers that pregnancy brain is NO TIME to be making huge decisions like that. Best of luck with whatever you choose!

Rebekah | 9:30 PM

I don't understand why some people who are commenting seem upset that Hal does not want to get a vasectomy.

He doesn't want one. You don't care that he doesn't want one. That's called: not a problem.

People should always retain their individual & personal rights when it comes to their body and their health. That is a very basic human right.

I do agree Science should invent one zillion temporary contraceptives for men so they can be as miserable as women with the pill / IUD / shots, etc.

Until that time of equal opportunity arrives, it seems like there are a lot of other great options. My mom taught natural family planning for years (charting) and after 7 kids, she remained fertile for another 10 years, but never got pregnant again. It worked for her -- and it was au natural!

The copper IUD thing also seems like a good option. Good Luck!

Jamie | 10:02 PM

I'm 33 and had my tubes tied during my c-section seventeen months ago, when I gave birth to my second child...

Best decision I ever made.

My husband and I both always knew we didn't want more than two, and yes, we have a girl and a boy, so our family felt complete in that sense. Apparently, I am a less-than-pleasant pregnant woman, because my husband brought safety scissors to the delivery room and threatened my OB (& friend) that he would "do it myself, if you don't"!

A secondary, but hugely bonus is that our sex life is rockin' now that we have no worries about barrier methods. This is purely for recreation, not procreation and we are definitely enjoying that!!!

A Serious Girl | 10:33 PM

This is an amazing conversation - thank you for starting it.

Elective surgery + permanent bodily alteration = absolutely terrifying, as far as I'm concerned.

As far as Essure goes - it's only been around for five years, so really? We have no idea what happens to an Essured pair of fallopian tubes twenty years down the line.

IUDs also scare me. My husband's first love suffered an infection that scarred her uterus permanently, thanks to an IUD. But I hear that is very, very, very rare and lots of women commenting here have had a wonderful experience with the copper IUD.

We use condoms. Always have, probably always will. I don't really understand why people hate them so much. I think they're kind of awesome. Super easy, super convenient, and they don't mess with the important stuff at all.

Jessi | 11:07 PM

@ A Serious Girl~ Essure has been around since 1997. It's just hit the states in the last few years. It's commonly used in Europe with great success. We're just always last on the party train.

jessica | 11:17 PM

All birth control pills that I have tried have made me crazy in one way or another. Even the Nuvaring upset my cervix. I have been charting since I was 21, and using condoms and I have never been pregnant.

When I met my husband we stopped using condoms but I continued the charting- we just used them while I was fertile. It works. It works SO well. BUT. I am regular- to the freaking hour. So charting is easy for me.

Every time I go in for a yearly, my doctor tries desperately to convince me to get on some kind of pill. It drives me nuts! No means no! And I wouldn't do the IUD- my periods are heavy and last 7 days as it is- I couldn't handle more blood and more pain.

We are now trying for a baby- yea! And it's in my generation to have twins...yikes!

Anonymous | 11:27 PM

I just wanted to say I hope you do your very best to deliver vaginally! So much better for you and the babies. Keep informed, be your own best advocate, don't let them induce you because it's all downhill from there.

Anabelle Tess | 12:02 AM

Me and my man we have 5 kids (I have 2, including 1 with him... talk about new families!!) so I think we will not want another one. But I just can't imagine not being able to have another baby if I ever want to. You never know what's going to happen in your life. What if you want another child in ten years? My two children are ten years apart, I "married" twice. I would have been desperately sad if I couldn't have had a child with the man I love now.
At 40, I'll consider permanent contraception maybe. In the meantime, I am still trying to find the best contraception for me (I have migraines and forget my pill every other day anyway).. we're just careful and so far it worked!!

Anyway, in France, permanent contraception is not very popular...

Tirzah Hochreiter | 4:45 AM

ParaGard is good and has a pretty high success rate, just be careful with it as it (just like mirena) has a history of burying itself within the tissue surrounding it (I've known several women who this has happened to with ParaGard, specifically, but as far as what they have told me it wasn't painful just scary when their doctors were "unable to find it". As far as I know it is not very difficult to extract it should that happen, but may be that's worth looking in to?)

My husband and I are expecting number 2 in December, and he is convinced that this will be it for us. I, on the other hand, am not 100 percent sure about it, so I am sort of debating the same thing with myself right now (however, neither a tubal nor a vasectomy are in my radar). I hated the Mirena and I hated the pill. I have several friends who have their cycles down to a science and dont use any kind of contraception other than "we're not having sex for the 5 days to a week where I may possibly be ovulating" which may be the route I take. Perhaps not for the faint of heart, but if it works when you are trying to conceive I am sure it is just as effective if you're not :)

Kendra | 5:36 AM

I had Essure done 2 years ago and couldn't be happier with it. I will say that after 2 bouts of postpartum depression, I didn't want to go there again and I was very sure of my decision. The procedure was pretty painless and it was an office visit so I went back to work after and felt pretty good. The prep was worse than the actual procedure and even that wasn't too bad. I would check with insurance because you have to have a hysterosalpingogram (HSG) imaging (or at least you did two years ago to make sure the procedure worked), which is mostly used for infertility. My insurance company gave me a hard time about paying for the imaging. The hospital used an infertility diagnosis when they submitted the billing and it took me almost a year to get it worked out so they paid for it like they were supposed to in the first place. I would speak to your doctor about surrogacy if you wanted to help others who couldn't have babies. I'm not a doctor, but I don't see why you couldn't be a gestational surrogate if you wanted to. It might depend on the doctor.

