Kelsey Silverstein made the big decision to get her tubes tied at the age of 24, and now she’s opened up about the process.

Kelsey Silverstein had been adamant that she didn’t want children ever since she was a teenager. As a result, she approached her doctor in the hopes of having her tubes tied and preventing any unwanted pregnancies. However, Silverstein had little idea of how hard getting a female sterilization would be.

Once upon a time, having children was simply a fact of life for most people. It was expected that adults who were able to produce kids would have them. Consequently, it became a societal expectation for them to want to reproduce. But in recent years, it seems that more and more individuals are opting out of parenthood.

In 2019 official government figures in the United States confirmed that birth rates had fallen to their lowest level in more than three decades. Some 3,788,235 babies had been born across the nation during 2018, which represented a two percent decrease from 2017. Furthermore, the fall was part of a larger ten-year trend that had continually seen fewer births year on year.

In 2018 the general fertility rate in the U.S. worked out at 59 births per 1,000 women between the ages of 15 and 44. This was an all-time low for the country. And – for a bit of context – it meant that fewer babies were born in 2018 than even during the period that followed the Great Depression.

America’s declining birth rate could be partly due to the changing roles of women in society, of course. As a result, many females aren’t getting married or trying to have children until later on in life, when they may not be as fertile. And then there’s a growing number of women who are choosing not to have kids at all.

In fact, U.S. Census Bureau figures for 2014 showed that a record number of women weren’t mothers. That’s because 47.6 percent of females within the 15 to 44 age bracket had no children. There were many reasons why women were choosing not to procreate, and they ranged from the financial to the environmental.

With that in mind, this trend of child-free females looks set to continue. Nonetheless, some women who’ve chosen not to procreate have found it difficult to be open about their decisions. And often, females who’ve opted out of motherhood have discovered that their personal choice sometimes sparked public debate.

One woman who knows that all too well is Kelsey Silverstein. She lives in Nashville, Tennessee, with her spouse Mark Donoher, and neither of them want to have children. However, despite Silverstein’s determined attempts to ensure she would never accidentally conceive, she encountered difficulties when trying to secure control of her own body.

Silverstein was a teenager when she started to believe that she didn’t want to become a mother. Even at her young age, she worried about the task of raising children and whether she was cut out for it. However, Silverstein put these doubts to the back of her mind and got on with her life.

Then, when Silverstein was 18, she learned about tubal ligation. Also known as female sterilization, the relatively simple process involves the clipping, tying or even removal of the fallopian tubes. As a result, it provides women with a solution for avoiding pregnancy.

While having your tubes tied might sound like an extreme contraception method, it’s actually very common. In fact, the American College of Obstetricians and Gynecologists states that tubal ligation is the most prevalent type of birth control across the planet. Furthermore, more than one in eight females between the ages of 15 and 44 have undergone the procedure, according to the Centers for Disease Control and Prevention.

Dr. Donna Mazloomdoost is an executive at Bethesda, Maryland’s Eunice Kennedy Shriver National Institute of Child Health and Human Development Pelvic Floor Disorders Network. Explaining tubal ligation to Today in June 2019, she said, “It is a surgical way to basically occlude or prevent an egg from getting fertilized by sperm.”

“It is the most common birth control worldwide and the most common single form of birth control that people use,” Mazloomdoost continued. However, she did acknowledge that the procedure does differ from other contraceptive methods. Why? “It is permanent,” the doctor explained.

Tubal ligation can be completed in a number of ways. However, all of the methods used in the procedure work in the basic same manner. They serve to create an obstruction from scar tissue in the fallopian tube. This in turn stops eggs from travelling into the uterus where they can be fertilized. What’s more, the surgery isn’t very invasive.

So, when Silverstein learned about tubal ligation, she was sold. The 18-year-old subsequently requested to undergo the procedure during a routine appointment with her doctor in Connecticut. However, the medic declined her request. Silverstein would later open up about this disappointing reaction in a self-penned piece for Today in June 2019.

“I asked if I could have a tubal ligation, a permanent way of preventing pregnancy by blocking, clipping, removing or tying the fallopian tubes,” Silverstein wrote of the appointment. “She quickly refused. She said I was too young and it was a procedure reserved for women in their 30s or 40s, who had at least two children and knew they were done having children.”

And Silverstein’s doctor wasn’t the only person not to take her requests for tubal ligation seriously. In another piece Silverstein penned for Love What Matters, she revealed, “Everyone in my life told me I’d change my mind about not wanting kids. However, I didn’t want to run the risk of being stuck with a child I wasn’t prepared for and not having a way out.”

But while Silverstein’s request for a tubal ligation had been flat out refused, she didn’t give up on her quest for female sterilization. Instead, she repeated her plea to undergo the procedure at each one of her regular exams with her OB-GYN until she reached the age of 21. Every time, however, her doctor declined.

With her attempts to obtain tubal ligation going nowhere, Silverstein was forced to rely on the Pill for birth control. But this wasn’t ideal. “When I became sexually active, I felt constant worry,” she told Today. “If my period was even a little bit late, I rushed to the grocery store for a pregnancy test – just to be sure. I fretted about becoming accidentally pregnant and needing an abortion.”

Moreover, as Silverstein struggled to control her fertility in a way she felt was practical, her views on parenthood became even more defined. “As I aged, my thoughts evolved and I knew I never wanted children,” she explained. “I did not feel maternal and if I did change my mind, I could always adopt.”

