Future Pregnancy Considerations after Premature Birth of an Infant Requiring Intensive Care: A Qualitative Study

Published:April 28, 2022DOI:



      Postpartum contraception counseling and method use vary widely among patients who had a preterm birth. We performed this study to explore what issues and concerns individuals with preterm infants requiring intensive care describe as influencing their postpartum contraceptive choices.


      We conducted a qualitative study using semi-structured interviews with participants who gave birth to a singleton preterm infant admitted to the neonatal intensive care unit (NICU). We explored pregnancy, childbirth, postpartum care, and NICU experiences, as well as future reproductive plans and postpartum contraceptive choices. Two coders used a constant–comparative approach to code transcripts and identify themes.


      We interviewed 26 participants: 4 (15%) gave birth at less than 26, 6 (23%) at 26 to 27 6/7, 8 (31%) at 28 to 31 6/7, and 8 (31%) at 32 to 36 6/7 weeks of gestation. We identified three main themes related to future pregnancy plans and contraception choice. First, participants frequently described their preterm birth and their infants' NICU hospitalization as traumatic experiences that affected plans for future pregnancies. The loss of control in predicting or preventing a future preterm birth and uncertainty about their premature child's future medical needs resulted in participants wanting to avoid going through the same experience with another child. Second, participants chose contraception based on previous personal experiences, desired method features, and advice from others. Last, having a preterm birth did not result in any ambivalence among those who desired permanent contraception.