Anonymous | 5:51 AM

The first thing I said to my doc after learning I was having twins was "I don't want a C-section, but if I end up with one, I want my tubes tied. Write it down in my file right now!"

I did end up with an unscheduled c-section and the whole thing took an extra 5 minutes. Perfect, never have to worry about it again. If I hadn't had the c-section, they would have done the surgery the day following the delivery while I was still in hospital. Win/win! I took the pill for 10+ years and was tired of the invasive hormones in my body, and eeked out by the thought of a piece of plastic/metal embedded in my lady area. This was perfect for me.

Anonymous | 6:16 AM

Hal knows vasectomies are reversible, right? That would be the least invasive and easiest thing for both of you.

Maggie | 6:47 AM

I'm 26 and currently half way through pregnancy #3. I have a 5 and 3 year old. It took my husband 2 1/2 years to even have a conversation about a 3rd without panicking. I'm a crazy Dugger type lady that could go on and on forever! So because he is the one who is 100% done after this he is getting a vasectomy after the birth. His choice. I am not ready at all to do any permanent birth control to my body, but he happily volunteered(insisted). I am so thankful he got on board for #3 that I don't care what he does now. He really made a dream come true for me to have a larger family so I feel it would be unfair to ever ask him for a 4th.

I do completely understand your support of Hal's decision. He doesn't want it so why would it even be an option? I certainly don't want my tubes tied so not an option. You two seem to have this whole marriage/support thing figured out pretty well :)

Michelle Horton | 6:56 AM

I haven't read through all of these comments, so I apologize if I'm the bagillionth person to tell you this, but my vote is for the Paraguard. A remember reading your heinous account of the Mirena IUD, and I think that's largely because of the hormones. I have the Paraguard and, although my periods are heavier than they were, they're also shorter. I have one, maybe two days of a heavy period (some months more painful than others), and then it's over. No hair loss, no mood swings, no sexual issues. It's super easy, super removable and -- hooray! -- hormone free. And I'm sure you already know the effectiveness of an IUD, which is on par with sterilization. Good luck!

randi | 7:41 AM

I sent you a note on twitter about it but I'll post here too if that's ok!?!

I had my tubes cut during my last c-section. I was 27. I'm not regretting that because we are DONE DONE having kids (we have 2 boys) but I have almost every side effect that was warned about before the procedure.

Severe cramps? CHECK
Heavy Bleeding? CHECK
Messed up schedule? CHECK!

I'm not sure I'd do it again. I love the idea of permanence but I am almost to the point where I may need to go on a mini-pill on top of it to regulate and lighten my period. As it stands right now, my cycle varies from 21-40 days. That is a lot of time spent per month worrying about WHEN I'm going to get my period. Also, they last for 8+ days and the first 4 are pure torture. I've had to be prescribed pain killers for cramps. NOT FUN.

I say wait.

Anonymous | 8:05 AM

YOU don't sound ready to make a permanent decision. I had a tubal ligation and I'm very happy with it -- but I'm 45 with two little kids. I also think when your pregnant or exhausted dealing with enfant(s) it makes sense that your whole mind and body says NO MORE. But when the enfant(s) starts walking around eating her own pb&j, then it's not uncommon to start thinking about another.


Bottom line -- I don't see how waiting on a permanent decision could harm you in any way (especially since you're not likely to have a c-section).

Lara | 8:23 AM

ParaGard is the best! It kept me baby-free without any nasty hormones for 8 years and then I got pregnant 3 weeks after taking it out. It rocks and I think it's definitely the best "semi-permanent" birth control option.

amyunicorn | 8:25 AM

I got my tubes tied after trying every form of birth control (including a copper IUD which I hated every minute it was in me), and although it was serious surgery and a tough recovery, I don't regret it for an instant. We have two wonderful children, I know I don't want to have any more, and my husband was not willing to have a vasectomy. This was the only way to make sure I didn't get pregnant. The freedom I felt after it was done created a surge in my sex drive.

And if you tie your tubes, are you not still able to surrogate via in vitro fertilization should that situation come up? Your uterus is still fully functional, it's just the prevention of ripe eggs reaching your uterus that tying your tubes does. Or am I missing something? I still get periods every freaking month (grr!!)

Andrea | 8:33 AM

We were completely and totally blown away to be expecting our third child. So, after much thought we decided it would be best for my husband to get a vasectomy. He is a rockstar for doing it. It wasn't an easy decision and we didn't take it lightly. There is very much a sense of finality about it.

We knew we were done. Our family of five is very complete. I have two lovely girls and my beautiful son.

Jen | 8:36 AM

Timely topic- my husband I were discussing this at 11pm last night... being pregnant with twins now following our first who took years to conceive we both KNOW we're done (I think he always thought we'd be a family of 3!) and since my twins are both breech at 30+ weeks pretty sure I'll be having a c-section, he wants me to get my tubes tied. I'm 100% about being done, but there's something about the tube thing I don't like-maybe it comes from years of infertility. Never heard of para guard- will research it now-- and talk to my OB-- good luck w/ your decision =!

