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ACOG: Physicians should counsel women on immediate, postpartum LARC

Physicians should counsel pregnant women on the convenience and effectiveness of immediate, postpartum long-acting reversible contraception in reducing the risk for unintended or short-interval pregnancy, according to new recommendations issued by the American College of Obstetricians and Gynecologists.

The opinion and recommendations, developed by the ACOG Committee on Obstetric Practice, note how postpartum long-acting reversible contraception (LARC) can be beneficial to women, particularly those at highest risk for unplanned or short-interval pregnancy. The authors added that physicians should also counsel patients on the risks for intrauterine device (IUD) expulsion, and the option for implant and alternative methods of contraception.

“Obstetrician-gynecologists and other obstetric care providers should discuss LARC during the antepartum period and counsel all pregnant women about options for immediate postpartum initiation,” Ann E. Borders, MD, MSc, MPH, of the NorthShore University health system, in Illinois, and colleagues wrote. “Education and institutional protocols are needed to raise clinician awareness and to improve access to immediate postpartum LARC insertion.”

The ACOG’s recommendations, published in Obstetrics & Gynecology, are:

• Women should receive prenatal counseling regarding immediate postpartum LARC, including guidance on the risks for IUD expulsion, contraindications and alternatives to allow for informed decision making;
• LARC should be offered as an effective option for postpartum contraception, and care providers should specifically counsel women about their convenience and effectiveness, and the benefits of reducing unintended pregnancy and lengthening intervals between pregnancies;
• Counseling should include discussions on the increased risk for expulsion, including unrecognized expulsion, in connection with immediate postpartum IUD insertion compared with interval IUD insertion;
• Care providers should have systems in place to ensure that women who desire LARC can receive it during the comprehensive postpartum visit if immediate postpartum placement did not occur;
• Care providers and institutions should have the resources to support immediate LARC placement after vaginal and cesarean births, including stocking LARC devices in the labor and delivery unit, and maintaining coding and reimbursement strategies; and
• Care providers should advocate for appropriate reimbursement for immediate postpartum LARC from public and private insurers.

According to the ACOG, nearly half of all pregnancies in the United States are unplanned. Those at highest risk for unplanned pregnancies are minority women of low socioeconomic status, aged 18 to 24 years.

In addition, although many women may plan to resume or implement a contraceptive method at their postpartum follow-up visit, up to 40% do not attend a follow-up appointment, and never obtain an IUD or alternative contraceptive.

LARC placement in the immediate postpartum period, according to the ACOG recommendations, would reduce barriers women face in securing the appropriate contraceptives in the weeks and months following delivery. – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.