Hospital change limits contraceptive procedure

April 28--When Walla Walla General Hospital closes its birth center on June 30, it will leave more than one gap in community health care.

In addition to the loss of three WWGH obstetricians and one less location to have a baby, women wanting tubal ligations immediately after delivering a baby will have limited options.

The remaining birthing center in Walla Walla, at Providence St. Mary Medical Center, does not offer postpartum tubal ligations upon patient demand due to the Catholic hospital system's religious directives regarding contraception.

Postpartum tubal ligations have been endorsed by the American College of Obstetricians and Gynecologists as one of the best methods of birth control.

Data from January to June of 2015 shows WWGH doctors performed 13 postpartum tubal ligations, also referred to as having one's "tubes tied." A total of 18 tubal ligations, postpartum or later on, were done in that time span, said WWGH spokeswoman Amy Alderman.

The hospital will still do the surgical procedure, but not in the "one stop" process it has been offering, she added.

Walla Walla Clinic also offers tubal ligations at its outpatient surgery center, said chief executive Kevin Michelson.

Higher-risk patients have historically been sent to WWGH for the procedure and that option will continue. But obstetricians there prefer to wait six to eight weeks after delivery to perform a tubal ligation to reduce the risk of hemorrhaging and increase the likelihood of success, he added.

Although the Clinic's obstetricians used to offer patients the convenience of having the 30-minute operation done in the hospital following a birth, "medical evidence indicates a higher failure rate for tubal ligations performed immediately after delivery," Michelson said, adding that the Clinic's position is that "postpartum" can indicate a time beyond delivery.

The American College of Obstetricians and Gynecologists, however, takes a different stand.

"Postpartum tubal sterilization is one of the safest and most effective methods of contraception," said ACOG spokeswoman Kate Conners.

The surgery is performed after 10 percent of all hospital deliveries, particularly among women with lower levels of income and education, black and Hispanic women and those with government health insurance or no insurance at all, Conners said, citing a 2012 ACOG committee report that was renewed in 2014.

Women who wanted a tubal ligation but did not get one have a repeat pregnancy of nearly 50 percent within the following year, the report said.

"Given the consequences of a missed procedure and the limited time frame in which it may be performed, postpartum sterilization should be considered an urgent surgical procedure," the authors wrote.

"It's easier to do postpartum tubal ligations than in a separate visit," Connors said, pointing out no matter the delivery method, a sterilization done at that time is less invasive and technical.

"For all these various reasons, we support it, " she said.

Michelson said that between the city's two hospitals and the Clinic's surgery center, the Clinic's obstetricians do approximately 60 such procedures a year.

"In some cases, it may be best for the patient to have the procedure performed at the time of caesarean delivery. St. Mary has been accommodating when such a need has arisen in the past," Michelson said.

Providence St. Mary Medical Center said in a statement that doctors acting as providers at St. Mary are expected to follow the hospital's ethical and religious directives, as well as sound medical practice.

"These situations and the best course of treatment are assessed on a case-by-case basis," St. Mary spokeswoman Kathleen Obenland stated.

Colleen Wadden, spokeswoman for St. Mary's parent group, Providence Health & Services in Renton, Wash., said in an email today there are medical instances where postpartum and other tubal ligations are performed at St. Mary.

She provided no further clarification on the hospital system's ethical and religious directives. Data for how many of the sterilization procedures were done in 2015 was not readily available, Wadden said.

Sheila Hagar can be reached at sheilahagar@wwub.com or 526-8322.

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