By Melinda Young
Adequate birth spacing is an important way to reduce the risk of preterm births. For it to succeed, providers need to include contraception counseling when meeting with pregnant patients and also discuss patients’ contraception plans after delivery.1
Researchers looked at birth spacing, breastfeeding, and postpartum contraception among people living in Western North Carolina, where preterm births at 11.2% are higher than the state’s average.1 “This study was developed out of my research around immediate postpartum contraceptive provision in the hospital setting,” says Liane Ventura, MPH, a graduate research assistant and PhD candidate in the department of epidemiology and community health at the University of North Carolina at Charlotte.
“We were investigating immediate postpartum contraceptive provision in the hospital setting,” she explains. “One thing we noticed were different types of providers engaging with the topic of contraception.” That led to the study, which included interviews with postpartum individuals and providers throughout Western North Carolina. Interviewees included nurse midwives, lactation consultants, doulas, and a perinatal-focused certified mental health clinician.
Providers told researchers they emphasized giving people information during the prenatal period, Ventura notes. “For example, one of the providers said, ‘I’m teaching them about the menstrual cycle and when you can get pregnant and when you will start your period after you have your baby,’” she recalls. “Postpartum individuals emphasized the importance of demystifying the thought around breastfeeding as being a successful form of postpartum contraception.”
Women wanted to have information on what works and what they could do to help them feel empowered as they made decisions about breastfeeding and contraception, she adds. The research made clear that shared decision-making is important between individuals and providers. This includes thorough education on menstrual cycles, a full range of contraceptive methods, and respect for patients’ autonomy and ability to make their own decisions.
The five themes that emerged from the interviews were:
- Prioritize individual decision-making autonomy about infant feeding methods and postpartum contraception.1
- Provide perinatal patient education about infant feeding and postpartum contraception.1
- Strengthen social support for successful breastfeeding and postpartum contraception.1
- Monitor the impact of infant feeding on mental health.1
- Consider contextual factors influencing infant feeding and postpartum contraception.1
“The contextual factors was a really interesting finding because we didn’t necessarily set out to investigate this piece of the whole picture of short interval pregnancy,” Ventura explains. “But our respondents discussed the importance of historical and cultural context around reproduction in the South and changes in virility.”
For instance, there was discussion about the lack of transportation and the distance people had to travel to a labor and delivery unit and also to OB/GYN or other provider visits, she adds. “The distance they have to travel is a huge barrier,” one participant said. “Think about it, if you have a newborn — who wants to get into the car for a few hours?”1 People living in rural and Western North Carolina have to travel very far distances for reproductive health and pregnancy care.
“It’s important to make a distinction between individual social factors like not having a car in the context of going to the labor and delivery unit and system-wide factors like making someone need transportation for longer periods of time or outside of their immediate community, where there might be a bus system,” Ventura says. “The providers speak to that context because they are seeing it among their patient populations.” For example, one provider said there are places in Western North Carolina where the labor and delivery unit was shut down in the local hospital, she adds.
The study’s findings also highlight the importance of having perinatal care providers work with patients and giving them information and social support. One postpartum participant said, “I also wish I had known that there would be different stages [to breastfeeding], and it’s something that I just figured out along the way.”1
It is important that providers engage women in discussions about breastfeeding and contraception, Ventura says. “We need to know what women think about these topics and what helps them make the decisions that are best for them.”
Melinda Young has been a healthcare and medical writer for 30 years. She currently writes about contraceptive technology.
Reference
1. Ventura LM, White M, Strasser R, Beatty KE. Exploration of the intersection between infant feeding and postpartum contraception in Western North Carolina: Perspectives of postpartum individuals and providers. South Med J. 2025;118:189-195.
Adequate birth spacing is an important way to reduce the risk of preterm births. For it to succeed, providers need to include contraception counseling when meeting with pregnant patients and also discuss patients’ contraception plans after delivery.
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