Jenny O | 8:38 AM

I am really interested to read all these responses. My husband and I have pretty much agreed that our daughter is enough for us but I neither of us has made a move towards getting the snip. I think I will probably end up getting an IUD (thanks for all the input from you and commenters re: the different kinds) because yeah, I don't think I want kids, but I'm only 30, who knows what the future holds. I hate to think this way but if our marriage ended somehow I'm not too old to remarry and have another child with another man. While I don't want more RIGHT NOW in the specific situation I'm in, I don't want to definitively rule anything out either.

growingapair | 8:56 AM

I have done it all-- pills, that crazy shot you had to have every three months, Mirena (same story here!) and natural (read: child number two).

After my third, I knew that even if my mind wasn't done, my body was. I had complications and if I wanted to keep another child in I would have to walk on my hands for 40 weeks.

At my c-section, I had my tubes tied. Then, later, to take care of copious nasty periods, I had a Novasure ablation. I figured why keep the apartment furnished if I wasn't going to rent it out anymore?

For the most part, I have no bleeding during my periods, it's non-hormonal, and I love the ease of it. I do sometimes have baby twinges, but I know that even if my belly could carry another my wallet can not. We are complete.

Good luck. This is a hard decision.

Molly | 8:56 AM

I have had a Paragard in for 5 years and never had the heavy period thing, or the poking string thing.. It's been super great. I don't deal well with being on the pill (makes me insane), so hormone filled IUDs were not for me. Paragard rocks! Another plus is that is is fully reversible, which is nice.

amelie | 8:58 AM

I love the idea of long-lasting non-hormonal birth control, however the paragard did not work for me at all. For almost two years I suffered through two week long periods, hellish cramps, and frequent yeast infections. I finally decided that I couldn't take anymore, and went to have it removed, only to find that it was embedded in my cervix. I had to have surgery to have it removed.

Unfortunately, I haven't been able to find anything else that works for me. I hate the idea of hormonal birth control, for both environmental and personal reasons, and tubal ligation seems so permanent. Hopefully, paragard will work for you because I had really hoped it would work for me.

Kim T | 9:08 AM

I had a paraguard for about two years after my second dd was born. I knew no more children were coming out of my body. If we ever got the urge to have another we were adopting. My husband wasn't ready to have a vasectomy and at that time my only options for permanent BC were surgical. But two years in we definitely decided IUD was not for us. It poked my husband's penis every time we did it. To the point he didn't want to do it much and certain positions were off the table. I bled constantly, it wasn't painful, but there was almost never a day were there wasn't some blood. My drs. thought this was weird, both the poking and the blood. Anyway, husband had vasectomy and all was good. It is so wonderful not to have to think about BC any more. If something (god forbid) were to happen to my husband while I was still of childbearing age and I found a new partner I would have some permanent alteration done to my body. Not getting pregnant again and def not going the route of any of the options out there.

Gennie | 9:20 AM

I totally agree with you and Hal that the person who is sure they never want more children in any circumstances is the one who has to take responsibility.

I'm 37 and I have 2 kids: age 7 and 4. I currently have a Paraguard IUD, which I love. I had it inserted when my youngest was 6 weeks, and since I was breastfeeding it was 6 months before I got a period, so I think I skipped the worst of the cramping side effects. That first period was a doozy (SUPER heavy) but after that no big deal.

I went the IUD route (rather than something surgical for one of us) because though there are not many circumstances under which I would want another child, there is at least one: if one of my children died. I have a friend who lost her 2 year old to leukemia, so the thought crosses my mind.

By the time my IUD reaches it's lifetime limit, I'll be 43, and by then there will be no circumstances under which I would want a biological child. So at that point, it will be DH's turn and he has agreed to get snipped. He is even more adamant than I am about not wanting more kids, so it will be all him then.

A Serious Girl | 10:04 AM

@ Jessi - Thank you for correcting me! Ok, so Essure has been around for 14 years, not 5. But still. That doesn't tell us what happens to a pair of Essured fallopian tubes 20 (or 30 or 40 or 50) years down the road. I'm not trying to rail against Essure - perhaps it's the most wonderful permanent contraceptive the world has ever seen - I'm just saying it's too new for me.

Also, I'm afraid I'd be able to feel those plugs in my tubes, and that they would drive me batsh*t crazy. Can anyone who has it comment and say whether or not they feel those things in there? And how painful was it to have them inserted? And how often does it fail? (I read that not all women get correct placement of the plugs.)

blueskypie | 10:14 AM

So many good observations and comments here, but I'll add my two cents. I'm 37, with two young kids (2 and 4). Pregnancy wasn't really fun for me and due to complications I had two c-sections. I'm not 100% sure that we're done... more like 92%. But in the meantime, I'm trying to sort things out. Right now I'm taking the Pill continuously - skipping the placebo pills and never having a period. My doctor recommended this to curb the monthly migraines I was having. But... I'm concerned because the migraines were due to the hormones to begin with. I'm thinking about trying the copper IUD as well. Thanks to everyone for writing about their experiences with this.

Oh, and I did read Taking Charge of Your Fertility. Really great book, but I found that I just wasn't dedicated or motivated enough to do this effectively. We tried for a while, but I was tired of never being completely certain that I wasn't going to get pregnant. Also, a couple of friends have misjudged their fertile windows and ended up unintentionally pregnant.

Sounds like the copper IUD might be the right mix of hormone-free and mostly effortless for me.

