Contraception provision in the postpartum period: Knowledge, views and practices of midwives

Published:September 07, 2020DOI:



      Women are susceptible to unintended pregnancies in the first year after giving birth, particularly as consideration of contraception may be a low priority during this time. Discussing and providing contraception before women leave hospital after giving birth may prevent rapid repeat pregnancy and its associated risks. Midwives are well placed to assist with contraceptive decision-making and provision; however, this is not routinely undertaken by midwives in the Australian hospital setting and little is known regarding their views and experiences in relation to contraception.


      An anonymous survey was conducted with midwives at two urban hospitals in New South Wales to better understand their contraceptive knowledge, views and practices regarding midwifery-led contraception provision in the postpartum period.


      The survey was completed by 128 midwives. Most agreed that information about contraception provided in the postpartum period is valuable to women, although their knowledge about different methods was variable. The majority (88%) believed that midwives have a role in providing contraceptive information, and 79% reported currently providing contraceptive counselling. However, only 14% had received formal training in this area.


      Findings demonstrate that most midwives provide some contraception information and believe this is an important part of a midwife’s role. Yet most have not undertaken formal training in contraception. Additional research is needed to explore the content and quality of midwives’ contraception discussions with women. Training midwives in contraceptive counselling would ensure women receive accurate information about available options. Upskilling midwives in contraception provision may increase postpartum uptake and reduce rapid repeat pregnancies.


