Contraceptive advice from your Midwife in pregnancy.(223 Posts)
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?
I have no recollection at all of the midwife asking me about contraception before I left hospital. That's not to say they didn't; it's more likely that I was preoccupied by other things (like not having slept for a week, or establishing bfing) to have paid the question any attention.
So for me, having it mentioned at an antenatal appointment would have been better. My antenatal midwife was great and none of the potentially offensive questions she had to ask were a big deal (smoking, drinking, domestic violence etc).
However, bear in mind that a significant minority of babies are born before 36 weeks so these mums could get missed out.
Did nobody else get MW visits at home post-birth? I think my MW raised the subject at about 8-10 days, just before he signed me over to the HVs.
I think they should speak about the effect pg and birth has on contraceptive choices, eg diaphragm needs refitting, hormones may be unpredictable, impact of bf on mini pill, that kind of thing. Mirena coil advice might be useful as well. but basic contraceptive advice would just come across as patronising and as though we shouldn't have bred in the first place, as though we have somehow fallen by the wayside. Practical post birth scientific information immediately relevant to the postnatal state is probably what most people want and expect.
In my case the only 'conversation' was angled towards trying to get me to let them shove a Mirena up me. If you are in your 30s, they treat this like the only option there is.
BTW if I had that kind of information aimed at me at 36 weeks I would point out that there was a reason I hadn't been pg every year of my adult life, and that would be USING CONTRACEPTION. <duh>
I think efforts would be better spent checking pelvic floors more thoroughly and referring more women on for specialist gynae services so we all have better sex, like in France. Many women are repaired very badly and it makes them miserable, and a few clenches at a bus stop once a day sure ain't going to make any inroads there.
The issue was raised with me at my booking appointment at 8 weeks - I thought it was ridiculous; I had heard from others that contraception was going to be discussed with me, and I didn't welcome it but was prepared to nod and smile.
But at 8 weeks pregnant, when I'd already been to EPU for bleeding and was having complications? It felt totally inappropriate and, to be honest, absolutely fucking stupid.
This stuff is basic health surveillance. Of course many many women know enough about contraception (or have the sense and ability to look up what they don't know) that for them this conversation isn't necessary. But there are plenty of women who don't know or have been misinformed (being unable to get pregnant whilst breast feeding or before first period is a very very common misconception), there are plenty of women who don't know what contraception they can use when breast feeding, there are plenty of women in abusive situations where a partner may refuse to use contraception or let them access contraception.
The midwife doesn't know just by looking at you which group you fit into. So she has to ask everyone these questions so as not to miss the one vulnerable woman in her caseload. Just think how discriminatory it would be if she only asked the women she thought were a bit clueless and how shit you would feel to be asked if you knew this was the case!
In paeds we have to ask every single family seen in hospital if they are receiving any support from social services. If I made a judgement based on appearances and apparent intellect and only asked the families who looked 'that type of family' I would be being pig ignorant and discriminatory.
If we only did smear tests on people who'd had multiple partners we would miss cases of cervical cancer and being chosen for a smear test would have certain implications!
And so on and so on!
The whole point of this type of health surveillance is that everyone is asked so nobody is missed because they don't fit into a stereotype and nobody feels discriminated against by being selected out to be asked.
Oh yes, and as someone who's been on Cerazette for ages and gets a leaflet about the mirena every few months I'm fed up with the whole thing anyway. I'm aware that when I'm at the GP, a little box pops up on their screen that tells them to steer me towards longterm contraception. I've seen this at midwife appointments, as well.
I don't appreciate being constantly hassled about that.
My response would be " fuck off and mind your own business". I hate being patronised by health care professionals who have boxes to tick.
I wasn't asked with either of mine, but as I was paying a substantial bill first time round I would have thought it even more rude than in the quota filling one size fits all NHS. I do remember the second time around the community midwife asking if I was planning any more but fortunately she did not continue the conversation when I said I thought 40 was too old for me to contemplate a third.