Brandi M Walsh | 10:27 AM

Pretty sure I chimed in on the Mirena discussion, but anyways, I'm 30 and currently pregnant with my 4th! My kids are 12, 9, and 5, and I will never permanantly close up shop. I've had the paraguard 3 times (between each pregnancy) and it's perfect. I have 4 day periods, 2 normal/heavier, 2 light. I'll def. be getting it again after this little one makes an appearance in January.
My mom was a 5th baby, born when my grandma was 40....as kind of a "maybe just one more" type thing.
If she hadn't gone for it, neither my mom, me, my sister, my 2 brothers, my niece and nephew and my 3 wonderful kids would exist, and that's just too tragic to comprehend.
Really makes me want to keep my options open.

Kate | 10:46 AM

While I'm well aware of the fallacy of "I know someone this happened to" arguments, I will say that the only reason my boyfriend has a little brother is that their mom's copper IUD failed. It's remarkable that he was born healthy, since when IUDs fail the consequences are a lot more severe than hair falling out: ectopic pregnancies, uterine tearing (followed by expensive surgery), etc.

Anonymous | 10:48 AM

I've have a Pargard for 2 years now and love it. I'm 28, and never had children, but don't tolerate hormones at all ( bitchy and no sex drive). Sex drive is wonderful now. Periods are heavier and crampier, but I say that dwindles after the first year or so. Though I've always had heavy/crampy periods. It's well worth it for a spontaneous,worry-free sex life. My partner has said he's felt the strings every now and again, but said it doesn't bother him.

Janyne | 11:14 AM

I had my third child almost 8 months ago, and my husband and I had decided waayyy before his conception that he would be the last. I had a tubal a few months ago and have already felt negative feelings towards it. Not so much regret as much as the fact that I *can't* have any more babies, something about it just makes me sad.
I would highly recommend waiting.. even if only for a year, and using alternative methods until you are absolutely certain that these girls will be your last, because soemtimes you just never know until you know. You know? ;)

Jennifer | 11:16 AM

My husband and I debated for a while if we wanted a second child and then I got pregnant with twins... At my 5-wk pregnancy confirmation appointment I had them note on my chart that at delivery I wanted my tubes tied. 3 weeks later when I found out I was having twins I was even more sure. I have a daughter and 2 2-yr old boys who are healthy and happy and wonderful. I was 37 when I had my boys so maybe it was an easier decision at that age. I got pregnant very easily...so permanent was the right decision for me.

Makyo | 11:32 AM

I had a copper IUD for seven years and it was the awesomest thing ever. My periods were exactly the same with & without it, and I couldn't feel it at all. But it dislodged itself and had to be removed at a time when I had no insurance... Since I couldn't afford another I ended up on the pill, which made me crabby and mean and completely libido-less. My plan was to get another IUD after my daughter was born, but we're doing just fine at the moment using condoms. When I decide we need a more permanent (or semi-permanent) solution though, IUD is where I'll be headed without a moment's hesitation.

Anonymous | 11:53 AM

Rebecca,

You're spot on for giving Hal his reproductive rights. That anyone would rail against him for his choices shows the true nature of a lot of women: My way or the highway. There are risks associated with any procedure, and as of late it has become a question if vasectomies contribute to cancer and prostrate problems because of *ahem* "stuff" not clearing out down there and not reabsorbing.

Is it possible that you guys are supposed to have a truckload of children? I know this isn't popular these days with all the anti-children opinions out there, but there are folks that are just amazing with lots of wee ones. Not one myself, but have 2 friends that both have 6 children apiece (and they make it look easy!). Not a big fan of many forms of BC, but will give a plug for "Taking Charge of your Fertility". I have used it for years and have 2 well spaced children :).

Lori | 12:48 PM

I had the ParaGard IUD several yrs ago & loved it, planning on getting it again after baby #3!

Anonymous | 1:29 PM

Wow, Bec I am seriously bothered by the "what if Hal wants to knock up some other lady he loves" argument! In my mind that would be such a betrayal to the family he created with you, it isn't a valid argument! I mean, you wouldn't say something like "well, we never got legally married because what if my husband wanted to be a bigamist and marry several other women?" Uhhhh. I get that there are lots of different levels of commitment, but I would think 4 children would seriously cement any notion of committed family man a man had of himself.

For us, after we are done with babies, husband will get a vasectomy. He volunteered, and thought it was only fair after I carried and birthed the children. I was relieved because there are SO many more complications that can happen with female sterilization!
-Rachael.

Anonymous | 1:38 PM

"ED: Please don't tell me Hal should get a vasectomy. If the roles were reversed and he was pressuring me to do something that might compromise my reproductive system against my will everyone would agree that would be uncool. Same goes for him because he is also a human with feelings."

Eeek. Um, but Hal IS in fact pressuring you to do something you are uncomfortable with (at least in the video you said you were nervous about a tubal) and that IS very uncool. Like, it takes two to tango, and if one partner refuses to deal with birth control for the mutual sex they are both having, than yeah, that person is in fact pressuring the other person to do it by their refusal to be responsible. Which is uncool.

I find it especially uncool given that Hal must know about all the problems and side effects you've experienced with hormonal birth control. Like, seriously.

Jessica | 1:41 PM

My OB informed me that an IUD acts as an abortive form of birth control. As in it's not preventing pregnancies so much as aborting the ones that do occur. Quite a shock to find out that.

We rely on the natural family planning method, which has allowed us to love and adore six kids. I say go for the large family and love unabashedly!