And it seemed that Silverstein had some reasonable arguments as to why she didn’t want children of her own. “With so many people straining the planet’s resources, it felt irresponsible for me to bring another life into the world,” she said. “And I have a family history of illnesses such as depression and Parkinson’s disease that I did not want to pass onto a child.”

Silverstein feelings towards motherhood were further cemented when she met her husband Donoher. He, too, was open about the fact that he had no desire to have children. And so Silverstein’s eagerness to undergo tubal ligation grew. Moreover, the situation became even more urgent when she turned 24.

It was then, following her move to Nashville, that Silverstein realized that she wouldn’t be covered for much longer under her parents’ health insurance plan. She was self-employed and facing the prospect of having no cover at all. As a result, she went to her new OB-GYN with a demand. “I told her I wanted a tubal ligation before being without health insurance,” Silverstein revealed.

Rather that immediately dismissing Silverstein’s request for tubal ligation as her previous doctor had done, this new OB-GYN at least seemed open to a discussion. However, she asked to meet with Silverstein’s husband in order to see if he would give his “permission” for the procedure. And, unsurprisingly, asking for her Donoher’s blessing to undergo sterilization didn’t sit well with Silverstein.

In her Love What Matters piece, Silverstein explained, “I was stunned that as an adult woman I needed my husband’s blessing to make decisions about my body. Yes, I believed it was important my husband and I be on the same page, but my body is my body. Why did a man have to approve of my choice to make it valid?”

But with her doctor at least seeming to entertain the idea of a tubal ligation, Silverstein must have felt like she was closer to receiving a sterilization than ever before. And so she agreed to bring Donoher in for a consultation. Nonetheless, she was still frustrated that she needed to obtain her husband’s permission. “Mark wasn’t the one who could get pregnant,” she pointed out.

In addition, before returning to her OB-GYN, Silverstein wanted to be sure that tubal ligation was the right choice for her. “I went home and wrote a pros and cons list, including all my concerns and the benefits of having permanent birth control,” she revealed. “As I read it, I felt more confident that permanent birth control was right for me.”

So Silverstein returned to her doctor with her husband Donoher in tow, confident about her decision to undergo sterilization. However, that’s when her OB-GYN suggested that it might be a better option for the couple for Donoher to have a vasectomy. To Silverstein, however, it felt like the doctor was missing the point. Because all she wanted was to have control over her own body.

“I plan on being with Mark my entire life,” Silverstein explained to Today. “But what if I’m raped and become pregnant? Or what if something happens and I can no longer be with him? Having a tubal ligation was something that would help me feel more comfortable in my body.”

With that in mind, the doctor was unable to steer Silverstein away from tubal ligation and towards a vasectomy for her husband. But despite her clear determination, Silverstein still had some way to go before being granted access to the procedure. Aside from gaining her husband’s blessing, she stated that she’d adopt if she ever experienced a change of heart about motherhood in the future.

Only then was Silverstein finally permitted to receive tubal ligation surgery. Revealing this breakthrough in her piece for Today, Silverstein wrote, “I underwent the outpatient, minimally invasive procedure, where my doctor clipped my tubes to permanently prevent pregnancy.”

Silverstein’s account makes the tubal ligation procedure sound easy. Especially when you consider the difficulties she had in obtaining a sterilization in the first place. But it would be easy to wonder whether Silverstein glossed over the realities of the operation simply to spare her readers from any gory details.

However, according to Dr. Mazloomdoost, tubal ligation really is quite straightforward in the majority of cases. “For most women it is pretty quick,” she explained to Today. “You can probably go back to normal daily activities in the next day… I would still say most clinicians would agree that a tubal ligation is a safe method of contraception… The risks are immediate, not long-term.”

Moreover, according to the Centers for Disease Control and Prevention, failure of tubal ligation occurs in just 0.5 percent of cases. With that in mind, accidental pregnancy is still a long-term risk of the procedure, albeit a limited one. Furthermore, a low number of those who fall pregnant after sterilization will have potentially dangerous ectopic pregnancies.

Image: Jose Luis Pelaez Inc/Getty Images

Another complication that can occur following tubal ligation is for the patient who underwent the procedure to change their mind and want children. While the operation can be reversed, a person’s suitably for this depends on a number of factors. In addition, the reversal procedure is considerably more invasive than female sterilization.

A few years on from her own tube-tying operation, Silverstein was happy to report to Today that she had “no regrets.” However, she did admit that she’d initially struggled to open up about the procedure. “I hesitated to share that I had undergone tubal ligation surgery. It felt so dirty,” Silverstein said.

In the piece that Silverstein penned for Love What Matters, she revealed why she’d felt ashamed about having her tubes tied. “The hospital made me feel this way after refusing to perform on me because of their own religious beliefs, despite [the fact] that vasectomies could be performed there,” she explained. “I was sent to a different hospital for the operation.”

“There seems to be a taboo when women admit they do not want to have children,” Silverstein continued. “But I enjoy life as it is. Mark and I love spending time with our three adopted dogs and I look forward to the day when I can be an aunt and spoil nieces and nephews – and then send them home.”

And through sharing her experience of getting her tubes tied with the world, Silverstein finally felt vindicated in her decision. Writing on Facebook in June 2019, she stated, “Aside from it just being fun to get my five minutes of fame, this whole experience has been so beyond moving!”

“For three years I held in this secret from friends and family, afraid of being shamed for making this decision [about] my body,” Silverstein added. “And for the first time in a long time I feel how I felt when I initially made the decision, EMPOWERED! Empowered that I made a responsible choice about my life and fought like hell to get what I knew I needed!”