The reports from India read more like the review of a horror movie rather than a detailing of a government funded surgical program: 83 women receiving a surgical sterilization leaving 11 dead and another 50 hospitalized, 20 of whom (as of this posting) are seriously ill. And all of this happened in six hours with one surgeon at a government sponsored sterilization camp.
As an OB/GYN I want to tell you how bad this actually is.
The most common method of tubal ligation is by laparoscopy, which is major surgery. An operating telescope is placed into the belly and a clip is placed across the Fallopian tubes to clamp them shut. Sometimes doctors remove the Fallopian tubes or burn them. The biggest risk from the surgery is inadvertently injuring the bowel (spilling stool leading to potentially catastrophic infection, bleeding, and even death), cutting a blood vessel (resulting in uncontrollable bleeding), and infection (from non bowel injury causes). There is also risk from the anesthesia. Patients are counseled about warning signs of these complications so they can get care sooner rather than later should a problem arise.
With competent surgeons, anesthesiologists, and nurses and clean hospitals the risks of laparoscopic tubal ligation are low. In one study of over 9,000 tubal ligations in the United States there was one serious complication and no deaths. Using a more liberal definition of serious complication the rate rose to 1 percent. A Swiss study indicates no deaths in a review of more than 27,000 procedures. Overall, the estimate is that 1 to 2 women will die for every 100,000 laparoscopic tubal ligation with most deaths anesthetic related. Basically, 99 percent of healthy women should expect to have no major issues beyond a day or two of recovery and for the women who do have major complications most involve getting a larger surgical incision and immediate repair of the damage with no long-term issues.
The other method of tubal ligation is done through the uterus and called a hysteroscopic tubal ligation. This can be done in the office (and takes about 20 minutes start to finish versus 40 minutes for a laparoscopic tubal ligation), saving the risk of the anesthesia. It is also less expensive. The risk of injuring blood vessels and bowel is still there (if the device is inserted incorrectly it can puncture the uterus and potentially cause bleeding/bowel injury/and infection), but studies tell us that the complication rate is likely lower than a laparoscopic tubal ligation.
It is likely the women in India had laparoscopic tubal ligations as the procedures are described in the press as “tubectomies” (impossible to do through the uterus).
That is why 11 deaths and 50 women hospitalized with 20 seriously ill is so appalling. A mortality rate of 13 percent for a procedure that should have a mortality rate of 0.001 to 2 percent.
83 tubal ligations in 6 hours and reportedly one surgeon and one or perhaps two assistants is nothing short of a horror show. It takes an average of 40 minutes to give a women an anesthetic, clean her belly, insert the instruments, clip the tubes, make sure nothing is injured, remove the scope, sew or glue the incisions, reverse the anesthetic, and get her off the operating table. It is possible, if everything is going smoothly and there are no complications, to sometimes have this done in 20-30 minutes. Even if there were 3 surgeons, 83 women in 6 hours is impossible unless of course hands were not cleaned and dirty instruments were just stabbed into bellies. The thought that the women may not have had adequate (or even any) anesthesia makes it even more horrifying. How could they given what has been described?
That the government funded this horror show is terrible. That a doctor was involved with this makes it even worse. Agreeing to such a perversion of health care is an abomination — 83 women simply can not have tubal ligations in 6 hours even with 3 competent surgeons and 3 anesthesiologists in a modern hospital never mind in a field. Understanding that doesn’t require a medical degree, just common sense and compassion. Money was offered to the women increasing an element of coercion. How many were forced by their families to go?
Government quotas for sterilization don’t empower women to make better decisions for themsleves and their families they only treat women like livestock. Or worse.
Jennifer Gunter is an obstetrician-gynecologist and author of The Preemie Primer. She blogs at her self-titled site, Dr. Jen Gunter.
