A survey of postnatal contraception in opiate-using women

A survey of postnatal contraception in opiate-using women

C. Sinha

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.

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