Women & Children's Business Unit Maternity Contraception and Sexual Health

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1 Women & Children's Business Unit Maternity Contraception and Sexual Health Author/s Contact name Approval process Obstetric Guidelines Group/Associate Medical Director First Issue Date Trust intranet ref: Version no: Draft 3 Review Date: Consultation Process Obstetric Guidelines Group/Labour Ward Forum/Associate Medical Director Scope of guidance Clinical condition Patient Group Professional Group Approved by Contraception and Sexual Health All women accessing maternity services All midwives/medical staff within the Hull & East Yorkshire NHS Trust xxxx Ratified by Distribution List Dissemination xxxx All Obstetricians within the Women and Children's Business Unit. Associate Medical Director Head of Midwifery Midwifery Sisters and Matrons for consultation with midwives Via Clinical Governance Midwife References National Institute for Health and Clinical Excellence (NICE) 2005 CG30 Long-acting reversible Contraception - the effective and appropriate use of long-acting reversible contraception National Institute for Health and Clinical Excellence (NICE) 2007PH3 One to one interventions to reduce the transmission of sexually transmitted infections (STIs) including HIV, and to reduce the rate of under 18 conceptions, especially among vulnerable and at risk groups National Institute for Health and Clinical Excellence (NICE) 2006 CG37 Routine postnatal care of women and their babies Department of Health (DOH) 2002 Better prevention, Better services, Better sexual health The national strategy for sexual health and HIV Implementation action plan DH_ Department of Health (DOH) 2004 Department of Health (DOH) Best practice guidance for doctors and other health professionals on the provision of advice and treatment to young

2 people under 16 on contraception, sexual and reproductive health DH_ Department for Children Schools and Families (DfCSF)2008 Information sharing: Guidance for practitioners and managers Department for Children Schools and Families (DfCSF)2009 Getting Maternity Services right for pregnant teenagers and young fathers - 2nd edition Faculty of Sexual and Reproductive healthcare (2008-Updated 2009) Progesterone-only implants Faculty of Sexual and Reproductive healthcare (2009) Postnatal Sexual and reproductive Health Faculty of Sexual and Reproductive healthcare (2009) UK Medical Eligibility Criteria for Contraception Use The Equality Strategy - Building a Fairer Britain Broad Recommendations To identify and provide for women information, advice and provision of contraception services Equity and Diversity Hull and East Yorkshire Hospitals NHS Trust believes in fairness, equity and above all values diversity in all dealings, both as providers of health services and employers of people. The Trust is committed to eliminating discrimination on the basis of gender, age, disability, race, religion, sexuality or social class. We aim to provide accessible services, delivered in a way that respects the needs of each individual and does not exclude anyone. By demonstrating these beliefs the Trust aims to ensure that it develops a healthcare workforce that is diverse, non discriminatory and appropriate to deliver modern healthcare. Background and information Page 3 Antenatal pathway Page 4 Antenatal Contraception Pathway of Care Appendix 1 Postnatal Contraception Pathway of Care Appendix 2 Specialist Contraception Referral Appendix 3 Appendix 4 Maternity Referral for Nexplanon, IUCD, or IUS (Mirena) insertion

