Women’s experiences of accessing postpartum intrauterine contraception in a public maternity setting: a qualitative service evaluation

Abstract

Objectives

The aims of the study were to explore women’s experiences of an immediate postpartum intrauterine contraception (PPIUC) service recently introduced in a UK maternity setting, to identify areas for improvement and inform service provision.

Methods

Qualitative research was carried out in hospital and community maternity services in Lothian, UK. In-depth interviews were conducted with 35 women who had received PPIUC at vaginal or caesarean delivery. The interview data were analysed thematically to explore the women’s experiences of PPIUC service provision.

Results

Women’s decisions to choose PPIUC were influenced by their perception of intrauterine contraception (IUC) as a suitable and effective method and the convenience of immediate postpartum insertion. Most women were satisfied with their experience of PPIUC. Women delivering vaginally sometimes reported concerns about delays to insertion, particularly where they perceived a lack of communication from staff about when and where insertion would occur. PPIUC information was described as being difficult to absorb in the context of ante/postnatal information overload. Those receiving PPIUC at caesarean delivery sometimes expressed concerns about what post-insertion support might be available in primary care.

Conclusion

Women typically reported satisfaction with their decision to have PPIUC. For maternity services considering introducing PPIUC, our findings reinforce the importance of anticipating and addressing implementation challenges in order to enhance women’s experience of the service. These include ensuring that: clear and appropriate PPIUC information and support are provided antenatally; women are able to access PPIUC immediately after delivery; robust clinical pathways are in place to support post-insertion IUC care; and both staff and women are familiar with the clinical pathways.

摘要

目的：本研究的目的是探索最近在英国产科设施中引入女性产后即时宫内避孕(PPIUC)服务的相关经验, 以确定需要改进的地方, 并为服务提供提供信息。方法：在英国洛锡安医院和社区妇产科服务机构进行定性研究。对35名在经阴道或剖腹产时接受PPIUC的女性进行了深入访谈。对访谈数据进行主题分析, 探讨为女性提供PPIUC服务的经验。结果：女性对PPIUC的选择受其观念影响, 她们认为宫内节育(IUC)是一种合适有效的方法并且产后即刻放置是便利的。大多数女性对PPIUC的经历感到满意。阴道分娩的女性有时会反映对延迟放置的担忧, 特别是当她们感觉工作人员关于放置时间和位置缺乏沟通时。在产前/产后信息过量的情况下, 关于PPIUC的信息描述难以被女性吸纳。那些在剖宫产时接受PPIUC的人有时会关心初级保健中可能提供的节育器放置后相关支持。结论：女性通常对她们选择PPIUC感到满意。对于考虑引入PPIUC的产科服务, 我们的研究结果强化了预测和解决实施过程中挑战的重要性, 以加强女性对该服务的体验。这些措施包括确保：产前提供明确和适当的PPIUC信息和支持；女性能够在分娩后即刻获得PPIUC；有强大的临床路径支持IUC放置后的护理；工作人员和女性都能熟悉临床路径。

Keywords:

• Health care service delivery
• intrauterine contraception
• postpartum contraception
• postpartum intrauterine contraception
• qualitative research

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 In NHS Lothian, where the study took place, IUC and implants are available in maternity services; provision of LARC in maternity services in other regions of Scotland, and the rest of the UK, is uneven.