Read the latest updates in the obstetrics/gynecology field such as lack of postpartum contraceptive use among Medicaid recipients, new guidelines on managing pelvic girdle pain in the postpartum period, and a report outlining risk for infection with alternative birth practices (eg, water birth, placenta consumption, and delayed vaccination) from the American Academy of Pediatrics (AAP).
Two-Thirds of Postpartum Medicaid Recipients Not Using Contraceptives
Only 34% of postpartum people in the United States are using an effective form of contraception 60 days after giving birth, according to study findings in JAMA Network Open. This rate is below the 58.8% national goal outlined by the US Department of Health and Human Services Office of Disease Prevention and Health Promotion in the Healthy People 2020 goals for family planning.
The findings are based on data from the 2016 Medicaid Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files and included data on 1,287,573 women receiving Medicaid who gave birth in 2016.
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Rates of effective contraceptive use varied widely by state from 19.8% in Utah to 43.9% in Louisiana. Eight states had rates at or above 40% while 4 states had rates at or below 25%. Use of long-acting reversible contraceptives was particularly low at 9.3% nationwide.
Guidelines on Postpartum Pelvic Girdle Pain
New guidelines on pelvic girdle pain in the postpartum period emphasize the importance of physical therapy and assessing for accompanying mood disorders. These guidelines from the Academy of Pelvic Health Physical Therapy were published in the Journal of Women’s Health Physical Therapy.
Pelvic girdle pain is common during pregnancy or after childbirth. The guidelines specifically focused on persons with pelvic girdle pain lasting up to 2 years after giving birth. These patients have consistent patterns of pain in the posterior and anterior pelvis (particularly in the sacroiliac joint), pain with rolling in bed, and pain with weight-bearing.
In addition to physical therapy, other interventions with strong evidence of benefit include patient education, use of a pelvic belt when combined with exercise and functional training, and use of manual therapy to provide short-term improvements in pain and disability when used in conjunction with other interventions.
An accompanying clinical decision-making flowchart is available to guide testing and treatment strategies.
Infection Risk With Alternative Birth Practices
Water immersion for labor and delivery has been shown to improve maternal comfort in the first stage of labor but should not be used during or past the second stage of labor as it is may not be beneficial and has been linked to rare but serious bacterial infections in the newborn, according to a review of clinical trial data on several alternative birth practices by the American Academy of Pediatrics (AAP) Committee on Infectious Diseases and Committee on Fetus and Newborn.
Other alternative birth practices included in the review were water birth, vaginal seeding in infants born by cesarean section, keeping the umbilical cord and placenta attached to the infant until the cord falls off spontaneously, consumption of the placental (usually in powdered form in capsules), deferral of hepatitis B virus vaccination, deferral of ocular prophylaxis, and delayed bathing for several hours after birth (Table).
Table. AAP Guidelines on Alternative Birthing Practices
| Practice | Recommendation |
| Water birth | • Data suggest this practice improves comfort of the pregnant person in the first stage of labor but has not shown benefit for the second stage of labor or delivery. • Not recommended during or after second stage of labor • Rare but serious neonatal infections may occur, such as with Legionella and Pseudomonas species |
| Vaginal seeding | • No known benefits to date • May expose infants to GBS or HSV |
| Umbilical nonseverance | • No clear evidence-based benefit shown to date • May increase risk of neonatal sepsis |
| Placenta consumption (typically in powdered form in capsules) | • No clear evidence of benefit other than in self-reports • One case report linked consumption in a parent to recurrent GBS sepsis in an infant • Food safety practices should be emphasized to parents using this practice |
| Deferred HBV vaccination | • Discourage this practice as birth dose provides a critical safety net for prevention |
| Deferral of ocular prophylaxis | • Ocular prophylaxis is effective for treating some causes of ophthalmia neonatorum particularly in high-risk populations with limited prenatal testing for causative organisms and in areas with high endemicity • Deferral may be considered in low-risk situations but may be impacted by state legislation |
| Delayed bathing | • May promote initiation and exclusivity of breast feeding • Discourage this practice in infants exposed to HSV genital lesions or in those born to individuals with a history of HIV infection |
Source: Nolt et al.
Sources
Rodriguez MI, Meath T, Watson K, Daly A, Tracy K, McConnell KJ. Postpartum contraceptive use among US Medicaid recipients. JAMA Netw Open. 2022;5(1):e2145175. doi:10.1001/jamanetworkopen.2021.45175
Simonds AH, Abraham K, Spitznagle T. Clinical practice guidelines for pelvic girdle pain in the postpartum population. J Womens Health Phys Therap. 2022;46(1):E1-E38.
Nolt D, O’Leary ST, Aucott SW. Risks of infectious diseases in newborns exposed to alternative perinatal practices. Pediatrics. 2022;149(2):e2021055554. doi:10.1542/peds.2021-055554
