POSTPARTUM PERMANENT CONTRACEPTIVE PROCEDURES: A 360-DEGREE QUALITATIVE INVESTIGATION

Abstract

Objectives

We aimed to explore interdisciplinary factors affecting completion of postpartum permanent contraceptive procedures after vaginal delivery.

Methods

We conducted a multi-center qualitative study on completion or non-completion of postpartum permanent contraceptive procedures at three academic institutions from July 2023-March 2024. We recruited postpartum patients who desired permanent contraceptive procedures following vaginal delivery. We conducted semi-structured interviews with patients and their nursing, obstetric, and anesthesia teams. We double-coded transcripts using Dedoose and performed inductive thematic content analysis, concluding data collection after thematic saturation.

Results

We interviewed 19 patients (11 completed and 9 non-completed procedures) and 47 staff (mean 2.5/patient). We identified three major themes: (1) Standard perioperative counseling can be overshadowed by a focus on overcoming obstacles to completion (“What did [your doctors] tell you to expect?” “Really nothing, they just asked if I was sure I want it…”); (2) Healthcare workers’ personal values influence the prioritization of these procedures (“I believe that some are elective and some are more urgent”); (3) Procedure completion often relies on one champion to optimize interdisciplinary communication and push past barriers (“We could not get a slot for her on day 1…and then we did on day 2, mostly because [attending] advocated for her”).

Conclusions

Unlike most surgeries, the completion of postpartum permanent contraceptive procedures centers around overcoming barriers to access rather than patient needs. The propensity for clinician advocacy to detract from perioperative patient care is a novel finding, and it sustains a culture where contraceptive requests are actualized based on care-team factors rather than patient factors.