Expanding Midwives' Role: Incorporating Home Contraceptive Care in Postnatal Visits

Recent research conducted by Monash University's SPHERE Center of Research Excellence highlights a growing interest among Australian midwives in providing contraceptive care during postnatal home visits. The study, titled "Implementability of contraceptive implant insertions during midwife postnatal home visits: an exploratory qualitative study," published in Women and Birth, suggests that delivering contraception in the home setting is both acceptable to midwives and potentially feasible for women.

This innovative approach could include the home insertion of contraceptives such as the Implanon NXT implant. Although internationally trialed, this method has not yet been explored in the Australian context. The findings indicate that integrating contraceptive services into postnatal home visits could address many barriers women face, including limited mobility after cesarean sections, childcare demands, rural isolation, and financial constraints.

Midwives have emphasized that contraceptive provision should be part of an ongoing, comprehensive dialogue with mothers, blending family planning with ongoing infant care. International examples from countries like Sweden and the UK demonstrate that midwives routinely offer postnatal contraceptive advice and procedures, including implant insertions, highlighting potential pathways for Australia.

Dr. Jessica Botfield, the study's lead researcher, notes that many Australian women remain unaware of their fertility status postpartum, or of available contraceptive options, particularly while breastfeeding. She points out that closely spaced pregnancies, often unplanned, can impose significant physical, mental, social, and financial burdens.

Participants in the study recognized that in-home contraceptive services could improve access, especially for women facing obstacles such as mobility issues, childcare responsibilities, or geographic isolation. The study underscores the importance of establishing clear policies, dedicated training, supportive leadership, and policy frameworks to ensure safe and effective contraceptive care, including implant insertions.

Midwives expressed strong interest in upskilling for this role, believing it could benefit women and enhance the efficiency and accessibility of postnatal care. They considered implant insertion during home visits as practical, cost-effective, and beneficial for early contraception access.

The next step identified by the research team is to conduct further trials to assess the practicality and acceptability of implant insertions during postnatal home visits under real-world conditions.

Overall, this research advocates for broader integration of contraception services into midwifery care, aiming to improve reproductive health outcomes and reduce barriers faced by new mothers.