Tubal ligation in Catholic hospitals:
A qualitative study of ob–gyns’ experiences

Scripps Mercy Hospital

In our recently published qualitative study, obstetrician-gynecologists who work in Catholic hospitals say that not being able to perform a post-partum tubal ligation (sterilization procedure) is a major frustration that gets in the way of good patient care. It’s frustrating because hospital religious policy mandates that physicians cannot give the patient what she wants and needs, despite their own medical judgment. One doctor we quoted in the article explains,

“If you’re doing a C-section on somebody that wants a tubal and has had six other previous C-sections and, you know, if I tie her tubes I’m going to get kicked off the staff. And I just don’t think that’s right.”

There are certainly other issues that physicians were concerned about—in our interviews, doctors discussed obstetric complications that Catholic employers did not allow them to manage according to standard medical practice. Assisted reproductive technologies, such as IVF, also came up among ob-gyns who were trained to offer infertility treatment but had to work around Catholic prohibition on this care.

But the denial of medically indicated sterilizations at Catholic hospitals was such a common recurring theme in our interviews that we decided to dedicate a paper just to this topic. Many respondents told us that Catholic directives prevented tubal ligations even when a woman was already undergoing a cesarean section or when the harm to her from a future pregnancy would be grave, and doctors found this medically egregious.

Why do doctors object to Catholic directives preventing tubal ligations?

Nearly half of American women rely on sterilization to end their childbearing. Sure, we have more reversible tools women can use such as IUDs, implants, and other forms of contraception (which are also prohibited in Catholic hospitals), but the uptake is slow and access is spotty. To date, about 1 in 10 childbirths end with an in-hospital sterilization which is, if you are already in the hospitals and having surgery, an extremely simple, safe, and effective procedure. There is really no excuse for requiring a woman to go through the risks of surgery twice, when only once is necessary. Another physician recounted a case,

“It was her fourth c-section and she wanted her tubes tied… We had her scheduled to be at the other hospital so we could do her c-section and tie her tubes. But when she came in in labor before that time, then she came into the Catholic hospital, which was our primary facility, and she couldn’t get her tubes tied… it felt really stupid.”

In certain situations, where women have many health problems and difficulty accessing care, denying the procedure surpasses “stupid.” It can be extraordinarily distressing. Our article tells the story of one such denial in detail. The doctor recounts her patient begging, “‘I can’t go through another procedure. Look at me.’ And I…couldn’t have agreed with her more and I told her that. And I just kept apologizing.”

Those of us in the fields of reproductive health, rights, and justice may be accustomed to concerns about the way sterilization can be pushed upon women—which is a real problem worthy of our attention and activism! But between Medicaid-related barriers and the growth of Catholic health systems, an equally troubling trend is women being denied a desired sterilization. Women who have decided they are done having kids and are in the hospital anyway are regularly told they will need to go to a different facility months later if they want their tubes tied. Among women denied tubal sterilization at the time of delivery, one study showed that half had an unintended pregnancy again within a year.

Why do concerned doctors take jobs in hospitals with religious restrictions on care?

Many wonder, if doctors are so concerned, why they take jobs in hospitals with religious restrictions on care. Some providers are taken by surprise when their hospitals are bought by large Catholic health networks. Others indicated that Catholic hospitals may have been more lenient at the time they originally decide to work there and have since changed.

“It was apparently bishop by bishop, and the bishop in [my city] was fairly liberal…15 years ago…[if a woman was] at risk for having diabetes in the next pregnancy, that’s reason enough. And they would let them do [a tubal ligation]. But then the bishop became much more conservative and the diocese became much more conservative and it’s absolutely never allowed.”

National data show that 52% of ob-gyns working in Catholic hospitals had conflicts with their hospital policies. We are getting a clearer and clearer picture of what lies behind that statistic and what the implications may be for women.

Photo courtesy of Walleigh via Wikimedia Commons

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Comments
  • TB:

    it’s very simple, find a doctor who practices at only non-catholic hospitals and you neither the patient or physician will have any issues.

  • Lori Freedman:

    If only it were that simple… But in some areas there are few non-Catholic hospital options. Some people have health insurance that ties them to Catholic health care. And many people don’t quite understand how religious ownership affects care, especially if their physicians are not very explicit early in prenatal care. Check out some background info: http://www.mergerwatch.org/mergerwatch-news/2013/12/18/rise-in-catholic-sponsored-hospitals-threatens-womens-health.html

  • RR:

    In the case of the C-section tubal, requiring the patient to have a second surgery when the tubal could be easily and safely incorporated into the C-section surgery isn’t “really stupid.” It’s unethical. It exposes the patient to addition pain, an additional incision, and the risk of harm from another surgery and anesthetic, for no medical reason. To be clear, the ethical problem lies not with the OB/gyn, who wants to do the right thing for his/her patient, but with the powers that be that prohibit the procedure.

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