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First Person

Sterilization was my choice. It felt like everyone else’s.

What it really takes to gain full control of your reproductive rights

By Megan Koester

“So…no more babies, eh?” the nurse asked, grinning as he inserted my IV.

“Indeed,” I replied. “No more babies.”

“How many babies do you have?”

“No babies. Zero.”

His smile vanished.

He finished his task in uncomfortable silence. Point taken — he didn’t approve of the tubal ligation surgery I was about to undergo. Not that I needed his approval. The decision was mine alone. But was I sure I wanted to be sterilized?

One after another, they’d approached my hospital bed — the doctor, the anesthesiologist, the woman clutching a handful of consent forms — and asked something to the effect of, “You know this means you won’t be able to have kids, right?”

When I awoke the morning of my surgery, the thought had occurred to me: What if today was the day I changed my mind? The idea seemed absurd, comically beyond the realm of possibility. It was.

I’d never dreamed of being a mother. Whenever I’d dreamt about children, which was infrequently, it was always in the context of a nightmare. Place one in a room with me and I feel ineffably uncomfortable, unable to play, paranoid I’ll somehow injure them.

I’m in the waning years of my fertility. Yet still, it was assumed I would be riddled with remorse as soon as the deed was done.

As a result, I’d never wanted to be fertile. In fact, I always believed infertility was one of the only things I had going for me. A doctor told me I couldn’t have children when I was about 18, and for the entirety of my adult life I had operated as though my body was blissfully incapable of reproduction. That proved false a week before my 35th birthday.

A 99-cent store pregnancy test informed me I was pregnant. But can one really place 100 percent trust in a pregnancy test purchased from the 99-cent store? I decided I needed a second opinion, the opinion of one of those bourgeois tests you see advertised on television, with spokespeople who are actually excited when the tests turn out positive, which mine did. Brakes squeaking as I pulled out of the garage to buy such a test, I looked in my rearview mirror to where a child would sit, were I to have one. There are no seat belts in the back seat of my car. It was one of the myriad reasons why it was not a good idea for me to have a child. So I didn’t.

The abortion was draining, both emotionally and physically. I never wanted to be placed in that position again. So I decided to seek a permanent solution. Tubal ligation is just that — a permanent, effective way to prevent pregnancy in the form of a one-time, non-invasive outpatient surgery. Unlike pills, patches, shots, and IUDs, it’s non-hormonal. And unlike a hysterectomy, it leaves your reproductive system in place. It’s the most common form of contraception used by married couples, with 700,000 procedures performed each year.

Tubal ligation is, like any elective surgery, relatively easy to obtain when you have private insurance, and especially easy to obtain when you’ve already given birth. It’s significantly less so when, like me, you’re nulliparous (a delightfully clinical word for a woman who’s never given birth) and on public assistance — a parable for how much more difficult everything is when you’re poor.

Under the Affordable Care Act, women on Medicaid, which I am, should be allowed sterilization if they’re over 21 and of sound mind. But many doctors choose to ignore the law for moral or religious reasons, in much the same way a handful of pharmacists choose not to dispense birth control. Nulliparous women who request sterilization are often offered IUDs instead, even though they’re less effective, must be inserted and removed at regular intervals, and can have negative side effects.

Hearing my friends talk about what they’d suffered on birth control over the years riddled me with fear. They’d spent their entire reproductive lives jumping from option to option, dodging side effect after side effect. I failed to see the point of potentially opening myself up to this litany of horrors.

So I waited months for my sterilization consultation, only to ultimately have a nurse declare she’d “advocate for me,” pleading my case in the hopes one of the doctors on staff would agree to perform the surgery.

The most commonly given reason for denial is that a woman is too young, but studies show that 80 percent of women younger than 30 don’t regret their decisions to be sterilized. I’m, well, older than 30, in the waning years of my fertility. Yet still, it was assumed I would be riddled with remorse as soon as the deed was done. Even the (female) doctor the nurse successfully advocated to on my behalf felt the need to make sure I was sure.

“How long have you been thinking about this?” she asked in a phone call, the unspoken subtext being, “convince me you deserve this.”

“I don’t know,” I replied, “20 years? Is that good enough?”

During my initial consultation, the nurse offered me an IUD while I waited the requisite 30 days in case — in the hope? — I would change my mind. I declined.

Which is not to say the procedure was a cake walk. I woke up afterward alone and disoriented, writhing in pain while staring at an LED clock indicating two hours had passed. My jaw, throat, and shoulders hurt; I could feel my bones under my skin. The doctor made it seem as though I’d be able to ride a bike again immediately after the procedure. This was not the case.

“Why does my throat hurt so much?” I asked a nurse who finally wandered over to my bedside.

“Because they put a breathing tube in,” she replied.


“So you could breathe,” she sighed.

I was not told a breathing tube would be placed in me while I was under anesthesia. I didn’t expect that eating, sleeping, and walking would be difficult in the days after surgery. But slowly, in more ways than one, I began to feel like myself.

In a world of IVF and egg freezing, in which women’s fertility is routinely extended at any cost, both physically and financially, making a concerted decision to end it is widely seen as, if not insane, at least something one will eventually regret. In the weeks since my surgery, I have not once regretted it. Now I feel normal. I feel like I can breathe again.

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Megan Koester is a writer and comedian based in Los Angeles. 


Illustration by Rose Wong

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