The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Original Article

Limited Uptake of Planned Intrauterine Devices During the Postpartum Period

Authors: Jennifer Salcedo, MD, MPH, Natalie Moniaga, MD, Tabetha Harken, MD, MPH

Abstract

Objectives: The primary objective of this study was to determine the percentage of women with a documented plan for postpartum intrauterine device (IUD) insertion who had a device inserted within 8 weeks of delivery. The secondary objective was to determine factors associated with successful initiation of postpartum IUDs as planned.

Methods: We conducted a retrospective chart review of women who had at least one prenatal visit and delivered a viable pregnancy at our academic medical center. Methods of planned and established postpartum contraceptive methods were recorded, as well as demographic information and documented reasons for failure to initiate planned intrauterine contraception.

Results: A total of 110 women planned postpartum IUD placement. Of these women, 84 (76%) presented for at least one postpartum appointment. Only 22.6% (95% confidence interval 13.7–31.5) of those presenting for postpartum follow-up underwent IUD placement within 8 weeks of delivery. Women planning postpartum IUD insertion were just as likely as women with no planned postpartum contraceptive method to fail to establish contraception within 8 weeks ( P = 0.55).

Conclusions: Failure to establish planned postpartum intrauterine contraception occurs frequently, even in a setting with a high rate of postpartum follow-up.

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References

1. Perez A, Vela P, Masnick GS, et al. First ovulation after childbirth: the effect of breast-feeding. Am J Obstet Gynecol 1972;114:1041-1047.
 
2. Campbell OM, Gray RH. Characteristics and determinants of postpartum ovarian function in women in the United States. Am J Obstet Gynecol 1993;169:55-60.
 
3. Gray RH, Campbell OM, Zacur HA, et al. Postpartum return of ovarian activity in nonbreastfeeding women monitored by urinary assays. J Clin Endocrinol Metab 1987;64:645-650.
 
4. Visness CM, Kennedy KI, Gross BA, et al. Fertility of fully breast-feeding women in the early postpartum period. Obstet Gynecol 1997;89:164-167.
 
5. Connolly A, Thorp J, Pahel L. Effects of pregnancy and childbirth on postpartum sexual function: a longitudinal prospective study. Int Urogynecol J Pelvic Floor Dysfunct 2005;16:263-267.
 
6. Seibel-Seamon J, Visintine JF, Leiby BE, et al. Factors predictive for failure to perform postpartum tubal ligations following vaginal delivery. J Reprod Med 2009;54:160-164.
 
7. Gilliam M, Davis SD, Berlin A, et al. A qualitative study of barriers to postpartum sterilization and women’s attitudes toward unfulfilled sterilization requests. Contraception 2008;77:44-49.
 
8. Ogburn JA, Espey E, Stonehocker J. Barriers to intrauterine device insertion in postpartum women. Contraception 2005;72:426-429.
 
9. Celen S, Sucak A, Yildiz Y, et al. Immediate postplacental insertion of an intrauterine contraceptive device during cesarean section. Contraception 2011;84:240-243.
 
10. Chen BA, Reeves MF, Hayes JL. Postplacental or delayed insertion of the levonorgestrel intrauterine device after vaginal delivery: a randomized controlled trial. Obstet Gynecol 2010;116:1079-1087.
 
11. Grimes D, Schulz K, Van Vliet H, et al. Immediate post-partum insertion of intrauterine devices. Cochrane Database Syst Rev 2003;1:CD003036.
 
12. Levi E, Cantillo E, Ades V, et al. Immediate postplacental IUD insertion at cesarean delivery: a prospective cohort study. Contraception 2012;86: 102-105.
 
13. Hatcher RA, Trussell J, Nelson AL, et al. Contraceptive Technology. 20th ed. New York: Ardent Media; 2011.
 
14. Day T, Raker CA, Boardman LA. Factors associated with the provision of antenatal contraceptive counseling. Contraception 2008;78:294-299.
 
15. Hernandez LE, Sappenfield WM, Goodman D, et al. Is effective contraceptive use conceived prenatally in Florida? The association between prenatal contraceptive counseling and postpartum contraceptive use. Matern Child Health J 2012;16:423-429.
 
16. Glasier AF, Logan J, McGlew TJ. Who gives advice about postpartum contraception? Contraception 1996;53:217-220.
 
17. Yee L, Simon M. Urban minority women’s perceptions of and preferences for postpartum contraceptive counseling. J Midwifery Womens Health 2011;56:54-60.
 
18. Finer LB, Sonfield A, Jones RK. Changes in out-of-pocket payments for contraception by privately insured women during implementation of the federal contraceptive coverage requirement. Contraception 2014;89:97-102.
 
19. Rodriguez MI, Caughey AB, Edelman A, et al. Cost-benefit analysis of state- and hospital-funded postpartum intrauterine contraception at a university hospital for recent immigrants to the United States. Contraception 2010;81:304-308.
 
20. Washington CI, Jamshidi R, Thung SF, et al. Timing of postpartum intrauterine device placement: a cost-effectiveness analysis. Fertil Steril 2015;103:131-137.
 
21. American Congress of Obstetricians and Gynecologists. Medicaid reimbursement for postpartum LARC: by state. http://www.acog.org/About-ACOG/ACOG-Departments/Long-Acting-Reversible-Contraception/Coding-and-Reimbursement-for-LARC/Reimbursement-Resources-for-Postpartum-LARC-Initiation. Accessed April 16, 2015.
 
22. Heikkila M, Luukkainen T. Duration of breast-feeding and development of children after insertion of a levonorgestrel-releasing intrauterine contraceptive device. Contraception 1982;25:279-292.
 
23. Chen BA, Reeves MF, Creinin MD, Schwarz EB. Postplacental or delayed levonorgestrel intrauterine device insertion and breast-feeding duration. Contraception 2011;84:499-504.
 
24. Lopez LM, Grey TW, Stuebe AM, et al. Combined hormonal versus nonhormonal versus progestin-only contraception in lactation. Cochrane Database Syst Rev 2015;3:CD003988.
 
25. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention. U.S. Selected Practice Recommendations for Contraceptive Use, 2013: adapted from the World Health Organization selected practice recommendations for contraceptive use, 2nd ed. MMWR Recomm Rep 2013;62(RR-05):1-60.