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Perspectives of obstetricians and midwives on the provision of immediate postpartum intrauterine devices: a qualitative service evaluation
  1. Nicola Boydell1,
  2. Michelle Cooper2,
  3. Sharon T Cameron2,3,
  4. Anna Glasier3,
  5. Shiona Coutts4,
  6. Frances McGuire4,
  7. Jeni Harden1
  1. 1 Usher Institute, The University of Edinburgh, Edinburgh, UK
  2. 2 Chalmers Centre, NHS Lothian, Edinburgh, UK
  3. 3 MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
  4. 4 Department of Obstetrics and Gynecology, NHS Lothian, Edinburgh, UK
  1. Correspondence to Dr Nicola Boydell, Usher Institute, Centre for Biomedicine, Self and Society, The University of Edinburgh, Edinburgh EH8 9LN, UK; nicola.boydell{at}


Background Immediate postpartum intrauterine device (PPIUD) insertion is safe and effective but largely unavailable in Europe. Data on maternity staff views on the provision and implementation of PPIUD services are limited. The objective of this qualitative evaluation was to explore the views and experiences of obstetricians and midwives providing PPIUD within a UK maternity setting, in order to identify areas for improvement and inform service provision in other areas.

Methods Qualitative health services research within two public maternity hospitals in Lothian (Edinburgh and surrounding region), UK. Interviews with 30 maternity staff (obstetricians n=8; midwives n=22) involved in PPIUD provision. Data were analysed thematically.

Results Maternity staff were positive about the benefits of PPIUD for women. Midwives reported initial concerns about PPIUD safety, and the impact on workload; these views shifted following training, and as PPIUD was embedded into practice. Having a large pool of PPIUD-trained staff was identified as an important factor in successful service implementation. Having PPIUD ‘champions’ was important to address staff concerns, encourage training uptake, and advocate for the service to ensure continued resourcing.

Conclusions PPIUD in maternity services can help address unmet need for effective contraception in the immediate postpartum period. We emphasise the importance of widespread engagement around PPIUD among all healthcare professionals involved in the care of women, to ensure staff are informed and supported. Clinical champions and leaders play a key role in amplifying the benefits of PPIUD, and advancing organisational learning.

  • health services research
  • qualitative research
  • long-acting reversible contraception
  • intrauterine devices
  • medicated
  • copper

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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  • Contributors STC, JH, AG, FMcG, SC: original idea and overall study design. NB, JH: qualitative study design, data collection and analysis. MC, STC: led/directly involved in clinical service implementation. NB, JH: initial manuscript preparation. MC, SC, STC, AG: manuscript editing. All authors reviewed the final draft.

  • Funding The study was funded through a joint Chief Scientist Office and Wellbeing of Women research grant (RG1903). The review process included external (lay and expert) peer review of the scientific content and overall study design. The study funders were not involved in research conduct or manuscript preparation.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Further details are provided in the Methods section.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.