Interconception care is confusing and hard to access for women – if they know about it at all.
Getting advice between pregnancies is difficult, confusing and inconsistent, Australian women say, while some aren’t aware that it’s even a healthcare option.
In the early days of parenting, women’s health can be easily overlooked when their babies are the centre of attention.
Researchers from the SPHERE Centre of Research Excellence at Monash University surveyed 15 women of reproductive age who had had at least one child and wanted to have another.
Interviews with the women revealed that they had a lack of engagement with interconception care (ICC) services and found services difficult to access – particularly in rural areas – while some women were unaware of the term and what it involved.
“Our findings show that participants were not familiar with the term ICC, they faced barriers accessing ICC, and that ICC was not consistently delivered,” researchers said inBMJ Sexual & Reproductive Health.
Reasons could include inadequate awareness of interconception care among healthcare professionals, a lack of guidelines or delivery model, and insufficient funding for services, training and resources, they said.
“The lack of ICC provided to participants was perceived as ineffective to achieve the desired outcome of improving their health and supporting future pregnancies. While pregnancy is considered a ‘teachable moment’ for behaviour change interventions to be implemented, preventive care needs to occur sooner.”
All the participants who had their six-week postpartum check-up with a GP or obstetrician said the appointment felt “rushed”, researchers said.
Women who saw a nurse or midwife felt that they had time to talk about interconception care, including previous pregnancy outcomes, health risk factors, pregnancy spacing and contraception.
SPHERE research fellow Dr Sharon James said interconception care was not well understood by women or healthcare practitioners, and more immediate issues were often dealt with during postpartum health checks with GPs.
Interconception care was “opportunistic” unless women initiated it themselves or make an appointment to discuss contraception, a mental health care plan or to follow up other health issues, said Dr James, who supervised the research along with Professor Danielle Mazza.
“If somebody comes in after they’ve had a baby and they have their postpartum check at six weeks, it might be that diabetes or hypertension or those kinds of risks are discussed, but in all likelihood it will be things like breastfeeding issues or mental health issues or the focus is on the child,” she told TMR.
“Interconception care ideally should deal with those immediate issues as well as prevention.
“Participants wanted healthcare practitioners to routinely initiate those discussions around contraception and pregnancy spacing and medications, lifestyle risks, and indication of pregnancy preparation and any referrals that might be needed in order for them to do that.”
Ideally, interconception care would manage issues such as any previous poor pregnancy outcomes, risk factors such as high blood pressure or diabetes, education about lifestyle risks, contraception and pregnancy spacing, Dr James said.
The other difficulty for women at this stage of life was that there was a lot to juggle: not only recovering from pregnancy and birth but making decisions about work, childcare or their own health more broadly, as well as any other caring responsibilities.
“Prioritising their own health can be tricky,” Dr James said.
“If we look after the woman’s health, then we look after the child’s health as well, and any prospective subsequent pregnancy.”
Dr James suggested that healthcare practitioners could ask women questions around pregnancy intention over the following 12 months, risk factors, medications and the management of any existing hypertension or diabetes.
Lead author Ms Sarmitha Kodavaluru said the interconception period was a critical time when issues such as breastfeeding problems and mental health concerns could occur.
“Women are often also juggling childcare and employment,” she said.
“A stronger focus on women’s health during the interconception period provides an opportunity to significantly improve the health of women, infants and subsequent pregnancies.”
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Participants told researchers there were inconsistencies in the information they received from different healthcare providers.
One woman said: “She [midwife] was like … the GP will talk to you about it [contraception], but then I actually went for the six-week check, and she [GP] didn’t mention… contraception at all.”
Another participant said: “I haven’t had anyone sort of say to me … this is how long you should wait between pregnancies, or … this is what you should … be doing between pregnancies … you have to think of all the questions yourself to ask … nobody really prompts anything.”
Participants were also unsure who to contact for information in the interconception period.
“It’ll be nice to know exactly who to … reach out to,” one participant said.
“Do I reach out to … my GP? Do I reach out to like the nurses in the community? … Do I reach out to … a mum’s helpline or something?”
