The SBH OB/GYN department has been selected to participate in a new program called QINCA (Quality Improvement Network for Contraceptive Access). The program is headed by the DOH and involves 10 hospitals across the city with a goal to help decrease the rate of unintended pregnancies. St. Barnabas Hospital is one of two hospitals selected in the Bronx to participate in the program and achieve a Certificate of Excellence in Contraceptive Access.
The QINCA team, which includes OB/GYN providers, nursing staff, pharmacy staff, IT department and finance, has been working with the OB/GYN department to offer new options to postpartum women, including long-acting reversible contraceptives (LARCs), such as IUD’s and implants. This project is significant on a national level, but particularly in NYC, where unintended pregnancy rates continue to rise. The U.S. national rate is approximately 50%, whereas in NYC it has climbed to 65% and is even higher among low-income and high-risk populations.
One of our first steps to address this challenge will be with the use of immediate postpartum placement of an IUD or implant. These LARCs are traditionally placed in the office after the six-week postpartum visit. Evidence shows that placement in the immediate postpartum period is both effective for contraception as well as cost effective, allowing patients to leave the hospital with a form of contraceptive already in place.
Not only is placement of LARCs a muchneeded resource, but they are also greatly desired. Patients at SBH have already requested such treatment, but have been deferred to their six-week follow-up visit, as the program is not yet in place. In an era of low follow-up and compliance rates, both the patient and the provider stand to reap significant benefits from this program. Patients will be reassured knowing they will not have an unintended pregnancy, while providers will have the peace of mind knowing their patients are leaving the hospital with a safe and long-term form of contraception.
The implementation of this new standard will be a seamless process, as it does not disrupt the current postpartum routine. In fact, considerable time will be saved by placing the LARC while the patient is already enduring a multi-day hospital stay, as opposed to taking up valuable outpatient clinic time. The IUD may be placed intra-operatively during a Csection delivery and immediately postpartum following a vaginal delivery. The implant may easily be placed any time during the patient’s postpartum recovery period. As intermittent bleeding is to be expected in both a postpartum patient and a patient with a newly inserted LARC, the side effect profile and patient discomfort is greatly minimized.
Both IUDs and implants are equally as effective as tubal ligation. The efficacy rate is approximately 99% due to the fact that patient reliability does not play a role. These methods are therefore ideal for high risk and low-income patient populations and should be discussed as a valid option with every pregnant patient.
The major disadvantage is an increased expulsion rate when an IUD is placed in an immediately postpartum patient versus waiting for the six-week follow-up visit. Most patients notice right away after an IUD has been expelled and either a new device may be placed or a different method of contraception chosen at this time. This is not dangerous or a cause for concern, but patients should be warned of this potential complication. The increased expulsion rate is not a contraindication and the benefits continue to outweigh the risks. The complications of unintended pregnancies are far more serious than those of an expelled IUD, especially when most unintended pregnancies have been noted to end in an induced abortion.
This project is certain to make great strides in increasing patient safety and contraceptive access to all methods, and decreasing unwanted pregnancy rates. The OB/GYN community is honored to be chosen to partake in this initiative and invites questions and involvement from other departments.
Photo above: Some members of the SBH QINCA team: Ann Hennessy, RN, Director, Maternal and Child Health; Sophia Lubin, DO, OB/GYN; Christine Rapasarda-Giga, RN, OB Safety Nurse Coordinator.
Dr. Sophia Lubin