Birth spacing: Are we missing a “teachable moment”?

Interpregnancy (birth to conception) intervals of >18 months are associated with the lowest risk of adverse pregnancy outcomes. Whether providers counsel patients about birth spacing above and beyond contraceptive counseling is unclear. We sought to determine patient characteristics associated with counseling about timing of a next pregnancy at the time of the postpartum visit.

A cohort of low-income postpartum women were interviewed within 12 weeks of delivery and were asked whether their provider discussed plans for a next pregnancy. Logistic regression was used to determine risk factors not having had a next pregnancy discussed.

Of 215 respondents, 81% reported having had a postpartum visit. 72% of women who had a visit reported that their provider discussed plans for a next pregnancy. In comparison, postpartum discussions about current health, breast feeding and birth control methods occurred with 95%, 95% and 94% of women, respectively. In multivariable models, only race/ethnicity independently predicted likelihood of having counseling around family planning other than contraception: Latinas were most likely to have had such counseling (73% of Latina women vs. 54% Black vs. 40% White, p=0.01 for Latina-White comparison).

Counseling of women about appropriate birth spacing at the postpartum visit is inadequate as compared with other topics covered. Variation in likelihood of receiving such counseling may reflect practice patterns at different sites of care, though patient-level disparities need to be further explored. Inasmuch as short interpregnancy intervals contribute to population rates of prematurity and other adverse outcomes, obstetric providers should improve their efforts in this area.