Contraception After Pregnancy: Choice, Consistency, Collaboration by Dr Rebecca Heller
A blog from a Dr Rebecca Heller on the new FSRH Contraception After Pregnancy Guideline released on 25th January 2017
The 2017 FSRH guideline Contraception After Pregnancy is an incredibly exciting moment for clinicians working across women’s health, and in UK healthcare generally. Endorsed by the RCOG, RCGP, RCN and RCM, it aims to ensure women receive contraceptive consistency across pregnancy outcomes through collaboration across women’s healthcare settings, and, above all, that they are offered choice.
The guideline has the potential to transform contraception and pregnancy care in the United Kingdom. UK evidence shows that almost one in eight parous women presenting for an abortion or delivery had conceived within a year of their previous birth (http://jfprhc.bmj.com/content/42/2/93.full). An inter-pregnancy interval of less than 12 months increases the risk of pre-term birth, stillbirth and neonatal death. (https://www.ncbi.nlm.nih.gov/pubmed/12907483) Pregnancy, and the resultant contact with healthcare services, presents a key opportunity to provide women with information and offer contraceptive choice, better empowering her to avoid future unintended pregnancies.
The new guideline presents a truly holistic picture of contraceptive care for women, recognising all pregnancy outcomes as an excellent chance for women to discuss their reproductive choices, and for us as clinicians to empower women to avoid unplanned pregnancy. When women are provided with clear and accurate information about contraception, and there are as few barriers as possible to them obtaining it, we as practitioners offer them the best chance of avoiding unplanned pregnancy. A survey by BPAS and Bounty found that most women do not plan a further pregnancy immediately after having a baby, and generally women welcome full, informed discussion of contraception. () In antenatal care, this means enabling women to take time during their pregnancy to consider what contraceptive method suits them, and making sure that all options are easily available to them as quickly as possible after delivery. In miscarriage and abortion care, this means initiating a discussion around options for ongoing contraceptive care, and providing a woman’s chosen method if she finds a method that suits her individual needs.
Collaboration has been at the heart of the development of this guideline, with Contraception After Pregnancy receiving endorsement from RCOG, RCGP, RCN and RCM, and recommendations aimed at healthcare professionals across pregnancy care settings, from health visitors to the maternity ward.
The emphasis on contraception delivery in maternity services is especially new and exciting. In particular, the advice that intrauterine contraception (IUC) and progestogen-only implants can be inserted immediately after delivery, including insertion of IUC immediately following vaginal delivery or caesarean section. As a former obstetrics trainee who is now a sexual health trainee, I am passionate about maternity and SRH services working together to ensure contraception information and provision is a fundamental part of pregnancy care. Both explaining the risks of short inter-pregnancy intervals to women, and giving them the means to avoid such short intervals, seem to me an integral part of maternity services.
The guideline also states that if services are unable to provide women with their chosen method of contraception, they should offer women information about where services can be accessed, and have agreed pathways of care to local specialist contraceptive services. Nurturing a constructive working relationship with maternity services, and those providing miscarriage and abortion care, is a way that we as SRH clinicians can contribute to the smooth running of contraception care after pregnancy. In addition, Contraception After Pregnancy advises that clinicians giving advice about contraception after any pregnancy event should ensure information is timely, up-to-date and accurate. Here, there is an opportunity for SRH clinicians to provide training to staff who are currently unfamiliar with giving contraceptive advice, making sure that every contact with women in pregnancy care really does count.
This 2017 FSRH guideline represents significant progress towards providing truly comprehensive, holistic contraceptive care for women in the United Kingdom at every opportunity.
Dr Rebecca Heller, CSRH Trainee, January 2017