Infertility

Doctors should offer women birth control right after babies arrive, group says

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Women should have the chance to get long-acting birth control like intrauterine devices (IUDs) before they leave the hospital with a new baby, a leading group of U.S. obstetricians recommends.

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.

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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.

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.