Views of clinicians towards providing contraceptive advice and contraception to women following early pregnancy loss: a qualitative study

Abstract

IntroductionNational guidelines advise that clinicians caring for women post-pregnancy should give women opportunities to discuss contraception, regardless of pregnancy outcome, and provide contraception to women who choose to take up a method. This study aimed to explore knowledge, views and needs of Early Pregnancy Unit (EPU) clinicians around discussing and offering contraception and discussing pregnancy intendedness with women after early pregnancy loss using a qualitative approach.MethodsSemi-structured, audio-recorded interviews with 11 clinicians from a single regional EPU in Edinburgh, Scotland. Interviews were transcribed verbatim and analysed thematically.ResultsClinicians were reluctant to discuss contraception as they believed women would find the topic overwhelming and distressing. Thoughts on discussing pregnancy intendedness were polarised; some considered it insensitive, and others essential. Barriers to discussing contraception and providing it were numerous and included time pressure, and inadequate knowledge and training on contraception. Participants suggested training on contraception, closer working with sexual and reproductive health (SRH) services, and availability of information on contraception specifically aimed at women who have experienced an early pregnancy loss could facilitate discussions and method provision.ConclusionsEPU clinicians require ongoing training and support to be effective at discussing pregnancy intendedness and discussing and providing post-pregnancy contraception. This will require close working with SRH services and development of sensitive information around contraception for women experiencing an early pregnancy loss.

Implementation of the London Measure of Unplanned Pregnancy in routine antenatal care: A mixed-methods evaluation in three London NHS Trusts

“…A study of the potential introduction of the LMUP into early pregnancy units described clinician’s thoughts on asking about pregnancy intendedness as ‘polarized’, with some considering it essential and others insensitive 30 . Importantly, this study was hypothetical and, prior to being asked, none of the nurses interviewed knew of the LMUP.…”

“…JH developed a framework with high-level themes at the individual level of midwife and woman, organizational level and external factors, based on other research 29 , 30 , and sub-themes based on the data, and discussed with BS and CS. The transcripts were indexed by CS, BS and JH.…”

Telephone-Based Intervention to Improve Family Planning Care in Pregnancies of Unknown Location: Retrospective Pre-Post Study

“…Before using our EMR intervention, providers rarely discussed contraception with patients who had a resolved pregnancy of unknown location. In a qualitative study, investigators sought to explore clinicians’ views surrounding discussing contraception with patients after early pregnancy loss [ 6 ]. Within this study, they found that clinicians were reluctant to discuss contraception, and they also highlighted a barrier to providing contraceptive counseling as a lack of time [ 6 ].…”

“…In a qualitative study, investigators sought to explore clinicians’ views surrounding discussing contraception with patients after early pregnancy loss [ 6 ]. Within this study, they found that clinicians were reluctant to discuss contraception, and they also highlighted a barrier to providing contraceptive counseling as a lack of time [ 6 ]. This qualitative study highlights the possible bias providers experience surrounding patients experiencing pregnancy loss.…”