The Quick Start Contraception Initiation Method during the 6-week postpartum visit: an efficacious way to improve contraception in Federally Qualified Health Centers.

BACKGROUND: About half of all pregnancies in the United States are unplanned, and many start soon after a previous delivery. Our aim was to determine if the implementation of the Quick Start Contraception Initiation Method during the 6-week postpartum evaluation could improve the delivery of contraception. STUDY DESIGN: The medical records of 979 patients seen for their 6-week postpartum visit at our urban Federally Qualified Health Center (FQHC) between July 2004 and June 2006 were reviewed. The patients were distributed into two groups defined by evaluations performed prior to or after the implementation of the new contraception initiation method. Summary statistics and differences in the proportions were calculated. A probability of <.05 was considered significant. RESULTS: The Quick Start Contraception Initiation Method was implemented in July 2005. Five-hundred and sixteen patients were in Group 1, and 463 patients were in Group 2. Demographic variables were similar among groups. Contraception delivery rate was 50% in Group 1 and 72% in Group 2 (p<.05). Eighty percent of patients in Group 1 and 76% of those in Group 2 requested contraception, and 26% of Group 1 and 3% of Group 2 did not receive it. The improvement in dispensing contraception was most noticeable among teenagers. CONCLUSION: These findings suggest that the Quick Start Contraception Initiation Method at the time of the 6-week postpartum evaluation improves the delivery of contraception in FQHCs.

Childhood pregnancy as a result of incest: a case report and literature review with suggested management strategies.

BACKGROUND: Childhood pregnancy presents multiple challenges, which are compounded when the pregnancy is a result of abuse. While there is ample information regarding the psychological manifestations of childhood sexual abuse, a review of the literature provides modest information on childhood pregnancy, as distinct from teen pregnancy. CASE: A 10-year-old pregnant female reports for medical care at 28-30 weeks gestation. CONCLUSION: Sensitivity to the patient's and family's needs and having a care team who followed a well defined care plan appeared to be the key to optimizing the management of this patient. Although decisions should be based on medical standards, the psychological, social, and, at times, criminal concerns must be considered in every aspect of the patient's care and variations from established patterns of care should be allowed when needed.

Effectiveness of exclusive breastfeeding promotion in low-income mothers: a randomized controlled study.

OBJECTIVE: To evaluate the effectiveness of a breastfeeding promotion program in the Women, Infant and Children (WIC) Supplemental Nutrition Program participants. STUDY DESIGN: This randomized clinical trial included 52 women in the intervention group who received one-to-one pre- and postnatal breastfeeding education and support from a lactation consultant. Women (n = 52) randomized to controls received standard breastfeeding services. Data regarding their infants' feeding (classified as exclusive, partial, and bottle) during the first 7 days, 1, 2, and 3 months of age were compared. Additionally, the mothers were surveyed to assess their knowledge, attitude, and beliefs regarding breastfeeding. RESULTS: Among the 104 enrolled women, 91 (87.5%) were Hispanic. Almost all the pregnant women had planned to breastfeed their infants. Although the majority of women reported breastfeeding their infants, 45.6% in the intervention group and 28.9% of controls practiced exclusive breastfeeding during the first 7 days. By 3 months, the rate of exclusive breastfeeding in the intervention and control groups had dropped to 13.9% and 10.5%, respectively. Parity, mode of delivery, previous experience with breastfeeding, rooming in, and return to work did not significantly affect the exclusive breastfeeding rate. Maternal knowledge, attitude, and beliefs regarding breastfeeding were comparable between the study groups at the baseline stage as well as 3 months postpartum. CONCLUSIONS: Participation in the proposed breastfeeding promotion program by the low-income mothers was associated with an insignificant increase in the exclusive breastfeeding rate during the first 3 postpartum months.