Planning for postpartum birth control shared decision-making with patients

Sexuality, contraception and interpregnancy intervals are among the range of topics to be addressed in a comprehensive postpartum visit

Postpartum birth control conversations with patients are best started prepartum as a conversation about the desire for and timing of any future pregnancies, according to Kathryn R. Bradley, M.D., obstetrician and gynecologist with Women’s Care Physicians of Louisville, a Part of Norton Women’s Care.

“The American College of Obstetricians and Gynecologists (ACOG) advises this is a good time for a shared decision-making conversation with the patient,” Dr. Bradley said. “It also helps open the door to the full range of contraception options, their side effects and effectiveness.”

Sexuality, contraception and interpregnancy intervals are among the range of topics to be addressed in a comprehensive postpartum visit. The visit is crucial to providing access to effective postpartum birth control, but as many as 40% of patients don’t get the follow-up care, especially patients with limited resources.

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  • Resumption of sexual intercourse is going to vary from patient to patient and shouldn’t happen before the first postpartum visit, usually within six weeks of delivery.
  • Discuss managing dyspareunia with lubricants.
  • Discuss a reproductive life plan in the context of the patient’s desire for any future pregnancies.
  • Explain that very short interpregnancy intervals (six months) come with risks of preterm birth, low birth weight, small for gestational age and perinatal death. Discuss the risks and benefits of a pregnancy less than 18 months postpartum.
  • Review the use of 17 alpha-hydroxyprogesterone caproate to prevent recurrent preterm birth and low-dose aspirin to prevent preterm preeclampsia.
  • After a shared decision-making conversation about postpartum birth control, choose a method that matches the patient’s needs. If the patient wants long-acting reversible contraception (LARC), place it the same day.

“Taking proactive steps to encourage a postpartum visit is helpful because these visits have been shown to improve overall health and well-being,” Dr. Bradley said.

According to ACOG, ways to increase attendance to postpartum visits include:

  • Discussing the importance of postpartum care during prenatal visits
  • Using peer counselors, intrapartum support staff, postpartum nurses, and discharge planners to encourage postpartum follow-up
  • Scheduling postpartum visits during prenatal care or before hospital discharge
  • Using email, text or other means to remind patients to schedule postpartum follow-up

Trials have found 15 minutes of anticipatory guidance before hospital discharge and a phone call at two weeks reduced symptoms of depression and increased breastfeeding duration through six months postpartum among Black and Hispanic patients.

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