Online Program

Birth spacing: Are we missing a “teachable moment”?

Monday, November 4, 2013 : 8:50 a.m. - 9:10 a.m.

Allison S Bryant Mantha, MD, MPH, Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA
Ana Fernandez-Lamothe, University of California, San Francisco, San Francisco, CA
Miriam Kuppermann, PhD, MPH, University of California, San Francisco, San Francisco, CA
Interpregnancy (birth to conception) intervals of >18 months are associated with the lowest risk of adverse pregnancy outcomes. Whether providers counsel patients about birth spacing above and beyond contraceptive counseling is unclear. We sought to determine patient characteristics associated with counseling about timing of a next pregnancy at the time of the postpartum visit.

A cohort of low-income postpartum women were interviewed within 12 weeks of delivery and were asked whether their provider discussed plans for a next pregnancy. Logistic regression was used to determine risk factors not having had a next pregnancy discussed.

Of 215 respondents, 81% reported having had a postpartum visit. 72% of women who had a visit reported that their provider discussed plans for a next pregnancy. In comparison, postpartum discussions about current health, breast feeding and birth control methods occurred with 95%, 95% and 94% of women, respectively. In multivariable models, only race/ethnicity independently predicted likelihood of having counseling around family planning other than contraception: Latinas were most likely to have had such counseling (73% of Latina women vs. 54% Black vs. 40% White, p=0.01 for Latina-White comparison).

Counseling of women about appropriate birth spacing at the postpartum visit is inadequate as compared with other topics covered. Variation in likelihood of receiving such counseling may reflect practice patterns at different sites of care, though patient-level disparities need to be further explored. Inasmuch as short interpregnancy intervals contribute to population rates of prematurity and other adverse outcomes, obstetric providers should improve their efforts in this area.

Learning Areas:

Clinical medicine applied in public health

Learning Objectives:
Describe the likelihood that high-risk postpartum women will receive counseling about birth spacing in the postpartum period

Keyword(s): Quality of Care, Prenatal Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the PI of this longitudinal cohort study of postpartum women, examining attitudes toward interconception care and birth spacing.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.