Training midwives in the insertion of contraceptive implants to increase uptake in the immediate postpartum period: a feasibility pilot study

All nurses and midwives working in antenatal and postnatal care at participating hospitals (Royal Prince Alfred Hospital; RPAH, and Canterbury Hospital; CH) will be invited to complete a baseline survey assessing their current levels of contraception knowledge and attitudes towards midwives providing contraception counselling and Implanon NXT® insertion in the postnatal setting. General contraception training will be provided by Family Planning NSW (FPNSW) to all midwives and nurses working in antenatal and postnatal care at participating hospitals. The training will focus on contraceptive options, education and counselling for postpartum women. This will be provided as a 20-30 minute group education sessions during routine ward and lunchtime meetings. Light refreshments will be provided as appropriate. There will be no cost to participate. A recorded webinar will also be made available online. CPD (continuing professional development) points will be accrued for participating. The purpose of this education will be to provide information about contraception options (including but not limited to Implanon NXT®) and counselling in order to increase knowledge of midwives and nurses working in these settings. Additional resources will also be provided including the contraception efficacy card and web links to other FPNSW resources to use with patients. This will be important for this study (as well as for general professional development) as different midwives and nurses may interact with patients while at the hospital and it will be important for them to be aware of different contraceptive options and how to discuss them. The midwives will also be reminded of the study during the education. This will facilitate the recruitment of midwives into the study and inform other midwives and nurses about the availability of Implanon NXT® insertion for their patients. Of those who attend the general training, a subset of all midwives will self-select for Implanon NXT® (Etonogestrel) insertion training (“Implanon NXT® Insertion Training Course for Registered Nurses and Midwives” provided by Family Planning NSW). The course is a competency-based program run by FPNSW, designed to build nurses' and midwives' skills in Implanon NXT® procedures. The course has been available for several years through Family Planning NSW. The course combines online and face-to-face learning, simulated practice, and supervised clinical training and competency assessment. The number, length, and location of training sessions are: Online theory – approximately 2-3 hours – Managed online through Moodle Face-to-Face theory and simulated practice – 1 session, approximately 1.5 hours – at RPA and Canterbury Hospitals Supervised clinical practice until deemed competent for two insertions — < 1 month period – at RPA and Canterbury Hospitals. Certified clinicians experienced in contraceptive implant insertions will supervise participants until they are confident in completing the procedure without assistance. Participants must complete at least two supervised competent insertions where the implant is in the correct location and easily palpable to meet FPNSW current training requirements. Five midwives will undertake clinical training per month, over a six-month period. Clinical supervision and mentoring will be provided by PI Black. However, the midwife ‘champions’ will be trained first and credentialed as trainers, so they will then be able to supervise their colleagues in this procedure. An example of the video used in the training to provide an overview of the insertion process can be found here: https://bit.ly/2m8lfkJ Note: Training will only be available for Implanon NXT® insertion, not removal, as is appropriate for this particular hospital setting. Locations for removal will be discussed with patients at the time of the insertion. Participants in the Implanon NXT® insertion training program will complete a pre-training survey to identify existing knowledge, confidence, expectations and concerns, and a post-training survey to further explore knowledge, confidence and concerns. Midwives will also log their post-training implementation data using the Ethica platform (www.ethicadata.com). The app will be used by midwives to log all Implanon NXT® insertions over a six month period after they have achieved competency in the insertion procedure. After the six-month post-competency period is complete, midwives will be invited to participate in short, semi-structured interviews to explore their experiences of inserting Implanon NXT® in the postpartum setting, as well as challenges and enabling factors in relation to their practice. All midwives working in participating hospitals will be invited to complete an endline survey to determine current levels of contraception knowledge and attitudes towards midwives providing contraception counselling and Implanon NXT® insertion in the postnatal setting.