Initiation of postpartum contraception: A survey among health centre physicians and nurses in Finland

Abstract

Objective. To examine self-reported professional practices of postpartum contraceptive counselling at Finnish community health centres. Design. A survey study with self-administered online questionnaires. Setting. All local municipalities (n = 107) in the Expert Responsibility Area of Tampere University Hospital in Western Finland in 2005. Subjects. A total of 69 (64% of 107) health centre physicians and 80 (75%) nurses performing postpartum check-ups. Main outcome measures. Contraceptive method most often initiated or recommended to breastfeeding women at postpartum visit; timing of postpartum initiation of hormonal and intrauterine contraceptive methods in relation to breastfeeding and resumption of menses. Results. The most common contraceptive method initiated or recommended to breastfeeding women by both physicians (41%) and nurses (45%) was the condom, followed by progestin-only pills and intrauterine contraception. Few professionals recommended breastfeeding (lactational amenorrhea) as the only contraceptive method. Only eight (12%) physicians inserted a copper-releasing intrauterine device and five (7%) a levonorgestrel-releasing intrauterine system typically at the postpartum visit; the majority delayed the insertions until the resumption of menses. Fifty-three (77%) physicians initiated combined oral contraceptives mostly when breastfeeding was terminated and menses had returned. Over half of the municipalities involved in the study did not provide any medical contraceptives free of charge postpartum. Conclusion. Professionals’ reports indicate that initiation of effective contraceptive methods is delayed after childbirth. In order to promote better postpartum contraception practices, updated evidence-based guidelines are needed.