By Dr. Kate Campbell
In our paper, ‘Our COVID-19 cloud silver lining’: the initiation and progress of postnatal contraception services during the COVID-19 pandemic in a UK maternity hospital, we describe our experience of starting an immediate postnatal contraceptive service during the first wave of the COVID-19 pandemic in 2020.
The paper demonstrated how an immediate postnatal contraceptive service was rapidly set up and successfully provided a range of contraceptive methods to women on the postnatal wards. Between the 1st of April 2020 and 30th of June 2020, the team worked a total of 56 days and in this time provided 453 women with a method of contraception. This equated to approximately 26.4% (453/1715) of the eligible postnatal women. Of the women who initiated contraception, 19.6% (89/453) opted for a long acting reversible contraceptive (LARC) method. One third of the postnatal women who initiated a contraceptive method were high-risk due to a medical, surgical or social risk factor.
Following this successful initiation, we are now determined to grow this service to include antenatal contraceptive counselling and the option to provide any woman with the contraceptive method of her choice before discharge. This would be in line with guidance from the FSRH and the RCOG.
Furthermore, on the very first day of delivering the postnatal contraceptive service, the team was confronted by another, very real, unmet contraceptive need. Many of the female staff at the hospital were struggling to access contraception in the community during this unprecedented time. After discussion with senior management, it was agreed that contraception could be provided to staff with a registered hospital number. From this point onwards, the team was able to offer contraceptive methods to staff who approached them. This was done in a sensitive manner to maintain confidentiality. News spread fast and over this period, the team was able to provide a total of 26 staff members with a contraceptive method, with 65.4% (17/26) opting for a LARC method. The choices were as follows; 13 sub-dermal progestogen-only implants, 4 progestogen-only contraceptive injections, 3 progestogen-only pills and 6 combined oral contraceptive pills. This staff service was very well-received, with staff members being very grateful and feeling well-supported. This also helped to improve staff moral and contributed to the positive awareness of the postnatal contraceptive service.
During this difficult time when front line staff have all faced uncertainty and may have felt extremely vulnerable on occasions, they deserve a workplace where they feel valued and supported. Our service helps contribute to this and has also helped stimulate suggestions of supporting staff with other needs, for example offering overdue cytology screening. Additionally, this contraceptive service has prompted discussions about the cost-effectiveness of providing an ongoing contraceptive service that staff could self-refer to. A neighbouring trust has a similar self-referral model for staff requiring physiotherapy services.
Our priority focus remains building a sustainable, immediate postnatal contraceptive service as a routine part of our maternity pathway. However, we are very pleased to have been able to provide our staff with this contraceptive service. We believe that supporting staff to access effective contraceptive methods, and where possible avoiding time off work to attend appointments or for unplanned pregnancy, makes sense. The project has allowed us to learn valuable lessons and we will be looking at how we can continue to best support it moving forward.
Dr. Kate Campbell an ST5 CSRH trainee in Birmingham West Midlands. She has a special interest in abortion care, postnatal contraception and international sexual and reproductive health.