BEYOND BARRIERS: REIMAGINING ACCESS TO POST-PREGNANCY CONTRACEPTION THE CASE FOR CHANGE
HOW THE SYSTEM WORKS AGAINST YOU: The personal experience of a consultant obstetrician trying to access contraception after birth Foreword: Experience of a Consultant Obstetrician after Birth
I had my second baby by planned caesarean section at 39 weeks in March 2021, just as the first Covid restrictions were being lifted. Despite working in the Trust and being the Lead for Postnatal Contraception at the same hospital where I was having my caesarean section, I was unable to have a coil fitted at the same time, even though I knew that I didn’t want further children. This was because the service was not funded to provide this, nor did we have the community set up to support follow-up. This is despite experiencing two high-risk pregnancies and a scar opening during surgery. This would have been a clinically logical and convenient opportunity for this procedure, which only takes a few minutes, preventing repeat appointments and wasting NHS resources. Coils are safe to be inserted during or after the surgery and a convenient option for postpartum contraception. Research shows it is a highly effective method, with a very low failure rate. 8 Six weeks after my caesarean section, I contacted my GP for a coil fitting. I was told I was unable to book this appointment without a GP consultation first. I explained I didn’t think I needed to waste a GP’s time on this, having had coils since 2011, and being a Consultant Obstetrician. However, they still refused and could not tell me when they would be re-instating their LARC provision. Instead, I contacted my local Sexual Health service. They were happy to support a coil fit, but did not have their diary planned yet for the next month and would get back to me. They didn’t. So, I chased, two weeks later, and they still hadn’t confirmed their diaries, and couldn’t give me a timescale, even though it is standard NHS practice of giving six weeks’ notice for annual leave. I then contacted the next nearest Sexual Health clinic in the north of my county as I am lucky enough to have my own transport to enable me to attend this appointment. They could fit me in but there was a four week wait. When I attended this long-awaited appointment, they weren’t happy that I had brought my four- month old baby with me despite him being asleep in his car seat for the entire appointment. Unfortunately, this was unavoidable as I could not secure local childcare provision.
The clinician then said they were not happy to fit the coil as I was breastfeeding and advised me to come back when I had finished feeding. This is despite NHS guidance clearly outlining the safety of an Intra Uterine Device (IUD) during breastfeeding:
“ It’s safe to have an IUD when you’re breastfeeding, and it will not affect your baby or your milk supply .” 9
I finally had my coil fitted in November at the clinic further away from my home when my baby was eight months old. As a Consultant Obstetrician, I see patients everyday who face multiple barriers in trying to access contraception they need. If I had this kind of struggle – with my extensive knowledge of the health system, of the contraceptive options available to me plus the advantage of having transport, and having English as my first language – what chance do other women have of navigating this system and accessing the contraception while juggling the pressures of raising a newborn child? I can only imagine what other patients go through. What is the cost of this illogical system, both to the women themselves and to the health system? I see it too often in my line of work. For example, very recently in my termination of pregnancy service, I saw a 14+5 weeks pregnant woman, with her six-month-old baby in the clinic. This is not unusual – 20% of all women in termination of pregnancy service had a baby under one years old. We need policymakers to read stories like mine and understand the importance of action to get this right, to ensure women can easily access the contraception they need in the post-delivery period.
8 Goldstuck ND, Steyn PS. Insertion of intrauterine devices after caesarean section: a systematic review update. Int J Womens Health. 2017 Apr 18;9:205-212.
9 NHS.uk, Who can get the IUD (coil)?
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