Contraception
Conditions
Brief summary
The current postpartum care model of a single visit 4-6 weeks after delivery does not optimally address contraceptive needs. By this visit, many women have resumed sexual activity, potentially putting them at risk for unintended and rapid repeat pregnancy. In addition, many women with pregnancy-related Medicaid lose insurance coverage at this time, making it difficult to obtain long-acting reversible contraception (LARC) if desired. Therefore, an earlier postpartum visit may remove barriers to improve access to LARC thereby, reducing unintended and rapid repeat pregnancy. Our primary objective is to determine whether an additional 3-week postpartum visit, compared to usual postpartum care, will affect the initiation of LARC by 6 weeks postpartum.
Detailed description
Our primary objective is to determine whether an additional 3-week postpartum visit, compared to usual postpartum care, will affect the initiation of LARC by 6 weeks postpartum. Our secondary outcomes include: 1) desired method of postpartum contraception; 2) continuation and satisfaction with contraception; and 3) incidence of rapid repeat and unintended pregnancy at 12 months. We will also measure attendance and satisfaction with 3- compared to 6-week postpartum visits.We will perform a two-arm randomized controlled trial (RCT). Women will be randomized to routine postpartum follow-up compared to two postpartum visits; one at 3 weeks and one at 6 weeks, with initiation of contraception at the 3-week visit as indicated. Women will be recruited from the postpartum service of Barnes-Jewish Hospital and all women will receive structured comprehensive counseling (adapted from the CHOICE Project Model) prior to discharge from the hospital. Postpartum visits will occur at our outpatient ambulatory clinic sites. Participants will complete in-person surveys at baseline and at each visit, and telephone surveys at 6- and 12-months postpartum. Planned recruitment will be 200 women based on a 2-fold increase in LARC initiation in the intervention group compared to control group (40% vs. 20% initiation rate).
Interventions
OTHER3-week visit
The intervention will be an additional visit to the usual postpartum care provider at 3-weeks postpartum.
OTHERusual care
Participants in the usual care arm will receive no additional interventions.
Sponsors
Society of Family Planning
Washington University School of Medicine
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
14 Years to 45 Years
Healthy volunteers
Yes
Inclusion criteria
* Delivered at Barnes-Jewish Hospital * Receiving postpartum care at resident clinic
Exclusion criteria
* Received LARC, sterilization, or hysterectomy * Abortion, stillbirth, or neonatal death * Non-English speaking * Unable to comply with follow-up
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Initiation of LARC by time of standard postpartum visit | 4-8 weeks postpartum | Initiation of LARC method |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Contraceptive use at 6 & 12 months | 6 & 12 months postpartum | Use of contraception |
| Unintended rapid-repeat pregnancy | 12 months postpartum | Incidence of an unintended rapid-repeat pregnancy |
Countries
United States
Outcome results
None listed