A Comparison of Short Interval vs. Routine Postpartum Visit on Contraceptive Initiation
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Contraception
- Sponsor
- Washington University School of Medicine
- Enrollment
- 200
- Locations
- 1
- Primary Endpoint
- Initiation of LARC by time of standard postpartum visit
- Status
- Completed
- Last Updated
- 7 years ago
Overview
Brief Summary
The current postpartum care model of a single visit 4-6 weeks after delivery does not optimally address contraceptive needs. By this visit, many women have resumed sexual activity, potentially putting them at risk for unintended and rapid repeat pregnancy. In addition, many women with pregnancy-related Medicaid lose insurance coverage at this time, making it difficult to obtain long-acting reversible contraception (LARC) if desired. Therefore, an earlier postpartum visit may remove barriers to improve access to LARC thereby, reducing unintended and rapid repeat pregnancy. Our primary objective is to determine whether an additional 3-week postpartum visit, compared to usual postpartum care, will affect the initiation of LARC by 6 weeks postpartum.
Detailed Description
Our primary objective is to determine whether an additional 3-week postpartum visit, compared to usual postpartum care, will affect the initiation of LARC by 6 weeks postpartum. Our secondary outcomes include: 1) desired method of postpartum contraception; 2) continuation and satisfaction with contraception; and 3) incidence of rapid repeat and unintended pregnancy at 12 months. We will also measure attendance and satisfaction with 3- compared to 6-week postpartum visits.We will perform a two-arm randomized controlled trial (RCT). Women will be randomized to routine postpartum follow-up compared to two postpartum visits; one at 3 weeks and one at 6 weeks, with initiation of contraception at the 3-week visit as indicated. Women will be recruited from the postpartum service of Barnes-Jewish Hospital and all women will receive structured comprehensive counseling (adapted from the CHOICE Project Model) prior to discharge from the hospital. Postpartum visits will occur at our outpatient ambulatory clinic sites. Participants will complete in-person surveys at baseline and at each visit, and telephone surveys at 6- and 12-months postpartum. Planned recruitment will be 200 women based on a 2-fold increase in LARC initiation in the intervention group compared to control group (40% vs. 20% initiation rate).
Investigators
Eligibility Criteria
Inclusion Criteria
- •Delivered at Barnes-Jewish Hospital
- •Receiving postpartum care at resident clinic
Exclusion Criteria
- •Received LARC, sterilization, or hysterectomy
- •Abortion, stillbirth, or neonatal death
- •Non-English speaking
- •Unable to comply with follow-up
Outcomes
Primary Outcomes
Initiation of LARC by time of standard postpartum visit
Time Frame: 4-8 weeks postpartum
Initiation of LARC method
Secondary Outcomes
- Contraceptive use at 6 & 12 months(6 & 12 months postpartum)
- Unintended rapid-repeat pregnancy(12 months postpartum)