This week the Royal College of Obstetricians and Gynaecologists 2019 conference was held in London. The event spanning 3 days covered sessions on maternal and fetal medicine, health policy, early pregnancy, training and abortion care.

A poster of Fetal Pillow was presented at the congress highlighting the impact of introduction of Fetal Pillow for management of a deeply impact head. Of the 131 deliveries included in the study there was use of Fetal Pillow in 61 Cases. Outcomes from cases where Fetal Pillow is used includes a reduction in postpartum haemorrhage, massive obstetric haemorrhage, and mean blood loss.

​The study highlights:
‘The fetal pillow can be a useful tool in reducing overall blood loss at full dilatation caesarean in preventing both postpartum and massive obstetric haemorrhage.’

https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.11_15703#

A Norwegian study has looked at womens’ perceptions of the care they receive in the maternity ward following an emergency cesarean section.

Interviews were conducted with women who had experienced an emergency cesarean section. Analysis of the interviews identified 4 key themes:

• Post-surgery experience
  • Need for pain relief
  • Importance of sleep and rest
  • Attention only on the baby not on the mothers well-being
• Importance of continuity and midwife presence
  • Confusion with changing staff
  • Need for greater staff presence
• Importance of knowledge and good information
  • Informed women felt more confident
• Value of a partners presence
  • Important to have partner staying over to support

The study concludes that the general feeling from women was that they didn’t always feel adequate help and support was available when needed. There were some instances of medication being forgotten or complications being overlooked.

https://sykepleien.no/en/forskning/2019/06/perceptions-postnatal-care-after-emergency-caesarean-sections

An article from cosmopolitan magazine ‘6 myths about caesarean sections too many women believe’ highlights some of the myths surrounding the delivery of a baby that may cause unnecessary anxiety for expectant mums.

The 6 myths covered:

• Cesarean section scars are big and visible
• If you have had a cesarean section, you will be unable to have a vaginal birth in future pregnancies
• There is a limit to the number of cesarean sections you can have
• You can't breastfeed babies delivered via cesarean section
• The recovery period for cesarean section and vaginal delivery is roughly the same
• You won’t feel anything at all during a cesarean section

In the article Dr Penelope Law, Consultant Obstetrician and Gynaecologist address these myths explaining the evidence and experience surrounding the topics.

https://www.cosmopolitan.com/uk/body/a28001821/c-section-scar-caesarean/

What is Diastasis-Recti?
​
Diastasis-Recti, common in pregnancy. is a condition in which the large abdominals (top abdominal layer- Rectus Abdominis) separate. It is commonly defined as a gap of roughly 2.7cm or greater between the two sides of the rectus abdominis muscles.
 
Who is likely to get Diastasis?

Anyone can end up with Diastasis-Recti, however, it is more common in:

• Women who carry larger babies
• Multiple births
• Multiple pregnancies
• Very tight abdominals
• Anyone can get it… babies, children, men, low and high BMI.

 
How to test if you have Diastasis?

1. Lie on your back with your knees bent, feet flat on the floor.
2. Place your fingers with the palm facing you on your belly button.
3. Lift your head and neck just slightly off the floor while you press down with your fingers. If you can feel a gap, that is the diastasis.
4. Conduct the same test just above your belly button and just below the belly button (as the gap can measure differently in these places).

 
What you can do to try avoid Diastasis?

For those carrying multiple babies or large babies it can be hard to avoid but there are things you can do or stay clear of to reduce the chance of getting separation of the abdominals. Try to avoid:

• Abdominal curls and planks

• Putting too much load on your abdominals (includes carrying heavy weight; especially above your hips).
• Lying on your back and leveraging legs away from your centre.
• Twists (especially closed rotations)
• Rolling up from lying on your back.
• Jumping out of bed

  
If you know you have Diastasis also stay clear of the above exercises until it has recovered or minimised and you feel strong and stable in your core and pelvic floor.
 
What can you do if you have Diastasis?

You can try the following exercises and tips to help strengthen your body and help heal your abdominal separation:

• Roll over to your side from a lying position
• Strengthen your pelvic floor and Transverse Abdominal muscles
• Improve your posture
• Breathing exercises – Controlled deep lateral diaphragm breaths, lower belly breathing.
• Strengthen your spine
• Seek a specialist in post-natal care and exercise (Physiotherapist, Pilates Instructor) to work with

 
Every individual is going to have a different situation so it is best to seek help and advice from a professional who specialises in pre and post-natal care. Enjoy the journey in getting to know your new body as a mother. 

