Postpartum Tubal Ligation (PPTL)

Postpartum tubal ligation is a procedure to close the fallopian tubes. This is done so that you cannot get pregnant. When the fallopian tubes are closed, the eggs that the ovaries release cannot enter the uterus, and sperm cannot reach the eggs.

PPTL is done right after childbirth or 1–2 days after childbirth, before the uterus returns to its normal location.

PPTL is sometimes called “getting your tubes tied.” You should not have this procedure if you want to get pregnant someday or if you are unsure about having more children.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Previous problems you or members of your family have had with the use of anesthetics.
• Any blood disorders you have.
• Previous surgeries you have had.
• Any medical conditions you may have.
• Any past pregnancies.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Injury to surrounding organs.
• Side effects from anesthetics.
• Failure of the procedure.

This procedure can increase your risk of a kind of pregnancy in which a fertilized egg attaches to the outside of the uterus (ectopic pregnancy).

What happens before the procedure?

• Ask your health care provider about:
  • How much pain you can expect to have.
  • What medicines you will be given for pain, especially if you are planning to breastfeed.
• Follow instructions from your health care provider about eating and drinking restrictions.

What happens during the procedure?

If you had a vaginal delivery:

• You may be given one or more of the following:
  • A medicine that helps you relax (sedative).
  • A medicine to numb the area (local anesthetic).
  • A medicine to make you fall asleep (general anesthetic).
  • A medicine that is injected into an area of your body to numb everything below the injection site (regional anesthetic).
• If you have been given a general anesthetic, a tube will be put down your throat to help you breathe.
• An IV tube will be inserted into one of your veins to give you medicines and fluids during the procedure.
• Your bladder may be emptied with a small tube (catheter).
• An incision will be made just below your belly button.
• Your fallopian tubes will be located and brought up through the incision.
• Your fallopian tubes will be tied off, burned (cauterized), or blocked with a clip, ring, or clamp. A small portion in the center of each fallopian tube may be removed.
• The incision will be closed with stitches (sutures).
• A bandage (dressing) will be placed over the incision.

If you had a cesarean delivery:

• Tubal ligation will be done through the incision that was used for the cesarean delivery of your baby.
• The incision will be closed with sutures.
• A dressing will be placed over the incision.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
• You will be given pain medicine as needed.
• Do not drive for 24 hours if you received a sedative.

Postpartum Tubal Ligation, Care After

Refer to this sheet in the next few weeks. These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After the procedure, it is common to have:

• A sore throat.
• Bruising or pain in your back.
• Nausea or vomiting.
• Dizziness.
• Mild abdominal discomfort or pain, such as cramping, gas pain, or feeling bloated.
• Soreness where the incision was made.
• Tiredness.
• Pain in your shoulders.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not take aspirin because it can cause bleeding.
• Do not drive or operate heavy machinery while taking prescription pain medicine.

Activity

• Rest for the rest of the day.
• Gradually return to your normal activities over the next few days.
• Do not have sex, douche, or put a tampon or anything else in your vagina for 6 weeks or as long as told by your health care provider.
• Do not lift anything that is heavier than your baby for 2 weeks or as long as told by your health care provider.

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures) in place. They may need to stay in place for 2 weeks or longer.
• Check your incision area every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Other Instructions

• Do not take baths, swim, or use a hot tub until your health care provider approves. You may take showers.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have more redness, swelling, or pain around your incision.
• Your incision feels warm to the touch.
• You have pus or a bad smell coming from your incision.
• The edges of your incision break open after the sutures have been removed.
• Your pain does not improve after 2–3 days.
• You have a rash.
• You repeatedly become dizzy or lightheaded.
• Your pain medicine is not helping.
• You are constipated.

Get help right away if:

• You have a fever.
• You faint.
• You have pain in your abdomen that gets worse.
• You have fluid or blood coming from your sutures.
• You have shortness of breath or difficulty breathing.
• You have chest pain or leg pain.
• You have ongoing nausea or diarrhea.