Postpartum Long-Acting Reversible Contraception Obstet Gynecol; 2016 Aug; Committee on Obstetric Practice, et al

 The American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice has issued a Committee Opinion and recommends the following strategies for immediate postpartum long-acting reversible contraception (LARC):

Optimally, women should be counseled prenatally about the option of immediate postpartum LARC. Counseling should include advantages, risks of intrauterine device (IUD) expulsion, contraindications, and alternatives to allow for informed decision making.

• Immediate postpartum LARC should be offered as an effective option for postpartum contraception; there are few contraindications to postpartum IUDs and implants. Obstetrician–gynecologists and other obstetric care providers should counsel women about the convenience and effectiveness of immediate postpartum LARC, as well as the benefits of reducing unintended pregnancy and lengthening interpregnancy intervals. 

• Obstetrician–gynecologists and other obstetric care providers should include in their contraceptive counseling the increased risk of expulsion, including unrecognized expulsion, with immediate postpartum IUD insertion compared with interval IUD insertion. 

• Systems should be in place to ensure that women who desire LARC can receive it during the comprehensive postpartum visit if immediate postpartum placement was not undertaken. 

• Obstetrician–gynecologists, other obstetric care providers, and institutions should develop the resources, processes, and infrastructure, including stocking LARC devices in the labor and delivery unit and coding and reimbursement strategies, to support immediate LARC placement after vaginal and cesarean births. 

• Obstetrician–gynecologists and other obstetric care providers should advocate for appropriate reimbursement for immediate postpartum LARC from public and private insurers.