The Clinical Importance of Postpartum Contraception Upon Hospital Discharge [25J

Abstract

INTRODUCTION: The immediate postpartum period is critical for contraceptive provision due to rapid fertility return but only half of women attend the postpartum visit. Our objective was to examine whether immediate postpartum contraception influenced the likelihood of postpartum follow-up or subsequent pregnancies within 3-years of delivery. METHODS: The IRB approval was obtained. We conducted a retrospective chart review of hospital deliveries from April–July 2015 and reviewed follow-up data through 2018. The primary outcome was immediate postpartum contraception (provided before discharge). Secondary outcomes were postpartum visit attendance, follow-up after postpartum visit, and subsequent pregnancies. Chi-square analysis was used for between-group comparisons. RESULTS: Among 307 patients, the largest percentage (n=76, 24.8%) received contraceptive implants. Only 44.3% (n=133) of women returned for the postpartum visit; there were no differences by contraceptive method. There were 171 (55.7%) women without follow-up past the postpartum period. Patients who received LARC or permanent contraception immediately postpartum were less likely to follow up after the postpartum visit (n=52, 38.2%) compared to less effective methods (n=84, 61.8%; P<.05). Of 55 women with subsequent pregnancies, 13 (23.6%) had been discharged with LARC, and 42 (76.4%) with less effective methods or no method (P<.001). CONCLUSION: Less than half of patients returned for postpartum care. Women discharged with LARC or permanent methods were less likely to have follow-up after the postpartum visit, or have subsequent pregnancies within a 3-year time frame compared to women discharged with less effective or no contraception. Results highlight the importance of offering contraception in the immediate postpartum period.