A survey of postnatal contraception in opiate-using women
Hull Royal Infirmary, Department of Obstetrics and Gynaecology, Hull, UK
This work was undertaken because of the increasing number of unplanned
pregnancy in opiate-using women, as contraception has very low priority in
opiate-using women. Drug dependency is a serious health problem. In addition to
the large direct health costs (psychiatric and physical), there are massive
costs in terms of crime, loss of earnings and productivity, as well social
damage (NUTT 1997). At Hull Maternity Hospital, all pregnant opiate-using women
booked for antenatal care, it became apparent that all of them were unplanned
and no contraception was used before pregnancy. Contraception has a low priority
in opiate-using women.
Objective: To determine the spectrum of use of postpartum
contraception in opiate-using women. To document the continuation of the use of
contraception when the chosen method was provided during the postnatal period.
To identify any method of contraception which appear to be suitable for this
category of patient by the study of the side effects and discontinuation rates.
Method and Result: All 40 women were given methadone in the antenatal
period. Post delivery 10 women were taking methadone, 9 went back to using
heroin and stopped methadone, 11 women were using both heroin and methadone and
10 had stopped opiate use completely. 14 women had Depo Provera intramuscularly
for contraception, which was initiated from day 4 to 21 weeks postpartum, with
the mean of 13 days. The mean duration of use was 3.5 months. All 14 women had 1–3
injections and then stopped use. 19 women had implants (9 had Norplant and 10
had Implanon) which was sited from day 7 to 28 postpartum, the mean was 22.7
days and this method was ongoing for months (pattern.)
Conclusion: This study demonstrates the effectiveness of initiation of
postpartum contraception in a group of opiate-using women who are counselled
antenatally. Continuation rates were good with implants, but poor with Depo
Provera. Contraception should be discussed and provided in clinic where
methadone is prescribed which will improve the reliability of contraception
being offered, accepted and provided to the women who are substance users.