Tubal ligation was considered serious surgery when Elaine Riddick Jessie and thousands of other North Carolina women were sterilized.

Doctors would put a woman under anesthesia and cut one to three incisions into her abdomen. Then a surgeon would reach inside with fingers and instruments to locate her fallopian tubes. The surgeon would cut and "tie" the woman's tubes to prevent eggs from reaching the uterus. This effectively ended her ability to bear children.

Before the 1970s, Jessie and other women who had tubal ligations would have faced several days in the hospital and about a month for a full recovery.

The operation was painful because the surgeon had to cut through several layers of skin and muscle to get to the tubes.

"You'd go home with a sore abdomen but most people would be OK (in a few weeks)," said Dr. Robert Brame, a retired obstetrician/gynecologist who has taught at several medical schools around the state.

Today, women can expect to be out of the hospital the same day they have the surgery and back to their normal routines within a week. The surgery leaves smaller scars and less chance of complications from infection.

Doctors today are also more concerned with the psychological impact of the surgery. They are hesitant to perform surgery on women whose partners don't want it, on young women or on those who have just had children.

"It is important to look at her situation," said Dr. Jeff Deaton, an associate professor of obstetrics and gynecology at Wake Forest University Baptist Medical Center. "You do this to be a permanent procedure with no intent on reversal."

Physically, the surgery has become easier in the past few decades with the advent of laparoscopy, Deaton said.

Laparoscopy is a surgical technique perfected in the past 30 years. Doctors make several small incisions. They put a tiny camera into one and tiny surgical instruments into others. The camera allows them to see inside the area they are operating on without having to make a large incision. Doctors can watch the image on television.

To actually tie the tubes, they usually either burn or cut them, then tie the ends. Some doctors prefer to put a clip or ring around the tubes that also closes them off, Deaton said.

Tubal ligation and the male version of sterilization - vasectomy - have become the most popular methods of birth control in the world. They are permanent and, though they carry some increased risk of medical complications, they are generally considered safe.

People in poorer countries prefer the surgery because it is a relatively inexpensive one-time option for preventing more pregnancies. In the United States and other Western countries, mostly upper- or middle-class people who have already completed their families choose the surgery.

Women who are sterilized also have an increased risk of ectopic pregnancy, a potentially deadly condition where a fetus implants outside of the uterus. They also have risks of complications during surgery, such as an accidental puncture of a bowel or blood vessel.

Vasectomy has traditionally been simpler than female sterilizations. Typically, an incision is made in the man's scrotum. His vas deferens - the tubes that carry the sperm to the penis - are then cut and tied. Patients go home the same day and are usually back to their normal routine within a few days.

The technique has not changed much through the years, though some doctors use a new instrument that allows them to punch a small hole through the scrotum, eliminating the need for stitches.