Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Meeting the Needs of Postpartum Women With and Without a Recent Preterm Birth: Perceptions of Maternal Family Planning in Pediatrics

  • 70 Accesses



Women face distinct barriers to meeting their reproductive health needs postpartum, especially women who deliver preterm. Pediatric encounters present unique opportunities to address women’s family planning, particularly within 18 months of a prior pregnancy, when pregnancy has an elevated risk of an adverse outcome, such as preterm birth. To ensure maternal family planning initiatives are designed in a patient-centered manner, we explored perspectives on addressing reproductive health in a pediatric setting among women with and without a recent preterm delivery.


We conducted semi-structured, qualitative interviews with 41 women (66% delivered preterm). Women who delivered at any gestational age were interviewed at a pediatric primary care clinic. We also interviewed women whose infants were either in a level II intensive care nursery or attending a high-risk infant follow-up clinic, all of whom had delivered preterm. Data were analyzed using team-based coding and theme analysis.


While women’s preferred timing and setting for addressing peripartum contraception varied, they largely considered pediatric settings to be an acceptable place to discuss family planning. A few women felt family planning fell outside of the pediatric scope or distracted from the child focus. Women discussed various barriers to accessing family planning care postpartum, including circumstances unique to women who delivered preterm.

Conclusions for Practice

Family planning interventions in pediatric settings were overall an acceptable approach to reducing barriers to care among our sample of women who predominantly delivered preterm. These exploratory findings justify further investigation to assess their generalizability and to develop maternal family planning interventions for pediatric settings.

This is a preview of subscription content, log in to check access.

Fig. 1


  1. Ahrens, K. A., Nelson, H., Stidd, R. L., Moskosky, S., & Hutcheon, J. A. (2018). Short interpregnancy intervals and adverse perinatal outcomes in high-resource settings: An updated systematic review. Paediatric and Perinatal Epidemiology. https://doi.org/10.1111/ppe.12503.

  2. Althabe, F., Howson, C. P., Kinney, M., Lawn, J., & World Health Organization. (2012). Born too soon: The global action report on preterm birth. Retrieved from http://www.who.int/pmnch/media/news/2012/201204%5Fborntoosoon-report.pdf.

  3. Ando, H., Cousins, R., & Young, C. (2014). Achieving saturation in thematic analysis: Development and refinement of a codebook. Comprehensive Psychology. https://doi.org/10.2466/03.CP.3.4.

  4. Bellanca, H. K., & Hunter, M. S. (2013). One key question: Preventive reproductive health is part of high quality primary care. Contraception,88(1), 3–6. https://doi.org/10.1016/j.contraception.2013.05.003.

  5. Caskey, R., Stumbras, K., Rankin, K., Osta, A., Haider, S., & Handler, A. (2016). A novel approach to postpartum contraception: A pilot project of Pediatricians’ role during the well-baby visit. Contraception and Reproductive Medicine,1(1), 7. https://doi.org/10.1186/s40834-016-0018-1.

  6. Clark, E. A. S., Esplin, S., Torres, L., Turok, D., Yoder, B. A., Varner, M. W., et al. (2014). Prevention of recurrent preterm birth: Role of the neonatal follow-up program. Maternal and Child Health Journal,18(4), 858–863. https://doi.org/10.1007/s10995-013-1311-0.

  7. Copen, C. E., Thoma, M. E., & Kirmeyer, S. (2015). Interpregnancy Intervals in the United States: Data From the Birth Certificate and the National Survey of Family Growth. National Vital Statistics Reports : From the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System,64(3), 1–10.

  8. Crabtree, B. F., & Miller, W. L. (1999). Doing qualitative research. Thousand Oaks: SAGE Publications.

  9. Dehlendorf, C., Krajewski, C., & Borrero, S. (2014). Contraceptive counseling: Best practices to ensure quality communication and enable effective contraceptive use. Clinical Obstetrics and Gynecology,57(4), 659–673. https://doi.org/10.1097/GRF.0000000000000059.

