Counseling for Immediate Postpartum LARC

Optimally, women should be counseled prenatally about the option of immediate postpartum LARC. Counseling should include advantages, risks of intrauterine device (IUD) expulsion, contraindications, and alternatives to allow for informed decision making.

Immediate postpartum LARC should be offered as an effective option for postpartum contraception; there are few contraindications to postpartum IUDs and implants. Obstetrician-gynecologists and other health care providers should counsel women about the convenience and effectiveness of immediate postpartum LARC, as well as the benefits of reducing unintended pregnancy and lengthening interpregnancy intervals.

Obstetrician-gynecologists and other obstetric care providers should include in their contraceptive counseling the increased risk of expulsion, including unrecognized expulsion, with immediate postpartum IUD insertion compared with interval IUD insertion.

Systems should be in place to ensure that women who desire LARC can receive it during the comprehensive postpartum visit if immediate postpartum LARC was not undertaken.

Timing of Contraceptive Counseling

When is the best time to discuss postpartum contraception? They are all good times!

  • Prenatal care – Optimally, counseling beings during this time
  • Intrapartum – Reinforce themes from prenatal counseling
  • Postpartum – Opportunity for more education

Research has shown that the prevalence of postpartum contraceptive use, including the use of more effective methods, was highest when contraceptive counseling was provided during both prenatal and postpartum time periods.

Citation:

Citation: Zapata LB, Murtaza S, Whiteman MK, Jamieson DJ, Robbins CL, Marchbanks PA, et al. Contraceptive counseling and postpartum contraceptive use. Am J Obstet Gynecol 2015;212:171.e1-8.

Learn more about clinical considerations for providing LARC immediately postpartum