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.
Article info
Publication history
Published online: December 19, 2019
Accepted:
November 11,
2019
Received in revised form:
October 30,
2019
Received:
March 27,
2019
Footnotes
Disclosure Statement: The authors report no conflicts of interest.
Transparency Statement: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.
Funding Statement: This research was supported by the University of California, San Francisco, California Preterm Birth Initiative, funded by Marc and Lynne Benioff. The award was reviewed by a scientific board and a community stakeholder group which includes women with past preterm births. Preliminary findings and interpretation were presented and discussed with the stakeholder groups; the research team has sole responsibility for the preparation of this manuscript. All authors had full access to the data and can take responsibility for the integrity of the data and accuracy of the data analysis.
Patient and Public Involvement Statement: Depending on the recruitment location, patients were approached by either a lactation consultant and identified as an eligible participant by clinic staff, then contacted by a research associate for the study. Participants were informed before giving their consent about the duration of the interview and the types of questions that would be asked. Additionally, participants were given the option to stop the interview at any time or skip questions as needed.
Identification
Copyright
© 2019 Jacobs Institute of Women's Health. Published by Elsevier Inc.