3 Background Health professionals should find opportunities during both the antenatal and postnatal period to discuss all methods of contraception. Health professionals should assess a woman s postpartum contraceptive needs by taking account of her personal beliefs/preferences, cultural practices, sexual activity, breastfeeding pattern, menstruation, medical and social factors. The benefits of long-acting reversible contraception methods in terms of efficacy should be highlighted to all postpartum women. Considerations for Breastfeeding Women Women can be informed that available evidence suggests that use of progestogen only contraception while breastfeeding does not affect breast milk volume. Postpartum women (breastfeeding and non-breastfeeding) can commence the Progesterone only Pill or have the contraception implant (Nexplanon) inserted at any time postpartum. UKMEC (2009) Sexually Transmitted Diseases Screening for Chlamydia and gonorrhoea should be offered to all women under the age of 25 years as recommended by the CASPHER team at Hull and East Riding Sexual and Reproductive healthcare partnership Women with a history of sexually transmitted disease or with a current diagnosis in pregnancy should be referred to the Women & Children's Hospital for an appointment with a Consultant Obstetrician to determine management in conjunction with advice from an appropriate sexual health practitioner at Hull and East Riding Sexual and Reproductive Healthcare Partnership, Conifer House, Hull Telephone: (01482) Individual management plans in pregnancy At first contact the midwife will complete the Antenatal Contraception Care pathways (Appendix 1) to facilitate the provision of information and help women make an informed choice. Information about LARC methods should take into account the woman s needs. Consideration must be taken when providing contraception advice for young people midwives and health professionals should be aware of guidance outlined in the document Best practice guidance for doctors and other health professionals on the provision of advice and treatment to young people under 16 on contraception, sexual and reproductive health DOH (2004) s/digitalasset/dh_ pdf. Young women should also be provided with appropriate information which can be accessed via It is imperative that for vulnerable women midwives and other health professionals follow appropriate guidance from the Safeguarding Adults Board. The consideration of capacity is crucial at all stages of Safeguarding Adults procedures. The key development affecting this area of work is the implementation of the Mental Capacity Act (2005), which provides a statutory framework to empower and protect vulnerable people, who may not be able to make their own decisions. It makes it clear who can

4 take decisions in which situations, and how they should go about this. It enables people to plan ahead for a time when they may lose capacity. Referral should be made to the Consultant in Reproductive and Sexual Health if any medical or additional needs are identified (Appendix 3 Specialist Referral Form) Antenatal The midwife should ensure the Antenatal Contraception Care pathway (appendix 1) is inserted into the hand held records. On completion, the woman should be offered: A Family Planning Association information (Brook if under 19 years) leaflet appropriate to choice of contraception. A referral to Hull & East Riding Sexual and Reproductive Healthcare Partnership, Conifer House if an IUD/IUSD or Nexplanon (contraceptive implant) is required (appendix 4). Specialist Contraception Referral for medical and additional needs (appendix 3). If it is identified the chosen contraception method is a contraception implant (Nexplanon) and this is required prior to discharge from the Women & Children's Hospital or Jubilee Birth Centre please attach sticker to back page of handheld records CONTRACEPTION IMPLANT/INJECTION REQUIRED PRIOR TO DISCHARGE Post natal Prior to discharge complete the postnatal contraception care pathway (Appendix 2.) Identify if contraception implant required prior to discharge from postnatal areas YES NO Refer to rota to identify practitioner available to insert the contraception implant (Nexplanon) Refer to Nexplanon folder for consent forms and equipment required Women to have counselling and consent by medical staff and midwives who are family planning practitioners Part 1 and 2. The practitioners should be trained to insert a contraception implant (Nexplanon) and approved a Consultant for Reproductive Health Services. Provide contact details of Family Planning Clinics to facilitate access to other methods of contraception discussed. Refer to Provide the relevant Family Planning Association/Brook leaflet (Under 19 years) If a IUD/IUSD or Nexplanon (contraception implant) is required post discharge consider completing the MATERNITY REFERRAL FOR NEXPLANON INSERTION, IUD OR MIRENA INSERTION (appendix 4) and send to Hull & East Riding Sexual and Reproductive Healthcare Partnership Conifer House Ensure postnatal care pathway is retained with postnatal care plan for community midwives/health visitor information and to facilitate further discussion.

