BTL Not Offered Here

I just finished seeing the last patient on the male ward. Just when I am getting ready to go home, the midwife comes up and asks me to check on a new admission on the labor ward.

The heavily pregnant woman was at the market earlier in the day when her water broke. She felt the baby’s arm coming out, and was brought in to the hospital. The nurse pulls back the sheets and reveals the baby’s forearm reaching out from the birth canal, an occasional twitch of the hand signals that the baby is still alive but may be in distress. The fetal heart sound is barely audible through the fetoscope. Fortunately the Doppler ultrasound picks up a definite fetal heart beat. By now, the medical officer is called in and everyone prepares the theater for an emergency Cesarean section.

It is the woman’s eleventh pregnancy but her first Cesarean. Upon learning that she is about to undergo a Cesarean, the woman asks if she can have a bilateral tubal ligation (BTL); in other words, she wants her tubes tied. One constraint of working at a Catholic mission hospital is that, contraception of any form is not allowed, even if it means a future pregnancy may jeopardize the woman’s health or may even cost her life. So, sticking to the rules, the medical officer denies the request. The surgery goes without a hitch and a healthy baby boy is born. The mother, who is only forty-two, will go home in a few days and will probably come back pregnant a twelfth time in a few months.

And so the life of this couple is greatly affected by a policy made by men in funny dresses ten thousand miles and a universe away, men who never had to raise a child. While mission hospitals like this one have save countless lives, the Church’s idiosyncratic rules have also helped to keep those lives impoverished. Hospitals should operate based on the rational and reality on the ground and not be bound by rigid rules that ignore the suffering of the people they serve. I have heard about previous doctors who would do BTLs “off the books” or as part of a Cesarean section, while leaving out that little detail off the op notes. If that was true, it was probably because the rational side of them as doctors had led them to break the rules. And, as they say, rules are made to be broken. The Catholic Church, of all people, should be familiar with that one, I would tend to think.