Rates of Immediate postpartum LARC placement at MMC
Maine Medical Center, Medical Education, Maine Medical Center Research Institute, Family Medicine, Sports Medicine
Humans, Long-Acting Reversible Contraception, Female, Postpartum Period
Purpose/Background Short interval pregnancy – a pregnancy occurring in the first year after a birth – is an independent risk factor for preterm delivery and adverse neonatal outcomes. Additionally, at least 70% of short interval pregnancies are unintended. Long-acting reversible contraception methods (LARC) (intrauterine devices and etonogestrel implants) have been shown to be safe and effective for most women, have few contraindications, and have successfully decreased unintended pregnancy, abortion, and adolescent birth rates (data from Contraceptive CHOICE Project). LARC can be implemented in the immediate postpartum period (prior to hospital discharge) with the goal of reducing both unintended pregnancy and short-interval pregnancy. Despite the availability and safety of LARC, many women are not counseled about the option of immediate postpartum LARC or are unable to obtain it. Our research aims to review our hospital’s practices regarding immediate postpartum LARC placement and identify factors that are associated with offering and successfully placing LARCs in eligible, interested women during the immediate postpartum period.
Methods/Approach We obtained deidentified data from EPIC for all deliveries at MMC for one year (January 1, 2018 – December 31, 2018), excluding patients with hysterectomy at time of delivery. We gathered demographics (age, parity, contraceptive plan, delivery method and clinician caring for the patient) and contraception outcome of LARC receipt in hospital (Yes/No). Descriptive statistics were calculated for the demographic characteristics (proportions and means). We calculated the number of participants who received LARC prior to discharge and rate of those receiving LARC who had planned that method.
Results We had 2237 subjects who delivered in the study period. 70.0% were vaginal deliveries, 92.9% were delivered by OB-Gyn, 5.7% by Family Medicine and 1.3% by other disciplines. Age distribution was predominantly 26-34 years old (61.4%). Primiparous women were 46.4% of the group. Only a third of these women (754; 33.8% ) had documented contraceptive plans: 309 planned LARC, 225 planned permanent methods (Tubal ligation or vasectomy), and 220 planned shorter-acting contraception. Overall, 126 LARCs were placed during the hospitalization (5.6% of all deliveries). There was no significant difference in LARC placement by delivery method, or clinician type; LARC was more likely to be placed in younger women (15.6% of the 288 women 16-25) and in multiparous women (7.2% of women who were G2 or G3, 8,9% of women G4 or more). LARC was received by 73 (30.9%) of the 236 women who planned LARC, 20 (10%) of those who planned permanent contraception, and 27 (2%) of the 1492 women whose plans were unknown at the time of delivery. Both OB and FM providers were able to provide LARC to approximately one fifth of the women who had planned it.
Conclusions Although women may plan to use long acting contraception, few women received LARC at the time of delivery in our study. Multiparous women, and women in younger age groups were more likely to plan LARC, and approximately one third of these women got it in the hospital. More work is needed to reduce barriers to LARC receipt in the immediate post-partum period.
Holt, Christina; Haskins, Amy; Smith, Valerie; and Der Simonian, Kohar, "Rates of Immediate postpartum LARC placement at MMC" (2020). Costas T. Lambrew Research Retreat 2020. 89.