  10. Dehlendorf, C., Levy, K., Kelley, A., Grumbach, K., & Steinauer, J. (2013). Women’s preferences for contraceptive counseling and decision making. Contraception,88(2), 250–256. https://doi.org/10.1016/j.contraception.2012.10.012.

  11. Dehlendorf, C., Rodriguez, M. I., Levy, K., Borrero, S., & Steinauer, J. (2010). Disparities in family planning. American Journal of Obstetrics and Gynecology,202(3), 214–220. https://doi.org/10.1016/j.ajog.2009.08.022.

  12. DiBari, J. N., Yu, S. M., Chao, S. M., & Lu, M. C. (2014). Use of postpartum care: Predictors and barriers. Journal of Pregnancy. https://doi.org/10.1155/2014/530769.

  13. Earls, M. F., & The Committee on Psychosocial Aspects of Child and Family Health. (2010). Incorporating Recognition and Management of Perinatal and Postpartum Depression Into Pediatric Practice. Pediatrics,126(5), 1032–1039. https://doi.org/10.1542/peds.2010-2348.

  14. Fagan, E. B., Rodman, E., Sorensen, E. A., Landis, S., & Colvin, G. F. (2009). A survey of mothers’ comfort discussing contraception with infant providers at well-child visits. Southern Medical Journal,102(3), 260–264. https://doi.org/10.1097/SMJ.0b013e318197fae4.

  15. Greenberg, K. B., Makino, K. K., & Coles, M. S. (2013). Factors associated with provision of long-acting reversible contraception among adolescent health care providers. Journal of Adolescent Health,52(3), 372–374. https://doi.org/10.1016/j.jadohealth.2012.11.003.

  16. Hagan, J. F., Shaw, J. S., & Duncan, P. M. (Eds.). (2008). Bright futures: Guidelines for health supervision of infants, children, and adolescents (3rd ed.). Elk Grove Village, IL: American Academy of Pediatrics.

  17. Hall, J. A., Barrett, G., Copas, A., & Stephenson, J. (2017). London measure of unplanned pregnancy: Guidance for its use as an outcome measure. Patient Related Outcome Measures. https://doi.org/10.2147/PROM.S122420.

  18. Henderson, V., Stumbras, K., Caskey, R., Haider, S., Rankin, K., & Handler, A. (2016). Understanding factors associated with postpartum visit attendance and contraception choices: Listening to low-income postpartum women and health care providers. Maternal and Child Health Journal,20(1), 132–143. https://doi.org/10.1007/s10995-016-2044-7.

  19. Higgins, J. A. (2014). Celebration meets caution: LARC’s boons, potential busts, and the benefits of a reproductive justice approach. Contraception,89(4), 237–241. https://doi.org/10.1016/j.contraception.2014.01.027.

  20. Hsieh, H.-F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research,15(9), 1277–1288. https://doi.org/10.1177/1049732305276687.

  21. IMPLICIT Network Leadership Council. (2016). IMPLICIT Interconception Care Toolkit: Incorporating maternal risk assessment into well-child visits to improve birth outcomes (p. 42).

  22. Kumaraswami, T., Rankin, K. M., Lunde, B., Cowett, A., Caskey, R., & Harwood, B. (2018). Acceptability of postpartum contraception counseling at the well baby visit. Maternal and Child Health Journal,22(11), 1624–1631. https://doi.org/10.1007/s10995-018-2558-2.

  23. Leaverton, A., Lopes, V., Vohr, B., Dailey, T., Phipps, M. G., & Allen, R. H. (2016). Postpartum contraception needs of women with preterm infants in the neonatal intensive care unit. Journal of Perinatology,36(3), 186–189. https://doi.org/10.1038/jp.2015.174.

  24. Miller, M. K., Randell, K. A., Barral, R., Sherman, A. K., & Miller, E. (2016). Factors associated with interest in same-day contraception initiation among females in the pediatric emergency department. Journal of Adolescent Health,58(2), 154–159. https://doi.org/10.1016/j.jadohealth.2015.10.016.

  25. Patton, M. Q. (1999). Enhancing the quality and credibility of qualitative analysis. Health Services Research,34(5 Pt 2), 1189–1208.

