Interpartum Health Care: How Do We Educate Our Clients?
I imagine any childbirth educator can attest to the fact that we tend to be approached by our students/clients on a wide range of topics–most pregnancy related, but many related to the near or distant postpartum period. When covering physiological postpartum issues, including return to sexual activity, the issue of contraception will sometimes even come up.
As childbirth educators, I firmly believe we are compelled to discuss issues pertinent to the interpartum time span–particularly as they relate to recent and/or future childbearing. I can certainly recall being asked about ideas for contraception while a mother is breastfeeding, how breastfeeding does or does not affect sexuality (and fertility!) and what recommendations I might offer regarding contraception during the interpartum year(s).
Being aware and well-read on medical (and alternative) treatments and options, of course, does not necessarily justify recommending or verbally prescribing those treatment options to our students–particularly if we are not trained/certified to do so. While many childbirth educators are also trained/certified health care providers, many others have come to childbirth education from different and equally wonderful routes. Resultantly, when teaching childbirth education classes outside the realm of a provider/patient relationship, referring our students/clients to well written articles, books and studies is an appropriate means of sharing information that spans beyond childbirth ed. without risking the over-stepping of our professional bounds.
Some of you may have heard of the recent re-occurrence of concerns over oral contraceptives (Yasmin/Yaz, to be specific) and the related increased risk for venous thrombosis /embolism (blood clots formed and/or released into the blood stream). Here is a good journal article/study I recently came across which addresses this concern. But in terms of referring our patients/clients to information that can help them make decisions about interpartum contraception, here are some other resources you might consider:
No discussion on contraception would be complete without first teaching a woman how to recognize her own fertility. Regardless of which type of contraception she does or doesn’t select, gaining a heightened state of awareness of when she is/is not more apt to become pregnant is a must. The book I have referred students and friends to over the years is Your Fertility Signals by Merryl Winstein.
But, let’s face it: we live in a go-go techno-savvy world where people want quick information in bite-sized pieces. So as educators, we should be aware of a handful of reliable websites we can also refer our clients to which can, if nothing else, provide enough information to spark a healthy discussion with their health care providers.
On-line resources like this pdf document from the FDA can be helpful as a basic overview of the types of contraceptive methods available, but lacks significant substance. (Risking making your client feel as if she’s been sent back to junior high school health class.) This page on WebMD delves deep into oral contraceptives, including a brief discussion about the “mini pill” which tends to be prescribed to breastfeeding moms due to its lack of estrogen which is known to decrease milk supply. Famed pediatrician/writer Dr. Sears offers additional thoughts for parents about the preference of the mini pill vs. combined oral contraceptive pills in terms of breastfeeding, as does this site which also discusses potential side effects to the fetus, should a woman continue taking an oral contraceptive during pregnancy. (I know, I know…doesn’t make sense, right?)
And, perhaps, the most lay person-friendly and yet informationally detailed resource I dug up, which incorporates details on all the above topics (including explanations which would pair nicely with the FDA document referenced above) is this overview on breastfeedingbasics.com. Written by an IBCLC, La Leche League leader, six-time nursing mom and once-upon-a-time Lamaze class student, this reference outlines the various contraceptive methods a woman might consider during the interpartum period, including how breastfeeding can delay fertility IF continued in a very particular manner, and paired with strict observation for signs of returned fertility. The article goes on to provide details about all present-day contraceptive options–all of them in terms of the impact, or lack there of, on breastfeeding.
I’d love to hear from our readers: what resources do you recommend to your students/patients/clients regarding interpartum contraception? Surely, empowering our students in terms of their interpartum health experiences as they pertain to reproductive health is equally important as educating and empowering them about their perinatal health and experiences.
http://www.medicalook.com/Birth_control/
Posted By: Kimmelin Hull, PA, LCCE
GREAT article! Opening up the dialogue in this area is very helpful. In 2001, nearly one half of pregnancies were unintended (Finer 2006, Perspectives on Sexual and Reproductive Health).
Our ability to support women with intrapartum health is crucial. Thanks for bringing this up, and I look forward to hearing what others have to share.
Some links:http://www.guttmacher.org/pubs/journals/3509403.html http://www.cdc.gov/reproductivehealth/unintendedpregnancy/index.htm
Finer LB, Henshaw SK, Perspectives on Sexual Reproductive Health, 2006:38:90–96. PDF 3.27MB
Great article and such important information!
I am a nurse-midwife who is passionate about this topic. I am consistently disappointed in health care providers who refuse to acknowledge the effectiveness of certain methods such as withdrawal, fertility awareness and lactation amenorrhea (what? it needs to be prescribed by us or bought in order to be effective?).
For this reason, I really like ARHP’s website, and specifically their Method Match site that allows one to compare methods related to such criteria as effectiveness, cost, ease of use, etc.
http://arhp.org/MethodMatch/
Just want to point out that link from the ARHP groups the Fertility Awareness Method and NFP in with the “rhythm method”. This is one of my main frustrations with how birth control options are discussed with women…you get information like this. NFP and FAM are barely related to the rhythm method of the past and have MUCH higher effectiveness rates (some recently put symptothermal methods on par with the pill). In fact, I have never met ONE single woman who currently uses the rhythm method, or anyone who promotes it, while I know hundreds who use NFP or FAM. They are not the same thing and it demonstrates their bias against natural methods.
I have yet to meet a single health care provider up to date on FAM/NFP. Luckily I have met some birth educators who had some knowledge on it.