Immediate Postpartum LARC
What is immediate postpartum LARC?
Immediate postpartum LARC refers to LARC initiation after delivery and before hospital discharge
- ACOG supports immediate postpartum LARC insertion as a best practice, recognizing its role in preventing rapid repeat pregnancy and unintended pregnancy.
Immediate postpartum LARC:
- Should be offered as an option for postpartum contraception
- Can reduce unintended pregnancy and lengthen interpregnancy intervals
Patients should be counseled prenatally about immediate postpartum LARC, including its:
- Disadvantages and possible side effects
- Risk of IUD expulsion
- Contraindications and alternatives to allow for informed decision making
Definitions: timing of LARC placement
Placement while still in the delivery room (within 10 minutes of placental delivery, when possible)
Placement within 6 weeks of delivery
Placement during hospital admission for delivery
Placement at any time during the menstrual cycle and not in relationship to the end of a pregnancy (or >6 weeks after delivery)
What are some advantages of Immediate Postpartum LARC?
- LARC methods can lengthen interpregnancy intervals
- Patient is still in the midst of care and placement can be convenient for both patient and clinician
- Time limits on postpartum insurance coverage for some patients can limit access to postpartum contraception after discharge
- Patients are known not to be pregnant and many are motivated to avoid short-interval pregnancy
- Cost-effective despite higher IUD expulsion rates
- Patients using LARC methods have high satisfaction and continuation rates
- Up to 40% of patients do not attend the postpartum visit and many face barriers to attending
- Up to 75% of patients who plan to use an IUD postpartum do not obtain it
- Some patients may attend the postpartum visit, but encounter barriers to receiving LARC, such as inability to pay, clinicians or clinics not offering LARC, or need for a repeat visit for placement
What are Some Disadvantages and Key Considerations for IPP LARC?
- Must be placed and removed by a trained clinician, which may impact patient autonomy
- Patient may lose insurance coverage postpartum, limiting access to removal services
- Possible contraindications
- Increased risk of expulsion, including unrecognized expulsion of IUD
- Possibility of non-visualized strings and difficult removal
- Health care provider bias may contribute to coercion