The views of postnatal women and midwives on midwives providing contraceptive advice and methods: a mixed method concurrent study

Abstract

Background Provision of contraception to women in the immediate postnatal period has been endorsed by professional bodies, to reduce the incidence of short inter-pregnancy intervals. This study examined the views of postnatal women and practising midwives regarding provision of contraceptive advice and contraceptive methods by midwives, in a region of the United Kingdom. Methods A mixed-method approach using qualitative interviews with midwives, and a postnatal survey followed by qualitative interviews with postnatal women, in five hospitals in the East of England. Twenty-one practising midwives and ten women were interviewed. Two hundred and twenty-seven women returned a survey. Survey data was analysed descriptively, augmented by Student’s t-tests and Chi-squared tests to examine associations within the data. Interviews were recorded, transcribed and analysed guided by the phases of thematic analysis. Results Midwives and women supported the concept of increased midwifery provision of contraceptive advice, and provision of contraceptive methods in the postnatal period. Convenience and an established trusting relationship were reasons for preferring midwifery provision over visiting a doctor for contraception. The best time for detailed discussion was reported to be antenatal and community visits. The Progesterone-only-pill (POP) was the method, in which women indicated most interest postnatally. Concerns for midwives included the need for increased education on contraceptive methods and training in supplying these. Structural barriers to such provision were time pressures, low prioritisation of contraceptive training and disputes over funding. Conclusions Women reported interest in midwives supplying contraceptive methods and expressed the view that this would be convenient and highly acceptable. Midwives are supportive of the concept of providing enhanced contraceptive advice and methods to women in their care, and believe that it would be advantageous for women. Institutional support is required to overcome structural barriers such as poor access to continuous professional development, and to allow contraceptive provision to be fully recognised as integral to the midwifery role, rather than a marginalised addition.

Introduction of the London Measure of Unplanned Pregnancy at the booking visit and the midwives’ perspective

“…The midwives in our study told us that they want to work to the full scope of their practice and provide holistic care 24. National and international studies have found women want midwives to offer expert care across their pregnancy journey 25 26. Postpartum contraception advice from midwives, for example, was well received by women in a UK study in which women cited trust and continuity of care as contributing factors 25.…”

“…National and international studies have found women want midwives to offer expert care across their pregnancy journey 25 26. Postpartum contraception advice from midwives, for example, was well received by women in a UK study in which women cited trust and continuity of care as contributing factors 25. Dutch midwives are already providing unstructured preconception counselling 27.…”

Profiles of copper intrauterine devices and levonorgestrel intrauterine systems users in France in 2019: A national observational population‐based study

“…16 Promoting consultations about contraception with midwives outside the perinatal period could be another option. 17 Lastly, training other health professionals, such as nurses, on the insertion of IUDs is a possibility that should be considered. 18 In the present study, women who had a pregnancy history in the year before dispensation of a device were more likely to get a Cu-IUD rather than a LNG-IUS.…”

“…The financial incentive for general practitioners to insert an IUD could be a lever to promote dispensation of Cu‐IUD/LNG‐IUS and to decrease unequal access to long‐acting reversible contraception as observed in the United Kingdom 16 . Promoting consultations about contraception with midwives outside the perinatal period could be another option 17 . Lastly, training other health professionals, such as nurses, on the insertion of IUDs is a possibility that should be considered 18 …”

Opportunities for Increasing Access to Effective Contraception in Australia

“…47 48 Both nurses and midwives are generally supportive of such an expanded role within their scope of practice, 5 49 50 as occurs in other international settings. 40 41 51 52 Exploration of nurse- and midwifery-led models of contraceptive care in Australia will therefore be critical to increasing access to effective contraception. 38 39 53…”