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        • Chan A.
        • Sage L.C.
        Estimating Australia’s abortion rates 1985–2003.
        Med. J. Aust. 2005; 182: 447-452
        • Cheney K.
        • Sim K.A.
        • D’Souza M.
        • Pelosi M.
        • Black K.I.
        Unintended pregnancy amongst an early pregnancy clinic cohort: identifying opportunities for preventative health interventions.
        Aust. N. Z. J. Obstet. Gynaecol. 2016; 56: 426-431
        • Rowe H.
        • Holton S.
        • Kirkman M.
        • Bayly C.
        • Jordan L.
        • McNamee K.
        • et al.
        Prevalence and distribution of unintended pregnancy: the understanding fertility management in Australia national survey.
        Aust. N. Z. J. Public Health. 2016; 40: 104-109
        • Taft A.J.
        • Shankar M.
        • Black K.I.
        • Mazza D.
        • Hussainy S.
        • Lucke J.C.
        Unintended and unwanted pregnancy in Australia: a cross-sectional, national random telephone survey of prevalence and outcomes.
        Med. J. Aust. 2018; 209: 407-408
        • Mwalwanda C.S.
        • Black K.I.
        Immediate post-partum initiation of intrauterine contraception and implants: a review of the safety and guidelines for use. Australian and New Zealand.
        J. Obstet. Gynaecol. 2013; 53: 331-337
        • Yang J.M.
        • Cheney K.
        • Taylor R.
        • Black K.
        Interpregnancy intervals and women’s knowledge of the ideal timing between birth and conception.
        BMJ Sex. Reprod. Health. 2019; 45: 249-254
        • Tocce K.M.
        • Sheeder J.L.
        • Teal S.B.
        Rapid repeat pregnancy in adolescents: do immediate postpartum contraceptive implants make a difference?.
        Am. J. Obstet. Gynecol. 2012; 206 (481.e1–7)
        • Heller R.
        • Cameron S.
        • Briggs R.
        • Forson N.
        • Glasier A.
        Postpartum contraception: a missed opportunity to prevent unintended pregnancy and short inter-pregnancy intervals.
        Fam. Plann. Reprod. Health Care. 2016; 42: 93-98
        • Lewis L.N.
        • Doherty D.A.
        • Hickey M.
        • Skinner S.R.
        Implanon as a contraceptive choice for teenage mothers: a comparison of contraceptive choices, acceptability and repeat pregnancy.
        Contraception. 2010; 81: 421-426
        • Hanley G.E.
        • Hutcheon J.A.
        • Kinniburgh B.A.
        • Lee L.
        Interpregnancy interval and adverse pregnancy outcomes: an analysis of successive pregnancies.
        Obstet. Gynecol. 2017; 129: 408-415
        • Brammeier K.
        • Cutter J.
        • Cook S.
        • Scherf C.
        The Cardiff postpartum family planning initiative: improving provision of postpartum contraception.
        BMJ Sex. Reprod. Health. 2019; 45: 68-70
        • Haran C.
        • van Driel M.
        • Mitchell B.L.
        • Brodribb W.E.
        Clinical guidelines for postpartum women and infants in primary care–a systematic review.
        BMC Pregnancy Childbirth. 2014; 14: 51
        • Hill S.
        • Tapley A.
        • van Driel M.L.
        • Holliday E.G.
        • Ball J.
        • Davey A.
        • et al.
        Australian general practice registrars and their experience with postpartum consultations: a cross-sectional analysis of prevalence and associations.
        Aust. N. Z. J. Obstet. Gynaecol. 2019; 0
        • Brodribb W.
        • Zadoroznyj M.
        • Dane A.
        The views of mothers and GPs about postpartum care in Australian general practice.
        BMC Fam. Pract. 2013; 14: 139
        • Woolhouse H.
        • McDonald E.
        • Brown S.J.
        Changes to sexual and intimate relationships in the postnatal period: women’s experiences with health professionals.
        Aust. J. Prim. Health. 2014; 20: 298-304
        • American College of Obstetricians and Gynecologists
        Immediate postpartum long-acting reversible contraception. Committee opinion no. 670.
        Obstet. Gynecol. 2016; 128: e32-e37
        • Weisberg E.
        Promoting the use of long-acting reversible contraceptives.
        Austin J. Obstet. Gynecol. 2014; 1: 1-6
        • Australian Healthcare and Hospitals Association
        A Health System That Supports Contraceptive Choice.
        Australian Healthcare and Hospitals Association, Deakin ACT2016
        • Cameron S.T.
        Postabortal and postpartum contraception.
        Best Pract. Res. Clin. Obstet. Gynaecol. 2014; 28: 871-880
        • Damle L.F.
        • Gohari A.C.
        • McEvoy A.K.
        • Desale S.Y.
        • Gomez-Lobo V.
        Early initiation of postpartum contraception: does it decrease rapid repeat pregnancy in adolescents?.
        J. Pediatr. Adolesc. Gynecol. 2015; 28: 57-62
        • Rodriguez M.I.
        • Evans M.
        • Espey E.
        Advocating for immediate postpartum LARC: increasing access, improving outcomes, and decreasing cost.
        Contraception. 2014; 90: 468-471
        • Mazza D.
        • Bateson D.
        • Frearson M.
        • Goldstone P.
        • Kovacs G.
        • Baber R.
        Current barriers and potential strategies to increase the use of long-acting reversible contraception (LARC) to reduce the rate of unintended pregnancies in Australia: an expert roundtable discussion.
        Aust. N. Z. J. Obstet. Gynaecol. 2017; 57: 206-212
