[CG] Postnatal contraception during COVID-19 pandemic - SBAR

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Situation

Sandyford has largely closed its sexual health clinics and there are limited access face to face GP appointments during the current COVID-19 situation, women are likely to be unable to access contraception following discharge.  Women may also perceive their contraceptive need as low priority during the pandemic. There is a significant risk of increasing unplanned pregnancy. We have an opportunity to address this before discharge from maternity services . 

Background

All women should have access to contraception following pregnancy .   Midwives and Obstetricians and Gynaecologists are able to discuss postpartum  contraceptive requirements, and help facilitate provision of the safest and most practical option in the circumstances of the pandemic.

Assessment

Contraception available:-

  • Progestogen-only injectable (POI) Depoprovera (Medroxyprogesterone Acetate 150mg IM every 12 weeks)
  • Progestogen-only pill (POP) Cerelle 75 micrograms daily
  • Progestogen-only implant (IMP) Nexplanon (Etononogestrel) 68mg subdermal implant liscensed for 3 years. Long acting reversible contraceptive. Most effective option.
  • Condoms to be available for discharge from all clinical areas.
  • Sterilisation at section should be subject to usual considerations due to the irreversible nature.
  • Combined (oestrogen containing) pills and patches shouldn’t be started until at least 21 days postnatal at the earliest but 6 weeks for patients who or breastfeeding or have risk factors for VTE. For this reason, we don’t plan to supply them from the ward. However, when this is the desired option of the patient it should be communicated via the IDL so that GP can ideally prescribe without the patient having to go to the surgery.
  • Currently within PRM there is a pathway in place to consent and insert IUCD’s at delivery. There is a known higher expulsion rate after delivery and whilst follow up won’t be able to be facilitated by Sandyford, it is not currently recommended.

Requirement

  • Wards to order supply of Depo-provera injections, Cerelle Desogestrel 75 microgram tablets and Nexplanon implants.  Supplies of condoms are also required.  Charge to COVID19 code.
  • The number of clinicians trained for implant insertion varies across the sites. Each site should identify a list of all trained implant inserters including medical staff and local leads should make arrangement to use this staff resource to optimise a Nexplanon service for their site, ensuring that there is equitable provision throughout the week. It is suggested that the number of women requesting implant should be discussed at each daily huddle so that staff resource can be utilised effectively.
  • All women within the ante-natal period to have these contraceptive options fully discussed. This can happen any time after the booking and screening discussions are complete. There is a specific pandemic contraception leaflet which signposts women to websites. If women want more information about a particular method leaflets are available on the Sandyford website.
  • A woman’s contraceptive choice should be documented by 36 weeks in the Badgernet record (see BadgerNET user guide).
  • All midwifery and obstetric staff have had training in contraceptive counselling during their training. There is a Learn Pro module on postpartum contraceptive choices which is very useful, succinct update and appropriate for all midwives and obstetricians including junior medical staff.  There is a GG&C guideline available.
  • Within the postnatal period method of contraception should be discussed and provided prior to discharge. It’s important that the contraceptive option that is actually given is recorded in Badgernet and Immediate Discharge Letter IDL (See attached BN user guide for instruction).
  • PGDs are available to enable midwives to appropriately administer contraceptive injections and POP medications. Clearly medical staff may also prescribe contraception.
  • Assessing capacity and progress: all sites to keep a record of
    • Contraceptive supply used (number of women opting for each option)
    • Daily huddle to identify number of women requesting Nexplanon
    • Number of staff trained to insert Implants
    • Staff completion LearnPro Contraception Model
    • Badgernet is used to assess contraception planned and contraception given

Drug Costs

12 week supply of Cerelle

£3.17

12 week dose of Depoprovera

£6.90

3 year Nexplanon

£88.43

 

Last reviewed: 15 April 2020

Next review: 15 April 2021