Emily | 1:48 PM

I am 29 and got paragard put in 6 weeks after my daughter was born. I love and hate it all at the same time. While I was still nursing and not having the cycles it was amazing (not freaking myself out that I had gotten pregnant before having a period was a def. plus!). After cycles started up again, I was in love with it still for a couple of months, then for a few months I had a lot of inter-cycle bleeding (2 weeks of spotting, 1 week of heavy ass crazy period, 1 week of nothin'). Now, things seem to be settling down. I have a bit longer (7 days vs. 5) cycle and some spotting, but the pros totally outweigh. I love being hormone free (since I am still nursing my 1 1/2 year old), and I love not having crazy ass mood swings. I hope you find your way.
Maybe try the paragard and see what's up with it first, then go back and do the irreversible if you feel so inclinded later. I am sure you will make the right decision for you and your uterus :)

Trysha | 2:16 PM

I had my tubed tied after our third son was born almost 3 years ago. I had an emergency c-section and since they were already down there, we closed up shop.

I don't regret it (it makes me a little batty when people see me with 3 boys and assume we want to try for a girl. Uh, no). I made the decision because 3 kids is enough for us. We didn't ever plan on having 1 and after having two, well we're not quitters and two was just too easy. Most days it's like Home Improvement up in here, someone is always being picked on and two are always teaming up against the other. I digress.

I cannot handle hormone based contraceptives. I basically fall apart. It's not something I wanted to do to myself and my family. I didn't want my kids thinking mom was going to lose her shit any day/everyday/all day.

I have noticed that since my tubal, my periods have gotten heavier and much much more clotting/cramping. It's not worrisome quite yet, but it's something I am keeping tabs on.

Some days I am sad about not having any more babies (and my husband actually more than I am) but it's never a regret.

Anonymous | 2:36 PM

I had Essure implanted and am extremely satisfied. It requires general anethesia but was well worth it. I had to cover 10 percent of the cost as well. But still worth it. I am beyond thrilled to be off hormonal birth control. As
permanent option i highly recommend it. Thanks. JenW.

GIRL'S GONE CHILD | 2:59 PM

Rachael. If I were to die or if Hal and I were to split and he ended up with a woman that he wanted to breed with, how does that make him less of a family man? We choose to live our lives (and marriage) day by day with no plans of "forever" because that is what makes us the happily married couple we are. NO. PRESSURE.

Anon 1:38 - how is Hal pressuring me? If it was up to him neither of us would be on anything ever and we'd pull out and pray from now until forever... I am the boss of my body just as he is the boss of his. I'M the one who wants to permanently close shop, not him. So please don't argue with your own assumptions. x

Sally | 4:19 PM

It sounds like our situation is kind of the reverse of yours. My husband got a vasectomy a couple of weeks ago because he is 100% sure he doesn't want more kids (we have two). Although I don't want any more either, I did worry about what happens to him in the future if he did want to have more children, for whatever reason. I did feel a sense of loss because of the permanence of it. A couple of months down the track, though, I'm so totally happy he did it. For the first time in forever, not having to worry about contraception is so so so great.

JKB | 5:15 PM

I had paraguard for a year and actually had no side effects, it was uncomfortable when they inserted it but I had an appendectomy 2 weeks before so any tensing up in my abdomen was not fun.

I will say this, no idea if it is just anecdotal but, my first postpartum period (my daughter was 20 months old thank you nursing) dislodged the IUD. It ended up rotating and embedding itself in my cervix. My MW consulted with an OB who said "that's why I dont put them in before they've had their first pp period." Like I said, this could totally have been a fluke, but it is maybe something to consider/ talk to doctor about. I am still planning on getting another paragard after this LO is born in january I just may old school it with skins until first period.

Catherine | 6:09 PM

We have two children so far, and after my daughter was born we decided to wait until she was two to try for a third (and last) baby. I'm 34, I'm pretty certain I only want three, but we've decided not to do anything permanent until we're both 40. Currently I'm a big fan of using the FAM method and it works. I've gotten pregnant every single time I wanted to (one miscarriage) and not gotten pregnant when I didn't. As for permanent measures. My husband has decided he'll get a vasectomy. He's a physician and made that decision on his own comparing risks to each of us. Also, he just diagnosed a 42 year old who had a tubal 12 years ago - yep pregnant. Of course, vasectomies fail as well... so what to do! It is a good question, and yes, one I think about regularly.

Carla | 6:29 PM

So funny this should come up. Last time you wrote about your experience w/Mirena I was debating getting it. Now I just learned about Essure & we're debating if we're officially done or not. Like you it seems terribly permanent to close up shop for good. Almost a waste of a perfectly good, fertile body. I have no words to offer as advice. Just chiming in to say thanks for bringing up this topic. It's nice to know I'm not the only one confused as hell =)

Anonymous | 7:24 PM

Whatever you decide, I would wait until after the stress- and bliss- and hormones-fueled time of pregnancy and newborn-hood to have a clearer head about making such a permanent decision. Personally, I have heard great success stories about the IUD, and somehow it feels (to me) more "natural" than permanently revoking the power Mother Nature gave me.

Anonymous | 7:56 PM

My DH had the big V a couple weeks ago and we both regret it. He didn't want more kids, I did. But, the no vote rules here, no question. No kid deserves to be born into a family where one parent didn't want him/her/them. His regrets all come from the difficult (and unusual)recovery he has had, mine are just the tiny desire for the chance of maybe just one more. However, no reversal is in our future cause like I said, the no more vote always wins on the kid discussion.