Written by: Tenille Samuelson
www.awomanswellness.com



​​Tenille is a qualified Yoga and Pilates Instructor. Over the past 10 years Tenille has operated her own Pilates and Wellness studio with a passion for women’s health. Providing guidance to many women through fertility, pregnancy (pre and post-natal) and supporting women after traumatic birth experiences.

What is the pelvic floor?

The pelvic floor is a thick, sling shaped group of muscles located at the base of the pelvis that span from the tailbone (coccyx) to the pubic bone. It is a group of muscles that can be consciously controlled and exercised just like any other voluntary muscle in the body.

Why is it so important?
 
A balanced pelvic floor is one that you can control to switch on and off throughout movement and breath. A connected and strong pelvic floor helps to support your organs, control your breathing, increase your sex drive and correct your posture. 

Exercise and the pelvic floor

It is best to work with a specialist (Pilates or Physio) who can assist you in the correct exercises and movements for pelvic floor. It is highly recommended that you have good functioning pelvic floor before undergoing more intense exercise like long walks, running, weight and strength training. 
 
Pelvic Floor Exercise (Lift & Hold)
​
You can try this exercise to work on your pelvic floor: 

• Try this exercise kneeling, sitting (on an exercise ball would be best) or in a squat.
• Imagery: imagine your pelvic floor like a lift. When it’s off it is at ground level. As you lift a little it’s at level 1, lift a little more to level 2, gradually lifting your pelvic floor to its maximum at level 5. The aim is to control your pelvic floor muscles, gradually switching them on and off, like a lift going from level 1-5-1.
• Start by drawing your awareness toward your pelvic floor and completely relaxing all the muscles around your pelvic floor, abs, hips, glutes and bottom.
• Inhale: to prepare. Breathing deeply in to your lungs and keeping pelvic area relaxed.
• Exhale: gradually lift your pelvic floor muscles. Thinking about a lift gradually lifting from Ground level (nothing on) to level 5 (maximum strength)
  • Important that you keep the muscles in your bottom, hips and abdominals relaxed. Only engage pelvic floor
• Inhale: hold your pelvic floor at Level 5
• Exhale: to gradually (with control) release your pelvic floor from level 5-1 and back to ground level (switch off).
• Repeat this 5-10 times.
• Progression: Once you can control this see if you can hold your connection at level 5 for 3-5 breaths before gradually letting it go again.

​
Written by: Tenille Samuelson
www.awomanswellness.com


​​Tenille is a qualified Yoga and Pilates Instructor. Over the past 10 years Tenille has operated her own Pilates and Wellness studio with a passion for women’s health. Providing guidance to many women through fertility, pregnancy (pre and post-natal) and supporting women after traumatic birth experiences.

​We do so much research during our Pregnancy for our Birth and together with our support partner and specialists we plan for our Birth…However, it is just as important to have a Post-Natal Plan and be informed in how we can support our bodies as we transition in to Motherhood.
 
Every woman has her own unique birthing experience, from natural birth to cesarean section. First, it is important to acknowledge that there is no correct or one way to birth… we all have different views, customs, symptoms, bodies, growing babies and support. However, no matter what your pregnancy or birthing experience there are a few things you can do to help re-balance your hormones, strengthen your body and keep you sane post-birth.
 
Here are my 7 tips for after Birth:

1. Sleep as much as you can. Yes everyone says it but studies show that Sleep is the best way to re-balance your hormones. 
2. Put Together a Post Pregnancy Plan. This doesn’t have to be complex, it could be as simple as just writing down a few points to focus on over the next year or 2. This could include things like feeding times, or how long you’d like to feed for, when you’d like to go to bed by each night, meal times, when to prepare food, your partners roles, when you get to exercise, when you have to go back to work, when you want your child to start day-care or school or just a financial plan.
3. If breastfeeding do not over exercise or over-stimulate your body. You need that energy to feed and nurse. 
4. Feed your body to help re-balance your hormones and keep your energy up. Think warm, nourishing, easy to digest foods. Foods best for this are soups, broths, steamed veggies, fish, tea, poached or cooked fruit, good/healthy carbs and sugars.
5. Don’t be Afraid to Ask for Help. It really does take a village to raise a child. Use your support networks around you. Family, mums and babies classes, local council nurse, parenting support groups, a friend. We all have something different and unique to teach a child and help them grow. 
6. Strengthen your pelvic floor muscles. A balanced pelvic floor is one that you can control to switch on and off throughout movement and breath. A connected and strong pelvic floor helps to support your organs, control your breathing, increases your sex drive and corrects your posture. Best to work with a specialist (Pilates or Physio) who can assist you in the correct exercises and movements for pelvic floor. It is highly recommended that you have good functioning pelvic floor before undergoing more intense exercise like long walks, running, weight and strength training.
7. Do some relaxation, breathing or meditation exercises. This could be as simple as taking 10 conscious deep breathes before bed, going for a swim, lying over a Yoga Bolster and relaxing in to your body and breath, doing a restorative Yoga class, practising 5-10 minutes of mindfulness or meditation each day. The better you breathe, connect to your body and clear your mind the more relaxed and connected you will be as a parent. 

