Postpartum contraception initiation: Does an earlier postpartum visit make a difference?
Awarded 2014
Complex Family Planning Fellowship Research
Melissa Chen, MD, MPH
University of California, Davis

Short interval pregnancies, defined as pregnancies conceived within 18 months of a previous birth, are associated with adverse pregnancy outcomes, such as preterm birth and low birth weight. Postpartum use of long acting reversible contraception (LARC), which includes intrauterine devices (IUDs) and contraceptive implants, has been shown to decrease the risk of short interval pregnancies as compared with barrier methods. Women typically initiate contraception at a six-week postpartum visit. However, many couples resume intercourse by six weeks after delivery. Waiting until a six-week postpartum visit to initiate contraception may be too late for some women, and an earlier postpartum visit may be more optimal for contraception initiation. The primary objective of this study was to compare LARC initiation at the postpartum visit between women who are scheduled for a visit at six weeks versus 2-3 weeks after delivery. Secondary objectives included postpartum follow-up rates, overall contraception initiation at the postpartum visit, satisfaction with timing of the postpartum visit, LARC use at three and six months after delivery, and breastfeeding rates at the postpartum visit, three, and six months after delivery. This prospective cohort study compared outcomes before and after the University of California, Davis Department of Obstetrics and Gynecology implemented a policy to change the timing of the postpartum visit scheduling from six weeks to 2-3 weeks after delivery. After providing informed consent, participants completed a baseline questionnaire during their third trimester of pregnancy assessing demographic information, postpartum contraceptive plan, and breastfeeding intention. We reviewed the electronic medical record for delivery and postpartum visit data. At three and six months postpartum, participants completed a telephone questionnaire assessing contraception use and breastfeeding status.