A Comparison of Short Interval vs. Routine Postpartum Visit on Contraceptive Initiation
| Status: | Completed |
|---|---|
| Conditions: | Contraception, Contraception |
| Therapuetic Areas: | Reproductive |
| Healthy: | No |
| Age Range: | 14 - 45 |
| Updated: | 1/10/2019 |
| Start Date: | May 2016 |
| End Date: | May 2018 |
The current postpartum care model of a single visit 4-6 weeks after delivery does not
optimally address contraceptive needs. By this visit, many women have resumed sexual
activity, potentially putting them at risk for unintended and rapid repeat pregnancy. In
addition, many women with pregnancy-related Medicaid lose insurance coverage at this time,
making it difficult to obtain long-acting reversible contraception (LARC) if desired.
Therefore, an earlier postpartum visit may remove barriers to improve access to LARC thereby,
reducing unintended and rapid repeat pregnancy. Our primary objective is to determine whether
an additional 3-week postpartum visit, compared to usual postpartum care, will affect the
initiation of LARC by 6 weeks postpartum.
optimally address contraceptive needs. By this visit, many women have resumed sexual
activity, potentially putting them at risk for unintended and rapid repeat pregnancy. In
addition, many women with pregnancy-related Medicaid lose insurance coverage at this time,
making it difficult to obtain long-acting reversible contraception (LARC) if desired.
Therefore, an earlier postpartum visit may remove barriers to improve access to LARC thereby,
reducing unintended and rapid repeat pregnancy. Our primary objective is to determine whether
an additional 3-week postpartum visit, compared to usual postpartum care, will affect the
initiation of LARC by 6 weeks postpartum.
Our primary objective is to determine whether an additional 3-week postpartum visit, compared
to usual postpartum care, will affect the initiation of LARC by 6 weeks postpartum. Our
secondary outcomes include: 1) desired method of postpartum contraception; 2) continuation
and satisfaction with contraception; and 3) incidence of rapid repeat and unintended
pregnancy at 12 months. We will also measure attendance and satisfaction with 3- compared to
6-week postpartum visits.We will perform a two-arm randomized controlled trial (RCT). Women
will be randomized to routine postpartum follow-up compared to two postpartum visits; one at
3 weeks and one at 6 weeks, with initiation of contraception at the 3-week visit as
indicated. Women will be recruited from the postpartum service of Barnes-Jewish Hospital and
all women will receive structured comprehensive counseling (adapted from the CHOICE Project
Model) prior to discharge from the hospital. Postpartum visits will occur at our outpatient
ambulatory clinic sites. Participants will complete in-person surveys at baseline and at each
visit, and telephone surveys at 6- and 12-months postpartum. Planned recruitment will be 200
women based on a 2-fold increase in LARC initiation in the intervention group compared to
control group (40% vs. 20% initiation rate).
to usual postpartum care, will affect the initiation of LARC by 6 weeks postpartum. Our
secondary outcomes include: 1) desired method of postpartum contraception; 2) continuation
and satisfaction with contraception; and 3) incidence of rapid repeat and unintended
pregnancy at 12 months. We will also measure attendance and satisfaction with 3- compared to
6-week postpartum visits.We will perform a two-arm randomized controlled trial (RCT). Women
will be randomized to routine postpartum follow-up compared to two postpartum visits; one at
3 weeks and one at 6 weeks, with initiation of contraception at the 3-week visit as
indicated. Women will be recruited from the postpartum service of Barnes-Jewish Hospital and
all women will receive structured comprehensive counseling (adapted from the CHOICE Project
Model) prior to discharge from the hospital. Postpartum visits will occur at our outpatient
ambulatory clinic sites. Participants will complete in-person surveys at baseline and at each
visit, and telephone surveys at 6- and 12-months postpartum. Planned recruitment will be 200
women based on a 2-fold increase in LARC initiation in the intervention group compared to
control group (40% vs. 20% initiation rate).
Inclusion Criteria:
- Delivered at Barnes-Jewish Hospital
- Receiving postpartum care at resident clinic
Exclusion Criteria:
- Received LARC, sterilization, or hysterectomy
- Abortion, stillbirth, or neonatal death
- Non-English speaking
- Unable to comply with follow-up
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