LARC is the abbreviation for long-acting reversible contraception. It is an effective and easy form of reversible birth control. There are two types of LARC – intrauterine devices (IUD) and implant (Nexplanon). LARC methods, both hormonal and non-hormonal can be placed at any time, including right after giving birth, providing immediate contraception. Depending on the birth control brand, LARC devices can provide protection for 3 to 10 years.
Why target the postpartum period?
Women are highly motivated to avoid unintended pregnancy following delivery and there may be higher rates of adherence. There is confirmation that a woman is not pregnant at the time of insertion and the woman and clinician are at the same place at the same time, eliminating access barriers to insertion.
How soon after delivery can a LARC be placed?
Nexplanon implants can be placed anytime immediately after delivery. IUDs can be placed within 10 minutes of placental delivery in both vaginal and cesarean deliveries.
What is the rate of expulsion for an IUD placed soon after delivery?
For an IUD placed at the time of delivery, there is an increased risk of expulsion, reported to range from 10-27% nationally. Results from the pilot study at UAMS recorded expulsion rates of 6% when devices were consistently placed 10 minutes after the delivery of the placenta. Women who had an IUD placed immediately after delivery were more likely to continue with the method compared with women who had an interval placement. This is especially important in women who are not likely to follow up postpartum.
What are the contraindications to immediate postpartum LARC placement?
There are no additional contraindications to Nexplanon placement during the postpartum period compared to interval insertion. Immediate postpartum IUD placement is contraindicated with women with an intrauterine infection at the time of delivery, postpartum hemorrhage, or puerperal sepsis.
Why is prenatal choice counseling important?
Ideally, choice counseling and reproductive life planning options should be discussed, at a minimum, during the third trimester of pregnancy. This enables women to make an informed decision in advance of their delivery date.
Healthcare providers should inform their patients about all the reproductive planning options during the prenatal visits and ensure that the individual’s priorities, needs, and preferences guide her decision.
What is the effect on breastfeeding?
Although there is a theoretical risk of decreased lactogenesis associated with administration of progesterone, several studies have shown that there is no difference in lactogenesis in women who underwent postpartum LARC placement. In addition, there was also no difference in the length of time women reported breastfeeding.
In women who remain very concerned about this despite the evidence, placement of a copper IUD may be appropriate. For non-breastfeeding women, the implant has no restrictions on immediate postpartum use. Limited data on hormonal methods’ effects on breastfeeding indicate no negative effects on breastfeeding outcomes.
Because of theoretical concerns related to hormonal effects on milk production and infant growth and development, the advantages of insertion generally outweigh the theoretical or proven risks.
Why not wait until the postpartum visit to insert LARCs?
Up to 40% of women do not return for their 6-week postpartum visit (Gurtcheff, 2011) and 40-75% of women who plan to use an IUD postpartum do not obtain it (Simmons, 2013). Between 40 and 57% of women resume sexual activity before their postpartum check-up (Brito, 2009, Connolly, 2005).
About the Initiative
54
In Arkansas in 2020, 54% of women reported pregnancies that were unintended.
The results of unintended or closely spaced pregnancies can have significant consequences for a mother and her family.
In April 2023, Arkansas HB 1385 passed, allowing birthing hospitals to obtain Medicaid reimbursement for immediate postpartum LARC.
ACOG supports immediate postpartum insertion as a best practice, recognizing its role in preventing rapid, repeat, and unintended pregnancy. This period is particularly favorable for IUD or implant insertion as women are often highly motivated to use contraception and are known not to be pregnant.
The Department of Obstetrics and Gynecology at the University of Arkansas for Medical Sciences was awarded a privately funded grant to design training opportunities for hospital administration, clinical providers, and billing personnel to utilize immediate postpartum long-acting reversible contraception information and resources in a seamless manner.
Our mission is to ensure that every hospital and provider in the state of Arkansas has access to all the information and tools they need to provide immediate postpartum long-acting reversible contraception to birthing women. Increasing access will empower women to decide if, when, and under what circumstances to get pregnant and have another child.