5 Appendix 1 Antenatal Contraception Pathway of Care Personal information details Age / DOB: Note: For under 16 years refer to Hull & East Yorkshire Hospitals NHS Trust Teenage Pregnancy Guideline for Fraser guideline to assess competency MIDWIFERY TEAM- BOOKING Was this pregnancy planned? Yes No If NO was this pregnancy due to contraceptive failure? Yes No If failed - type of contraception used (please tick) Combined oral contraceptive pill Contraceptive patch Progestogen only pill Progestogen injection Intrauterine device Condoms Nexplanon Emergency contraception Intrauterine system (Mirena) Natural methods Nuvaring Other (please state) Antenatal Discussion from 34 weeks gestation Possible choices post birth (please tick) Combined oral contraceptive pill Contraceptive Patch Progestogen only Pill Progestogen injection Natural methods Condoms Nuvaring Intrauterine device Nexplanon Intrauterine system (Mirena) Brook-Contraception made simple (under 19 s) YES NO FPA Guide to Contraception leaflet given If above LARC method identified consider completing MATERNITY REFERRAL FOR NEXPLANON, IUCD OR IUS (MIRENA) INSERTION to Conifer House Please identify if referral made YES NO Nexplanon required prior to discharge from post natal ward? YES NO If YES identify in handheld record Identified need for specialist contraception referral for women with medical/additional needs? YES NO If YES complete specialist contraception referral form Comments: Date Midwife Name Signature

6 Appendix 2 Postnatal Contraception Pathway of Care Personal information details Age / DOB: Note: For under 16 years refer to Hull & East Yorkshire Hospitals NHS Trust Teenage Pregnancy Guideline for Fraser guidelines to assess competency Breastfeeding Postnatal Area YES - Progesterone only contraception advised if hormonal methods discussed Information leaflet given - FPA/Brook (under 19 years) Your guide to contraceptive choices after you have had your baby YES NO N Under 18 Outreach referral completed if appropriate YES NO N/A Condoms provided following discussion YES NO Has a method of contraception been provided prior to discharge? If YES please state method - YES NO Community Midwife visit - Preferred contraception following discussion Combined oral contraception Pill Contraceptive Patch Progestogen only pill Progestogen Injection Natural methods Condoms Nuvaring Other (please state) Intrauterine device Intrauterine system (Mirena) Nexplanon Contraception Provided in hospital If above LARC method identified consider completing :- MATERNITY REFERRAL FOR NEXPLANON, IUCD OR IUS (MIRENA) INSERTION to Conifer House Please identify if referral made YES NO Family Planning Timetable Information Sheet given? Available at Identified need for specialist contraception referral for women with medical/additional needs? YES NO If YES complete specialist contraception referral form Date Midwife Name Signature Please retain top copy of form in postnatal records Leave bottom copy for woman and health visitor information Yes No

7 Appendix 3 SPECIALIST CONTRACEPTIVE REFERRAL Dr xxxx xxxxxxxxxxxxx Tel: x (telephone number to be given to patient) Fax: x Dear Dr x Addressograph Contact Details (essential) (Please obtain 2 contact numbers if possible and state any contact/confidentiality issues) Contact telephone/mobile Number(s) A request has been made for Specialist Contraceptive Advice. Consultation undertaken by:- Name (Please print) Signature Ward/Area GP Name GP Address Delivery Date Current Age Previous Medical/Surgical History Gynae/Obstetric history Reason for referral Weight BMI at maternity booking appt. Further Comments

8 Appendix 4 MATERNITY REFERRAL FOR NEXPLANON, IUCD OR IUS (MIRENA) INSERTION This form will enable any women living in Hull and East Riding of Yorkshire to access the Community Gynaecology Service (part of the Hull and East Riding Sexual and Reproductive Healthcare Partnership). Please complete the form and send it to: Community Gynaecology, Conifer House, Prospect Street, Hull HU2 8PX. Today s date Mobile number EDD DOB of baby Can the GP be contacted? Yes No Reason for appointment: Nexplanon insertion Yes No If Yes is this required prior to discharge from the maternity hospital? Yes No If Yes please identify by placing attached sticker on handheld maternity records IUD or Mirena insertion Yes No Other (please state) Any known disabilities? Yes No If yes (please state) Is an interpreter required? Yes No If yes, which language: Past or present health problems and/or medication Any known allergies? Please state preferred contact: Mobile phone YES/NO Text YES/NO Home telephone can a message be left YES/NO When is the best time to contact? (Please circle one) Morning Afternoon Both Contact will be made 3 times and then the woman will be discharged. Telephone calls will come from a withheld number.

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