Making Contraception Accessible Through Implementation of Immediate Postpartum Long-Acting Reversible Contraception

Abstract

Women in our community desired a program that would help them decrease the risk of unintended pregnancy. Make long-acting, reversible contraception (LARC) available to women in the immediate postpartum period so as to provide a timely and convenient alternative to waiting for a 4–6-week postpartum follow-up visit. A multidisciplinary team consisting of providers, registered nurses, pharmacists, a nurse informaticist, and a fiscal representative convened to build an inpatient program that would allow for insertion of a hormone-releasing intrauterine device within 10 min of placenta delivery or placement of an etonorgestrel implant prior to discharge. Women were counseled by their obstetric provider antenatally, and their election to participate in the LARC program was documented in the electronic health record. On admission to the labor and delivery unit, the admitting nurse confirmed the woman’s desire to participate in the LARC program as well as her choice of contraception. The program began in July 2018. Between July1, 2018, and December 31, 2018, 128 women with medical assistance–managed care benefited from immediate postpartum LARC. Forty intrauterine devices and 88 etonorgestrel implants were placed. Additional long-term evaluation of this program’s impact on decreasing unintended pregnancies is needed. Nurses in the prenatal setting as well as in the immediate postpartum setting are uniquely situated to affect the implementation of immediate postpartum LARC. Nurses must be provided with the tools to effectively teach women about the benefits of LARC so they can make informed decisions about their reproductive health.