“This included embedding contraception planning into the handheld maternity record, ensuring contraception was discussed as part of routine antenatal appointments, and identifying suitable points for delivery, whether on the postnatal ward or in the community.” Specialist Midwife, Gloucestershire Contributors emphasise that these consultations should not be seen as a ‘tick box’ exercise but rather as a careful and considerate discussion centred around the women’s wishes and needs on this important topic. Ultimately while contributors stressed that counselling during pregnancy is most effective, PPC pathways should be designed to enable women to receive contraception at the best time for them post-pregnancy. Flexibly providing this broader time window to enable women to reflect, consult with their partner or support network if desired, and make more informed, autonomous decisions in a less pressured environment often during home visits or community- based appointments was recommended. Gloucestershire’s PPC model enables midwives to offer contraception up to 21 days post-pregnancy, in recognition that: Furthermore, this approach is particularly valuable in rural populations where access to healthcare is often more limited and centralised services are difficult to reach. By offering community-based or outreach contraceptive care in rural areas delivered by midwives, Gloucestershire has: “Helped overcome geographical and transport-related barriers that can disproportionately affect women in remote locations.” “Not all women are ready to receive contraception while still on the maternity ward.”
Overall, contributors were in strong consensus that contraceptive counselling must be initiated in the antenatal period for it to facilitate careful consideration and allow the healthcare professional (HCP) to build a trusted relationship with women and their birthing partners. An effective offer of PPC must include delivery of the contraception to suit the woman’s own needs. Sensitive contraceptive counselling is particularly important for bereaved parents and women who have needed an abortion. Having a stillbirth or experiencing pregnancy loss or neonatal death is often a very traumatic event for women and birthing partners. Therefore, one of the bereavement care standards embedded in the National Bereavement Care Pathway (NBCP) is to have a system in place to clearly signal to all healthcare professionals and staff that a parent has experienced a bereavement. This is to ensure that all paper and electronic documentation provides clear communication about a bereavement and enables joined- up, responsive care. Information should be provided in different formats for women to access when they feel ready, and healthcare professionals should practice compassion, empathy, and sensitivity, while demonstrating an understanding that women may want to wait to receive certain information on contraception. Further information and guidance can be found in the resources section of this report. Similarly, abortion care providers should ensure contraception is available but never imposed, and that individuals are supported in selecting and using the method that best aligns with their needs and values. A non-directive, person-centred approach is essential to uphold reproductive autonomy and deliver respectful, high-quality care. Further information and guidance can be found in Appendix 4 and in the resources section of this report. At a local health system level there are resources to help inform these discussions, both at the ICB and clinical levels, and this includes guidance from the Advisory Group on Contraception (AGC) commissioning toolkit, which can be found in the resources section of this report. Further information is also available via the Contraceptive Choices website. Recommendation 5 Standardise Contraceptive Counselling Before End of Pregnancy Ensure that discussions of contraception become standard for all women during their pregnancy, reflecting women’s desire for these early discussions whilst allowing for post pregnancy discussion for those who prefer it. The timing of these discussions should be patient-led and sensitive to the individual’s needs. Contraceptive decisions should be recorded in a contraceptive plan prior to end of pregnancy. Sands recommends that healthcare professionals should also arrange for a follow-up health check to take place, and contraception could form part of this conversation. 36
36 Further information on discussing contraception sensitively following pregnancy loss can be found in Appendix 3.
20
Made with FlippingBook Digital Proposal Creator