NEW ORLEANS – Use of a novel guided educational pamphlet during the immediate postpartum period is feasible and effective for promoting the use of long-acting reversible contraceptive methods, according to findings from a prospective cohort study.
Of 134 study subjects aged 18 years or older, 78% reported a preference regarding contraceptive method at baseline, and the most popular choices were non–long-acting reversible contraceptive (LARC) methods followed by intrauterine devices (IUDs), implants, and injections. Nearly a quarter (23%) of these women changed their minds after the intervention, with 94% of those ultimately choosing a LARC method, Dr. Ariel Cohen reported at the annual meeting of the American College of Obstetricians and Gynecologists.
Of the 22% of women who had not decided on a contraceptive method at baseline, more than half selected a method after the intervention, and 82% of those selected a LARC method, with IUD being the most popular choice followed by implant and injection methods, said Dr. Cohen of Baystate Medical Center, Springfield, Mass.
The intervention involved a brief interaction between the subject and a research assistant within 4 days of delivery. The research assistant guided the subject through an eight-page educational pamphlet, which included three sections: an interactive section including six questions about contraceptive preferences, a comparative effectiveness section including a World Health Organization contraceptive comparative effectiveness chart, and an information section that provided more details about each contraceptive method.
Subjects were asked about their predelivery method of choice, and were called at 3 months and 6 months post partum for a follow-up evaluation.
The initial intervention took a mean of 8 minutes, and the research assistant had little difficulty obtaining the necessary time and privacy with the subjects, Dr. Cohen noted.
Mean age of the women was 24 years. Most identified as white or Hispanic, most (58%) had at least one other child (median parity, 2), and 84% had a 12th grade education or less.
The findings are important because although ACOG recommends that contraceptive counseling be provided during the intrapartum period, many physicians delay contraception discussion until the postpartum visit, Dr. Cohen said.
"However, research has shown that patients who are at the highest risk for unintended pregnancy have up to a 50% no-show rate at the postpartum visit," she said.
The immediate postpartum period provides a unique opportunity for contraceptive counseling, she added.
"Not only is the patient a captive audience ... she’s also highly motivated to avoid a rapid repeat pregnancy," she said.
Based on these findings, it appears this educational tool would be useful prior to discharge, if administered by either a physician or trained nurse or medical assistant, she said, noting that plans are underway to validate the tool by developing a pre- and posttest and conducting a randomized study, she said.
Dr. Cohen reported having no disclosures.