SoMo | 8:44 PM

I had a very pushy OB when I was pregnant with my second. We were unsure of a third, but the dr just kept pushing. You know, because we had a girl and boy (perfect family). I swear I was afraid she was going to tie my tubes whether I signed on the dotted line or not. It took her leaving me nude in an exam room and kicking my kids and mother out of the waiting room for me to find another dr.

After our surprise number 3, I knew we couldn't handle anymore children. I will say that if I was guaranteed a boy as my fourth child I might have gone for it but you don't get those guarantees. So we were sure I would get a tubal since I would be all open anyway. No problems that I can tell. It has been 2 yrs. Anyway, I had the dreaded AMA (advanced maternal age) disease with my third and would rather not go through all those unnecessary test again. They were just scary and produce more stressed than the relived.

Good luck with your decision. I will admit it is a hard one. It is hard to put that part behind you, but I am ready to get on with the watching kids grow and being young enough to enjoy some grandkids part.

Anonymous | 9:27 PM

I just have to say, please don't get your tubes tied while they are in there for a c-section. My sister's neighbor had two kids and wanted to be done, so when she after she had her second child, she had her tubes tied. Within a year she was pregnant again. My mom had a coworker that gave birth to her first child and wanted to be done with one. She got her tubes tied. She ended up pregnant with #2. Right after birth she got her tubes tied AGAIN. She ended up pregnant with #3. It's faulty doing it right after giving birth. I've heard of so many stories where this has happened. I'm not sure about what kind of perma-contraceptive to offer. I'm in the same boat. I have two children and I feel I want to be done, but my husband and I are only 26. It feels so... soon to just be done. He is totally game for a vasectomy, but I just hate to do something so permanent. I've heard that after having the Essure procedure you can't have an MRI on that section of your body because it is metal. Whether this is true or not, I'm not sure. But if it is, it's something to discuss. You NEVER know if you will need some kind of MRI or whatever later on. I have the Mirena and the first year was rough. I bled a lot and had no sex drive and it was just not good. Reading you go through it (you got it just before I did I believe) made me want to pull it out but it was too expensive to just yank. Now I'm at about a year and a half in and it's not so bad. My periods have stopped for the most part. Once every other month (give or take) I have some light discharge and I seem to be having more of a drive. My husband has never said anything about the strings. I've asked. I would say go with what you want. Maybe start with the copper IUD. See how it goes. If you can leave it in for up to 10 years, which I've seen some commentors say, you could leave it in and see how you feel about more permanent methods. I agree with your no pressure about the vasectomy. It's a tough road to walk when you don't want to get pregnant.

Samantha | 9:45 PM

I had a great experience with ParaGuard between my two pregnancies. I had more cramping than normal, but nothing that a few days of alieve couldn't handle. And I conceived again a few days after I had it removed. However, after I had my twins just as my oldest turned two, my husband agreed to get snipped! Best decision ever. He has no interest in having more kids, and I had been on the pill, IUD, or pregnant for nearly half my life - I was so sick of it. It is incredibly refreshing to not have anything foreign in my body (chemical or copper). That said, if something in my life were to change such that I needed to worry about it again, I'd go with the ParaGuard for sure.

elizabeth | 6:36 AM

I have four kids as well. My husband had a vasectomy soon after the fourth was born. I think after all we go through in pregnancy and childbirth, it's the hubs turn!

Angie | 9:50 AM

Considering you are months away from delivering children three and four, your body is already "altered"....I say have your tubes tied and be done with the worrying. I think you will probly have enough to worry about/keep you busy without the hassle of terrible periods, temp taking, or more HORMONES!
BTW, you look FAB and I just love your "little" family! :)

shelly | 10:34 AM

After struggling with hormonal birth control for four years, and knowing the IUD just isn't for me, I finally ordered myself the Lady Comp. It's a NFP tiny computer/thermometer that tells you what days you are fertile/when you can have sex. The pearl index is 99.3%. Which is as good as the pill. Def something I'd consider women to look into-something to work with our bodies instead of fight against them.

Erin | 11:43 AM

Had my tubes tied after baby #2 arrived in a 2 year period. Now, the only problem is my period. Heavier than its ever been- e-v-e-r. Doctor swears its not from the tubal, but what else could it be? Otherwise I'm happy with the results. Especially since birth control pills gave me ridiculous migraines.

Expat Mom | 4:34 PM

Correct me if I'm wrong, but if you tie your tubes, couldn't you still be a surrogate? You'd be using embryos from the parents, so I'd think that would work still.

Anonymous | 5:25 PM

I LOVE MY COPPER HORMONE FREE IUD!!!!
I did have light bleeding for the whole first month (it is inserted right after your period and I bled until my next expected period). From the on I have had no bleeding between periods, and NO EXTRA CRAMPING!! Also, more effective than a tubal and can be easily removed if you change your mind. I have had the ParaGard for almost two years : )

BKC | 9:16 AM

It was eye-opening for me to learn that you could still be a surrogate after having a tube tying/blocking procedure. In that case, I think Essure is a great option given all the factors in your situation.

