Long-acting reversible contraception device preserves option to have more children

Sally Wihera, a mother of two from Dover, Delaware, doesn’t think she and her husband will be having any more children, but she wants to keep their options open.

So, after she gave birth to daughter Mesa Jeanne in January 2015 and son John Wesley in February 2016, both at Christiana Hospital, she opted for long-acting reversible contraception (LARC), choosing an intrauterine contraceptive device (IUD).

“It’s semi-permanent, easier than the birth-control pill and more convenient,” said Wihera, a military police officer stationed at Dover Air Force Base. “We’re 100 percent certain that we won’t want to have another child in the near future. Getting the IUD made sense.”

Wihera is among a growing number of women who, according to the Centers for Disease Control and Prevention, are choosing LARC, the most effective method of birth control short of sterilization or abstinence. Options are an IUD inserted into the uterus or an implant placed under the skin of the arm. The devices, which are placed in a doctor’s office, can be kept in place for years or easily removed by a medical professional if a woman decides she wants to become pregnant.

Christiana Care is providing women with more convenient access to LARC, increasingly offering the option in primary care doctors’ offices and OB-GYN practices. Christiana Care also offers the option to women in the hospital after giving birth.

Doctors, nurse practitioners and nurse midwives receive training in LARC and other contraceptive options through a new state initiative called Delaware CAN (Contraceptive Access Now), intended to reduce the number of unintended pregnancies in Delaware. With training, primary care and OB-GYN clinicians can offer LARC as an in-office procedure. The goal is to provide more options for women in Delaware, which has one of the highest rates of unplanned pregnancy in the nation.

Christiana Care, the largest employer of physicians in the state, is poised to make a significant impact on reducing unplanned pregnancies, said Julie Silverstein, M.D., FACP, medical director of the Rocco A. Abessinio Family Wilmington Health Center at Wilmington Hospital and associate service line leader for Primary Care & Community Medicine.

“This training will give us the skills to address women’s questions and to offer contraceptive counseling in a primary care setting,” Dr. Silverstein said. “Opening up options for women visiting their primary care providers improves their access to a fuller spectrum of care and opportunities to help them achieve optimal health”
Lauren Foy, D.O., a primary care physician at Springside Family Medicine in Newark, offers LARC to her patients.

“LARC has been shown to be very effective, with a less than 1 percent failure rate,” Dr. Foy said. “It takes user error out of the equation and allows a woman to choose pregnancy when her body is at its healthiest. When young women tell me they aren’t using any birth control or are using it intermittently, I say, ‘Let’s talk about the options.’ I always discuss LARC first.”

Planning and spacing pregnancies is one of the most important things a woman can do for her health, said Elizabeth Zadzielski, M.D., MBA, FACOG, medical director for ambulatory women’s health and associate Women and Children’s service line leader.

“It takes a mom’s body at least a year, if not two, to recover from the demands of pregnancy,” Dr. Zadzielski said. “The outcomes are better for mom and baby when pregnancies are spaced, decreasing the risk of prematurity and lower birth weight. There are also the far-reaching benefits of a mom’s ability to return to school and the workforce.”

At an average cost of $700 for the procedure, LARC is expensive, and Christiana Care and Delaware CAN are partnering to provide solutions. Susan Wilson, M.D., MSc, director of Family Planning and Adolescent Services at Christiana Care, said her staff discusses options with patients before their visit, asking them if LARC is of interest.

“This allows us to check their insurance coverage or eligibility for a grant-provided device so that women can get a LARC on the same day as their visit with us,” she said. “It’s all about making access to LARC easier for patients. It’s important for LARC to be available because it is our most effective form of birth control. This is the right thing to do, to make sure it’s available to all women, especially women of lower socio-economic status and minorities, who tend to have more unintended pregnancies and are not as aware of all their contraceptive options.”

Delaware Medicaid covers LARC for women who are not pregnant or who are at least six weeks postpartum. In 2015, Medicaid extended its coverage to include immediate postpartum insertion. Since then, hundreds of women giving birth at Christiana Hospital have chosen to have LARC placed immediately after giving birth, Dr. Wilson said.

Among them was 19-year-old Anna, of Wilmington, who recently gave birth to Alexander. She would like to go back to school to become a dental hygienist.

“When it comes to birth control, I knew I might forget about it, and it would be easier for me not to worry about it,” said Anna, who chose an IUD and plans to keep it for at least three years. “My mom encouraged me. She said, ‘You can wait, and later on you can have a friend for Alexander.’”