In addition to the reversible methods of birth control listed above, undergoing surgery to become infertile is an option for either you or your partner. Different forms of sterilization follow.
Tubal ligation, also known as getting your “tubes tied,” is a procedure in which the surgeon creates a surgical incision below your navel and either ties off or cauterizes your fallopian tubes. This procedure can be done within a day or so after you give birth, before you leave the hospital — in fact, it can be easier for the surgeon to perform this procedure shortly after the birth of a baby because the position of your uterus makes it easier for the surgeon to reach your fallopian tubes. If you have a c-section birth, the tubal ligation can be done at the same time as the surgery before your doctor closes up your abdominal incision.
Tubal ligation is very effective and is one of the most popular forms of contraception in the United States. But there are health risks involved with any kind of surgery, and tubal ligation is considered a more invasive and risky surgery than male sterilization, or vasectomy. Also, it's very difficult to reverse the procedure once it's done, and is considered a permanent means of birth control. You'll need to very carefully consider whether you'll want to have more children before you plan a tubal ligation. If you've had a stressful pregnancy or had a difficult birth experience, you may think you won't ever want to have more children, but it's possible you may change your mind later. Unless you are absolutely sure that there are no circumstances under which you might want to get pregnant again, you may want to wait until your life has settled down a little bit before deciding to have a tubal ligation. Your care provider can help you decide on a method of contraception to use in the meanwhile.
Vasectomy isn't for everyone, but it is a very safe and effective option for many. It is far less invasive and risky than female sterilization, not to mention less expensive. During a vasectomy, a doctor will make a small incision on each side of the scrotum, snip the vas deferens tubes, then tie them off or cauterize them. The procedure should take less than an hour and only requires a local anesthetic and no hospitalization. It can take a while for the man's semen to become free of sperm, so his doctor will probably ask him to provide some sperm-free semen samples before he's given the all-clear to have unprotected sex, which can take up to three months. In the meanwhile, you'll have to abstain from sex or use another form of birth control. If you're absolutely sure neither of you want to have more children, you can arrange for your husband to have the procedure early in the postpartum period or while you're pregnant, though some doctors will refuse to perform the procedure on a man whose wife is pregnant.
Though the vasectomy procedure is safe and simple, many men are a little queasy at the thought of any cutting in “that area.” Though some women are able to use the “Hey, I gave birth, now it's your turn” line of reasoning to convince their men to go under the knife, it doesn't always work. Some men, however, are relieved by being able to exert such control over their own fertility and will gladly — or at least resolutely — volunteer for the procedure.
If you and your husband both know you're done having children and you really want him to consider vasectomy, but he gives a knee-jerk veto, try playing up the benefits. The two of you will be able to enjoy much more freedom and spontaneity in your sex life; you won't have to worry about hormones that may give you mood swings, or barrier methods that can reduce both your enjoyment; and most of all, eliminating the fear of getting pregnant again may make you both feel a little sexier. He may just see things your way.