​Written by: Tenille Samuelson
www.awomanswellness.com
​

​​Tenille is a qualified Yoga and Pilates Instructor. Over the past 10 years Tenille has operated her own Pilates and Wellness studio with a passion for women’s health. Providing guidance to many women through fertility, pregnancy (pre and post-natal) and supporting women after traumatic birth experiences.

Genome sequencing can help with diagnosis and treatment of critically ill babies

A study is using advanced genome sequencing to help identify genetic conditions in neonatal and pediatric intensive care units. The study found that 1 in 4 babies had an underlying genetic condition and the identification of this in many cases altered the treatment plan. The findings of the study will allow doctors to intervene and manage conditions earlier with potential to improve outcomes and save lives. Within the UK there is potential to help more than 3000 patients through implementing this genome sequencing.

 https://www.elystandard.co.uk/news/cambridge-study-to-give-hope-for-sick-babies-1-6100326

PTSD - A maternal-fetal medicine specialists experience

Dr. Shivani Patel is a maternal-fetal medicine specialist and Assistant professor of obstetrics and gynecology in the US. She developed preeclampsia during her first pregnancy at 32 weeks and her baby was delivered via caesarean section within 24 hours of diagnosis which led to PTSD. Now having her blood pressure taken can trigger flashbacks and anxiety. Her experience has helped her awareness of the fears and anxieties parents may be experiencing.

She highlights ‘The onus is really on doctors to try to gauge whether a patient had a traumatic birth experience and may be experiencing PTSD. This is yet another instance in which a patient’s emotional well-being can play as big a role in care as her physical well-being.’

https://www.mysanantonio.com/opinion/commentary/article/PTSD-and-pregnancy-yes-it-s-real-13969325.php

Increased neonatal deaths from overseas IVF

Study finds that women who conceived a multiple pregnancy from IVF abroad had poorer obstetric and neonatal outcomes. In a large center in northwest London 65 women were referred to the fetal medicine center between 2012 and 2016. 38 of those women had IVF overseas and within that group 24% of live born babies died in the neonatal period compared to 0 in the UK group. The average cost  per overseas IVF baby was £20,600. It is suggested that providing IVF in the UK may improve obstetric and neonatal outcomes with lesser cost burden for families and service providers.
​​
https://www.ejog.org/article/S0301-2115(19)30194-0/fulltext

Three things to know about the state of maternal mortality research in the United States
​
A blog from Maternal Health Task Force presents 3 things to know about maternal mortality research in the US from a seminar by Dr Gene Declercq:

1. Maternal mortality is calculated differently in the US compared to other countries. Maternal mortality ratio is used by all other countries, but the government stopped reporting this in 2007.
2. The problem involves women not just dying in labor but also before and after birth. The US statistics may cover a large time frame than data reported from other countries so rate of maternal mortality may appear higher.
3. Maternal morbidity is also an important issue – listening to women is an integral part of improving outcomes.

https://www.mhtf.org/2019/06/07/redefining-the-challenge-of-maternal-mortality-in-contemporary-mch-a-seminar-with-dr-gene-declercq/?utm_source=MHTF+Subscribers&utm_campaign=22d1ff13cf-RSS_EMAIL_CAMPAIGN&utm_medium=email&utm_term=0_8ac9c53ad4-22d1ff13cf-183820305

Is your hospital safe?

US Hospital safety grades have been released providing hospitals with a rating from A to F. Patients treated at hospitals graded D and F were at 92% greater risk of dying from safety problems compared to those with an A grade. In total it was found that 160,000 lives are lost annually in the US due to avoidable errors.