        • Australian Healthcare and Hospitals Association
        Consensus Statement: Reducing Unintended Pregnancy for Australian Women Through Increased Access to Long-acting Reversible Contraceptive Methods.
        2017 ([Available from:])
        • Zapata L.B.
        • Murtaza S.
        • Whiteman M.K.
        • Jamieson D.J.
        • Robbins C.L.
        • Marchbanks P.A.
        • et al.
        Contraceptive counseling and postpartum contraceptive use.
        Am. J. Obstet. Gynecol. 2015; 212 (171.e1–.e8)
        • Lindh I.
        • Skjeldestad F.E.
        • Gemzell-Danielsson K.
        • Heikinheimo O.
        • Hognert H.
        • Milsom I.
        • et al.
        Contraceptive use in the Nordic countries.
        Acta Obstet. Gynecol. Scand. 2017; 96: 19-28
        • Buhling K.J.
        • Zite N.B.
        • Lotke P.
        • Black K.
        Worldwide use of intrauterine contraception: a review.
        Contraception. 2014; 89: 162-173
        • West of Scotland Sexual Health Managed Clinic Network
        Professional Guidance Training for Inserting and Removing Subdermal Implants West of Scotland Sexual Health Managed Clinic Network.
        • McCallum A.
        • Byers-Heinlein A.
        • Byers E.S.
        • Pukall C.
        Are ontario midwives prepared to respond to their clients’ sexual concerns? A survey of attitudes, perceived training, knowledge, and comfort.
        Can. J. Midwifery Res. Pract. 2018; 17: 20-33
        • McCance K.
        • Cameron S.
        Midwives’ experiences and views of giving postpartum contraceptive advice and providing long-acting reversible contraception: a qualitative study.
        J. Fam. Plann. Reprod. Health Care. 2014; 40: 177-183
        • Byers-Heinleina A.
        • McCallum A.
        • Byerse E.S.
        • Pukallf C.
        Sexual health-related training of Canadian midwives and its association with practice outcome.
        Women Birth. 2020; 33: e199-e207
        • Gallimore A.
        • Craig A.
        • Cameron S.
        • Milne D.
        • Lakha F.
        Developing the role of midwives as ‘contraceptive champions’ to support early access to effective postnatal contraception for women.
        BMJ Sex. Reprod. Health. 2019; 45: 309-312
        • Centre for Epidemiology and Evidence
        New South Wales Mothers and Babies 2017.
        NSW Ministry of Health, Sydney2018
        • Planning Unit SLHD
        • Central and Eastern Sydney PHN
        Canterbury Local Government Area Health Profile.
        Sydney Local Health District, Sydney, NSW2015
        • Hernandez L.E.
        • Sappenfield W.M.
        • Goodman D.
        • Pooler J.
        Is effective contraceptive use conceived prenatally in Florida? The association between prenatal contraceptive counseling and postpartum contraceptive use.
        Matern. Child Health J. 2012; 16: 423-429
        • Wilson E.K.
        • Fowler C.I.
        • Koo H.P.
        Postpartum contraceptive use among adolescent mothers in seven states.
        J. Adolesc. Health. 2013; 52: 278-283
        • Sznajder K.
        • Carvajal D.N.
        • Sufrin C.
        Patient perceptions of immediate postpartum long-acting reversible contraception: a qualitative study.
        Contraception. 2020; 101: 21-25
        • Yee L.M.
        • Farner K.C.
        • King E.
        • Simon M.A.
        What do women want? Experiences of low-income women with postpartum contraception and contraceptive counseling.
        J. Pregnancy Child Health. 2015; 2: 191
        • Faculty of Sexual & Reproductive Healthcare
        FSRH Guideline: Contraception after Pregnancy.
        Faculty of Sexual & Reproductive Healthcare, United Kingdom2017
        • McCance K.
        • Cameron S.
        Midwives’ experiences and views of giving postpartum contraceptive advice and providing long-acting reversible contraception: a qualitative study.
        J. Fam. Plann. Reprod. Health Care. 2014; 40: 177
        • Cameron S.T.
        • Craig A.
        • Sim J.
        • Gallimore A.
        • Cowan S.
        • Dundas K.
        • et al.
        Feasibility and acceptability of introducing routine antenatal contraceptive counselling and provision of contraception after delivery: the APPLES pilot evaluation.
        BJOG Int. J. Obstet. Gynaecol. 2017; 124: 2009-2015
        • Thwaites A.
        • Logan L.
        • Nardone A.
        • Mann S.
        Immediate postnatal contraception: what women know and think.
        BMJ Sex. Reprod. Health. 2019; 45: 111-117
        • Henderson V.
        • Stumbras K.
        • Caskey R.
        • Haider S.
        • Rankin K.
        • Handler A.
        Understanding factors associated with postpartum visit attendance and contraception choices: listening to low-income postpartum women and health care providers.
        Matern. Child Health J. 2016; 20: 132-143
        • Lunniss H.
        • Cameron S.
        • Chen Z.E.
        Views of general practitioners on providing contraceptive advice and long-acting reversible contraception at the 6-week postnatal visit: a qualitative study.
        J. Fam. Plann. Reprod. Health Care. 2016; 42: 99-106
        • Garrett C.C.
        • Keogh L.A.
        • Kavanagh A.
        • Tomnay J.
        • Hocking J.S.
        Understanding the low uptake of long-acting reversible contraception by young women in Australia: a qualitative study.
        BMC Womens Health. 2015; 15: 72