Access LARC Meeting Focuses on Implementing Immediate Postpartum LARC Procedures


The Second Harvest Food Bank in Orlando was the site of the mid-project meeting for the Florida Perinatal Quality Collaborative’s Access LARC Initiative on May 11, 2018. This project is aimed at increasing access to a new contraception choice for women – the insertion of immediate postpartum long acting reversible contraception (LARC).  Participants attended this meeting to discuss progress and share tips on their pre-implementation steps as well as learning about and plan for the implementation phase of the project. The hospital teams were joined by representatives of Medicaid managed care plans, Healthy Start, the Department of Health, and the March of Dimes.

The morning of the mid-project meeting included an overview of project-wide progress toward quality improvement process changes in the Pre-Implementation Phase, presented by Drs. Bill Sappenfield and Estefania Rubio, which set the stage for later discussions.  A round robin session with four different pre-implementation topics was then conducted, allowing for troubleshooting and brainstorming of potential solutions to challenges identified by the hospitals. This activity allowed teams to discuss and share their experiences and provide advice to one another on various challenge areas.  Community partners, including Medicaid managed care plans, Heathy Start, March of Dimes and State Health Office representatives, formed a fifth group to discuss hospital/community collaboration necessary for successful implementation of Access LARC.  Valuable insight was shared during these sessions!

Teams spent time comparing notes from the round robin exercise and planning next steps for their pre-implementation phase as well as beginning planning for implementation of Access LARC in their facility. Discussion about pre-implementation as well as implementation next steps was guided by Betsy Wood, FPQC nurse consultant.

Special guest Erika Levi, MD, MPH presenting on immediate postpartum LARC insertion

The afternoon shifted to the Implementation Phase of the project.  Dr. Erika Levi, MD, MPH from the Albert Einstein College of Medicine at Montefiore Medical Center in New York City, described New York’s experience in successfully implementing immediate postpartum LARCs four years ago.  They now routinely place about 100 devices per month (either IUD or implant) for women who request this contraception choice. She described how the Montefiore Medical Center has incorporated this procedure into their routine checklist, discussing the option with every women who presents to their Labor and Delivery Unit. Drs. Rachel Rapkin, Access LARC physician lead and Jewel Brown then discussed insertion procedures and staff responsibilities for the insertion of both IUDs and implants.

An important topic of the day centered on comprehensive contraceptive choice counseling, including this new immediate postpartum LARC option.  Rachel Logan and Dr. Rapkin emphasized the shared decision making model and assuring that a woman’s autonomy and independent choice be honored throughout the contraception counseling process.

The day also included an intrauterine device (IUD) insertion demonstration for providers.  This was led by Dr. Levi, who is a featured trainer for immediate postpartum IUD insertion for ACOG District II. Providers from around the state, including one from North Carolina, observed the procedure, asked questions and then practiced inserting the devices into models of a postpartum uterus. The insertion practice was accompanied by much spirited discussion and insightful questions!

After a full day of sharing, planning and learning, the participants were energized to make Access LARC a reality in their institutions!