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 The American College of Obstetricians and Gynecologists (ACOG) has
long advocated that women have access to IUDs and contraceptive
implants along with other birth control options.
But this is the first time ACOG has explicitly recommended that
women having babies in the hospital get the opportunity to receive
IUDs and implants before they go home. The advantage of this
approach is that it may help avoid pregnancies spaced too close
together that carry a risk of serious complications for both mothers
and babies.
“Immediate postpartum long-acting reversible contraception (LARC)
has been shown to be a convenient and effective option for women
desiring postpartum birth control,” said Dr. Ann Borders of the
University of Chicago, who helped draft the ACOG recommendations.
“Providing effective contraception before a women goes home from the
hospital eliminates significant barriers” many women face after
they’ve had a baby, Borders added by email.
For example, she said, “Women may lose insurance post-delivery, miss
their postpartum follow up visit, their postpartum care site may not
offer LARC placement or may require pre-approval or more than one
visit for placement.”
In the U.S., almost half of pregnancies are unplanned.
While many women plan to resume or start birth control after having
a baby, up to 40 percent don’t go to the follow-up appointment
that’s needed to get a prescription for pills or an implant or IUD,
according to ACOG.
One of the biggest barriers to women receiving IUDs or implants
right after delivery is financial. Insurance typically pays a lump
sum for labor and delivery, without giving doctors or hospitals
money to cover the cost of providing long-acting contraception
during the hospital stay, said Dr. Michelle Moniz of the University
of Michigan in Ann Arbor.
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If doctors instead give women IUDs or implants at a follow-up
appointment in an outpatient setting several weeks later, then they
do get paid by the insurance companies, Moniz, who wasn’t involved
in the ACOG recommendations, said by email.
“It’s not offered by most maternity care settings because it’s not
reimbursed by most payers,” Moniz said.
This is gradually changing, Moniz said. Medicaid, the government
health insurance program for the poor, pays for roughly half of U.S.
births and covers IUDs and implants right after delivery in at least
20 states.
Contraceptive implants are flexible plastic rods about the size of a
matchstick that are inserted under the skin in the upper arm. They
can be used to prevent pregnancy for several years.
IUDs are T-shaped devices about the size of a quarter that are
inserted into the uterus. The devices can be used for several years;
they prevent pregnancy by stopping sperm from reaching the egg.
While placing an IUD immediately after birth carries a slightly
increased risk that it may loosen and fall out, the risks of other
complications, such as infections, are small and similar to the odds
of side effects from an IUD placed later in the doctor’s office.
SOURCE: http://bit.ly/2ahld5p ACOG, online July 25, 2016.
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