There are significant variations in post-natal contraception advice and services, with particular inconsistencies in the information provided to women who are breastfeeding, a survey of Mumsnet users commissioned by sexual health charity bpas suggests.
bpas designed the survey with Mumsnet after noticing a rise in the number of women experiencing unplanned pregnancy shortly after giving birth - and in particular whilst breastfeeding, believing it provided full contraceptive cover.
The survey of more than 1,000 women who had given birth in the last three years reveals that the majority did not discuss post-natal contraception with a healthcare professional whilst they were pregnant, while more than half did not discuss it until their postnatal check at around six weeks or later, both of which are contrary to the expert guidance issued by the National Institute for Health and Clinical Excellence (NICE) and the Faculty of Sexual and Reproductive Healthcare (FSRH) of the Royal College of Obstetricians and Gynaecologists.
The survey found:
· 61% of women said that there was no discussion with healthcare professionals whilst they were pregnant regarding plans for contraception after the birth of their baby.
· One third (32%) of women who were breastfeeding or planning to breastfeed said that safe contraception when breastfeeding was not discussed or raised at all.
· More than half (55%) of women who chose to use breastfeeding as a method of contraception said that no healthcare professional discussed with them what form of contraception they would use if they stopped or reduced feeds.
· Only 1% of all women discussed newer forms of contraception such as the contraceptive ring and patch.
· More than a quarter of women would have liked more support and advice about contraception.
As more women are encouraged to breastfeed, bpas believes it is important that consistent, accurate advice about the effectiveness of this in protecting against pregnancy is offered, and that women can access all the forms of contraception that are safe to use while nursing. Exclusive breastfeeding can work as an effective contraceptive, but only if strict criteria are met about frequency of feeds. There are a range of contraceptives that are safe to use while breastfeeding - including progestogen-based methods such as the coil and mini-pill. But a third of women breastfeeding or planning to breastfeed said these options were not discussed.
Many women were happy with the advice they received, but the survey does suggest that new mothers – both those who are breastfeeding and not - may not be given the choice from the full range of contraceptive options. Only a fifth for example reported discussing the implant and just 1% the contraceptive patch and ring. The latter, which provide protection on a weekly or monthly basis, may be a particularly good option for women "in between" children, who do not need years of protection but who do not want a daily pill.
The survey also suggested that for some women a discussion with a medical professional immediately after giving birth was not appropriate as they felt it was too much information at a time when resuming sex was the last thing on their minds. This highlights the importance of finding opportunities in the ante-natal period for those women who do want contraceptive advice.
Ann Furedi, bpas chief executive, said:
"There's never going to be a one-size-fits-all answer to postnatal contraception advice - and many women understandably find it laughable that they would want to discuss methods hours after giving birth or indeed find it patronising that it’s raised at all. Some women may want to fall pregnant again very rapidly - so healthcare professionals always have to tailor their care to the needs of the individual.
“But it’s vital that women who do want contraception can make their choice from the full range of options, particularly as their lifestyle and needs may have changed dramatically with the arrival of a new baby. At bpas we are concerned to see women experiencing the turmoil of an unplanned pregnancy within months of giving birth. Given the emphasis on breastfeeding, it is important that information is given about the limitations of this as a form of effective contraception, and what other methods can safely be used at the same time.”
Justine Roberts, Mumsnet co-founder said:
"Unreliable and unclear advice about contraception is the last thing a new mother needs. The number of discussions asking for advice about postnatal contraception on our forums indicates a worrying level of confusion amongst some parents, as confirmed by this survey. It would be helpful if mothers - whether breastfeeding or not - were offered access to clear, consistent advice from the medical profession before and after the birth."
Comments from Mumsnet users on how contraception advice and information could be improved after a baby:
“I would have preferred to have it discussed towards the end of pregnancy. I had to ring my GP when my daughter was 4 weeks, when I stopped breastfeeding and wanted to begin taking contraception again as I had no idea what to do about starting. I’d not discussed it with anyone up until this point.”
“I have found the information on what hormonal contraception is suitable whilst breastfeeding very muddled. For example, various guidance I have seen online say that I could go on the combined pill (youngest is 14 months and still breastfeeding) but the GP said categorically not.
“I received contradictory advice from the midwife and GP- the GP believed that breastfeeding was a safe form of contraception, whereas the midwife warned me that it wasn’t (but didn’t offer any alternatives.)”
“I specifically asked for contraception as I didn’t want to rely on breast feeding alone as it’s not fail safe. I was then told that I didn’t need it as I was breastfeeding and we just went round in circles.”
“[there should be] more discussion whilst pregnant as I felt a bit overwhelmed with a new baby to even think about contraception.”
“I think the discussion should start ante-natally. Day one postpartum I laughed when the midwife mentioned contraception. Antenatal advice could include discussion on what is and isn’t suitable if breastfeeding.”
For more information please contact the bpas press office on 0207 612 0206 or 07788 725185 or email firstname.lastname@example.org
About the survey:
· 1,055 UK Mumsnet users completed the online survey on Mumsnet.com
· All had had a baby in the last three years
· Survey dates: 3-9 September, 2012
Mumsnet is the UK’s biggest network for parents, with over 42 million page views and 5.7 million visits per month. It has 200 local sites, as well as a network of around 2,000 bloggers. It reguarly campaigns on issues such as support for families of children with SEN, improvements in miscarriage care and freedom of speech on the internet.
bpas supports reproductive choice and health by advocating and providing high quality services to prevent unwanted pregnancies with contraception or end them by abortion. We also offer a range of other reproductive health services through more than 50 centres throughout the UK, treating more than 60,000 women and men each year.