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• W2901520922 abstract "Objectives To identify barriers to postpartum permanent contraception procedures after vaginal delivery and to explore contraceptive and reproductive outcomes of women who experience unfulfilled requests. Study design We performed a retrospective cohort study of women requesting postpartum permanent contraception after vaginal delivery from 7/1/11 to 6/30/14 at Strong Memorial Hospital in Rochester, NY. We ascertained patient characteristics and outcomes through electronic medical records and birth certificate data search. Results Of 189 women in our sample, 78 (41.3%) had a postpartum permanent contraception procedure. Factors associated with unfulfilled requests in adjusted analysis included BMI ≥40 (OR 3.71, 95% CI 1.46–9.48 compared to BMI <35), federal sterilization consent signed ≥36 weeks (OR 5.10, 95% CI 1.64–15.86 compared to <36 weeks) and delivery in the latter half of the week (Wednesday–Saturday) (OR 2.02, 95% CI 1.08–3.79). Documented reasons for unfulfilled permanent contraception requests included patient changing her mind related to procedural issues (21, 18.9%), invalid consent (20, 18.0%), maternal obesity (17, 15.3%), lack of operating room availability (14, 12.6%) and ambivalence about permanent contraception (5, 4.5%). Of 57 women who planned for interval permanent contraception and had institutional follow-up over the subsequent year, 14 (24.6%) had a procedure, 8 (14.0%) initiated long-acting reversible contraception, and 13 (22.8%) became pregnant. Conclusions Fewer than half of women obtained desired postpartum permanent contraception after vaginal delivery, with logistical issues and obesity being the most common reported barriers. Health care providers should advocate for access to postpartum permanent contraception, as well as discuss prenatally the individualized probability of nonfulfillment and importance of alternative contraceptive plans. Implications Logistical barriers and inappropriate antenatal preparation contribute to the fact that over half of women do not obtain desired postpartum permanent contraception after vaginal delivery. To respect reproductive autonomy and improve care, clinicians and other health officials should eliminate barriers to immediate postpartum permanent contraception while increasing access to alternative options." @default.
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• W2901520922 date "2019-02-01" @default.
• W2901520922 modified "2023-10-17" @default.
• W2901520922 title "Barriers and outcomes associated with unfulfilled requests for permanent contraception following vaginal delivery" @default.
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• W2901520922 doi "https://doi.org/10.1016/j.contraception.2018.11.005" @default.
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