Role of Bridge Contraception in Postpartum Long-Acting Reversible Contraception and Sterilization Fulfillment Rates

Montague, Mary‐Louise; Ascha, Mustafa; Wilkinson, Barbara; Verbus, Emily; Morris, Jane; Mercer, Brian M.; Arora, Kavita Shah

doi:10.1097/aog.0000000000002803

Cited by 9 publications

(6 citation statements)

References 17 publications

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“…A previous study showed that initiation of bridge contraception before obtaining interval LARC and sterilization was associated with increased interval LARC and sterilization fulfillment. 11 In our study, however, patients with PPLARC as a bridge were less likely to receive interval BTL despite ongoing desire. Again, for two of the patients interviewed, the PPLARC allowed they to continue to delay plan for PPBTL as they felt secure with the method.…”

Section: Discussioncontrasting

confidence: 53%

Outcomes for Women Denied Postpartum Tubal Ligation During the Initial COVID-19 Surge

Cosgriff,

Plummer,

Concepcion

et al. 2024

Women's Health Reports

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Objective: To evaluate the utilization and outcomes of postpartum long-acting reversible contraception (PPLARC) following unmet postpartum bilateral tubal ligation (PPBTL) requests during a time in which elective surgeries were canceled due to the initial COVID-19 surge. Methods: We conducted a mixed-methods study using an embedded design. Using a retrospective cohort design, we collected data from patients seeking PPBTL following vaginal delivery between March 15, 2020, and June 20, 2020; this reflects a time period during which elective surgery was canceled thus making PPBTL unavailable. We recorded demographic data, method of contraception at time of discharge and 18 months postpartum, and incidence of interval pregnancy at 18 months postpartum. Additionally, we conducted five semistructured interviews to gain deeper insights into patient experiences with PPLARC as a bridge method. Results: Forty-five patients had unfilled PPBTL requests with follow-up data available for 35. The median age was 34 years. Ten (22%) accepted PPLARC as a bridge to interval bilateral tubal ligation (BTL). At the 18-month mark, only 1 out of 7 (14.3%) PPLARC users had undergone an interval BTL procedure, compared to 11 out of 28 (39.3%) nonusers. None of the PPLARC users experienced pregnancies, while 6 out of 28 (21.6%) nonusers became pregnant. Qualitative interviews underscored themes such as inadequate counseling preparation for unmet PPBTL requests and persistent barriers to BTL access. Conclusions: Raising awareness of unmet PPBTL risks may drive greater adoption of PPLARC as a bridge method. While not a substitution for PPTBL, PPLARC provides a reliable form of interval contraception for patients seeking to delay pregnancy. It is essential to recognize that patient security with PPLARC's contraceptive efficacy may introduce delays in achieving the desired interval sterilization. Enhancing antenatal counseling on contraception options and providing transparency regarding barriers to sterilization could mitigate the challenges associated with unmet PPBTL requests.

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Section: Discussioncontrasting

confidence: 53%

Outcomes for Women Denied Postpartum Tubal Ligation During the Initial COVID-19 Surge

Cosgriff,

Plummer,

Concepcion

et al. 2024

Women's Health Reports

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“…A sample size of 198 participants was calculated, based on an estimated incidence of 47% (± 5%) contraception use at 90-days postpartum and an alpha of 0.05. 5,9 A random sample of 299 charts was reviewed to account for patients who would be excluded or lost to follow-up by 90 days. Each patient's chart was reviewed by one of six fourth-year medical students trained in chart abstraction.…”

Section: Methodsmentioning

confidence: 99%

“…In one study of over 8,000 postpartum women at a single institution, less than one in four women who expressed interest in LARCs at the time of hospital discharge successfully obtained one by 90 days postpartum. 9 States have been working to improve access to immediate postpartum contraception, including LARC. [10][11][12] In May 2018, a policy change was made for Kansas Medicaid to reimburse immediate postpartum LARC.…”

Section: Introductionmentioning

confidence: 99%

“…While providers at UKH typically recommended a postpartum visit at six weeks, the follow-up window was expanded to 90 days, reflecting previous studies on postpartum contraception. 5,9 To evaluate contraceptive initiation in the hospital, the type of contraception documented for all women before hospital discharge was recorded. To evaluate contraception use by 90 days, the type of contraception for women who attended a follow-up visit or had documentation of HEM or injectable contraception at discharge was recorded.…”

mentioning

confidence: 99%

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Initiation of Postpartum Contraception by 90 Days at a Midwest Academic Center

