By Melinda Young

New research suggests clinicians can do a better job of counseling patients on the risks and benefits of postpartum contraception, including permanent contraception procedures.^1,2 One paper finds that postpartum decision-making is an ongoing process, and providers can support mothers’ individual preferences and personal factors related to social, economic, and historical forces that affect their decision-making.²

“This study is looking at multiple-level influences on postpartum decision-making,” says Liane Ventura, MPH, a graduate research assistant and PhD candidate at the University of North Carolina at Charlotte. “We spoke with mothers and healthcare professionals who provide services for postpartum mothers, including certified nurse midwives, lactation consultants, doulas, and mental health specialists,” Ventura says. “This is a qualitative study, and we wanted to explore how postpartum mothers make decisions about postpartum contraception.”

New mothers face various challenges to obtaining their desired method. These include lack of access to transportation, intergenerational trauma, substance use, and caretaking responsibilities, she notes. “Health insurance policies can be protective in that extended coverage covers postpartum contraception for longer periods of time, but can also present barriers to permanent contraception procedures,” she adds.

“Our article highlights that the decision-making process is not a one-time thing; providers don’t just have one conversation in the prenatal period and then someone makes their decision,” Ventura explains. “It’s more of an ongoing, iterative decision as mothers consider breastfeeding goals and family planning goals and other factors like if they have used contraception in the past and what their personal preferences are.”²

“The immediate, in-hospital provision of contraception postpartum is a facilitator to access,” Ventura says. “That was noted in terms of placement of IUDs [intrauterine devices] and implants immediately postpartum and also with Depo shot provision postpartum.” But some smaller hospitals, those that are understaffed, or hospitals that no longer have a maternity unit can have difficulty with providing postpartum contraception. In those hospitals, certified nurse midwives and mid-level providers can fill an important care gap, and they may be more readily available than OB/GYNs, Ventura says.

Nurse midwives may not be able to provide all types of contraception, depending on licensing and training limitations in various states. They could make sure they are well informed about various contraceptive options and how different types may affect breastfeeding, she adds. “There was an interesting finding where we highlight this disparity between medical guidelines regarding postpartum contraception and lactation as compared to lactation consulting guidelines,” Ventura explains.

For instance, some lactation consultants believe certain contraceptives can reduce or end a woman’s breast milk supply. This is not backed up by evidence, she adds. “Medical guidelines suggest progesterone-only methods are permissible and do not impact breast milk supply and are safe to use while breastfeeding,” Ventura says. “So, one of our recommendations is we suggest the importance of interdisciplinary medical education.”

Healthcare professionals need to learn the latest evidence on contraception and breastfeeding so they can interact with postpartum mothers and have a dialogue with accurate information, she adds.² “We need [information to be] harmonized and not have disparate perceptions on the impact of contraception on breast milk,” she says. “The limitations of our study [are] where we have certified nurse midwives as respondents but not OB/GYNs, even though they were invited,” Ventura says. “It may understate the medicalized care of contraception piece.”

The study’s chief findings are about the decision-making process, and study participants offered differing views on contraception postpartum. “One lactation consultant noted her discontent around patients receiving immediate postpartum contraception because her perception was it does reduce the breast milk supply,” Ventura explains. “So, receiving the Depo shot could impact successful breastfeeding practice for the mother.”²

The lactation consultant’s belief does not align with current evidence regarding contraception and breastfeeding.³ Depo-Provera, which is depot medroxyprogesterone acetate (DMPA), is considered one of the hormonal contraceptives of choice during all stages of lactation. Fair-to-moderate quality evidence shows that DMPA does not harm breast milk supply, and additional evidence suggests progestin-only contraceptives like DMPA may provide some protection against bone mineral density loss during lactation.³

“The other important piece that came out of this study is that in order to provide in-hospital provision, it requires these ongoing conversations in the prenatal period so mothers can go into the birth and have the decision made in a fully informed way,” Ventura says. “So, it’s not pressuring them or pushing them to decide something at the last minute or in a high-pressure environment without a thoughtful, shared decision with their medical provider.”

Pregnant patients may even be unaware they have a choice in contraception. For example, an interviewer asked a new mother, “What do you know now about postpartum birth control that you wish you had known while you were pregnant or at the time you had your infant?” The mother answered, “That it was your choice.”²

“Many mothers don’t have autonomy or empowerment to make those decisions for themselves,” Ventura says. Providers try to avoid the appearance of pressuring patients about contraceptive choices, but historical context may make some patients wary during contraceptive counseling. “One provider in North Carolina said, ‘It wasn’t that long ago that we were still sterilizing people without consent,’” Ventura explains.

Another new study found that preoperative counseling about permanent contraception was limited, according to reports from patients who requested the procedure, she says.¹ “One person said, ‘They just asked me if I wanted it,’” says Kathryn Crofton, MD, a complex family planning fellow with a subspecialty in OB/GYN, at Rush University Medical Center in Chicago.

Another patient was surprised by the amount of pain she experienced after the permanent contraception procedure because she was not counseled that she might have more pain than what she experienced with previous vaginal births, she says. Others were frustrated with the lack of communication when they were not able to have the procedure postpartum.

“Patients who didn’t have the procedure expressed frustration with communication and often didn’t know why the procedure had not been completed,” Crofton says. “It was interesting to hear all the different perspectives: the attending says the unit was so busy, and we just kept trying to get back to do her case; the resident said things were busy but then it settled out and if there was a different attending, they would have tried harder; the patient said no one ever explained it to her.” One solution is for prenatal providers to offer prenatal patients a preoperative consultation about permanent contraception if they request the procedure.

Clinicians also can put more energy into prenatal counseling about permanent contraception and shift culture to thinking of permanent contraception as a necessary procedure and not an elective procedure. When hospital factors make it difficult or impossible to safely deliver postpartum permanent contraception, the team needs to communicate this to the patient and recommend an alternative plan that is acceptable to the patient.

“Talking about postpartum contraception as a routine part of prenatal care can be challenging for those of us in large practices, where we might miss that conversation for some patients or have it over and over again for others, and there are problems with both,” Crofton says.

Counseling patients about these nuances could include telling them this: “I understand you want a permanent tubal procedure, and I’ll do my best to remove the full length of both fallopian tubes because that is more permanent and it reduces the risk of fallopian tube cancer, but if it is not possible to remove the full tubes because of scar tissues from endometriosis or adhesive disease or inflammatory disorders, I will do tubal ligation, which reduces risk of bleeding,” Crofton says.

Melinda Young has been a healthcare and medical writer for 30 years. She currently writes about contraceptive technology.

References

1. Crofton K, Johnston A, Kaszubinski S, et al. Postpartum permanent contraceptive procedures: A 360-degree qualitative investigation. Contraception. 2025;Oct 30:111281. [Online ahead of print].

2. Ventura LM, Dahl AA, Kapran MI, Beatty KE. Spheres of influence on contraceptive decision-making: Qualitative interviews with postpartum mothers and providers. Midwifery. 2026;152:104665.

3. Drugs and Lactation Database. Medroxyprogesterone Acetate. Last revision: Nov. 15, 2025. National Institute of Child Health and Human Development. https://www.ncbi.nlm.nih.gov/books/NBK501287/