Planned Parenthood (my gyn, since I have no insurance) told me my uterus is too big for IUDs, so I'm doing back to back 3 year cycles of Implanon until I find someone/save enough money to get something more permanent. Everyone I've gone to for the Essure procedure has sent me home to "think about it." Apparently at 23, with one child, I must not know my own reproductive mind?

bridget | 8:45 PM

You are amazing. I love your blog and I love how open you are. 30 is young to close up shop but that's coming from someone who like Hal would have had as many as were sent my way.

Anonymous | 9:31 PM

During the birth of my daughter I sustained a uterine prolapse, and although it was initially tucked back up there, after a couple years it needed to be surgically dealt with. One of the options was a hysterectomy. I was young for such a procedure, part of me wanted another baby, but I opted for the hysterectomy and I am SO HAPPY! No more cramps, no more periods, no more flooding, no more "sorry honey, not tonight," no more pap smears, no risk of uterine cancer in my future... and no worries about birth control in my 40's when I don't think I'd have the energy for another baby. When I get baby lust I just focus on investing myself in the children I DO have, or I offer to babysit for the neighbor's baby! So, it is OK to close the book on childbearing, and I feel hysterectomy should be an option offered to all women who would like one.

SaraMinerva | 6:43 AM

We decided on tubal ligation after the birth of our 2nd child, a boy. We have one of each, and we like the idea of not being outnumbered. I am a better mother to my two without having to worry about an unexpected baby. My body completely rejects all forms of hormonal BC (Mirena sucks big ones, as do the pill and the shot), and with a latex allergy condoms aren't exactly an option. I have been asked many times in the last 2 years "Do you regret it?" and I can answer with absolutely certainty "Not a bit." A friend of mine went the Essure route with no ill effects and was up and going like nothing happened in a day. If given the choice between Essure and tubal ligation, go Essure.

Sidenote: the hottest sex you will ever have is baby-making sex and sterile sex.

Brenda | 7:19 AM

I'm 26 and my husband and I have 2 kids (just had one 4 weeks ago). I eventually want one more, my husband is not convinced but when I/we agreed we're done, he is getting a vasectomy. It's definitely the easiest and most practical solution for us. It's the least they can do for everything we go through (xx months of total pregnancy combined, labor, etc.). There's no front runner in "permanent" women's contraception...I am definitely not a fan of any artificial hormones, "contraptions shoved up my vag" as you so eloquently put it, burning the lining of my uterus, etc. Hubby's turn to step up :)

Wendy | 10:02 AM

I was in very much the same place as you(one less child though!), and was sure I was finished my childbearing years while I was pregnant with my twins. We had only ever planned for 2 kids, although I had tossed around the thought of 3 when I first found out I was pregnant, the second time. 3 kids feels like our family is complete.

My OB asked if I wanted more children, and upon hearing "no way, no how", asked if I would like a tubal ligation directly after my c-section. As if it was a side of fries to be served!

I had hoped so desperately not to have a c-section, but both babies went breech, so on the way to the hospital, my husband and I decided that a tubal was the best option.
The c-section required so much time for recovery, that I didn't even notice any recovery time or pain for the tubal. I have no regrets-I'm so glad it was done.

Luckily for us, we've never had any fertility problems, and I tend to think that if I was not careful with my birth control, I may have ended up with a dozen children. I could not handle a dozen, 3 is fine for me!

My husband was ready to go have a vasectomy, but since I was already having surgery to get those babies out, I decided I might as well get my tubes tied. Or cut, or whatever else they do!

hoko_onchi | 3:00 PM

Paragard is awesome and can be removed at any time! I've had zero side effects and no abnormal periods. Do it! :)

Jenn | 7:13 PM

Just beware of the effectiveness of the Paragard IUD. I loved mine for 2 years. Then i got pregnant with it. It was inserted correctly and now i have a third AMAZING daughter...which is actually 100% awesome.

KO | 9:03 PM

In regards to people feeling "ick" about the idea of a husband possibly wanting children with someone else--marriage is not forever and things change. A spouse could die. A child could die. Lots of unexpected things could make someone change their mind about having more children. I think it's a valid argument.

Anonymous | 11:11 AM

I had a tubal when I was 22. I had my first (a girl) when I was 18 and my second (a boy) when I was 19. After their father and I divorced, I made the decision that if I ever had another child, it would be because the man in my life wanted me to, because I felt I was done. It took me a year to convince my OB/GYN that I would not change my mind, despite my age before she would agree to do the procedure. And I was right. I married a man that loves the kids we have and is content with that.

My point being, you know what is right for you.

Anonymous | 12:07 PM

My doctor tried to convince me to do Essure, but I was sort of "done" having things "done" to me after years of infertility. We were blessed with two kids, after a long struggle. Stayed on the pill, it's never been an issue for me. Fast forward, I'm now divorced and SO FREAKING GLAD I did not do anything permanent. I'm nowhere near even wanting to date, but I can imagine a scenario in which I would maybe, some day in the very distant future, want to have a baby again with some imaginary future husband. Most likely not, but I'm glad the option is still there.

jessica | 6:27 PM

after you got your mirena and LOVED it sooooo much (for a month) i got a paragard. i didn't want hormones which is why the pill wasn't for me (although short, light periods are the best!) so why would i get something with hormones in it? so i got the paragard and my dr left the strings long because he said you can always cut them but you can't grow them (he's smart like that because he's a doctor). my husbandish isn't bothered by them at all. sometimes he says he can feel them but they don't hurt because they're long. if they were short they'd stab him like they stabbed hal (not mine, yours. nevermind.)

the bleeding is the same as it was without the pill- heavy and long. but since that's normal for me i don't think it would be fair to blame paragard.
i like that it can carry me right into menopause without the real commitment of never having any more children. i don't want any more but i also don't like to be told that i CANT do something so this is more like my choice and i can change my mind. i'm crazy like that.
my word is dooffes. i'm a dooffes.

