BACKGROUND: United States obstetrical and gynecology professional organizations recommend that women consider use of intrauterine devices (IUDs) beginning in the immediate postpartum (PP) time period to prevent unintended pregnancy. However, little has been published about the potential for difficult IUD insertion at different times PP with or without breastfeeding.
OBJECTIVES: To estimate the prevalence of indicators of difficult IUD insertion across three PP categories and among women who were and were not breastfeeding at the time of IUD insertion.
METHODS: Women receiving IUDs were identified at four sites (three Kaiser Permanente sites—Northern California, Southern California, and Washington—and Regenstrief Institute, Indiana). Structured data (National Drug Codes, ICD-9/10 diagnosis and procedure codes, Current Procedural Terminology codes) and unstructured data (clinical notes) were used to identify breastfeeding and PP status as well as five indicators of potentially difficult insertion (cervical dilation, ultrasound guidance, paracervical block, misoprostol, and provider note for “difficult insertion”). The proportion of women with these indicators was assessed by breastfeeding status (yes/no) and time PP (≤ 6 weeks, 6 to ≤ 14 weeks, 14 to ≤ 52 weeks) at IUD insertion.
RESULTS: Among 97,824 women with IUD insertions who delivered in the past year, 20.5% were ≤ 6 weeks PP, 57.3% were 6 to ≤ 14 weeks, and 22.2% were 14 to ≤ 52 weeks; 65.6% were breastfeeding, 31.3% were not, and 3.1% had unknown breastfeeding status. The proportion of women with an indicator of difficult IUD insertion was 2.6% among those breastfeeding and 3.5% among those not breastfeeding. The proportion of these indicators differed by time PP (≤ 6 weeks: 2.9%, 6 to ≤ 14 weeks: 2.2%, and 14 to ≤ 52 weeks: 5.3%). The most common difficult insertion indicator was paracervical block (4.5% of insertions). Women in the 14 to ≤ 52 weeks PP category had the highest proportion of all five difficult insertion indicators relative to the two earlier PP categories. Women who were not breastfeeding at IUD insertion had a higher proportion of all five indicators compared with those who were breastfeeding.
CONCLUSIONS: The prevalence of indicators of difficult insertions was lower for women with IUDs inserted at earlier PP time periods and among women who were breastfeeding. Thus, IUD insertions in earlier PP time periods and while women are breastfeeding do not appear to be more difficult insertions. Concomitant procedures may be performed with later PP insertions and should be assessed in future research.
