After giving birth in a hospital, some women are taking immediate action before they go home in order to prevent another pregnancy.
According to a study by the University of Michigan, published in Obstetrics & Gynaecology, the rate of IUDs or implants given to women right after childbirth increased from 1.86 per 10,000 deliveries in 2008, to 13.5 per 10,000 deliveries in 2013.
“Increased use of LARC [long-acting reversible contraception] reduces unintended pregnancies, increases the spacing between pregnancies, and therefore reduces adverse birth outcomes for mom and baby,” Dr Ann E. Borders, told Healthline.
Borders, who authored The American College of Obstetricians and Gynaecologists Committee Opinion on the topic, added that LARC gives women more reliable family planning with fewer side effects compared with other birth control methods. Additionally, women with LARC have high satisfaction and a higher rate of still using the same method of birth control a year after starting compared with other contraceptive options.
“Methods such as the pill, patch, or Depo [Depo-Provera] shot rely on on-going vigilance daily, weekly, or every three months, with multiple potential barriers to perfect use that could lead to an unexpected pregnancy,” said Borders.
Receiving LARC in the hospital safeguards women from future pregnancies if they don’t make it to their 6-week postpartum visit with their doctor, which is typically recommended after giving birth.
“[Immediate postpartum LARC] is essential to providing adequate contraception for patients with poor or unreliable insurance, poor access to care, or poor compliance for a variety of reasons,” Dr Jill Placek, an OB-GYN in Illinois, told Healthline.
Not all women follow up with a postpartum visit, and not all providers offer IUDs or implants at postpartum visits. Some providers ask patients to return for an additional visit or refer them to another provider.
“Unfortunately, it is often the same high-risk population who does not follow up to these visits who are often at risk of unintended pregnancy in the future. For compliant patients, it is a plus to not have to make a special trip back to the doctor’s office to get contraception after delivery, however, these patients are usually compliant with their postpartum visit anyway,” Placek said.
Borders added that the postpartum period is a challenging time for most women. “Women are focused on their newborn and unfortunately their own healthcare may not be a high priority. By providing women access to LARC methods before they leave the hospital, women can go home to focus on their newborn knowing they have a plan in place to have control of when, or if, they want to plan another pregnancy,” she said.
Not accessible to everyone
Despite the benefits of LARCs given immediately after giving birth, the University of Michigan study found about 96 percent of inpatient postpartum IUDs are given to women at urban teaching hospitals. Women who received implants postpartum in these hospitals tended to have lower incomes and be less healthy. Moreover, 15 per cent of these inpatient postpartum IUDs are given to women without insurance.
According to Placek, private practitioners in suburban hospitals like the one she works at are not routinely putting in LARCs right after a baby is born. However, her hospital recently responded to requests for stocking IUDs, and they are accessible to patients if a physician orders them.
Women who give birth in religious-affiliated hospitals may not have access to immediate postpartum contraception. So was the case at the Catholic-affiliated hospital where Placek completed her residency.
“I had to sign that I would abide by a document from the Archdiocese. IUD or implant placement was not permitted on hospital premises without extensive approval often requiring additional indication for use other than contraception. Patients would be counselled on contraceptive options and alternate arrangements were made for access to their desired contraceptive needs,” Placek said.
Risks of immediate placement
Inserting IUDs postpartum can cause expulsion and perforation due to the fact that the uterus is big and soft, and bleeding occurs. The string that is attached to the IUD can get lost in the uterus, which may require X-rays and surgery to remove it.
For these reasons, some doctors recommend placement of an IUD at the 6-week postpartum visit or later. Placek said this makes sense for the majority of her patients who are compliant with abstinence or using other forms of birth control during this time.
Waiting to place an IUD after the postpartum visit also allows patients to think about their contraceptive options for a time, and see what their new life is like at home with a baby or another child, and how contraception fits in.
However, “If I have a patient who I am concerned about compliance and who strongly desires IUD placement immediately postpartum, I would absolutely provide those services with risks and benefits counselling,” Placek noted.
While LARC methods are not right for every woman, Borders stressed it is important that women are educated about their options. She noted The CHOICE Project, which recruited about 10,000 women between 2008 and 2011, found that women who had been counselled regarding contraception options and had financial barriers removed chose LARC methods 75 percent of the time.
She added that an organized effort to implement and improve access to immediate postpartum LARC placement across birthing hospitals is needed.
“Urban teaching hospitals have likely led the way on providing access to immediate postpartum LARC, and rural and urban non-teaching hospitals may be lagging,” Borders said. “But regardless of the type of hospital or location, it will take provider and nursing champions, with support from administration, pharmacy, billing, to all come together to put together protocols and procedures in addition to the needed focus on patient and provider education.”