Mumsnet/bpas survey shows gaps in contraception care for new mums – unclear advice to breastfeeding women raises risk of unplanned pregnancy
There are significant variations in post-natal contraceptionadvice and services, with particular inconsistencies in the informationprovided to women who are breastfeeding, a survey of Mumsnet users commissionedby sexual health charity bpas suggests. Bpas designed the survey withMumsnet after noticing a rise in thenumber of women experiencing unplanned pregnancy shortly after giving birth -and in particular whilst breastfeeding, believing itprovided full contraceptive cover.
The survey ofmore than 1,000 women who had given birth in the last three years reveals that the majority did not discuss post-natal contraceptionwith a healthcare professional whilst they werepregnant, while morethan 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 theNational Institute for Health and Clinical Excellence (NICE) and the Faculty of Sexual and Reproductive Healthcare (FSRH) of the Royal College of Obstetricians and Gynaecologists.
· 61%of women said that there was no discussion with healthcare professionals whilstthey were pregnant regarding plans for contraception after the birth of theirbaby.
· One third (32%) of women who were breastfeeding or planning to breastfeed said thatsafe contraception when breastfeeding was not discussed or raised at all.
· Morethan half (55%) of women who chose to use breastfeeding as a method ofcontraception said that no healthcare professional discussed with them whatform 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 ofwomen 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 aremet about frequency of feeds. There are a range of contraceptives that are safeto use while breastfeeding - including progestogen-based methods such as thecoil and mini-pill. But a third of women breastfeeding or planning tobreastfeed 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, whichprovide 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.
Thesurvey also suggested that for some women a discussion with a medical professionalimmediately after giving birth was not appropriate as they felt it was too muchinformation at a time when resuming sex was the lastthing on their minds. This highlights the importance of finding opportunitiesin 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:
“Iwould have preferred to have it discussed towards the end of pregnancy. I hadto ring my GP when my daughter was 4 weeks, when I stopped breastfeeding andwanted to begin taking contraception again as I had no idea what to do aboutstarting. I’d not discussed it with anyone up until this point.”
“Ihave found the information on what hormonal contraception is suitable whilstbreastfeeding 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 categoricallynot.”
“Ireceived contradictory advice from the midwife and GP- the GP believed thatbreastfeeding was a safe form of contraception, whereas the midwife warned methat it wasn’t (but didn’t offer any alternatives.)”
“Ispecifically asked for contraception as I didn’t want to rely on breast feedingalone as it’s not fail safe. I was then told that I didn’t need it as I wasbreastfeeding and we just went round in circles.”
“[thereshould be] more discussion whilst pregnant as I felt a bit overwhelmed with anew baby to even think about contraception.”
“Ithink the discussion should start ante-natally. Day one postpartum I laughedwhen the midwife mentioned contraception. Antenatal advice could includediscussion 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
Mumsnetis 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 regularly 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.