Patients may often have an option of what hospital they are treated at and therefore knowledge of hospitals with higher safety grades can be important. Across all states 32% of hospital graded received an A. Shockingly there were no A rated hospital in Wyoming, Alaska, Washington, D.C., Delaware or North Dakota. The states with the highest % of A graded hospital were Oregon, Virginia, Maine, Massachusetts and Utah.

https://www.cbsnews.com/news/is-your-hospital-safe-how-to-check-its-safety-grades/

Faecal incontinence from tears while giving birth

Up to 10% of mothers who give birth vaginally will develop some form of anal incontinence. An Irish barrister is working to raise awareness of the problem that affects a large number of women. She highlights the devastating impact that these injuries can have on women including the ending of careers and relationship breakdown. Noting that ‘For me, the major thing is information so people can make an informed choice’.

​https://www.echolive.ie/corklives/Mothers-can-feel-like-a-failure-isolated-and-deeply-ashamed-dc3141cc-f325-48b9-97da-568a69f3f7fb-ds

Assisted Vaginal Birth – Clinical Guideline - Society of Obstetricians and Gynaecologists of Canada

The Society of Obstetricians and Gynaecologists of Canada (SOGC) has released a clinical practice guideline ‘No 318 Assisted Vaginal Birth’. It provides recommendations for safe and effective assisted vaginal birth including:

• Encouraging safe and effective assisted vaginal birth by experienced and skilled care providers may be a useful strategy to reduce the rate of primary Caesarean delivery
• Safe and effective assisted vaginal birth requires expertise in the chosen method, comprehensive assessment of the clinical situation alongside clear communication with the patient, support people, and health care personnel
• The physician should determine the instrument most suitable to the clinical circumstances and their level of skill. Vacuum and forceps are associated with different short- and long-term benefits and risks. Unsuccessful delivery is more likely with vacuum than forceps

https://www.sciencedirect.com/science/article/pii/S1701216318308314

Antibiotics for operative vaginal delivery – Randomized Controlled Trial

Use of prophylactic antibiotic after operative vaginal birth can reduce the risk of women developing an infection. A randomized study of women across 27 UK obstetric units was conducted. Women were either allocated to receive a single dose of intravenous amoxicillin and clavulanic acid or placebo following operative vaginal birth at 36 weeks gestation or later.

In total 3427 women were randomly assigned treatment, 1719 to antibiotics and 1708 to placebo. The women who received antibiotics had a 56% reduction in confirmed infection compared to the placebo. The study also estimates that there is potential for a 17% reduction in overall antibiotic use when administered prophylactically.
​
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30773-1/fulltext

Pregnancy is a wonderful time filled with many expectations and bodily changes. For some women pregnancy can be a relatively easy time but for others it can present some challenges. We are all different but what can help are the preparations you take before falling pregnant. This alone can make a major difference to your pregnancy and growing baby. It is normal to experience a few minor or major changes and issues throughout your different stages of pregnancy and this is why choosing a specialist who works in this field is imperative.
 
Whilst working with your GP, Midwives, Obstetrician or Doula is imperative during your pregnancy, there are many other specialised professionals who can support you. Look for pregnancy specialist in areas of; Yoga, Pilates, Acupuncture, Naturopathy, Chiropractic and Massage. These holistic therapists can help support you throughout your pregnancy, prepare you for your labour and guide you through post-natal self-care and baby support.

Remember Pregnancy is a time to Nurture and Embrace! Whilst you want to look after you and your growing baby know you can use this time to also embrace some amazing pregnancy exercises and techniques which in turn will assist your labour.
 
Every woman’s body is different; therefore, the ability of exercise options will also be different from one woman to the next.

• Keep Moving: The most important thing in pregnancy is to keep moving in some way whether it just be walking or stretching.
• Strength: Light weight and strength exercises will support your changing body. It is important to have a balance of strength exercises and mobility/ opening exercises.
• Body Awareness & Breathing: Also choosing a form of exercise that focuses on body awareness and breathing will help to prepare you for labour and keep you mentally and emotionally balanced.
• Pelvic Floor: Specific Pelvic floor exercises will help to support your growing uterus and organs and get you back in to shape quicker post-natal.
• Exercises to AVOID:  abdominal curls/ crunches, too much forward flexion, closed rotation. Lifting heavy weight, lifting weight over-head, too much abdominal work and over-stretching.
• Post- Natal Exercise: First 6 weeks treat your body like it is still pregnant. Be gentle and kind. You don’t need to get straight back in to exercise. However, you can start pelvic floor exercises straight away and if have the clearance from your doctor start with light walks and gentle stretching. Once you have developed some pelvic floor and core strength then you can start progressing in your exercise.

