OB-GYNs should offer prenatal counseling about the placement of long-acting reversible contraception (LARC) immediately postpartum and the opportunity for placement right after delivery or at a follow-up postpartum visit at the patient's request, according to an American College of Obstetricians and Gynecologists (ACOG) committee opinion, MedPage Today reports.
Opinion details
In the opinion, ACOG's Committee on Obstetric Practice wrote, "Obstetrician-gynecologists and other obstetric care providers should counsel women about the convenience and effectiveness of immediate postpartum LARC, as well as the benefits of reducing unintended pregnancy and lengthening pregnancy intervals." The committee recommended that OB-GYNs also counsel patients about the risks of postpartum LARC, such as the risk of intrauterine device (IUD) expulsion.
The committee explained that a pregnancy happening within one year of a prior delivery, or "short-interval pregnanc[y]," is linked with a higher chance of premature birth and adverse health outcomes for the infant. In addition, the committee noted that roughly 50 percent of women say they had unprotected sex before they returned for a postpartum visit.
Moreover, according to MedPage Today, women at the highest risk of short-interval pregnancy often are those who are less likely to meet with a physician for a postpartum follow-up appointment. A 2015 study found that women who had an IUD placed immediately after delivery via cesarean section reported higher rates of IUD use than women who postponed placement until their six-week postpartum follow-up visit.
The opinion also called for public and private coverage of immediate postpartum LARC. According to MedPage Today, more than a dozen states include reimbursement for LARC immediately postpartum in their Medicaid programs, and CMS currently is assessing how to facilitate LARC access.
Comments
Opinion co-author Ann Borders said, "We encourage maternity providers to begin discussions about postpartum contraception prior to delivery to ensure women have the time and information they need to select the best method for them, which may be immediate postpartum LARC for many women." She added, "The period following delivery is a busy, exhausting, and often stressful time, and immediate postpartum insertion of LARC may eliminate some of the stressors during that time, like scheduling multiple appointments for LARC insertion."
Borders also called on OB-GYNS to "support our institutions in developing the infrastructure and processes needed to operationalize this practice" (Walker, MedPage Today, 7/29).