Eisenach

Uvodich

Wolff³

et al. 2020

kjm

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Introduction. Contraception is a critical component of addressing the health needs of women in the postpartum period. We assessed contraception initiation by 90 days postpartum at a large, academic medical center in the Midwest. Methods. In this retrospective cohort study, 299 charts were randomly sampled and 231 were analyzed from deliveries between May 1 to July 5, 2018. Contraceptive method, maternal demographics, and obstetric characteristics at hospital discharge were collected, as well as contraceptive method at the postpartum follow-up appointment. Methods and strata of contraception were categorized as follows: 1) highly effective methods (HEM) defined as sterilization, intrauterine device, or implant, 2) moderately effective methods (MEM) defined as injectable contraception, progestin-only pills, and combined estrogen/progestin pills, patches, and rings, and 3) less effective methods (LEM) defined as condoms, natural family planning, and lactational amenorrhea. Women lost to follow-up who had initiated a HEM or injectable contraception were coded as still using the method at 90 days. We used logistic regression to identity factors associated with HEM use. Results. Of the 231 included patients, 118 (51%) received contraception before hospital discharge and 166 (83%) by 90 days postpartum. Postpartum visits were attended by 74% (171/231) of patients. Before hospital discharge, 28% (65/231) obtained a HEM and 41% (82/200) were using a HEM by 90 days postpartum. Patients obtaining HEM or injectable contraception before hospital discharge attended a follow-up visit less often than those who did not receive HEM before discharge (RR = 0.68, 95% CI: 0.54 - 0.86, p ≤ 0.01). Conclusion. When readily available, many women will initiate contraception in the postpartum period. Health systems should work to ensure comprehensive access to contraception for women in the postpartum period.

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“…Studies suggest that patient race, ethnicity, and socioeconomic status affect physician attitudes and practices around reversible contraception and permanent contraception, which raises concerns regarding differential counseling (26,27). For example, among patients with identical medical histories, patient race or ethnicity and socioeconomic status influenced recommendations for intrauterine contraception in ways that may reflect racial, ethnic, and social-class stereotypes (27)(28)(29).…”

Section: Longitudinalmentioning

confidence: 99%

Permanent Contraception: Ethical Issues and Considerations

2024

Obstetrics &Amp; Gynecology

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Permanent contraception is the most used method of contraception among women aged 15–49 years and is one of the most straightforward surgical procedures an obstetrician–gynecologist can perform. At the same time, this therapeutic option is enormously complex when considered from a historical, sociological, or ethical perspective. This Committee Statement reviews ethical issues related to permanent contraception using a reproductive justice framework. Ethical counseling and shared decision making for permanent contraception should adopt a nonjudgmental, patient-centered approach, using up-to-date information about permanent contraception procedures and alternatives. Obstetrician–gynecologists should strive to avoid bringing into the clinical encounter biases around gender, race, age, and class that affect thoughts on who should or should not become a parent. Obstetrician–gynecologists should also ensure that permanent contraception requests reflect each patient's wishes, come from a desire to permanently end childbearing, and come from a preference for permanent contraception over all reversible methods as well as permanent contraception for the male partner. When difficulties in meeting a postpartum permanent contraception request are anticipated and permanent contraception is desired by the patient, transfer of care for the remainder of pregnancy should be offered. ACOG recognizes the right of all patients to unimpeded access to permanent contraception as a way of ensuring health equity, but it is unclear how to craft policies that protect from coercion but also do not create barriers to autonomously desired care. Determining the ethical balance between access and safeguards will require a collaborative interdisciplinary approach that involves a variety of stakeholders with varying perspectives.

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Role of Bridge Contraception in Postpartum Long-Acting Reversible Contraception and Sterilization Fulfillment Rates

Cited by 9 publications

References 17 publications

Outcomes for Women Denied Postpartum Tubal Ligation During the Initial COVID-19 Surge

Outcomes for Women Denied Postpartum Tubal Ligation During the Initial COVID-19 Surge

Initiation of Postpartum Contraception by 90 Days at a Midwest Academic Center

Permanent Contraception: Ethical Issues and Considerations

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