So if a MW that you've been chatting to for nearly 9 months about your various bodily functions politely asks "Have you thought about what contraception you will be using", your response is "Fuck off" rather than "Yes I have, thank you for asking".
Yes, Gobbolino - I managed for twenty years of very active sex life without some womand less educated than me having to explain how babies came about, your "hard stare" is a pretty low level response to such nosey rudeness.
I'd like to think that my contraception talk is brief and inoffensive.
Goes something like "here's a leaflet on contraception, have you any questions on specific contraception, just be aware that you can get pg before your first period so be careful".
I'm supposed to ask them specifically what method of contraception they're planning to use and enter that on the computer system. Why I have no idea. I must admit I don't tend to ask and just put "undecided" on the computer.
Higgle, how do you know a midwife is less qualified than you?
Chatting to for 9 months? I hadn't met the two who did my home birth until the day, and then I saw 3 different community midwives over the following 28 days. They were all very nice, but I'd no more expect them to discuss my private arrangements for my body than ask me how much my mortgage was.
'thanks, but I don't want a coil.' 'But it will stop your periods.' 'I had a coil I bled for 10 months straight.' 'It might be different this time.' 'I DON'T WANT A COIL!'
I get really sick of this.
To answer the question - I wouldn't appreciate a MW offering contraception advice at any stage in my pregnancy or post birth. I do not think it should be within their remit. I do not appreciate the "tick in the box" attitude which smacks of doing something for their records, targets or service level agreements and not for my benefit. Unless the MW can provide contraception there and then, what is the point of the question?
I think if midwives were able to initiate a sensitive, open-ended conversation on family planning then that would be fair enough to include during conversations. Personally I'd prefer that during a routine and quiet ante-natal appointment than after things may feel much busier when the baby has arrived and you may have so many other questions.
Can they not just ask whether you are planning any more and perhaps ask of your experiences of ttc this one and what contraception you were using before that, and whether you are still happy with that choice.
Having a baby after a 9 mth pregnancy and perhaps on average a similar amount of time before that of ttc does herald a change in the situation which it might be helpful for at least a significant minority to have the opportunity to discuss.
Also thinking as long as it's not a one size fits all approach eg not everyone will want or need to go on the pill at 3 weeks pp.
Oh and research has shown that nearly 40% of pregnancies are unplanned so those who have managed 20 years of successful contraception carry on feeling smug with yourselves but please realise that you are not everyone.
Viva, at the time I had my babies i had postgraduate qualifications and was partner in a very large law firm. I concede there may be the outside possibility of a few having better academic qualifications but as i generally research anything concerning my health in detail I have tended to be quite shocked that the NHS often expects you to follow advice that is not up to date.
Wintersrawsoff, because if a woman says she wants to go on the pill or whatever then the midwife can make sure she knows that until she gets it prescribed she needs to use an alternative method. Believe me there are a lot of women who don't realise they could get pregnant pretty much straight away.
Some women may also want to discuss breastfeeding as a method of contraception so I can discuss points about that which they'd need to know.
Well higgle I have two degrees and a masters as well as plenty of post grad level professional qualifications and am looking to start a phd. So please don't assume that a midwife isn't very well qualified.
I have to say, I would be incredibly monumentally offended for you to enter "undecided" on my permanent medical records, when the truth is I'm perfectly happy with my contraception decision but I simply don't wish to discuss it with someone I don't know from next door's dog.
Viva - that makes sense. Do you offer contraception?
Nope, sadly we can't prescribe contraception. To be honest I've never known anyone ask for contraceptive pills. I suppose if someone really wanted them before they left I could get an sho to prescribe them.
SaucyJack, mmm good point. Although the bit of the system it goes on doesn't get printed out on your take home post natal notes or go to the GP so I doubt anyone ever sees it again. And I have to put something in that box or the computer won't let me discharge the woman.! . So I either try to be sensitive and realise women don't want to be asked the specific question.....as well as thinking its not really my business as long as I give them enough basic info so they're not back in nine months (unless the want to be), or I ask them and risk offending the woman and been told to fuck off. What do you think would be better?
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