 
Having a healthy balanced diet will assist in your baby’s development, your growing body and how much energy you have throughout the day. Meditation is another practice that you and your partner can do together to keep a balanced mental and emotional state during this life changing experience. Meditation or mindfulness practice will also help you prepare for labour.
 
It is important for women to acknowledge that pregnancy and birth does not need to be feared or scary. Know your body, communicate with your specialists, research and ask questions about your pregnancy and labour. Be informed and know your options and choices, without over-whelming yourself. As you become more connected and informed you will make the right choices for you, your baby and your family.
 
Most importantly take time to slow down and connect with your growing baby. The more connection you both have the smoother your transition in to mother-hood will be.
 
Written by: Tenille Samuelson
www.awomanswellness.com

​​Tenille is a qualified Yoga and Pilates Instructor. Over the past 10 years Tenille has operated her own Pilates and Wellness studio with a passion for women’s health. Providing guidance to many women through fertility, pregnancy (pre and post-natal) and supporting women after traumatic birth experiences.

Keyhole surgery in the womb

Surgeons in the UK have performed keyhole surgery to repair a babies spine whilst in the womb. The baby was diagnosed with Spina bifida after a routine scan which showed the spine and spinal cord weren’t developing correctly. The mother underwent surgery at 27 weeks to correct the defect with doctors performing keyhole surgery to address the problems with the babies spine and spinal cord. Performing the surgery whilst the baby is still in the womb can reduce risk of complications for the baby later in life.
​
https://www.bbc.com/news/health-48253477

What happens to a baby during birth?

MRI showing the molding that occurs to a baby’s head during the second stage of labor has been examined in a recently published study. 7 women had an MRI before labor and during the second stage. All 7 showed fetal head molding in the MRI during the second stage of labor. Following delivery only 2 of the newborns showed deformed head contours.

The study highlights that the results suggest the fetus is subjected to greater stress than it was previously thought. It also highlights that a ‘normal birth’ where a mother gives birth by natural means with only a few maternal expulsive efforts may not lead to the optimal fetal outcome as it doesn’t take into consideration the amount of fetal head molding that may take place.

The study concludes that fetal head molding was observed in all 7 patients but was observed in only 2 following delivery. The ‘overlapping of the cranial sutures was most significant in the anterior-posterior direction, at the coronial and lambdoid suture’. The findings of the study are important for understanding the mechanism and risk of labor and birth.

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0215721

A new website ‘Every week counts’ is highlighting the importance of the last few weeks of pregnancy. Research from the Clinical and Population Health Perinatal Research Centre of the Kolling Institute, based at Royal North Shore Hospital, Sydney Australia has shown the benefits for babies born close to their 40 weeks due date.

The website aimed at healthcare professionals highlights the short term and long term benefit of birth at 40 weeks including:

• Reduced neonatal morbidity
• Better brain development
• Reduced risk of NICU admission

The website provides research papers and resource to support the conversations obstetrician are having with expectant mums.

https://www.everyweekcounts.com.au/

WHO: Strengthening quality midwifery education

The WHO report in midwifery education has been published identifying 3 strategic priorities and a 7 step action plan.

The 3 strategic priorities:

• Every woman and newborn to be cared for by a midwife, educated and trained to international standards and enabled to legally practise the full scope of midwifery. The title “midwife” should only be used for providers who are educated to international standards.
• Midwifery leadership to be positioned in high-level national policy, planning and budgeting processes to improve decision making about investments for midwifery education to help achieve UHC.
• Coordination and alignment between midwifery stakeholders at global, regional and country levels to align education and training processes, knowledge, research, evidence-based materials, indicators and investment.

The 7 step action plan to achieve this:

1. Strengthen leadership and policy
2. Gather data and evidence
3. Build public engagement and advocacy
4. Prepare educational institutions, practice settings and clinical mentors
5. Strengthen faculty, standards and curricula
6. Educate students
7. Monitor, evaluate, review and adjust

The full report goes into much greater detail on the importance of the strategic priorities and how they can be achieved.

https://www.who.int/maternal_child_adolescent/topics/quality-of-care/midwifery/strengthening-midwifery-education/en/

Legislation passed in Alabama is the most restrictive abortion bill in the US. It makes carrying out an abortion at any stage in pregnancy illegal even criminalizing abortion in cases of rape and incest. Doctors carrying out the procedure could face up to 99 years in jail.

