Don't overlook postpartum contraception - a critical window

Posted 13 Mar 2024

Date: 13 Mar 2024

Author: Dr Cindy Farmer

The weeks and months after having a baby can be an exhilarating and exhausting time for new parents. Between sleepless nights, caring for a newborn, and recovering from childbirth, contraception may not be a top priority. However, this postpartum period is a critical window when women are at increased risk of an unintended pregnancy. Vice President of Professional Learning and Development, Dr Cindy Farmer, shares an overview of the clinicians's responsibility to ensure our patients receive advice and access to contraceptive methods during this important transitional time.

Individuals can have high motivation to avoid another pregnancy soon after giving birth. However, studies show that fertility may return quickly after childbirth and sexual activity often resumes before effective contraception has been initiated. Many people report having unprotected intercourse before their first postpartum visit. This puts them at significant risk of rapid repeat pregnancy which can potentially negatively impact maternal health, child spacing, and prenatal outcomes.

Providing contraceptive education and services during antenatal care is an important first step, allowing people enough time to consider their options fully. But too often, conversations stop there, leaving postpartum women without a clear plan. As clinicians, we need to make postpartum contraception an ongoing discussion throughout a woman's pregnancy, hospital stay, and postpartum visits. Individuals should be counselled on contraceptive options that are safe for breastfeeding, methods that are effective for those not breastfeeding, and the importance of using a backup like condoms until their chosen method takes full effect.

Long Acting Reversible Contraception (LARC)

For many women, the postpartum period provides a window of opportunity to initiate long-acting reversible contraception (LARC) like the implant or IUD. These methods are among the most effective at preventing rapid repeat pregnancy. They have high continuation rates and don't require adhering to a daily medication routine - an important factor for many juggling the demands of new parenthood. The immediate postpartum period, before hospital discharge, is an ideal time for LARC insertion, removing the need to negotiate and travel to a health appointment thus reducing some of the barriers to access.

 

How can you support patients during this time?

We, as clinicians, need to get better at routinely raising the topic of postpartum contraception and ensuring our patients have an effective plan before leaving the hospital. This requires a team-based approach, with obstetricians, midwives, nurses, and allied health professionals all playing a role. Postpartum contraceptive access should be integrated into our birthing facilities through on-site insertion services and bridging women to convenient follow-up care.

The bottom line is that failing to address contraception is failing our postpartum patients. By providing them with counselling and access to the full range of contraceptive methods, including highly effective LARC, we can empower new mothers and support healthy birth spacing. Let's make a concerted effort to close this gap in sexual and reproductive healthcare.

Join the conversation at our forthcoming Post-Birth Contraception Conference. Speakers including Dame Professor Lesley Regan, Women’s Health Ambassador for England, Dr Michelle Cooper, Consultant in Sexual and Reproductive Healthcare, Dr Ed Mullins, Consultant Obstetrician, alongside other experts, will share their experiences and insights to equip you with the essential tools and tips to troubleshoot challenges, foster collaboration, and to overcome barriers in providing post-birth contraception.

Book your place