Losing treatment creates “unnecessary risk” for patients, doctors say
Mercy Hospital in Durango, the only hospital with obstetrics and childbirth services within a 45-mile radius, plans to phase out tubal ligation, a sterilization procedure for women, by spring next year because the procedure is inconsistent with Catholic values, according to a Durango gynecologist says she has been informed of the new policy.
Brie Todd, a gynecologist at Four Corners OB/GYN, an independent clinic that provides birthing and delivery services at Mercy, said the clinic had an Aug. 15 during a meeting with Mercy CEO Patrick Sharp and Rev. Augustine Nellary Received formal notification, Director of Mission Integration at Mercy, that the hospital will end female sterilization on April 15 for almost all.
“We have previously been able to perform a caesarean section sterilization for a woman who had given birth and had a medical reason not to have more children,” she said.
Beginning April 15, women at Mercy will no longer be able to tie off tubes for contraceptive reasons, socioeconomic reasons, or medically life-threatening reasons, she said. The only exceptions are for the few people who carry rare ovarian cancer or breast cancer genes, she said.
Neither Mercy Hospital nor its parent company Centura Health responded to requests for comment this week or last week.
Todd said Four Corners OB/GYN physicians disagreed with Mercy’s decision to remove the usual form of birth control from his services because there were valid medical reasons to prevent pregnancy.
“Let’s say someone has a serious heart condition or kidney condition that would put her life at risk if she were pregnant again. And we would recommend that she would not have any future children. But this (new policy) would not allow us to continue with this operation,” Todd said.
Mercy’s change of course would also force people to undergo two surgeries when seeking sterilization after a cesarean, Todd said.
She said that a tubal ligation performed at the time of a cesarean section takes only five minutes. The procedure involves removing part of the patient’s fallopian tube and results in permanent sterilization.
“That’s being taken away now,” she said.
dr Krista Ault, a general practitioner at La Plata Family Medicine and former director of family medicine at Mercy, said some forms of birth control, like vasectomies, are banned while the hospital is owned by Centura Health.
But during Ault’s tenure at Mercy from 2014 to 2020, doctors were allowed to prescribe patients other forms of birth control, such as IUDs and birth control drugs — as long as they didn’t directly say it was for birth control.
“Basically, if you needed to give someone birth control they could, but it was kind of an unwritten law that if there was a medical reason besides the need, you should probably code it as ‘painful period’ or ‘endometriosis’ or something birth control,” she said.
She added, “There’s never been a woman who hasn’t had a painful period.”
She learned about the sneaky birth control method during her onboarding process at Mercy, she said.
Ault described herself as a “huge supporter” of women’s rights and was “pleasantly surprised” to learn that Mercy performed a tubal ligation before starting work there. She wanted to be sure that she could offer contraception if a patient needed it.
Effects of refusing tubal ligation at the time of cesarean section
About 50 people underwent tubal ligation immediately after a cesarean in Mercy’s ER by Four Corners OB/GYN in 2021, Todd said.
If Mercy abolishes female sterilization, as Four Corners OB/GYN doctors have been told, a mother wishing to have her tubes tied after a cesarean would first have to recover from the surgery (typically a six-week process) and make an independent decision find opportunity to handle the tubal ligation procedure, undergo another dose of anesthesia, and undergo another surgery, she said.
Todd said the process would be cumbersome for a patient and would be particularly harmful to people of lower socioeconomic status and those with restrictive insurance policies.
“We know that the best way to prevent unwanted pregnancy is to use good birth control. That limits that,” she said.
She added that despite Mercy’s “great birthing and delivery services,” asking a patient to have a second surgery puts this woman’s health at unnecessary risk.
Ault shared similar feelings.
“Normally you take a young, healthy woman and put her under anesthesia a second time if there’s no earthly purpose for it,” she said. “The costs involved, the medical risk involved. And that means imposing your religious beliefs on another individual.”
During the September 10 Pride Festival at Buckley Park, Durango woman Katie Stewart said: “Even though we have codified abortion rights, people with wombs still do not have full access to their reproductive health care.”
The mother-of-five, including one adopted, said a tubal ligation saved her life after the birth of her youngest child. Almost all of Stewart’s four pregnancies were complicated in one way or another, she said, and she required a cesarean section for each birth.
After the second birth in 2011, one of her doctors encouraged her to have a tubal ligation. At the time, the proposal seemed very “final” and she decided against the procedure.
After having another child, she and her husband decided that they were done having children. But in 2015, Stewart took a pregnancy test, which came back positive.
This pregnancy wasn’t like most pregnancies, she said. She had hypertension, abnormally high blood pressure, and the pregnancy was taking its toll on her body.
“As my pregnancy progressed, it became increasingly difficult for me,” she said. “About 32 weeks my body really started to shut down. A typical pregnancy lasts 40 weeks. I was about eight weeks away from a full term pregnancy.”
Their fourth child was born prematurely and spent its first week in Mercy’s NICU. Before her fourth and final cesarean, Stewart undertook the tying off of her tubes. And because Mercy is a Catholic hospital, she needed a priest to sanction it, she said.
Stewart said she didn’t think she could have traveled to another hospital for a cesarean at the time of her fourth and final pregnancy. She saw her doctor weekly about her deteriorating health, she said.
“Having to travel 60 miles to get obstetric care is just mind-blowing,” she said.
It would also have been difficult to endure another surgery after recovering from the most grueling pregnancy she had experienced.
“When I think about my recovery period, it was my fourth cesarean and I was in a lot of pain for months,” she said. “I had a really hard time recovering. I struggled with postpartum depression dealing with how difficult the pregnancy was. And my son was in the NICU. It’s a tough road anyway.”
She added, “Everyone should have access to life-saving healthcare.”
The decision, reported by Mercy, comes at a time when reproductive freedoms are under scrutiny at federal and state levels across the country. Coloradans may take comfort in codified contraception and abortion rights under state law, but governments are not the only institutions that can grant or prevent access to sometimes life-saving procedures.
Colorado’s Reproductive Health Equity Act, which went into effect April 4, protects the right to contraception and abortion from public encroachment prompted by the US Supreme Court’s June decision overturning federal protections provided by the Roe v. Wade judgment of 1973. But the new state laws do not affect the private and non-profit sectors.
Todd, who was one of Stewart’s doctors during some of her pregnancies, announced in an email The Durango Herald, “Overall, Four Corners OB/GYN physicians work well with Mercy Regional Medical Center. I feel like we are providing excellent care to our mothers and babies.”
doctors and religion
Mercy is owned by Centura Health, a Catholic non-profit organization, which in turn is owned by CommonSpirit Health, one of the largest Catholic healthcare systems in the United States.
Todd said Mercy’s “course correction” in policy came from the “Ethical and Religious Guidelines for Catholic Health Services,” the sixth edition of which was developed in 2018 by the US Conference of Catholic Bishops.
Specifically: “The direct sterilization of males or females, whether permanent or temporary, is not permitted in a Catholic health facility. Procedures that induce infertility are permissible if their direct effect is to cure or alleviate an existing and serious medical condition and simpler treatment is not available.”
Todd said, “I read that and I’m a little confused because there’s this specific part of ‘An Easier Treatment Is Not Available’.”
Performing the sterilization procedure at the time of a cesarean is the simpler treatment — not having to have surgery twice, she said.
Todd said that a woman’s reproductive decisions should be hers alone and that another’s religious beliefs should have no bearing on those decisions.