Abortions would only be legal in cases where the mother’s life is in danger or if the fetus has a fatal condition. Many groups and organizations are planning to challenge the bill.

There are several countries around the world where there are also restrictions or bans on abortions including Northern Ireland, Malta, Philippines and Poland.

​https://www.independent.co.uk/life-style/women/abortion-ban-alabama-bill-countries-strictest-laws-punishments-prison-a8916496.html

Safety culture can positively impact surgical outcomes

This study into the influence of hospital safety culture on surgical outcomes highlights the positive impact safety culture can have. Those hospitals that reported a positive safety culture were significantly associated with lower risk of postoperative morbidity. The study concludes:
‘Hospital safety culture can influence certain surgical patient outcomes. Improving the safety culture within a hospital can represent a previously unrecognized approach that can be leveraged to strengthen surgical quality improvement efforts at the hospital level.’

The study can be found here.

Translating Maternal Mortality Review into Quality Improvement Opportunities in Response to Pregnancy-Related Deaths in California

An article has been published looking at improvement opportunities from the maternal mortality review in California. The study looked at readiness, recognition and response allocating data from 203 pregnancy related deaths into one of the 3 categories. Opportunities for improvement relating to each category were identified:

• Readiness – helping women to be prepared and knowledgeable about pregnancy and childbirth
• Recognition – Need for clinicians to better recognize risk factors, signs and symptoms for more accurate diagnosis
• Response – improved coordination of care, better timing of treatment and improvement in follow up care

Concluding that ‘Nursing leadership is necessary to support and guide national, statewide, and local efforts to improve the quality of maternity care through the implementation of quality improvement at the system, facility, clinician, and patient levels.’
​
Read the study here. 

The Centers for Disease Control and Prevention has published a report into pregnancy related deaths. It highlights that around 700 women die each in the US from pregnancy related complications estimating that 3 in 5 of these could be prevented.

Figures in the study outline the statistics for the 2011 – 2015 period. The split is relatively even between deaths happening during pregnancy, at delivery or up to 1 week after and 1 week to 1 year postpartum. Heart disease and stroke were the cause of over 1/3 of the deaths and Black and American Indian/Alaska Native women were about 3 times as likely to die from a pregnancy-related cause.

Although heart disease was one of the main causes of death other causes differ depending on the stage of pregnancy or postpartum period. Most deaths during delivery are caused by obstetric emergencies for example excessive bleeding and in the week after delivery bleeding and infections are common. Some of the factors that play a part in deaths include women’s access to care, missed/delay diagnosis and failure to recognise warning signs.
​
The report provides some recommendations for what all stakeholders can do:

• Health care providers can communicate with patients about warning signs and utilize tools to flag early warning signs
• Hospitals and health systems can improve prenatal and postpartum care and standardize approach to emergencies
• States and communities can support reviews of causes behind all deaths
• Women and families can know and communicate about any symptoms they may experience

The full report and further resources are available here. ​

New guidance on Immediate postpartum long-acting reversible contraception (LARC) for women at high risk for medical complications has been published by the Society for Maternal Fetal Medicine. The document has been designed to educate all providers about the benefits of postpartum contraception, and to advocate for widespread implementation of immediate postpartum LARC placement programs.
​
Recommendations from SMFM are:

• LARC should be offered to women at highest risk for adverse health events as a result of a future pregnancy
• Obstetric care providers should discuss the availability of immediate postpartum LARC with all pregnant women during prenatal care and consult the US MEC guidelines to determine methods most appropriate for specific medical conditions
• Women considering immediate postpartum IUD insertion should be counseled that although expulsion rates are higher than with delayed insertion, the benefits appear to outweigh the risk of expulsion, as the long-term continuation rates are higher
• Obstetric care providers wishing to utilize immediate postpartum LARC should obtain training specific to the immediate postpartum period
• For women who desire and are eligible for LARC, they recommend immediate postpartum placement after a high-risk pregnancy over delayed placement due to overall superior efficacy and cost-effectiveness
• Women considering immediate postpartum LARC should be encouraged to breastfeed, as current evidence suggests that these methods do not negatively influence lactation
• For women who desire and are eligible for LARC, they suggest that early postpartum LARC placement be considered when immediate postpartum LARC placement is not feasible.
• Contraceptive counseling programs should be patient-centered and provided in a shared decision-making framework to avoid coercion

The full article which includes the recommendations and background explanations is available here. Additional resources are also provided including a learning materials and a patient education leaflet.