{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T02:24:15Z","timestamp":1791944655678,"version":"4.3.4"},"reference-count":22,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2019,12,29]],"date-time":"2019-12-29T00:00:00Z","timestamp":1577577600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000325","name":"Wellbeing of Women","doi-asserted-by":"publisher","award":["RG1903"],"award-info":[{"award-number":["RG1903"]}],"id":[{"id":"10.13039\/501100000325","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000589","name":"Chief Scientist Office","doi-asserted-by":"publisher","award":["RG1903"],"award-info":[{"award-number":["RG1903"]}],"id":[{"id":"10.13039\/501100000589","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Expanding access to postpartum intrauterine contraception (PPIUC) can reduce unintended pregnancies and short inter\u2010pregnancy intervals; however, provision across Europe is limited. Our aim was to determine the feasibility, clinical outcomes and patient satisfaction of providing immediate PPIUC after vaginal birth using a health services research model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>Phased introduction of PPIUC across two Lothian maternity hospitals; all women intending vaginal birth during the study period without a contraindication to use of the method were eligible to receive PPIUC. Midwives and obstetric doctors were trained in vaginal PPIUC insertion using Kelly forceps. Women received information antenatally and had PPIUC insertion of either a levonorgestrel intrauterine system or a copper intrauterine device within 48\u00a0hours of vaginal birth. Follow\u2010up was conducted in\u2010person at 6\u00a0weeks postpartum and by telephone at 3, 6 and 12\u00a0months. Primary outcomes were: uptake, complications (infection, uterine perforation), expulsion and patient satisfaction at 6\u00a0weeks; and method of continuation up to 12\u00a0months. Secondary outcomes included hazard ratio for expulsion adjusted for demographic and insertion\u2010related variables.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Uptake of PPIUC was 4.6% of all vaginal births; 465\/447 (96.1%) of those requesting PPIUC successfully received it and most chose a levonorgestrel intrauterine system (73%). At 6\u00a0weeks postpartum, the infection rate was 0.8%, there were no perforations and 98.3% of women said they would recommend the service. The complete expulsion rate was 29.8% (n\u00a0=\u00a0113) and most had symptoms (n\u00a0=\u00a079). Of the additional 121 devices removed, 118 were because of partial expulsion. The rate of complete\/partial expulsion was higher for insertions by midwives compared with those by doctors. The re\u2010insertion rate after expulsion\/removal was 87.6% and method continuation at 12\u00a0months was 79.6%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Routine PPIUC at vaginal birth is feasible. Complications were extremely rare. High expulsion rates may be observed in early stages of service introduction and with inexperienced providers. Re\u2010insertion and therefore longer\u2010term continuation rates of intrauterine contraception were very high. In settings with low rates of attendance for interval postpartum intrauterine contraception insertion, PPIUC could be a useful intervention to prevent unintended and closely spaced pregnancies.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.13787","type":"journal-article","created":{"date-parts":[[2019,12,14]],"date-time":"2019-12-14T09:34:34Z","timestamp":1576316074000},"page":"598-607","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Provision of immediate postpartum intrauterine contraception after vaginal birth within a public maternity setting: Health services research evaluation"],"prefix":"10.1111","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3367-3749","authenticated-orcid":false,"given":"Michelle","family":"Cooper","sequence":"first","affiliation":[{"name":"MRC Center for Reproductive Health University of Edinburgh Edinburgh UK"},{"name":"Department of Obstetrics and Gynecology NHS Lothian 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