Anonymous | 7:51 AM

I am 51 years old and had my tubes tied at 23 after my second child was born. We have a daughter and a son and our family was complete. We have never regretted it and I never had any complications. For us, it was the right decision and it meant a lot less worry and hassle on the birth control situation. If you are still nervous and trying to decide, I would probably suggest that you try the IUD first. You can always do the tubal later, if you decide on a more permanent solution. Love your blog!

Giselle Taminez | 5:16 AM

I have one child and used Mirena for 6 years with no problem, now I want another child and have had no luck getting pregnant :( My mother had 4 kids by the time she was your age and when we were in our late teens and she was in her early 40's my dad and her wanted another child and they couldn't. She regrets it. My other friend, also a very young mom had her tubes tied after her 3rd child at 25 and her baby died at 10 months old. She had the surgery reversed and had to go through in vitro to have another child.

Life changes so much...and every child comes when it needs to come. After trying for a baby for almost 2 years and having pregnant so easily the first time around; I know no child is a coincidence and you will have as many kids as it's perfect for you and your family.

Lori | 8:55 AM

Well, I just turned 40 and I have two kids who are 10 years apart in age. My husband and I found out we were pregnant with twins (kids 3 and 4) the day after he had his consultation for a vasectomy. Given our news, he put of scheduling the actual procedure. Fast forward a few months and I had a miscarriage, losing both fetuses. Now that we've done some healing (physically for me, and emotionally for both of us), we're very glad he never got around to getting the ol' snip snip. Before all of this, we weren't planning to expand on our comfortable family of 4, but now we think we may actually want to in the very near future (before my 40 year old eggs implode). You just never know. I'm pretty sure if we are blessed with another child, we'll use ParaGard or some other reversible, non-permanent birth control option.

Joanna | 1:20 PM

I decided I was ready to "close up shop" and looked into getting the Essure procedure. I'd already done the Mirena IUD for 2 years and had some issues with it and was told I couldn't use BC pills anymore due to aura migraines.

During the Essure procedure the OBGYN could only find one Fallopian tube and thought I had a unicornuate uterus and could put the Essure in just one tube if I did indeed only have one. I ended up getting further testing (woo hoo!) to find out that I have a completely, lovely, perfectly developed uterus with 2 Fallopian tubes. That left me with the option of having my tubes tied.

My partner decided to have a vasectomy, bless him. I wouldn't have pressured him into it, either. It was just the sensible choice for us at that point.

LJ | 4:35 PM

i applaud you for not forcing Hal to get a vasectomy. if something (god forbid) were to happen to you and he remarried, he may or may not want to have children with her and add to the love. just saying. it is possibility as much as no one wants to imagine it. it's a big decision to permanently shut down for business.

i have not had children, so i don't have any thoughts pertaining to the best option really. but, i am a woman dealing with infertility. there are obviously contributing causes to this from both my husband and me ( i am 25, he is 30), but whenever someone speaks about permanent birth control, my heart breaks.
i view fertility as a huge gift at this point in my life. don't squander it. treat it kindly. i would give almost anything in the world to be pregnant and not going through the traumatic experiences which surround trying to get pregnant when nature doesn't get you there.

fruitandjuice | 10:23 PM

I am 30 years old, have 4 kids...the last two being twin girls. I had my tubes tied during my c-section with the twins (almost 1 year ago). I haven't had any problems physically, but emotionally I would say it's better to do something less permanent. Believe me, I have my hands FULL and have absolutely no plans to have any more babies, but just knowing I can't bothers me. There are so many other options and you can always go back in later and have your tubes tied. Btw, twins are AMAZING. :)

Lolo | 12:41 PM

Just an FYI, I agree don't pressure Hal but a vasectomy IS reversible whereas tube tying is NOT.

Lolo | 12:45 PM

Just an FYI and I admit I didn't read the other comments first to see if someone already mentioned this but... a vasectomy IS reversible, whereas tube tying is NOT. I support you in not pressuring Hal but he is older and it is something to consider, he has the capability of opting out, you, on the other hand, DO NOT.

Lolo | 12:53 PM

I will also mention, pressure sucks but you are the one that has to take all the hormones to prevent pregnancy, you are the one that has to go through the childbearing. I think these are all sacrifices we don't have the freedom of choice in, maybe the husband should bite the bullet and make his sacrifice, especially since he can reverse it later if he wants.

Jess | 6:04 PM

So, I'm a little bias. I've tried just about everything on the market that a migraine sufferer who can't take estrogen. period. can try. Suffice to say, I hated the Mirena also, hated the shot given its side effect re osteoprosis, reacted to hormonal controls entirely in the end and ended up on the Copper IUD. And ended up preggers on it twice. Not to be a downer, but seriously, the 99% is clearly a bluff if your as fertile as you, well, are. We're not at the close up shop permenatly place yet, and agree its a big decision. If your certain your done, and expressing as much concern as you have about living life with 4 babes, then maybe tubes are the right path for you, if not Hal.