  26. Rosener, S. E., Barr, W. B., Frayne, D. J., Barash, J. H., Gross, M. E., & Bennett, I. M. (2016). Interconception care for mothers during well-child visits with family physicians: An IMPLICIT Network Study. The Annals of Family Medicine,14(4), 350–355. https://doi.org/10.1370/afm.1933.

  27. Srinivasan, S., Schlar, L., Rosener, S. E., Frayne, D. J., Hartman, S. G., Horst, M. A., … Ratcliffe, S. (2018). Delivering interconception care during well-child visits: An IMPLICIT Network Study. Journal of the American Board of Family Medicine, 31(2), 201–210. https://doi.org/10.3122/jabfm.2018.02.170227.

  28. Swanson, K. J., Gossett, D. R., & Fournier, M. (2013). Pediatricians’ beliefs and prescribing patterns of adolescent contraception: A provider survey. Journal of Pediatric and Adolescent Gynecology,26(6), 340–345. https://doi.org/10.1016/j.jpag.2013.06.012.

  29. Tahirkheli, N. N., Cherry, A. S., Tackett, A. P., McCaffree, M. A., & Gillaspy, S. R. (2014). Postpartum depression on the neonatal intensive care unit: Current perspectives. International Journal of Women’s Health,6, 975–987. https://doi.org/10.2147/IJWH.S54666.

  30. Trope, L. A., Congdon, J. L., Brown, L., & Zuckerman, B. (2018). Family planning in pediatrics: An appeal for enhanced training. The Journal of Pediatrics,200, 4–5. https://doi.org/10.1016/j.jpeds.2018.06.012.

  31. Venkataramani, M., Cheng, T. L., Solomon, B. S., & Pollack, C. E. (2017). Addressing parental health in pediatrics: Physician perceptions of relevance and responsibility. Clinical Pediatrics,56(10), 953–958. https://doi.org/10.1177/0009922817705189.

  32. Verbiest, S., McClain, E., Stuebe, A., & Menard, M. K. (2016). Postpartum health services requested by mothers with newborns receiving intensive care. Maternal and Child Health Journal,20(1), 125–131. https://doi.org/10.1007/s10995-016-2045-6.

  33. Webb, D. A., Coyne, J. C., Goldenberg, R. L., Hogan, V. K., Elo, I. T., Bloch, J. R., … Culhane, J. F. (2010). Recruitment and retention of women in a large randomized control trial to reduce repeat preterm births: The Philadelphia Collaborative Preterm Prevention Project. BMC Medical Research Methodology, 10(1), 88. https://doi.org/10.1186/1471-2288-10-88.

  34. Zerden, M. L., Falkovich, A., McClain, E. K., Verbiest, S., Warner, D. D., Wereszczak, J. K., et al. (2017). Addressing unmet maternal health needs at a pediatric specialty infant care clinic. Women’s Health Issues,27(5), 559–564. https://doi.org/10.1016/j.whi.2017.03.005.

  35. Zuckerman, B., Nathan, S., & Mate, K. (2014). Preventing unintended pregnancy: A pediatric opportunity. Pediatrics,133(2), 181–183. https://doi.org/10.1542/peds.2013-1147.

Download references


The authors wish to acknowledge contributions from Dr. Barry Zuckerman and Courtney Pedersen. This research was supported by the Academic Pediatric Association Resident Investigator Award and the Lucile Packard Children’s Hospital Community Benefits Grant.

Author information

Correspondence to Jayme L. Congdon.

Ethics declarations

Conflict of interest

The authors have no financial relationships or conflicts of interest relevant to this article to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Congdon, J.L., Trope, L.A., Bruce, J.S. et al. Meeting the Needs of Postpartum Women With and Without a Recent Preterm Birth: Perceptions of Maternal Family Planning in Pediatrics. Matern Child Health J 24, 378–388 (2020). https://doi.org/10.1007/s10995-019-02829-x

Download citation


  • Family planning
  • Contraception
  • Postpartum
  • Preterm birth
  • Pediatrics