Immediate Postpartum

The immediate postpartum period can be a particularly favorable time to provide LARC methods, and postpartum provision of LARC is safe and effective. However, some providers and patients have found it difficult to access LARC in a hospital setting. The LARC Program has collected a variety of resources to aid with increasing access to postpartum LARC.

Postpartum Contraceptive Access Initiative

The ACOG LARC Program's Postpartum Contraceptive Access Initiative (PCAI) is designed to provide clinical and operational support training for immediate postpartum LARC implementation. PCAI’s mission is to ensure all women have access to the full range of postpartum contraceptive methods before leaving the hospital after a delivery. The PCAI website contains the resources below and much more, including details about the initiative, information about immediate postpartum LARC, and an application to request free, onsite training. 

ACOG Guidance

ACOG Practice Bulletin #186 (2017): Long-Acting Reversible Contraception - Implants and Intrauterine Devices

ACOG Committee Opinion #735 (2018): Adolescents and Long-Acting Reversible Contraception - Implants and Intrauterine Devices

ACOG Committee Opinion #672 (2016): Clinical Challenges of Long-Acting Reversible Contraceptive Methods

ACOG Committee Opinion #670 (2016): Immediate Postpartum Long-Acting Reversible Contraception

ACOG Committee Opinion #642 (2015): Increasing Access to Contraceptive Implants and Intrauterine Devices to Reduce Unintended Pregnancy

ACOG Committee Opinion #615 (2015): Access to Contraception

ACOG LARC Program: Immediate Postpartum LARC Resource Digests

The LARC Program compiled these two resource digests containing tools and research on immediate postpartum long-acting reversible contraception. The digests feature content on:

  • Clinical guidance and implementation
  • Billing and reimbursement
  • Capacity building and systems change
  • Immediate postpartum LARC safety, efficacy, expulsion, breastfeeding, cost-effectiveness, and barriers to access.

ACOG LARC Program: Immediate Postpartum IUD Expulsion Fact Sheet

The LARC Program created this fact sheet containing basic information and details regarding the safety, efficacy, and expulsion rates of intrauterine devices placed immediately postpartum.

ACOG LARC Program: Medicaid Reimbursement for Postpartum LARC by State

The LARC Program maintains a list of final or proposed state guidance regarding Medicaid reimbursement for immediate postpartum LARC by state.

ACOG LARC Program Webinar: Immediate Postpartum LARC Implementation: Systems and Sustainability

The LARC Program hosted a webinar in July 2018 that explains the stages of implementation for immediate postpartum LARC programs, from exploration through installation, initial implementation, and full implementation. This webinar can be viewed on-demand.

ACOG District II: Immediate Post-Placental LARC Insertion Educational Video

ACOG District II (serving New York and Bermuda) created this video to provide clinicians with knowledge and tools to improve their contraceptive practices, describe currently available LARC methods, and illustrate techniques for immediate postpartum IUD and implant insertion.


Other Resources

Kaiser Family Foundation: Medicaid Coverage of Intrauterine Devices (IUDs) & Implants Reimbursement Policy

This interactive table and map from the Kaiser Family Foundation presents state-by-state data on coverage for IUDs and implants, both in general and the specific postpartum hospital setting.

Choose Well Initiative and SCBOI: South Carolina Postpartum LARC Toolkit

The Choose Well Initiative and the South Carolina Birth Outcomes Initiative (SCBOI) created the South Carolina Postpartum LARC Toolkit, a resource for implementing South Carolina’s Medicaid policy on providing long-acting reversible contraception services in the hospital postpartum setting. The toolkit serves as a great resource for other states initiating postpartum LARC.

West Virginia Postpartum LARC Toolkit: A Resource for Providing Long-Acting Reversible Contraceptive (LARC) Services in the Hospital Postpartum Setting

This toolkit, developed by the West Virginia team of the ASTHO Immediate Postpartum LARC Learning Community, is designed to highlight the importance and benefits of immediate postpartum LARC and help providers navigate institutional barriers to implementation. In addition to providing information on currently available LARC devices, the toolkit contains guidance on developing implementation infrastructure, insertion processes, and clinical support for LARC provision in the hospital postpartum setting.

ASTHO: Immediate Postpartum LARC Learning Community

The Association of State and Territorial Health Officials (ASTHO) has established an Immediate Postpartum LARC Learning Community to assist states in the implementation of LARC initiatives focusing on postpartum insertion. A variety of other LARC resources are also available towards the bottom of this ASTHO webpage.

CDC Report: Working with State Health Departments on Emerging Issues in Maternal and Child Health - Immediate Postpartum Long-Acting Reversible Contraception

This report describes ASTHO’s immediate postpartum LARC Learning Community information-sharing collaborative. Specifically, it summarizes the experiences of these states in the LARC Learning Community, discusses the concept of shared learning as a mechanism for systems change, and provides the foundation for other states to initiate or supplement implementation of immediate postpartum LARC policies.

Hofler L, Cordes S, Swiak CA, Goedken P, Jamieson D, Kottke M. Implementing Immediate Postpartum Long‐ Acting Reversible Contraception Programs. Obstet Gynecol. 2017;129(1):3‐9.

This study in Obstetrics & Gynecology highlights some of the most important steps required to implement immediate postpartum LARC programs in hospitals, as well as barriers that are often encountered during implementation. Hospital teams reported that implementation of IPP LARC programs requires the involvement of multiple departments and a consideration of a number of key steps; a stage-based approach to implementation and a standardized guide detailing these steps may provide the structure necessary for the complex process of implementing these programs.

Contact:

Mica Bumpus
LARC Program Director
mbumpus@acog.org

For media inquiries about LARC, please contact:
communications@acog.org
202.863.3321

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