Contraceptive advice from your Midwife in pregnancy.

(223 Posts)
missismac Sun 23-Feb-14 09:47:28

I'm just doing a project on this topic and struggling to get any info about womens views on this. I was wondering how you would feel about your Midwife raising the issue of postnatal contraception whilst you were still pregnant - say around your 36 week appointment? Is it something you would welcome, or do you feel maybe your head wouldn't be in the right place to take it in? Should it even be a part of the midwife's role, or is it for the GP/ clinic nurse to advise you on?

LittleBearPad Sun 23-Feb-14 09:55:32

Well it's probably important for women to understand that they can be fertile before their periods come back, that bf isn't a contraceptive etc. a passing comment might be useful but not too much time. The appointments are short enough as it is.

thatstoast Sun 23-Feb-14 10:01:10

It was discussed at my antenatal classes and by the community midwife and health visitor straight after the birth. I wouldn't object to it being raised during pregnancy but not sure what the benefit would be as you can't act on the advice.

Tbh, I took offence at it being brought up right after the kids were born while still in hospital and feeling like crap. I did not like getting a lecture on what is better and "long term contraception". I am an adult and perfectly capable of finding out which (if any) contraception I want to use, on my own.
And what if the plan was to have children close together? In my experience Doctora/Nurses do not like being told that you don't want to discuss this with them, and that's not fair.

Sorry, that was basically meant to say that discussions about contraception while still pregnant and have not yet had a safe birth are very OTT.

missismac Sun 23-Feb-14 10:32:54

Thanks Guys, I wondered the same about squeezing it in to the appointment littlebear, but some Midwives offer a 1 hour 'birth talk at 36 weeks so it might work better with that model of care? I know at our local clinic the appointments are still only 15 mins - it's very much get-em-in-get-em-out, I can't imagine how a contraceptive talk would fit in there?

thatstoast I suppose I thought the benefit might be, as littlebear said, understanding when you might be fertile again (3 weeks post birth) and to enable you to plan your family spacing rather than get a surprise pregnancy that you're not ready for. I appreciate what you say Schro, I remember feeling the same and looking at the Midwife not he postnatal ward in horror as she asked me about contraceptive - thinking 'you've got to be kidding right?'. And yes, there are families for whom it's right, and their choice to have a small gap, but for most women their bodies need a year to recover and gain strength between birth and subsequent conception. If a contraception chat at 36 would help women think about what they want with regard to family spacing and contraception over the coming year then might it be a useful addition to maternity care? I guess I was looking at the issue from this perspective rather than an intrusive lecture on what you 'should' do - which wouldn't be helpful to anyone!

CrispyFB Sun 23-Feb-14 12:02:43

My consultant asked me at my 34 week appointment but that is because I need c-sections and this will be my third, and she was basically telling me not to have any more babies which is fair enough (fine by me, four was always the plan!)

It felt odd talking about contraception when we'd TTC for 14 cycles to get this one, but the conversation has to come up at some point.

I actually think it is better before the birth because you're not as exhausted, you're probably in "planning" mode preparing for everything too. Getting people thinking about it and then the midwife or HV bringing it up maybe post birth to put those plans into action. Anyway, that's just my opinion!

I am sure a lot of people dont know that they could start back on hormonal contraceptives from 3 weeks after the birth as they think they have to wait until their 6 week check. A talk about contraception before birth could be useful.

SaucyJack Sun 23-Feb-14 12:30:39

I'm in my 30s, and quite capable of making my own contraceptive decisions thanks so I wouldn't appreciate anybody taking it upon themselves to "advise" me at any stage if I'm being perfectly honest.

pixiestix Sun 23-Feb-14 12:37:08

Maybe pre-birth would be better. I remember being fairly pissed off with midwives trying to talk to me about it 12 hours after the birth.

My MW discussed contraception with me postnatally. I think there might have been a checklist involved.

I'm not sure that talking about it antenatally would have been any more useful.

sallysparrow157 Sun 23-Feb-14 12:53:09

Those of you who feel capable of making their own contraceptive decisions, that's great but there are women who may not have thought about it or women who don't know all the options and age isn't an indicator, there are 16 yr olds who are more clued up than some 30 yr olds.
Contraceptive advice doesn't have to mean a 2 hour lecture, it could just be
'have you considered contraception options after the birth?'
'Yes, I'm going to do x/I'm hoping to have another child soon after this one so we won't be using any/not yet but I plan on looking into my options myself'
'Great, if you need any advice at a later date you know where I am'

Having this chat at 36 weeks probably makes more sense than having it 12 hours after birth when I'm sure the idea of doing anything needing contraception is enough to bring tears to your eyes!!

VivaLeBeaver Sun 23-Feb-14 12:57:46

As a midwife I have to talk to women about this before they leave the hospital postnatally. There's a little box in their notes to tick to say its been done.

Some women aren't capable of finding out the options. Some women believe they can't get pregnant before their first period and are amazed and shocked to find themselves pregnant a few weeks after giving birth.

If you don't feel the advice is of benefit just smile and nod. I'm sure some women don't find half the advice in pregnancy of benefit. After all they're capable of looking up advice about what foods to avoid, alcohol, ibuprofen, Vit a, exercise, smoking, etc themselves aren't they??? hmm

Women won't see the GP until six week postnatal checkup which could be too late for some.

Gobbolinothewitchscat Sun 23-Feb-14 12:59:04

Why does the midwife or the health visitor have to mention it confused

The GP mentions at the 6 week check and they tend to be a lot less judgey pants than either the HV or midwives in that in my experience they tend to have much better tone and are able to leave out the highly unprofessional value based judgements

Just hand over a leaflet, if you must at the appointments or stick something in the green notes

alwaysneedaholiday Sun 23-Feb-14 13:03:03

Yes, I would prefer this conversation before the birth. I'm not usually embarrassed easily, but for some reason I really did not appreciate talking about contraception immediately after birth, or even at the 6 week check.

