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Postpartum contraceptive planning of women with substance abuse disorders

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International Journal of Clinical Pharmacy Aims and scope Submit manuscript

Abstract

Background

Women with substance abuse disorders have lower use of contraception. Unplanned pregnancies increase risk of fetal exposure to addictive and teratogenic substances. Postpartum inpatient periods for these women can be challenging times to facilitate contraception planning.

Objective

To explore postnatal contraceptive planning practices, patient preferences for contraception, and supply challenges, and to identify how clinical pharmacists may best provide care in this context.

Setting

A tertiary maternity referral hospital in metropolitan Victoria, Australia (January 2015—December 2018).

Method

A retrospective cohort study was conducted on postnatal women with substance abuse disorders. Patients were excluded if they had delivered at another health service, had inadequate documented evidence of a substance abuse disorder, or had incomplete or unavailable medical records. Records were reviewed for demographic data, admission details, and documented contraceptive planning.

Main outcome measures

Documented contraceptive planning, patient contraception preferences and identified supply challenges.

Results

Ninety-three women were included. Seventy-one (76.3%) had psychiatric disorders or impairments, and 92 (98.9%) had identifiable follow-up challenges (eg. Homelessness). Nine (9.7%) self-discharged/absconded. Eighty-seven (93.5%) had documented postnatal contraception discussions. Sixty-two of 87 (71.3%) considered a medicine/device, three (3.4%) preferred condoms, 10 (11.5%) considered sterilisation, 2 (2.3%) preferred no contraception, and 16 (18.4%) undecided. Etonogestral 68 mg implants were most commonly prescribed (28 of 42; 66.7%).

Conclusion

Inpatient postpartum periods for this cohort were characterised by psycho-social complexities, inconsistent contraceptive planning documentation, and patients seemingly unprepared to consider contraception. This study highlights a need for an earlier decision-making process and pragmatic counselling with antenatal pharmacists.

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Acknowledgements

Authors would like to acknowledge the input of Cathy Ta in the conduction of this study.

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Author notes

  1. Oran Milman

    Present address: Hawke’s Bay Hospital, Hastings, New Zealand

Authors and Affiliations

  1. The Royal Women’s Hospital Pharmacy Department, The Royal Women’s Hospital, Parkville, Victoria, Australia

    Christine E. Gilmartin, Oran Milman & Laura Leung

Authors
  1. Christine E. Gilmartin
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  2. Oran Milman
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  3. Laura Leung
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Correspondence to Christine E. Gilmartin.

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Authors did not have any funding to disclose for this study other than ordinary wages

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Authors do not have any conflicts of interest to disclose.

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Gilmartin, C.E., Milman, O. & Leung, L. Postpartum contraceptive planning of women with substance abuse disorders. Int J Clin Pharm 43, 1006–1014 (2021). https://doi.org/10.1007/s11096-020-01209-8

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  • DOI: https://doi.org/10.1007/s11096-020-01209-8

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