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

Croan, Louise; Craig, Alison; Scott, Lesley; Cameron, Sharon; Lakha, Fatim

doi:10.1136/jfprhc-2017-101749

Cited by 10 publications

(15 citation statements)

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“…It is worth being imaginative and flexible if it facilitates provision of an effective method that ensures prevention of unwanted pregnancy, particularly in vulnerable groups like adolescents, single mothers or drug‐users. Postnatal insertion of POC implants in women's homes was evaluated in a cohort of 40 Scottish women; the service, provided by specially trained “contraceptive champion” community midwives was highly acceptable to the women …”

Section: Methodsmentioning

confidence: 99%

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Contraception after pregnancy

Glasier

Bhattacharya

Evers

et al. 2019

Acta Obstet Gynecol Scand

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Whatever the outcome, pregnancy provides the opportunity to offer effective contraception to couples motivated to avoid another pregnancy. This narrative review summarizes the evidence for health providers, drawing attention to current guidelines on which contraceptive methods can be used, and when they should be started after pregnancy, whatever its outcome. Fertility returns within 1 month of the end of pregnancy unless breastfeeding occurs. Breastfeeding, which itself suppresses fertility after childbirth, influences both when contraception should start and what methods can be used. Without breastfeeding, effective contraception should be started as soon as possible if another pregnancy is to be avoided. Interpregnancy intervals of at least 6 months after miscarriage and 1‐2 years after childbirth have long been recommended by the World Health Organization in order to reduce the chance of adverse pregnancy outcome. Recent research suggests that this may not be necessary, at least for healthy women <35 years old. Most contraceptive methods can be used after pregnancy regardless of the outcome. Because of an increased risk of venous thromboembolism associated with estrogen‐containing contraceptives, initiation of these methods should be delayed until 6 weeks after childbirth. More research is required to settle the questions over the use of combined hormonal contraception during breastfeeding, the use of injectable progestin‐only contraceptives before 6 weeks after childbirth, and the use of both hormonal and intrauterine contraception after gestational trophoblastic disease. The potential impact on the risk of ectopic pregnancy of certain contraceptive methods often confuses healthcare providers. The challenges involved in providing effective, seamless service provision of contraception after pregnancy are numerous, even in industrialized countries. Nevertheless, the clear benefits demonstrate that it is worth the effort.

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Section: Methodsmentioning

confidence: 99%

“…Postnatal insertion of POC implants in women's homes was evaluated in a cohort of 40 Scottish women; the service, provided by specially trained "contraceptive champion" community midwives was highly acceptable to the women. 55…”

Section: Barriers To Provisionmentioning

confidence: 99%

Contraception after pregnancy

Glasier

Bhattacharya

Evers

et al. 2019

Acta Obstet Gynecol Scand

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“…Expanding the number and range of trained implant fitters to include hospital midwives could be a strategy to help meet the demand for this popular choice of method in the maternity setting. In addition, initiatives such as community midwives being trained to provide implants to women at home in the postpartum period is another possible option for improving access to this method 13…”

Section: Discussionmentioning

confidence: 99%

Antenatal contraception counselling and provision of contraception after delivery for first-time young mothers enrolled with a Family Nurse Partnership programme

Gallagher

Cameron

Craig³

et al. 2019

BMJ Sex Reprod Health

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ObjectiveTo evaluate antenatal contraceptive counselling and provision of postpartum contraception on contraceptive choices of first-time teenage mothers enrolled with a Family Nurse Partnership (FNP) programme.DesignHealth service research evaluation.PopulationCohort of FNP clients (n=195), Scotland, UK.MethodsAntenatal contraceptive counselling and provision of chosen method from the hospital. Evaluation consisted of (i) self-administered questionnaires of FNP clients and (ii) interviews with FNP clients and FNP nurses.Main outcome measuresFNP client views on intervention. Secondary outcomes included: contraceptive choice antenatally, at day 10 postpartum, 3 and 12 months after delivery, and views of FNP nurses on the intervention.ResultsAntenatal questionnaires were completed by 118/195 (61%) clients. 96/118 (81%) agreed that it was very or quite helpful to receive antenatal contraceptive counselling and 80/118 (68%) were planning to use a long-acting reversible method of contraception (LARC). 97/121 (80%) wished to receive contraception before leaving the hospital. 104/195 (53%) completed a questionnaire at day 10 postpartum, of which 33 (32%) indicated that they had received contraception from the hospital. FNP nurses expressed frustration when contraception was not provided; this was usually attributed to the busy workload of the maternity department.ConclusionsAntenatal contraceptive counselling was appreciated by FNP clients and they expressed a preference for contraception provision following delivery. Over two-thirds planned to use a LARC method but many did not receive this from the hospital. Further interventions are required to ensure that the provision of postpartum contraception is prioritised for this group of young women.

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“…Evidence of the acceptability of the role of a midwife with specialist knowledge of contraception and trained to insert implants was already available in NHS Lothian as a specialist midwife working for the PrePare Team (supporting women with substance misuse issues during pregnancy and 6 months afterwards) was already inserting implants for her clients in their homes 6. Feedback was positive, with many women having a preference for contraceptive provision from their own midwife 6…”

Section: How Was the Role Of Contraceptive Champion Implemented?mentioning

confidence: 99%

“…Hospital midwives who are contraceptive champions can provide the implant for women choosing this method while they are in a postnatal ward. Community midwives can provide this for women in the postpartum period in their home using a local coolant (ethyl chloride spray), an important fall back for those women who wish to have an implant inserted but who left the maternity service before this could be provided 6. To date, there are 17 contraceptive champions (seven hospital and 10 community midwives) working in NHS Lothian.…”

Section: How Was the Role Of Contraceptive Champion Implemented?mentioning

confidence: 99%

Developing the role of midwives as ‘contraceptive champions’ to support early access to effective postnatal contraception for women

Gallimore

Craig

Cameron

et al. 2019

BMJ Sex Reprod Health

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ObjectiveTo evaluate the acceptability of the new contraceptive champion role to the first hospital and community midwives in NHS Lothian trained in this role.DesignHealth service evaluation.PopulationHospital and community midwives trained as contraceptive champions, NHS Lothian, Scotland, UK.MethodsQualitative research: 1:1 semi-structured interviews (baseline and follow-up) with five contraceptive champions.Main outcome measureQualitative data on views of the new contraceptive champions on the first 6 months of the role.ResultsAll contraceptive champions stated increased confidence in their knowledge of postnatal contraception. They reported that women had not questioned the role of midwives in inserting contraceptive implants postnatally in hospital and at home. Midwife colleagues and hospital doctors had been supportive.ConclusionThe new role of contraceptive champion is reported by midwives to have been well received in its first year by women, the midwives themselves and their healthcare colleagues.

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

Cited by 10 publications

References 11 publications

Contraception after pregnancy

Contraception after pregnancy

Antenatal contraception counselling and provision of contraception after delivery for first-time young mothers enrolled with a Family Nurse Partnership programme

Developing the role of midwives as ‘contraceptive champions’ to support early access to effective postnatal contraception for women

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