I think just a leaflet about options and an offer to answer any questions is sufficient for most women.

Gobbolinothewitchscat Sun 23-Feb-14 13:04:08

I've got a 5 week old DD with only a 13 month gap between her and DS Thank God none of the midwives at the hospital brought up contraception or they would have got a very hard stare.

It's all so intrusive and big brother like. Most of us have managed not to get pregnant quite successfully for most of our adult lives before stsrting a family. Why would giving birth suddenly have robbed us of that skill?

As I've said, why not just have some leaflets available for the biologically challenged. The rest of us can google or rely on our previous skills which won't have deserted us just because we're "mummyz" now <boke>

purplemurple1 Sun 23-Feb-14 13:05:31

My midwife decided while I was birthing the placenta was the perfect time for the discussion. Before birth would have been beter than during.
It had taken 2 yrs and help to conceive, so not really relevant to us anyway.

Bubblegoose Sun 23-Feb-14 13:11:58

I'm with Schro and Saucy. Totally my decision as an adult.

When DC1 was a few days old a HV came to visit us at home. She asked about contraception and I looked at her like she was mad. She smiled wryly at me and said "I'll bet you any amount of money I'll be seeing you with a new baby in less a year's time."

I was 34 at the time and had been with my partner for 10 years and managed to avoid getting knocked up. Accidentally falling pregnant in the first few weeks after the birth of my first child with very little sleep and with lots of healing to do wasn't going to happen.

missismac Sun 23-Feb-14 13:14:30

Well Midwives don't HAVE to mention it antenatally, but they do postnatally - it's part of their job remit. As some of the other posters mentioned, if it's left to the 6 week check then for some women it will be too late and they'll have an unplanned pregnancy. One that possibly isn't welcome to them?

We all know that babies come, planned or unplanned and not everyone likes to live their life to a schedule, but I suppose I'm leaning toward favouring a mention by the Midwife in the antenatal period rather than no mention at all until, you've just pushed a melon out your vajayjay so as to give women a bit of time to mull it over. It doesn't have to be advice saucyjack, but would you have been offended if your Midwife had just asked you the question, as posed by sallysparrow upthread?

Gobbolino, I'm sensing Midwife antipathy? I'm sorry that you don't seem to have had good experience with your Midwives, I'm sure though that you're intelligent enough not to tar a whole profession with your experience with a few. Most of the Midwives I know are extremely hard working, caring and - mostly - intelligent women who come into the profession to do good in the world and help other women, not to make judgements. I hope you get to met some of this kind in the future.

SaucyJack Sun 23-Feb-14 13:16:51

SallySparrow

I do see what you're saying, but I still think HCPs should be offering women the chance to discuss contraception if they want to rather than straight out asking intrusive and patronizing questions at entirely inappropriate moments if they must "discuss" it at all. It might not seem like much of a difference to them, but it makes a Hell of a difference to those of us who don't appreciate being spoken to like naughty schoolgirls who've got knocked up behind the bike-shed.

I just object to my vagina being treated as public property, because I'm having a (much wanted btw!) baby.

SaucyJack Sun 23-Feb-14 13:17:51

Cross-post missimac smile

Gobbolinothewitchscat Sun 23-Feb-14 13:19:05

but for most women their bodies need a year to recover and gain strength between birth and subsequent conception. that's nonsense for a kick off. Unless - in some instances - the woman has had a c section, or a bad tear or some other medical issue. Please don't be spouting this bollocks to people. Who told you that?

If a contraception chat at 36 weeks would help women think about what they want with regard to family spacing and contraception over the coming year then might it be a useful addition to maternity care? Is it not the case that more women than not will already have been thinking about this without any tip offs from the midwife?

Honestly, it makes me really sad that midwives work on the basis that the women that they see are of such low basic intellect that they need the midwife prodding them to see this. As I've said above, do you not think that most people have been able to successfully family plan before they ever set a toe in a midwive's office?

Yes - there will be the chaotic few who have got pregnant accidentally 5 times or who can't cope with the children they have. However, they are the general exception in most cases and are easily identified for a more thorough and tactful discussion, if they seem receptive.

It's this one size fits all, failure to properly read situations etc that make most of the people I know disengage with midwives/health visitors. Doctors seen much better at quickly sizing up situations and tailoring their advice accordingly

Genuinely, why is that? Better training? Better emotional intelligence?

Gobbolinothewitchscat Sun 23-Feb-14 13:25:00

No - just antipathy with some midwives and with you. Rather than putting the onus on me. Maybe it would be a good idea to try and have some insight into your thoughts//behaviour? I don't seem to be the only person on the thread who finds your proposals rather, er.......patronising?

Being "hard working" and "caring" is not to the exclusion of being patronising and misguided.

MinesAPintOfTea Sun 23-Feb-14 13:27:47

Who is this project for? How are you making sure you have representative views of the whole population on this?

Most parents will have an idea of what family spacing they want already, they don't need midwives to suggest they think about it. Maybe a prompt to get back on the contraception post-birth (as used to not using it) but not to plan their lives!

As for me, I nodded and smiled at the midwife when she gave me "the talk" in hospital post-birth. Then again when the GP did at my 6 week check. It was only when DS was always sleeping through the night and I had recovered physically from the birth months later that I took myself to the GP as I had done for a decade prior to getting pregnant.

OrangeFizz99 Sun 23-Feb-14 13:29:57

They need to filter. I can't take hormonal contraception and their little speech makes me bored each time.

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