Postplacental IUD insertion: A mixed methods assessment of women’s experience
Awarded 2013
Complex Family Planning Fellowship Research
Shannon Carr, MD
University of New Mexico Health Sciences Center

Background: The immediate postpartum period is an ideal time to initiate contraception, however many women leave the hospital without an effective birth control plan. Intrauterine devices (IUDs) are highly effective at preventing pregnancy and can be placed immediately after delivery (post-placental insertion). Despite the safety and effectiveness of placing an IUD after delivery, this practice has not been widely adopted in the US for a variety of reasons. Research examining patient-centered outcomes about the procedure is lacking and these types of studies may help clinicians better inform patients and may lead to improved uptake of IUDs.
Objective: The purpose of our study was to describe women’s experiences with the post-placental IUD placement procedure. We sought to establish the average pain experienced by women who have an IUD placed immediately after vaginal delivery. We also performed interviews with women to learn more about their experiences.
Methods: We collected data among women who did and who did not have a labor epidural. We assessed IUD insertion pain on a visual analog scale (VAS) in order to calculate an average pain scores in both groups. We also used a verbal rating scale (VRS) to assess pain as a back-up measure. We interviewed women within 24 hours of delivery who had an IUD placed after delivery. Women who participated in an interview rated their overall satisfaction with their experience of having an IUD placed after delivery.
Results: The pain scales were administered to 30 women who did not have an epidural, and 36 women who had an epidural. We conducted 9 interviews in the no epidural group and 12 interviews in the epidural group. We did not achieve a reasonable average pain level, as measured on the VAS, in either group. The VRS scores revealed that among women who did not have an epidural, 53.3% reported none-mild pain and 46.7% reported moderate-severe pain. Among women who had an epidural, 88.9% reported none-mild pain and 11.1% reported moderate-severe pain. All women who were interviewed reported being very satisfied or satisfied with their post-placental IUD experience. Many women in both groups stated that labor pain was greater than IUD insertion pain, and that the IUD insertion pain was less than expected. The majority of women also stated that the duration of the procedure was less than expected. Women reported that their newborns were a welcome distraction from the procedure. None of the women had regrets about having the IUD placed after delivery. All of the women stated that they would recommend having a IUD placed after delivery to a family member or friend.
Conclusions: Our study offers clinicians useful information, including reasonable expectations for procedure pain and duration, to share with patients who are considering having an IUD placed immediately after vaginal delivery.