Objective: Provision of immediate postpartum intrauterine contraception (PPIUC) is known to be safe but not routinely practiced within the UK. Improving access to effective contraceptive methods during the postpartum period can reduce the risk of subsequent unintended pregnancy and short inter-pregnancy intervals. Our aim was to introduce an immediate PPIUC insertion facility within a large public maternity service in Scotland, UK.
Methods: Obstetricians and labour ward midwives were trained in PPIUC insertion techniques. Women received PPIUC information from community midwives during routine antenatal contraception discussion. They could choose to receive either a copper intrauterine device or levonorgestrel-releasing system at planned caesarean section (from July 2015) or after vaginal birth (from January 2017). Women received a clinical review at six weeks to confirm device placement followed by telephone consultation at three, six and 12 months. Data from the first 300 women to receive intra-caesarean PPIUC and the first 100 women to receive PPIUC at vaginal birth were analysed in relation to complications, continuation and patient satisfaction.
Results: The uptake rate of PPIUC at caesarean section was 13.3%. There were 9 cases of suspected endometritis (3.8%), no uterine perforations and a cumulative device expulsion rate of 8.0%. At 12 months, the follow-up rate was 84.3% (n=253) and 79.1% (n=100) had continued IUC use. Of the first 100 women receiving PPIUC at vaginal birth, 45 (46.9%) experienced partial or complete expulsion and 82.2% proceeded to have further IUC inserted. There were no uterine perforations and 7 cases of suspected endometritis. At 3 months, 74.0% had continued IUC use. Median satisfaction scores were 10 out of 10.
Conclusions: It is feasible and acceptable to introduce immediate PPIUC insertion within a public maternity setting. There is a low rate of complications and patient satisfaction and continuation is high. The expulsion rate after vaginal PPIUC is likely to improve with increasing provider experience.