Postpartum interest in and uptake of long-acting reversible contraception at a large university-based medical center in California

Abstract

Objectives: Unintended pregnancy and short interpregnancy intervals have been associated with adverse perinatal outcomes. We sought to assess interest in and uptake of long-acting reversible contraceptive (LARC) methods in the immediate postpartum period, including immediate postpartum uptake and uptake by 8 weeks postpartum. Methods: This retrospective chart review included subjects whose delivery was managed by the university teaching service from January 1, 2012 through December 31, 2012 at 24 weeks' gestation or later. Documented postpartum contraceptive plans at time of discharge and at the postpartum visit were recorded and analyzed. Results: A total of 2355 subjects were included. Some 651 subjects (28%) expressed interest in LARC methods at the time of discharge, and 44 (6.8%) of these subjects had immediate postpartum uptake of a LARC method (IUD or implant). Of the 895 women with anticipated postpartum follow-up in our outpatient clinic, 25% did not return for their postpartum visit. Only 15% of those interested in a LARC method at discharge had received this method by 8 weeks postpartum, and 32% of women interested in a LARC method at both discharge and their postpartum visit had not received this method by 8 weeks postpartum. Conclusions: A large percentage of women who express interest in a LARC method during the immediate postpartum period at our medical center are not receiving this method by 8 weeks postpartum. Efforts should be made to eliminate barriers to LARC method placement in both the immediate postpartum setting and at the postpartum visit.