Optimally, patients should be counseled prenatally about the option of immediate postpartum LARC, along with the full range of contraceptive options available. Counseling should include advantages, risks of intrauterine (IUD) expulsion, provider reliance for insertion and removal, contraindications and alternatives for LARC to allow for informed decision making.
Immediate postpartum LARC should be offered as an effective option for postpartum contraception; there are few contraindications to postpartum IUDs and implants. Obstetrician-gynecologists and other health care providers should counsel patients about the convenience and effectiveness of immediate postpartum LARC, as well as the benefits of reducing unintended pregnancy and lengthening interpregnancy intervals.
Obstetrician-gynecologists and other obstetric care providers should include in their contraceptive counseling the increased risk of expulsion, including unrecognized expulsion, with immediate postpartum IUD insertion compared with interval IUD insertion. The counseling should highlight the impact on patient autonomy with the reliance on a provider for insertion and removal of LARC and discuss options for low or no-cost removal services.
Systems should be in place to ensure that people who desire LARC can receive it during the comprehensive postpartum visit if immediate postpartum LARC was not undertaken.
