Angela Valavanis was denied a tubal ligation after giving birth to her son two years ago. A new bill in Illinois is intended to prevent such incidents in the future. (Photo: Angela Valavanis)
When Angela Valavanis established her birth plan for delivering her youngest child, she indicated that if a C-section was medically necessary, she wanted to get a tubal ligation at the same time. But, at the last minute, the Illinois mom was denied the sterilization surgery because the hospital where she was delivering was a Catholic institution and policy dictated it couldn’t perform contraceptive procedures — something Valavanis was never made aware of throughout her pregnancy.
“I knew that doctors are allowed to refuse to perform procedures based on religious beliefs, but I didn’t know that an entire institution could just say, ‘No, we don’t do that,’” she tells Yahoo Parenting. She didn’t find out until, after a long and arduous labor, doctors told her she had to have a cesarean section. “I said, ‘OK, and while you’re in there, I’d like to get a tubal ligation.’ The doctor on call told me he couldn’t do that, and I just said, ‘OK, can you get me someone who can?’ It wasn’t until after some prodding that he explained the hospital didn’t perform that procedure.”
Valavanis wanted the procedure because this was her second child, she’d also had two miscarriages, and she didn’t want any more children. Her doctor, who delivered Valvanis’s first child and had seen her through her other failed pregnancies, knew about Valvanis’s desire to get her tubes tied but never told her that because she’d sold her practice to a Catholic health care group, she would no longer be able to perform the procedure — or prescribe contraception.
As Valavanis was getting ready for her C-section, she says the doctor on call told her she could get her tubal ligation elsewhere at a later date. “The idea that I would go through a surgery and six weeks of healing and then go in for a second surgery for this was completely ridiculous to me,” she says. Performing tubal ligations during a C-section, because the patient is already in surgery, is common practice so as to avoid extra, unnecessary operations. “Had I known about all of this in advance, I would have reconsidered my options and likely have gone to a different hospital.”
Two years later, Valavanis has changed doctors — and has chosen to go without the surgery rather than go under the knife another time.
Valavanis’s is one of a number of stories that have inspired the Illinois ACLU to pursue a bill that will require all health care institutions in the state to ensure that patients are informed of the limitations to medical treatment they can receive based on a provider’s beliefs. The bill, which has already passed through the state Senate, is currently pending in the House.
“What we know for a fact is that lots of women aren’t getting the full conversation about their treatment options,” Lorie Chaiten, director of the Reproductive Rights Project at the ACLU of Illinois, tells Yahoo Parenting. “When Angela’s doctor sold her practice, [Angela] was entitled to know that it would limit her choice. She wasn’t told, and as a result she wasn’t able to make an informed decision about her care.”
The same is true for a patient who is denied information about other procedures, like abortion, Chaiten says. “A patient who is miscarrying at 18 weeks might go to the hospital thinking she is going for pregnancy care,” she explains. “When she gets there and the provider understands that the pregnancy is over and that she is at risk for infection, they need to tell her all of her options. One option is to ride it out, but another is to terminate, and if they don’t tell her that, she hasn’t been able to make an informed choice.”
Neither the Illinois Catholic Health Association nor the Catholic Health Association of the United States replied to Yahoo Parenting’s request for comment. However, the Illinois Catholic Health Association’s executive director, Patrick Cacchione, told the State Journal-Register that the state’s Catholic health care facilities already effectively communicate with their patients. “We want a fully informed patient — that’s good medicine,” he said. “I think it’s a bill in search of a problem. This isn’t a widespread problem.”
The new bill wouldn’t require health care facilities to provide services that don’t align with their religious beliefs; it would simply require doctors to notify patients in advance of anything they cannot or will not do. “The intention is to standardize the procedures within an institution to ensure there isn’t confusion and patients don’t come up at the short end of the stick when an institution or an individual has a religious objection to providing certain kinds of care,” Chaiten says.
And while this bill is specific to Illinois, this problem of women being uninformed when it comes to a hospital’s policies is widespread, says Lori Freedman, a medical sociologist at the University of California, San Francisco, who has studied the issue of tubal ligation in Catholic hospitals at length.
“Doctors that I speak with are all over the map about how much to talk about [their limitations] ahead of time,” Freedman tells Yahoo Parenting. “Some are very conscientious and say, ‘You need to know, my deliveries happen in a Catholic hospital so we need to talk about what that means.’ They take a lot of responsibility for that conversation. But some doctors are more laissez-faire about it, and they don’t bring it up unless asked or pushed on the issue.”
The limits to the kind of services religious-based institutions will perform include more than just tubal ligation, but that seems to be the issue that comes up most often, Freedman says. The sterilization procedure is currently the second most common form of birth control in the United States, according to the Centers for Disease Control. One in 10 childbirths end with an in-hospital sterilization procedure, and by the time they are done with their childbearing years, nearly half of women have been sterilized, according to a blog post by Debra Stulberg, MD, a family medicine physician at the University of Chicago and Freedman’s co-author and research partner. And often, as their research found, doctors don’t agree with the hospital’s policies regarding this and other procedures. “The thing that is really clear in our research and is really not clear to the general public is that the doctors are not necessarily aligned with the institution,” she says. “They break down the same way as the ob-gyn population in general, with a diversity of religion, and range of feelings about different medical procedures. We didn’t talk to anyone who agreed that sterilization should be prohibited.”
But considering doctors’ hands are often tied by hospital policies, they — and the institutions they work for – have a responsibility to their patients, Freedman says. “I think it’s a good idea to push on the institutions to do better disclosure and educate doctors on how to educate their patients better about limitations,” she says.
This issue isn’t specific to Catholic health care providers — the Illinois bill will apply to all hospitals, whether or not they have a religious affiliation — but they play a large role because they have such a powerful presence in the medical community. According to the Chicago Tribune, Catholic hospitals handle more than one in four admissions in Illinois. In Washington State, due to recent hospital mergers, 45 percent of hospital beds are in Catholic hospitals, according to the ACLU of Washington.
Freedman says that calling the Illinois legislation “a bill in search of a problem,” is “so dismissive of women’s suffering. Especially when there is data, and doctors candidly talk about this over and over again as one of the most daily frustrations and concerns about whether they are fulfilling their obligations to their patients.”
Across the board, information seems to be the root of the issue. Women don’t necessarily know the limits to a Catholic institution’s services, and doctors don’t always know to tell them. “People seem to pick their place to give birth based on geography, or based on word of mouth,” Freedman says. “They don’t seem very aware of what the implications of being at a Catholic institution are.”
Many of them, Chaiten says, just aren’t thinking about it. “When you go there you think you are going to a hospital,” she says. “You don’t think you are going to a religious institution.”