Are we providing adequate postpartum contraception?A Retrospective audit of postpartum contraception provided to 101 women delivering in University Hospitals of Leicester
Dr Annabel Sowemimo1, Dr Farah Siddiqui2, Mr Emeka Oloto3
1.Community Sexual and Reproductive Health ST2, Midlands Partnership NHS Foundation Trust
2.Consultant Obstetrician, University Hospitals of Leicester NHS Trust
3.Community Sexual and Reproductive Health Consultant, Midlands Partnership NHS Foundation Trust
Background: Following pregnancy it is imperative that those giving birth are given adequate information and access to the most effective methods of contraception1. Studies show that women underestimate their risk of pregnancy during the post natal period2,3; many being unaware that they require contraception after 21 days. One UK study demonstrated that 1 in 13 women presenting for an abortion or delivery had conceived within the previous year3.
Contraception in the post-natal period has been shown to avert >30% of maternal deaths and 10% of child mortality if couples space their pregnancies more than 2 years apart4. It is a particularly important intervention for women of high parity and pre-existing medical conditions. Pregnancy within the first year postpartum is associated with a greater risk of preterm, low birth weight and small for gestational age5. An inter-pregnancy interval of less than 12 months between childbirth and conceiving again is associated with increased risk of preterm birthand small for gestational age infants6.
Guidance from the Faculty of Sexual & Reproductive Health (FSRH)1 states that a choice of contraceptive method should be Initiated by 21 days after childbirth. The chosen method of contraception can be initiated immediately after childbirth if desired and if she is medically eligible. Women should be advised that the more effective long acting reversible contraceptive (LARCs) such as intrauterine contraception (IUC) and progesterone only implant (IMP) can be inserted immediately after delivery. Appropriately trained clinicians including SRH doctors and nurses, obstetricians, midwives, nurses, GPs and health visitors should be able to provide women with contraception after childbirth.
Attendances in the integrated Sexual & Reproductive Health (SRH) clinic in Leicester suggest that women are not accessing postpartum contraception in a timely fashion and often, have resumed sexual activity before accessing our services.If we are to meet the plans set out in the government’s Sexual Health Framework7 then a more robust strategy for postpartum contraception must be developed.
Objective:This audit aims to compare postpartum contraception provision at University Hospitals of Leicester (UHL) to the Faculty of Sexual and Reproductive Health (FSRH) clinical standards.