Evaluation of Postpartum Contraceptive Plan and Actual Use [4A

Abstract

INTRODUCTION: Using effective contraception postpartum can help women achieve recommended interpregnancy intervals. This study evaluated women’s postpartum contraception plan and actual use. METHODS: Medical record data was retrieved for women with at least one prenatal visit and a live birth between July 1, 2014–June 30, 2015 at a single academic medical center. Of those with a postpartum visit, a random sample of 200 women was selected for retrospective chart review. Records were reviewed up to three months postpartum to identify contraceptive method plan and actual use postpartum. RESULTS: Data was retrieved for 2445 women meeting criteria, of whom 23.1% (565/2445) had no postpartum visit. Among the sample of women with a postpartum visit, 33.5% (67/200) of actual contraception used postpartum diverged from the prenatal plan, of whom 59.7% (40/67) changed from higher to lower effectiveness. Prenatally, 47.0% (94/200) planned to use highly effective (tubal ligation, intrauterine device, implant, lactational amenorrhea), 26.0% (52/200) effective (pill, patch, ring, injection), 22.5% (45/200) less effective (barrier), and 4.5% (9/200) no method. Postpartum, 35.0% (70/200) used highly effective, 41.0% (82/200) effective, 23.5% (47/200) less effective, and 0.5% (1/200) no method. Breastfeeding was not included in analysis. There was no difference in effectiveness of contraception used between women seeing Ob/Gyn physicians and Nurse Midwives (P=0.413). Number of prenatal visits did not influence use of highly effective contraception (P=0.945). CONCLUSIONS: Most women adhered to the postpartum contraceptive plan made prenatally. Over half the women who deviated from their prenatal contraceptive plan used a less effective method.