Feasibility and acceptability of introducing routine antenatal contraceptive counselling and provision of contraception after delivery: the APPLES pilot evaluation

Abstract

Giving contraceptive advice antenatally is feasible and acceptable.

Successful implementation of immediate postpartum intrauterine contraception services in Edinburgh and framework for wider dissemination

“…In the 2 years prior to PPIUD service arrival, routine prenatal contraceptive counselling was introduced to the region in conjunction with increased awareness and general training in postpartum contraceptive methods for maternity staff. At this time, more than half (58%) of those women who expressed desire for a postpartum IUD did not attend a follow‐up appointment for insertion, reflecting findings from other studies that the additional visit for insertion was a significant barrier to uptake . This provided justification to introduce PPIUD within a maternity culture already geared toward enhanced contraceptive services.…”

“…Most clinical guidelines and public health policies now advocate earlier contraceptive discussion and enhanced provision from within maternity services . Routine prenatal contraceptive counselling is both feasible for community midwives to deliver and acceptable to women, and is associated with an increased uptake of methods after delivery . However, there are several barriers to effectively delivering this service, particularly in relation to IUD insertion.…”

Women’s and healthcare professionals’ views on immediate postnatal contraception provision: a literature review

“…However, evaluation of the APPLES (Access to Post Partum LARC in Edinburgh South) study, the first UK pilot of a maternity service offering routine antenatal contraception counselling together with postnatal provision of a choice of method, provides evidence of positive views of community midwives in this role 35. These midwives received contraception training and subsequently reported feeling able to deliver a routine, integrated system for antenatal contraceptive counselling and facilitating contraceptive choice.…”

Increasing access to contraceptive implants in the postnatal period via a home insertion service by community midwives

“…The Lothian Sexual Health and HIV Strategy specifically states that a key goal is to reduce inequalities in sexual health 2. As part of NHS Lothian’s sexual health strategy a pilot project known as ‘APPLES’ (Access to Post Partum Contraception in Edinburgh South East) was implemented throughout 2014–2016 3. In Lothian, since 2006, the Prepare Team, comprising two specialist community midwives, has been providing comprehensive midwifery care to women with substance misuse problems.…”

“…Within the context of the wider Lothian ‘APPLES’ project, women were enabled to consider their options prior to delivery and to register a preferred choice 3. All 40 women had opted for SDI as their method of choice.…”