Provision of immediate postpartum intrauterine contraception

Dr Michelle Cooper discusses her short oral paper presentation at this year’s Annual Scientific Meeting, featuring the successful implementation of postpartum intrauterine contraception (PPIUC) services in Edinburgh.

It’s been almost five years since PPIUC was first introduced for women having caesarean birth in Edinburgh, and more recently the service has also been made available to women having a vaginal birth. As there is a growing interest towards PPIUC provision in the UK, I was delighted to be able to share some of our preliminary findings with the SRH community at the recent Annual Scientific Meeting*.

Over 1000 women have received PPIUC insertion during caesarean section since the service first became available in the region – around 1 in 7 of all women having a planned caesarean birth. On this backdrop, a health services research study began in 2017 with the aim of implementing and evaluating PPIUC at vaginal birth, of which 400 procedures have been performed to date. To achieve this both midwives and doctors were trained in a new vaginal insertion technique – one with which most UK practitioners are unfamiliar. More than 80 maternity staff members have now been trained through the locally-developed programme of theoretical knowledge, model simulation and supervised practice; and feedback has been extremely positive.

“You’re seeing someone through the whole experience…you can look after a woman in labour, help to deliver her baby, repair any tears and then provide her preferred contraception before going home…true holistic care!” [Labour Ward Midwife]

More than 95% of women who opted for vaginal PPIUC during the study received this successfully, with around two thirds of women opting for the intrauterine system (IUS). Recorded complications were low - very few women in the study had an infective complication, and none thus far have experienced a uterine perforation. However, as expected, the complete device expulsion rate was higher than for caesarean section. Most expulsions were recognised by women, and four out of 5 of them opted to have further IUC inserted at the follow-up visit.

The reasons for the higher observed expulsion rate are likely to be multifactorial – inexperienced providers, newly introduced service, high uptake of IUS – to name but a few. But as other studies have shown, the overall expulsion rate tends to decline with increasing provider experience, therefore this is expected to improve over time. While some providers may consider this a disadvantage, it should be remembered that providing LARC in the immediate postpartum period has the potential to prevent more unintended pregnancies and short inter-pregnancy intervals. Also, and perhaps most importantly, it is clear that women value the opportunity to access PPIUC, and there is a definite demand for this service.

“It’s all done at the same time so you don’t need to worry about anything afterwards – I probably wouldn’t have gone to get it otherwise!” [Jodie, mum of 2]

Moving forward the onus is on researchers, healthcare providers, managers and commissioners to support the development of PPIUC services and continue to expand contraceptive choices for women around the time of childbirth.

For further information please contact Michelle Cooper

*Please note results are not presented in full as these are currently under review for publication