Variation in effectiveness of planned postpartum contraception at two time points from prenatal to postpartum care

Objective: To identify characteristics of women who have consistent plans in terms of contraceptive effectiveness from antepartum to postpartum care.

Study design: This is a secondary analysis of a retrospective chart review of women who delivered at a single tertiary care center from 2012 to 2014. Preferred postpartum contraceptive plan was abstracted at three time points (prenatal care, hospital discharge, and outpatient postpartum care) and categorized into three tiers of effectiveness. We then examined consistency between the first two time points for the effectiveness in postpartum contraceptive method planned.

Results: Of the 8,394 women in the study cohort, 2,642 (31.5%) had a consistent postpartum contraceptive plan. Women who had a consistent plan were more likely to have higher parity (aOR 2.36, 95% CI 2.06-2.70 for parity 2+), choose highly effective methods of contraception (p < 0.001), achieve their contraception plan (adjusted odds ratio [aOR] 2.16, 95% confidence interval [95% CI] 1.85-2.52), but not more likely to have a subsequent pregnancy within 365 days of delivery (aOR 0.92, 95% CI 0.81-1.05).

Conclusion: Better understanding contraceptive decision-making as a journey and removing external barriers during that process is a necessary component of pregnancy care.

Implications: Counseling and documentation of contraceptive preferences throughout antepartum and postpartum care can help improve contraceptive outcomes.