Prenatal visits are an opportunity to discuss future fertility plans and contraceptive planning following delivery. As ob/gyns, we have a responsibility to ensure that women feel empowered to make contraceptive decisions that best fit their needs and desires. Thus, it is important to review patients’ medical comorbidities as well as their preferences and beliefs during prenatal care to develop a postpartum contraceptive plan.
A provider’s contraceptive counseling approach has implications for the patient-physician relationship, patient satisfaction, and contraceptive continuation. Studies have shown that patient satisfaction with counseling is correlated with higher rates of contraceptive use and greater satisfaction with contraceptive choice.1 High-quality, fair counseling should incorporate the concept of shared decision-making—in which the provider and the patient work collaboratively, with the provider offering medical information and expertise and the patient stipulating her experiences and preferences—in order to select a method that is safe, effective, and meets the needs, desires, and expectations of the patient.2 It is also important to recognize that disparities exist in contraceptive care because of racial, ethnic, and economic differences.3 In addition, there is the potential for bias in contraceptive counseling or recommendations.4
Case Nina, a 34-year-old G4P3 at 28 weeks’ gestation, presents for her prenatal appointment. Her medical history is complicated by chronic hypertension, controlled with labetalol and nifedipine, and Crohn’s disease without medications. She has an obstetric history significant for three preterm deliveries at 36, 35, and 34 weeks due to induction of labor for preeclampsia with severe features. Nina also has a complicated surgical history, with multiple bowel surgeries and a small bowel resection due to Crohn’s disease. She feels that this pregnancy will complete her childbearing and is interested in discussing birth control options. In addition, she is concerned because she will lose her health insurance 60 days after delivery and she wants to have an effective contraceptive method in place beforehand.
Considering Nina's medical history, what contraceptive method meets her desire to avoid pregnacny, minimize risks, and addresses her insurance coverage concerns follwoing delivery?
- Postpartum sterilization
- Combined hormonal contraception
- Depot medroxyprogesterone acetate (DMPA)
- Immediate postpartum intrauterine device
The authors report no potential conflicts of interest with regard to this article.
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