BEYOND BARRIERS: REIMAGINING ACCESS TO POST-PREGNANCY CONTRACEPTION A GUIDE FOR BEST PRACTICE
“Women were unanimously open to midwife involvement in counselling and provision of contraception[..] Women found midwives ‘very relatable’, in established relationships, and ‘more convenient and comfortable’ than doctors. Women felt midwives were knowledgeable regarding contraception.” Freeman-Spratt et al. 31 Leading the way for best practice in this area is Gloucestershire, whose service is led by Specialist Midwife Vicki Pirie. In one of her contributions to this report, Vicki outlined that recognising and expanding the role of the midwife in this space is a vital step toward equitable, effective, and prevention-focused reproductive healthcare across the UK: “When we listen to women, it becomes clear that they want timely, honest, and compassionate conversations about their options delivered by people they know and trust. Midwives are ideally positioned to have these conversations, and when supported appropriately, they can make a lasting difference in the lives of the families they serve.” Vicki and her team in the Gloucestershire PPC pilot found having a lead specialist midwife dedicated to PPC was a vital component of the programme’s success. The specialist midwife supported ongoing staff training, ensured adherence to best practice, embedded PPC within the wider maternity model, and acted as a conduit – a central point of contact for troubleshooting, service development, and mentoring. Since embedding the service: “Early data from the neonatal unit has shown high engagement from mothers who may otherwise have missed the opportunity due to extended hospital stays, reinforcing the importance of flexible access points in ensuring equitable contraceptive care.” Specialist Midwife, Gloucestershire “[Audit] results astonished all those involved in the pilot, particularly regarding the high acceptance rates of contraception when it was offered proactively and sensitively by trusted midwives.” Specialist Midwife, Gloucestershire The Post-Birth Contraception Network UK was jointly developed by teams in Gloucestershire and Northwest London, led by specialist Midwifes Gillian Matthews, Vicki Pirie, and Dr Edward Mullins, to support national collaboration and innovation in PPC. Overall, the majority of successful PPC services have midwives or nurses acting as conduits including East Sussex, Bristol, North
relying upon the dedication, goodwill, and commitment of individual professionals is not sustainable, and as Greater Manchester recognise above, many areas do not have the adequate resource for a dedicated role. Overall, contributors, including a Consultant Obstetrician in South Tees, argued strongly for the importance of having a Champion in each unit whose job it is to promote PPC with sufficient time and resource allocated for delivery: “[..] to get a culture change within a unit requires someone to regularly be promoting it and discussing it and providing it as well Recommendation 2 Establish a Contraceptive Champion within your Service Services should appoint a ‘Contraceptive Champion’ within their service who will hold oversee, monitor, and advocate for the provision of PPC on the maternity ward, as well as ongoing staff development to ensure all maternity staff are equipped to deliver PPC. In many successful PPC services this is a midwife or nurse. 3. The Role of the Nurse or Midwife as a Conduit for PPC Provision All contributions outlined the important role of the nurse or midwife as essential to delivering a PPC offer successfully. Several areas spoke of them as conduit in their service, crucial for its efficiency, providing an important link across services: “The motivation of the Midwifery team is essential to the continued forward motion.” East Sussex PPC service as formal staff training.” Consultant Obstetrician, South Tees Importantly, women have been found to have positive experiences of midwives as conduits for PPC care, as many develop strong and trusting relationships with their midwife during pregnancy, providing a safe space to discuss sensitive topics such as contraception: “Midwives help women explore which options align with their personal values, medical history, and future family plans. These early conversations can continue throughout the antenatal journey, building knowledge and confidence.” Specialist Nurse, Bristol, North Somerset and South Gloucestershire 3
31 Freeman-Spratt GJ, Botfield JR, Lee GS, et al. Understanding women’s views of and preferences for accessing postpartum contraception: a qualitative evidence synthesis. BMJ Sex Reprod Health 2023;49:129–141.
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