Intrauterine contraceptive insertion at two-weeks postpartum: A study of acceptability and short-term outcomes
Awarded 2014
Complex Family Planning Fellowship Research
Matthew Zerden, MD, MPH
The University of North Carolina at Chapel Hill

Background: Half of all pregnancies in the United Stated are unintended. The traditional postpartum visit is scheduled at six-weeks following delivery. This time period may be too late as women can already be pregnant by that visit. Additionally, as many as 50% of women on Medicaid never attend a postpartum visit, and one reason for this poor attendance may be that six-weeks is longer than optimal timing for the visit. The intrauterine device (IUD) is as effective as permanent surgical sterilization. It has additional benefits of being reversible, being effective for multiple years, and having high rates of user satisfaction. An earlier time in the postpartum may be an ideal time period for IUD insertion in the office. However, it is not known if IUDs can be placed at two-weeks and if patients will be satisfied with placement at that time.
Methodology: Fifty women were recruited for this study during their antepartum care. Interested women attended a visit in the office during the second postpartum week. At this study visit, the women completed enrollment and then had an IUD placed. Women returned to their regularly scheduled six-week postpartum visit, where their doctor or midwife performed an IUD string check to ensure the IUD was in place. The final study visit was at six-months postpartum, where women returned for an ultrasound to visualize correct placement of the IUD in the uterus. At all visits, women completed questions related to the symptoms and satisfaction with the IUD.
Statement of Purpose: To determine if women would find it acceptable for an IUD to be placed two-weeks postpartum. Acceptability was assessed by asking the women who received the IUD whether or not they would recommend IUD insertion at two-weeks postpartum to a friend.
Important Findings: Seventy-five postpartum patients scheduled to have the IUD inserted, and from that cohort, 50 women presented to the initial study visit. All 50 had successful IUD placement at two-weeks postpartum. Rates of IUD expulsion, a rare but known side effect, were low (4.7%). Three women (7%) requested the IUD be removed during the study. Of the 43 women with IUDs placed who were reached at six-months postpartum, 93% recommended two-week postpartum insertion to a friend.
Relevance: IUD insertion at two-weeks postpartum may be an additional strategy to reduce unintended pregnancies because the women in our study found it acceptable.