Family physicians and provision of immediate postpartum contraception: A CERA study

Abstract

Background and objectives: The Centers for Disease Control and Prevention (CDC) support the provision of intrauterine devices (IUDs) and the contraceptive implant to women immediately after childbirth. We aimed to assess perceived training needs and barriers to immediate postpartum contraceptive service delivery among US family physicians.

Methods: We contributed items regarding postpartum contraception to the 2015 Council of Academic Family Medicine Educational Research Alliance (CERA) omnibus survey of a national cohort of family medicine educators. We assessed self-estimated adequacy of training to insert IUDs and implants immediately postpartum, how often these services are provided, and barriers to service provision.

Results: Our sample of 409 respondents who provide labor and delivery maternity care was primarily Caucasian (79.9%) and female (56.0%). Significantly fewer respondents felt comfortable counseling about long-acting reversible contraception (LARC), inserting an IUD, and inserting an implant immediately postpartum compared to at 6+ weeks postpartum (all comparisons P<0.001). Fewer respondents felt adequately trained to insert an immediate postpartum IUD (36.4%) than an implant (58.7%; P<0.001). Most respondents had never placed an immediate postpartum IUD (81.17%) or implant (80.1%). Device unavailability was the most commonly cited reason for never having placed an immediate postpartum IUD (67.8%) or implant (71.2%) at one's institution.

Conclusion: As reimbursement for immediate postpartum contraception becomes more common, family physicians are on the front lines to make these services available to patients who desire them. Training is necessary to enable family physicians to provide this evidence-based option to women.

Comment: As discussed earlier in this column, immediate post partum contraception is safe and highly effective, so the authors make a plea for reimbursement. Also governments and donors must be convinced of the advantages. And for providers who feel uncomfortable to insert an IUD immediately after delivery for fear of perforations, there is a great training tool available: see laerdalglobalhealth.com > Sister-U: multi-uterus-trainer. (HMV)