We thank Dr. McHugh et al for their interest in our work.1 They raise the point that lactation consultants are important members of the postpartum care team, and they ask specifically about resistance to postpartum long-acting reversible contraception (LARC) as a barrier to program implementation.
We agree that hospitals should engage many clinical care team members in the immediate postpartum LARC conversation. This engagement can be determined by individual hospitals because they understand their unique dynamics, culture, and stakeholder contributions best. Our study investigated the logistics for immediate postpartum LARC program implementation and the barriers to those logistics. Hospitals in the study agreed to participate in an immediate postpartum LARC initiative; therefore, we did not focus on the clinical merits of immediate postpartum LARC. In the snowball sampling, we made specific requests for lactation consultants, and the two we interviewed were the only two identified from 10 hospitals. The interview guide also included questions about breastfeeding. Like you, we expected to hear more about lactation than we did. The lactation consultants we interviewed provided thoughtful responses weighing anecdotal experiences with rapid repeat pregnancy, especially repeat preterm birth, against the theoretical risks you reference.
Our recommendation is to include, at a minimum, direct clinical care, pharmacy, and finance and billing perspectives in an immediate postpartum LARC implementation team. Further details about team composition, including lactation consultant participation, should be made by those who know hospital dynamics best. A successful and sustainable immediate postpartum LARC program will address this team-building decision as an important part of the “Exploration” phase of implementation and will follow it with early and frequent involvement of all clinical care members during the “Installation” phase.