Guidelines and Interventions Related to the Postpartum Visit for Low-Risk Postpartum Women in High and Upper Middle Income Countries.

Objectives A two-part review was undertaken to: (1) summarize current guidelines on the timing and frequency of postpartum follow-up care for generally healthy, non-high risk postpartum women and to delineate the evidence on which these guidelines are based; and, (2) summarize the results of intervention studies focused on increasing utilization of the postpartum visit for generally healthy, non-high risk postpartum women. Methods A review of guidelines from high and upper middle income countries published between 2000 and 2016 in English related to non-high risk postpartum follow-up visits was conducted in 2014-2016 using four databases and additional sources. In addition, articles published between 1990 and 2016 which evaluated interventions from high to upper middle income countries related to increasing attendance at the postpartum visit were gathered using three databases. Results This review located eight guidelines, all of which relied on expert opinion/group consensus as the evidence for their recommendations regarding the timing of the postpartum visit. The review located 19 intervention studies focused on increasing use of the postpartum visit; in 12 there was statistically significant evidence that these approaches improved utilization. However, no intervention strategy was evaluated more than a few times and many of the evaluations were relatively dated. Conclusions Guidelines for the timing of the postpartum visit are variable and are typically based on weak evidence; however, there is support for increased flexibility to meet women's needs. Additionally, while there is a diverse set of promising interventions to increase utilization of the postpartum visit, there is limited evaluative information. Future initiatives should focus on more rigorous evaluation.

Understanding Factors Associated with Postpartum Visit Attendance and Contraception Choices: Listening to Low-Income Postpartum Women and Health Care Providers.

Background While there is considerable variability with respect to attendance at the postpartum visit, not much is known about women's preferences with respect to postpartum care. Likewise, there is also limited information on providers' practices regarding the postpartum visit and care including the delivery of contraception. To understand and address deficits in the delivery and utilization of postpartum care, we examined the perceptions of low-income postpartum women with respect to barriers to and preferences for the timing and location of the postpartum visit and receipt of contraception. We also examined providers' current prenatal and postnatal care practices for promoting the use of postpartum care and their attitudes toward alternative approaches for delivering contraceptive services in the postpartum period. Methods Qualitative face-to-face interviews were completed with 20 postpartum women and in-depth qualitative phone interviews were completed with 12 health care providers who had regular contact with postpartum women. Interviews were coded using Atlas.ti software and themes were identified. Results Women believed that receiving care during the postpartum period was an important resource for monitoring physical and mental health and also strongly supported the provision of contraception earlier than the 6-week postpartum visit. Providers reported barriers to women's use of postpartum care on the patient, provider, and system levels. However, providers were receptive to exploring new clinical practices that may widen the reach of postpartum care and increase access to postpartum contraception. Conclusion Approaches that increase the flexibility and convenience of postpartum care and the delivery of postpartum contraception may increase the likelihood that women will take advantage of essential postpartum services.

Contraceptive Provision after Medication and Surgical Abortion.

OBJECTIVE: This study sought to compare contraception provided to patients after medication and surgical abortion. STUDY DESIGN: Women who underwent first trimester induced abortion at a university-based urban clinic between May 2009 and May 2014 were identified. Medical records were reviewed to determine the method of contraception provided by the clinic to patients after medication and surgical abortion. Postabortal contraception was defined as any contraception administered or prescribed from our health system within 4 weeks of surgical abortion or mifepristone administration. RESULTS: We reviewed 824 women who were 9 weeks gestational age or less and able to choose between medication and surgical termination of pregnancy. Overall, 587 (71.1%) had a surgical abortion and 237 (28.9%) had a medication abortion. Women who had surgical abortions were more likely to initiate long-acting reversible contraception (41.9% vs. 23.2%; p < .0001) and more likely to be provided with any type of contraception overall (83% vs. 64.6%; p < .0001). The overall follow-up rate after medication abortion was 71.7%. CONCLUSIONS: Women who had surgical abortions had a greater odds of receiving long-acting reversible contraception than those who had medication abortions. Surgical abortion patients were also more likely to be provided contraception overall. Further prospective research is needed to determine the reasons for this difference and to ensure that all patients obtain the contraception that they desire.

A novel approach to postpartum contraception: a pilot project of Pediatricians' role during the well-baby visit.

BACKGROUND: Postpartum women are at high risk of unintended pregnancy as many do not receive timely postpartum contraception. Utilization of routine postpartum care varies widely. Conversely, the Well-Baby Visit (WBV) for newborns is highly utilized and provides an opportunity to discuss contraception with mothers. This project aimed to test the feasibility and acceptability of having pediatric residents administer a simplified Reproductive Life Plan Tool (RLPT) with postpartum women during routine infant care. METHODS: Pediatric resident physicians used the RLPT with mothers of infants 16-weeks of age or less during WBVs. The RLPT prompts physicians to ask general questions about women's contraceptive needs and offer referral services for mothers who desire contraception services. Residents participated in a feedback session and survey to assess acceptance and perceived feasibility of using the RLPT during routine care. RESULTS: Pediatric residents completed 50 RLPTs. Seventeen percent of eligible women accepted a referral to contraception services. During feedback sessions, pediatric residents (n = 18) reported comfort implementing the intervention and acceptance of the RLPT for discussing contraception. Concerns included limited time during the WBV and the potential to shift focus away from infant. On a post-intervention survey (n = 14), 92.9 % of physicians reported comfort in using the RLPT, and 71.4 % reported that the tool was easily understood although findings were varied regarding ease of implementing a RLPT in practice. CONCLUSIONS: Findings indicate that use of the RLPT is generally feasible during routine infant care and acceptable to pediatric resident physicians with recognition of challenges to implementation. Acceptance of a referral was low among postpartum women in this pilot study.