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Background
Unplanned, closely-spaced pregnancies increase the risk of maternal and child morbidity and mortality.1 The Royal College of Obstetricians and Gynaecologists (RCOG) and the Faculty of Sexual & Reproductive Healthcare (FSRH) recommend that discussion and provision of contraception should be part of maternity care, including antenatal, intrapartum and postpartum care.2 3
The need for a robust postpartum contraception service has been highlighted through research from Edinburgh, where 96.7% of new mothers did not plan to conceive in the first year postpartum and 42.8% would use long-acting reversible contraception (LARC) if it were available before discharge.4 Following this, a pilot postpartum contraception service demonstrated the benefits of antenatal counselling, but also highlighted numerous barriers to providing immediate postpartum contraception.5
Why was the change needed?
An evaluation in the maternity unit of the University Hospital of Wales, Cardiff (approximately 6000 births per annum) found that 67% of new mothers planned to use contraception after delivery, but that none left the hospital with contraceptive supplies.6 Vulnerable women, such as teenage mothers, are disproportionately affected by rapid subsequent unintended pregnancies in the Cardiff and Vale University Health Board area,7 reflecting a wider issue with a lack of postpartum contraception provision. Women’s contact with maternity services presents an excellent opportunity to discuss contraception and arrange its supply immediately following childbirth. External input was secured to enable a busy maternity unit to provide contraception straight after delivery and before discharge from hospital.
What change was made?
In November 2016, a consultant midwife in public health collaborated with a consultant in sexual and reproductive healthcare (SRH) to create …
Footnotes
Contributors KAB designed the midwifery questionnaire, collected results and service data, summarised the findings and wrote the paper. JC designed and ran training for midwives, clinical services and commented on the draft paper. SC wrote the patient information and conducted preliminary audit to establish clinical need, helped design the service review and co-wrote the paper. CS designed and provided the clinical service and its review, and co-wrote the paper.
Funding Funding for the initiative came from Public Health Wales.
Competing interests None declared.
Patient consent Not required.
Ethics approval As this was a new service followed by a service evaluation, formal ethical approval was not required. However, permission to conduct the evaluation was granted by Cardiff University and the local Obstetrics and Gynaecology Department.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Since this was not a primary research project, there are no data that can be shared.
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