Current Guidelines: Immediate Postpartum Long-Acting Reversible Contraception

SUMMARY:

Long acting reversible contraception (LARC) has an effectiveness of greater than 99%. Placement of LARC in the immediate postpartum period is a safe and effective way to prevent unintended pregnancy, especially given 70% of pregnancies in the first year postpartum are unintended. Women should be counseled prenatally about benefits and risks of immediate postpartum LARC.

Implants

  • No additional risks or contraindications

Intrauterine Devices (IUDs)

  • Insert within 10 minutes of placenta delivery in both vaginal and cesarean births
  • Following vaginal delivery
    • Remove IUD from the inserter
    • Place with a ring or manually at the fundus, with the strings cut to 10 cm
  • During a cesarean delivery
    • Place at the fundus after initiating closure of the uterine incision
    • The string is gently placed manually or with ringed forceps in the cervix
    • Hysterotomy is then closed
  • Contraindications
    •  Intrauterine infection
    • Puerperal sepsis
    • Postpartum hemorrhage
  • Expulsion rates
    • Patients should be counseled on increased risk of expulsion compared with interval IUD insertion, including unrecognized expulsion
    • Expulsion of IUD can be as high as 10% to 27%

KEY POINTS:

  • Women should be counseled about the safety and effectiveness of immediate postpartum LARC
  • Long term data show no effect of progestin-only contraceptives impacting breastfeeding
  • Patients should be counseled on increased risk of expulsion
  • If immediate postpartum LARC is not chosen, women should be offered and able to receive LARC during postpartum visit
  • OBGYNs and institutions should undertake systems-based steps to facilitate placement of LARC after vaginal and cesarean births
  • Additional resources available (see ACOG Initiative in ‘Learn More – Primary Resources’ below)

Learn More – Primary Sources

Immediate Postpartum Long-Acting Reversible Contraception

ACOG: Postpartum Contraceptive Access Initiative

Medicaid Reimbursement for Postpartum LARC