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

Published:April 28, 2022DOI:https://doi.org/10.1016/j.whi.2022.03.004

      Abstract

      Background

      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.

      Methods

      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.

      Results

      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.

      Conclusions

      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.
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      Biography

      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.

      Biography

      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.

      Biography

      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.

      Biography

      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.

      Biography

      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.