Many women are offered long-acting reversible contraceptive devices (LARCs) such as implants or intrauterine devices (IUDs) shortly after giving birth as a convenient option that helps avoid pregnancies spaced too close together, which can carry a risk of serious complications for mothers and babies. But given the unique vulnerability and stress surrounding childbirth, do women feel ready to make such a significant decision about their reproductive health?
Research from Katharine Sznajder, MD, an ob-gyn at Kaiser Permanente, examined how physicians and nurses can better help pregnant women determine which contraceptive choice is best for them.
In 2015 and 2016, Dr. Sznajder and researchers at Johns Hopkins University School of Medicine conducted surveys and interviews of women who received long-acting reversible contraception after giving birth and those who did not. The questions aimed to explore women’s perception of and experiences with contraceptive counseling prenatally and around the time of delivery.
"Childbirth is a stressful and exhausting life event. It can make many women say they never want to endure it again while they are in the moment. So, are they more likely to agree to a LARC?” Dr. Sznajder said. “That was one question that prompted me to conduct this research.”
After analyzing the interviews, researchers found women wanted comprehensive, objective information about their contraceptive options and, above all, wanted autonomy in their decisions. They did not want to feel pressured to choose a certain type of contraceptive, and unfortunately, some did.
“One way we can improve this process is by encouraging providers to have open conversations about contraceptives in prenatal visits as opposed to at time of labor and delivery,” Dr. Sznajder said. “This gives them time to weigh their options and decide what’s best for them and their future plans.”
In 2023, Dr. Sznajder published research showing the four survey scales created and administered as part of this research are a reliable and valid way to measure perceived autonomy, agency, health care team support and family/partner support during contraceptive decision-making. The study offers a tool that other researchers and healthcare providers can use to evaluate their contraceptive counseling practices to ensure they remain centered on the values and goals most important to patients.
The Mid-Atlantic Kaiser Permanente Women’s Health Institute provides the full scope of maternity services; including preconception counseling, prenatal care for low-risk and high-risk pregnancies, labor and delivery, and post-partum care. Learn more at kp.org/doctor.