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Experiences with Prenatal and Postpartum Contraceptive Services among Women with a Preterm Birth

  • Heike Thiel de Bocanegra
    Correspondence
    Correspondence to: Heike Thiel de Bocanegra, PhD, MPH, Department of Obstetrics and Gynecology, University of California Irvine, 333 City Boulevard West, Suite 1400, Orange, CA 92868. Phone: (916) 384-7797.
    Affiliations
    Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California

    Department of Obstetrics and Gynecology, University of California Irvine, Orange, California
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  • Jazmine Kenny
    Affiliations
    School of Social Sciences, Humanities, and Arts, Department of Public Health, University of California, Merced, California
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  • Author Footnotes
    1 At the time of the study, Ms. Sayler was with the Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco.
    Kristina Sayler
    Footnotes
    1 At the time of the study, Ms. Sayler was with the Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco.
    Affiliations
    Department of Human Ecology, University of California, Davis, Davis, California
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  • Mary Turocy
    Affiliations
    School of Medicine, University of California San Francisco, San Francisco, California
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  • Subhashini Ladella
    Affiliations
    Department of Obstetrics and Gynecology, Fresno Medical Education Program, University of California San Francisco, Fresno, California
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  • Author Footnotes
    1 At the time of the study, Ms. Sayler was with the Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco.
Published:December 19, 2019DOI:https://doi.org/10.1016/j.whi.2019.11.002

      Abstract

      Background

      Providing postpartum contraception can help to achieve recommended interpregnancy intervals (≥18 months from birth to next pregnancy), decrease the risk of preterm birth, and thus improve maternal and infant health outcomes of future pregnancies. However, the experiences of women with preterm birth regarding contraceptive services have not been documented. We sought to better understand contraceptive counseling experiences and postpartum contraception of women with a preterm birth.

      Methods

      We interviewed 35 women, ages 18–42 years, with a recent preterm birth in California. The transcribed interviews were analyzed using ATLAS.ti v.8.

      Results

      Women had public (n = 15), private (n = 16), or no insurance (n = 4) at the time of the interview. Women were mainly Latina (n = 14), Caucasian (n = 9), or African American (n = 6); 15 women were foreign born. Women's experiences ranged from spontaneous preterm births to births with severe medical complications. We identified five themes that were associated with women's engagement in the contraceptive method choice and understanding of birth spacing: 1) timing and frequency of contraceptive counseling; 2) quality of patient–provider interaction and ability to follow up on questions; 3) women's personal experiences with contraceptive use and experiences of other women; 4) context in which contraceptive counseling was framed; and 5) system barriers to contraceptive use.

      Conclusions

      Postpartum contraceptive counseling should address women's preterm birth experience, medical conditions, age, contraceptive preference, and childbearing plans. Having a preterm birth intensifies gaps in hospital and outpatient clinic coordination and provider–patient communication that can lead to use of less effective or no contraceptive methods and risk of early subsequent unplanned pregnancies.
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      Biography

      Heike Thiel de Bocanegra, PhD, MPH, is Associate Professor, Department of Obstetrics and Gynecology, University of California, Irvine. She has more than 20 years of experience in mixed-method research on access to women's health and primary services.

      Biography

      Jazmine Kenny, MSPH, is a PhD candidate in Public Health at the University of California, Merced. Her research interests include improving healthcare access in rural settings, women and children's health, and health policy

      Biography

      Kristina Sayler, MPH, is a doctoral student in Human Development, University of California, Davis (UCD). Previously, Kristina worked as a clinical research coordinator for the University of California, San Francisco. Kristina earned her Master of Public Health degree at UCD in 2017.

      Biography

      Mary Turocy, BS, is a medical student at University of California San Francisco School of Medicine. Her research interests include patient–provider communication, particularly for women with complex psychosocial needs and/or medical conditions.

      Biography

      Subhashini Ladella, MD, FACOG, is Associate Clinical Professor in the Department of Obstetrics and Gynecology, UCSF-Fresno and Medical Director of the Perinatal Service Line for Community Medical Centers. Her research portfolio includes preterm labor, thromboembolism in pregnancy, birth defects, and preeclampsia.