      Preterm birth influences future pregnancy plans. When discussing reproductive goals with patients, clinicians should be aware of potential trauma associated with a premature birth, assess for whether patients want to discuss contraception, and center the conversation around individual needs if patients do desire contraceptive counseling.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Women's Health Issues
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • American College of Obstetricians and Gynecologists
        Committee Opinion no. 530: access to postpartum sterilization.
        Obstetrics & Gynecology. 2012; 120: 212-215
        • American College of Obstetricians and Gynecologists
        Committee opinion no. 695: sterilization of women: Ethical issues and considerations.
        Obstetrics & Gynecology. 2017; 129: e109-e116
        • American College of Obstetricians and Gynecologists
        Committee opinion no. 736: Optimizing postpartum care.
        Obstetrics & Gynecology. 2018; 131: 949-951
        • American College of Obstetricians and Gynecologists
        Committee opinion no. 825: Caring for patients who have experienced trauma.
        Obstetrics & Gynecology. 2021; 137: e94-e99
        • Arora K.S.
        • Castleberry N.
        • Schulkin J.
        Obstetrician-gynecologists’ counseling regarding postpartum sterilization.
        International Journal of Women’s Health. 2018; 10: 425-429
        • Bradshaw C.
        • Atkinson S.
        • Doody O.
        Employing a qualitative description approach in health care research.
        Global Qualitative Nursing Research. 2017; 4 (2333393617742282)
        • Berens P.
        • Labbok M.
        • Academy of Breastfeeding Medicine
        ABM clinical protocol #13: Contraception during breastfeeding, revised 2015.
        Breastfeeding Medicine. 2015; 10: 3-12
        • Crabtree B.
        • Miller W.
        Doing qualitative research.
        Sage Publications, Newbury Park, CA1992
        • DeFranco E.A.
        • Stamilio D.M.
        • Boslaugh S.E.
        • Gross G.A.
        • Muglia L.J.
        A short interpregnancy interval is a risk factor for preterm birth and its recurrence.
        American Journal of Obstetrics and Gynecology. 2007; 197 (264.e1–264.e6)
        • Dude A.
        • Matulich M.
        • Estevez S.
        • Liu L.Y.
        • Yee L.M.
        Disparities in postpartum contraceptive counseling and provision among mothers of preterm birth.
        Journal of Women’s Health. 2018; 27: 676-683
        • Flink-Bochacki R.
        • Hamm M.E.
        • Borrero S.
        • Chen B.A.
        • Achilles S.L.
        • Chang J.C.
        Family planning and counseling desires of women who have experienced miscarriage.
        Obstetrics and Gynecology. 2018; 131: 625-631
        • Flink-Bochacki R.
        • Flaum S.
        • Betstadt S.J.
        Barriers and outcomes associated with unfulfilled requests for permanent contraception following vaginal delivery.
        Contraception. 2019; 99: 98-103
        • Giacomini M.K.
        • Cook D.J.
        Users’ guides to the medical literature: XXIII. Qualitative research in health care A. Are the results of the study valid?.
        JAMA. 2000; 284: 478-482
        • Guest G.
        • Bunce A.
        • Johnson L.
        How many interviews are enough? An experiment with data saturation and variability.
        Field Methods. 2006; 18: 59-82
        • Hamilton B.E.
        • Martin J.A.
        • Osterman M.J.K.
        Births: Provisional data for 2020.
        Date: 2021
        Date accessed: July 15, 2021
        • Hirth J.M.
        • Dinehart E.E.
        • Lin Y.-L.
        • Kuo Y.-F.
        • Patel P.R.
        Reasons why young women in the United States choose their contraceptive method.
        Journal of Womens Health. 2021; 30: 64-72
        • Lasiuk G.C.
        • Comeau T.
        • Newburn-Cook C.
        Unexpected: An interpretive description of parental traumas’ associated with preterm birth.
        BMC Pregnancy & Childbirth. 2013; 13: S13
        • Leaverton A.
        • Lopes V.
        • Vohr B.
        • Dailey T.
        • Phipps M.G.
        • Allen R.H.
        Postpartum contraception needs of women with preterm infants in the neonatal intensive care unit.
        Journal of Perinatology. 2016; 36: 186-189
        • Madden T.
        • Secura G.M.
        • Nease R.F.
        • Politi M.C.
        • Peipert J.F.
        The role of contraceptive attributes in women’s contraceptive decision making.
        American Journal of Obstetrics and Gynecology. 2015; 213 (46.e1–6)
        • O’Donovan A.
        • Nixon E.
        “Weathering the storm:” Mothers’ and fathers’ experiences of parenting a preterm infant.
        Infant Mental Health Journal. 2019; 40: 573-587
        • Patton M.Q.
        Qualitative research & evaluation methods.
        4th ed. Sage Publications, Newbury Park, CA2015
        • Phillips S.J.
        • Tepper N.K.
        • Kapp N.
        • Nanda K.
        • Temmerman M.
        • Curtis K.M.
        Progestogen-only contraceptive use among breastfeeding women: A systematic review.
        Contraception. 2016; 94: 226-252
        • Robbins C.L.
        • Farr S.L.
        • Zapata L.B.
        • D’Angelo D.V.
        • Callaghan W.M.
        Postpartum contraceptive use among women with a recent preterm birth.
        American Journal of Obstetrics and Gynecology. 2015; 213 (508.e1–9)
        • Rodriguez M.I.
        • Chang R.
        • Thiel de Bocanegra H.
        The impact of postpartum contraception on reducing preterm birth: findings from California.
        American Journal of Obstetrics and Gynecology. 2015; 213 (703.e1–6)
        • Rossman B.
        • Asiodu I.
        • Hoban R.
        • Patel A.L.
        • Engstrom J.L.
        • Medina-Poeliniz C.
        • Meier P.P.
        Priorities for contraception and lactation among breast pump-dependent mothers of premature infants in the neonatal intensive care unit.
        Breastfeed Medicine. 2019; 14: 448-455
        • Sandelowski M.
        Whatever happened to qualitative description?.
        Research in Nursing & Health. 2000; 23: 334-340
        • Sobel L.
        • O’Rourke-Suchoff D.
        • Holland E.
        • Remis K.
        • Resnick K.
        • Perkins R.
        • Bell S.
        Pregnancy and childbirth after sexual trauma: patient perspectives and care preferences.
        Obstetrics & Gynecology. 2018; 132: 1461-1468
        • Sperlich M.
        • Seng J.S.
        • Li Y.
        • Taylor J.
        • Bradbury-Jones C.
        Integrating trauma-informed care into maternity care practice: Conceptual and practical issues.
        Journal of Midwifery & Women’s Health. 2017; 62: 661-672
        • Stuebe A.M.
        Enabling women to achieve their breastfeeding goals.
        Obstetrics and Gynecology. 2014; 123: 643-652
        • Substance Abuse and Mental Health Services Administration
        SAMHSA’s concept of trauma and guidance for a trauma-informed approach. HHS Publication No. (SMA) 14-4884.
        Date: 2014
        Date accessed: January 26, 2021
        • Thiel de Bocanegra H.
        • Kenny J.
        • Sayler K.
        • Turocy M.
        • Ladella S.
        Experiences with prenatal and postpartum contraceptive services among women with a preterm birth.
        Women’s Health Issues. 2020; 30: 184-190
        • Vaismoradi M.
        • Turunen H.
        • Bondas T.
        Content analysis and thematic analysis: implications for conducting a qualitative descriptive study.
        Nursing & Health Sciences. 2013; 15: 398-405
        • Wolfe K.
        • Wilson M.D.
        • Hou M.Y.
        • Creinin M.D.
        An updated assessment of postpartum sterilization fulfillment after vaginal delivery.
        Contraception. 2017; 96: 41-46
        • Yee L.
        • Simon M.
        Urban minority women’s perceptions of and preferences for postpartum contraceptive counseling.
        Journal of Midwifery & Women’s Health. 2011; 56: 54-60


      Melissa J. Chen, MD, MPH, is an obstetrician/gynecologist with subspecialty training in family planning at the University of California, Davis School of Medicine. Her research interests include postpartum contraception, lactation and contraception, new contraceptive development, and pregnancy termination.


      Laura R. Kair, MD, MAS, is a pediatrician and health services researcher who serves as the Medical Director of Well Newborn Care at the University of California, Davis Children's Hospital. Her research is focused on overcoming breastfeeding barriers and reducing disparities.


      Eleanor Bimla Schwarz, MD, MS, is the Chief of the Division of General Internal Medicine at San Francisco General Hospital. She is a health services researcher with a focus on women's health, specifically contraception, lactation, and abortion care.


      Mitchell D. Creinin, MD, is a tenured Professor and Director of Family Planning in the Department of Obstetrics and Gynecology at the University of California, Davis. He has research funding from the NIH, foundations, and industry for female and male contraceptive development.


      Judy C. Chang, MD, MPH, is an obstetrician/gynecologist, Assistant Dean of Medical Student Research, and Director of the Clinical Scientist Training Program at the University of Pittsburgh. Her expertise includes qualitative research methods and patient-provider communication in obstetric care for health promotion.