Table 2.

Sterilization in Catholic Hospitals: Themes and Illustrative Quotations

Themes and Subthemes	Illustrative Quotations
Theme 1. Risk of Harm to Women
Medical Indication to Prevent Pregnancy	You have a patient who has 32 weeks of pregnancy, this is a fourth pregnancy, she has had three previous c-sections and this is going to be a fourth c-section. She has hypertension, she’s got diabetes, she’s got bronchial asthma …and she weighs 332 pounds… So I feel frustrated at times that I can’t give them enough care that I’d like to do. Because for a patient like this, I mean, honestly speaking, it’d be nice if you can avoid pregnancy.
Unnecessary Additional Surgery	Women who have to have another anesthetic, another operative risk, another- I mean, I think it puts women at more risk …’cause someone who’s had four c-sections before has to have another operation to get her tubes tied, that’s not what’s in her best interest by any stretch of the imagination.
Theme 2. When Workarounds Don’t Work
Partial Workarounds	It was her fourth c-section and she wanted her tubes tied… We had her scheduled to be at the other hospital so we could do her c-section and tie her tubes. But when she came in in labor before that time, then she came into the Catholic hospital, which was our primary facility, and she couldn’t get her tubes tied… it felt really stupid.
Change in Enforcement	Two months ago having a tubal ligation wasn’t a bioethical issue; it was a decision a patient made after consultation with the physician and it got carried out safely and that was what it was. The hospital was sold and all of a sudden this procedure becomes a bioethical issue and I don’t understand why the procedure, which hasn’t changed, the patients, which haven’t changed… all of a sudden now we have to go to a committee that doesn’t even have a gynecological member on it and ask them for permission to do a tubal ligation.
	…It was apparently bishop by bishop, and the bishop in [my city] was fairly liberal… 15 years ago… [If a woman was] at risk for having diabetes in her next pregnancy, that’s a reason enough. And they would let them do it. But then the bishop became much more conservative and the diocese became much more conservative and it’s absolutely never allowed.
Insurance or Financial Barriers	…it comes down to…how motivated the patient is…if their insurance only covers the Catholic hospital but they want a tubal with their c-section, then sometimes they have to jump through a whole lot of hoops… But usually the insurance companies are pretty resistant.
	When they first stopped doing it I thought it was terrible because our hospital is the main maternity hospital and our patients…tend to be the lower socioeconomic patients… So you had a situation where if you had insurance, had a job or had money, you could go over across the street and get your tubal done. But if you were, you know, getting Medicaid or if you had [state public insurance], then you didn’t have access to that, and I thought it was a terrible double standard.