Original Article

Prenatal Contraceptive Counseling by Video

Authors: S. Allison Staley, MD, MPH, Samantha S. Charm, MPH, Laurel B. Slough, DO, MSPH, Matthew L. Zerden, MD, MPH, Jessica E. Morse, MD, MPH


Objective: Effective postpartum contraception can improve interpregnancy intervals. Opportunities exist for counseling and education during prenatal care. Few studies have assessed the use of multimedia as a tool to improve long-acting reversible contraception (LARC) use postpartum. The objective of this study was to evaluate whether LARC-focused video counseling during prenatal care increases uptake of postpartum LARC and overall contraception use.

Methods: In this randomized controlled trial, women receiving their prenatal care at a university-based resident clinic were randomized to receive LARC FIRST video contraceptive counseling along with routine prenatal care or routine prenatal care alone. All of the participants received information regarding access to free LARC methods in the postpartum period. The primary outcome was LARC uptake by 12 weeks postpartum. Secondary outcomes included overall contraception use at 12 weeks postpartum, postpartum visit attendance, and acceptability of video counseling.

Results: LARC use at 12 weeks postpartum rose from an estimated 6% preintervention to 39.4% (13/33) in the video group compared with 29.4% (10/34) of the control group. The difference between groups was not statistically significant. Although overall contraceptive use (72.7% vs 54.8%) and postpartum visit attendance (91% vs. 76.5%) were higher in the video group relative to the control group, these differences were not statistically significant. Participants overwhelmingly liked the video (95.2%, 41/42) and believed viewing it was a good use of their appointment time (92%, 38/42).

Conclusions: LARC use increased 32% across the entire study cohort; however, video-based contraceptive counseling did not increase LARC uptake at 12 weeks postpartum compared with routine prenatal care alone. Patients viewing the video reported high levels of acceptability and improved contraceptive knowledge. Video counseling may be a useful adjunct in many clinical settings.
Posted in: Obstetrics and Gynecology63 Family Planning & Reproductive Health12

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1. Conde-Agudelo A, Rosas-Bermudez A, Kafury-Goeta AC. Birth spacing and risk of adverse perinatal outcomes: a meta-analysis. JAMA 2006;295:1809-1823.
2. Hussaini KS, Ritenour D, Coonrod DV. Interpregnancy intervals and the risk for infant mortality: a case control study of Arizona infants 2003-2007. Matern Child Health J 2013;17:646-653.
3. Teal SB. Postpartum contraception: optimizing interpregnancy intervals. Contraception 2014;89:487-488.
4. American College of Obstetricians and Gynecologists Committee on Gynecologic Practice Long-Acting Reversible Contraception Working Group. ACOG Committee Opinion no. 450: Increasing use of contraceptive implants and intrauterine devices to reduce unintended pregnancy. Obstet Gynecol 2009;114:1434-1438.
5. Farr S, Folger SG, Paulen M, et al. US medical eligibility criteria for contraceptive use, 2010: adapted from the World Health Organization Medical Eligibility Criteria for Contraceptive Use, 4th ed. MMWR Recomm Rep 2010;59 (RR-4):1-86.
6. Lopez LM, Grey TW, Hiller JE, et al. Education for contraceptive use by women after childbirth. Cochrane Database Syst Rev 2015;(7):CD001863.
7. Lopez LM, Grey TW, Chen M, et al. Strategies for improving postpartum contraceptive use: evidence from non-randomized studies. Cochrane Database Syst Rev 2014; (11) :CD011298.
8. Schwarz EB, Burch EJ, Parisi SM, et al. Computer-assisted provision of hormonal contraception in acute care settings. Contraception 2013;87:242-250.
9. Travasso C. App helps to improve contraception uptake in rural India. BMJ 2016;352:i667.
10. Madden T, Mullersman JL, Omvig KJ, et al. Structured contraceptive counseling provided by the Contraceptive CHOICE Project. Contraception 2013;88:243-249.
11. Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Obstet Gynecol 2010;115:1063-1070.
12. McCambridge J, Witton J, Elbourne DR. Systematic review of the Hawthorne effect: new concepts are needed to study research participation effects. J Clin Epidemiol 2014;67:267-277.
13. Branum AM, Jones J. Trends in long-acting reversible contraception use among U.S. women aged 15-44. NCHS Data Brief 2015;(188):1-8.
14. Peipert JF, Madden T, Allsworth JE, et al. Preventing unintended pregnancies by providing no-cost contraception. Obstet Gynecol 2012;120:1291-1297.
15. Attanasio L, Kozhimannil KB. Health care engagement and follow-up after perceived discrimination in maternity care. Med Care 2017;55:830-833.
16. Pazol K, Zapata LB, Tregear SJ, et al. Impact of contraceptive education on contraceptive knowledge and decision making: a systematic review. Am J Prev Med 2015;49 (2 suppl 1):S46-S56.
17. Gilliam M, Hebert L, Brown R, et al. Exploring the feasibility and effectiveness of a contraceptive counseling waiting room app. Contraception 2016;94:412.
18. Kofinas JD, Varrey A, Sapra KJ, et al. Adjunctive social media for more effective contraceptive counseling: a randomized controlled trial. Obstet Gynecol 2014;123:763-770.
19. Sridhar A, Chen A, Forbes ER, et al. Mobile application for information on reversible contraception: a randomized controlled trial. Am J Obstet Gynecol 2015;212:774.e1-e7.
20. Gilliam ML, Martins SL, Bartlett E, et al. Development and testing of an iOS waiting room"app"for contraceptive counseling in a Title X family planning clinic. Am J Obstet Gynecol 2014;211:481.e1-e8.
21. Michie L, Cameron ST, Glasier A, et al. Giving information about the contraceptive implant using a DVD: is it acceptable and informative? A pilot randomised study. J Fam Plann Reprod Health Care 2016;42:194-200.
22. Kavanaugh ML, Jerman J, Finer LB. Changes in use of long-acting reversible contraceptive methods among U.S. women, 2009-2012. Obstet Gynecol 2015;126:917-927.
23. Moniz MH, Chang T, Heisler M, et al. Inpatient postpartum long-acting reversible contraception and sterilization in the United States, 2008-2013. Obstet Gynecol 2017;129:1078-1085.