Immediate Postpartum Contraception: A Survey Needs Assessment of a National Sample of Midwives

Moniz, Michelle H.; Roosevelt, Lee; Crissman, Halley P.; Kobernik, Emily K.; Dalton, Vanessa K.; Heisler, Michele; Low, Lisa Kane

doi:10.1111/jmwh.12653

Cited by 17 publications

(23 citation statements)

References 33 publications

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“…However, the overall percentage of obstetricians providing this service remains low. This finding remains consistent across other obstetric providers, including midwives and family medicine physicians [ 10 , 11 ] and continues to highlight the need for increased training related to immediate postpartum LARC.…”

Section: Discussionsupporting

confidence: 75%

Ongoing barriers to immediate postpartum long-acting reversible contraception: a physician survey

Holden

Lai

Morelli

et al. 2018

Contracept Reprod Med

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BackgroundPostpartum women are at risk for unintended pregnancy. Access to immediate long-acting reversible contraception (LARC) may help decrease this risk, but it is unclear how many providers in the United States routinely offer this to their patients and what obstacles they face. Our primary objective was to determine the proportion of United States obstetric providers that offer immediate postpartum LARC to their obstetric patients.MethodsWe surveyed practicing Fellows and Junior Fellows of the American College of Obstetricians and Gynecologists (ACOG) about their use of immediate postpartum LARC. These members are demographically representative of ACOG members as a whole and represent all of the ACOG districts. Half of these Fellows were also part of the Collaborative Ambulatory Research Network (CARN), a group of ACOG members who voluntarily participate in research. We asked about their experience with and barriers to immediate placement of intrauterine devices and contraceptive implants after delivery.ResultsThere were a total of 108 out of 600 responses (18%). Participants practiced in a total of 36 states and/or US territories and their median age was 52 years. Only 26.9% of providers surveyed offered their patients immediate postpartum LARC, and of these providers, 60.7% work in a university-based practice. There was a statistically significant association between offering immediate postpartum LARC and practice type, with the majority of providers working at a university-based practice (p < 0.001). Multiple obstacles were identified, including cost or reimbursement, device availability, and provider training on device placement in the immediate postpartum period.ConclusionThe majority of obstetricians surveyed do not offer immediate postpartum long-acting reversible contraception to patients in the United States. This is secondary to multiple obstacles faced by providers.

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Section: Discussionsupporting

confidence: 75%

Ongoing barriers to immediate postpartum long-acting reversible contraception: a physician survey

Holden

Lai

Morelli

et al. 2018

Contracept Reprod Med

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“…Intrauterine device (IUD) insertion in the immediate postpartum period is a safe contraceptive option that can be routinely offered to women, including adolescents. This approach is supported by the Centers for Disease Control and Prevention (CDC), American College of Obstetricians and Gynecologists (ACOG), and Association of Women's Health, Obstetric, and Neonatal Nurses . Although the American College of Nurse‐Midwives does not currently offer a position on access to immediate postpartum contraception specifically, it affirms that midwives maintain comprehensive and evidence‐based information about available contraceptive methods and apply this knowledge and skill in the provision of care…”

Section: Introductionmentioning

confidence: 99%

Immediate Postpartum Contraception: Intrauterine Device Insertion

Escobar

Shearin

2019

J Midwife Womens Health

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Insertion of an intrauterine device (IUD) in the immediate postpartum period is a safe, evidence-based form of contraception appropriate for most women. Despite the higher risk of expulsion as compared with interval insertion, the benefits of insertion in the immediate postpartum period are significant and include improved rates of contraception continuance and reduced instances of short interval birth. Through shared decision making, midwives and other clinicians can assist women in clarifying their reproductive goals and understanding of contraceptive options, including this method. In response to identified gaps in knowledge and insertion technique among midwives, this article provides an overview of immediate postpartum IUD insertion, risks and benefits, and eligibility criteria and describes preinsertion, insertion, and postinsertion care.

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“…A total of 438 surveys were sent and 77 midwives responded, for a response rate of 17.6%, which is similar to those obtained from other online surveys of midwives. 32,33 Demographic characteristics of the participants are listed in…”

Section: Resultsmentioning

confidence: 99%

Dissemination of Prenatal Drinking Guidelines: A Preliminary Study Examining Personal Alcohol Use Among Midwives in a Southwestern US State

Olusanya

Barry

2020

J Midwife Womens Health

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Introduction: The constellation of birth defects seen in fetuses exposed to alcohol in utero have been described as fetal alcohol spectrum disorders. Evidence suggests that health care providers' communication practices regarding prenatal alcohol use could have beneficial outcomes. There is a paucity of investigations, however, that have examined the health professionals' personal alcohol use and prenatal alcohol recommendations they provide. Methods: This study sought to examine and compare midwives' personal alcohol use and communication practices regarding prenatal alcohol consumption. Certified nurse-midwives (CNMs) and certified professional midwives (CPMs) in a southwestern US state participated. Inclusion criteria included training in prenatal care, labor, birth, and membership in a midwife professional organization. Personal drinking behaviors were assessed with Alcohol Use Disorder Identification Test-Consumption (AUDIT-C). Results: All midwives (N = 61; 100%) reported they typically screened a patient for alcohol use during an initial prenatal visit. However, 5 (8.2%) respondents opted for recommendations that advised patients to drink once in a while. Similarly, 4 (6.6%) midwives counseled no more than one drink per day. In the cohort of participants (n = 40) with AUDIT-C scores, 25 (62.5%) engaged in nonrisky drinking (AUDIT-C scores <3). Most respondents (n = 39 of 40; 97.5%) typically consumed 1 to 2 standard drinks on the day they drank. There was no statistically significant difference in mean overall AUDIT-C scores between CNMs and CPMs (P = .42). When examining midwives' (1) responses on the AUDIT-C questionnaire, (2) nonrisky or risky drinking behaviors, and 3) communication practices regarding prenatal alcohol use, Fisher's exact test showed no statistically significant differences between CNMs and CPMs. Discussion: Results of this study highlight the importance of advocating healthy lifestyles among health care professionals while also promoting communication practices that align with national alcohol guidelines. Future investigations that examine associations between health care professionals' personal alcohol use and type or effectiveness of services offered to patients may be beneficial.

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Immediate Postpartum Contraception: A Survey Needs Assessment of a National Sample of Midwives

Cited by 17 publications

References 33 publications

Ongoing barriers to immediate postpartum long-acting reversible contraception: a physician survey

Ongoing barriers to immediate postpartum long-acting reversible contraception: a physician survey

Immediate Postpartum Contraception: Intrauterine Device Insertion

Dissemination of Prenatal Drinking Guidelines: A Preliminary Study Examining Personal Alcohol Use Among Midwives in a Southwestern US State

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