Options done inpatient prior to discharge: Nexplanon, Depo-Provera, postpartum BTL/BS, progesterone-only pills.
Nexplanon can be placed inpatient for eligible patients — predominantly those with NC Medicaid. Patient must be consented prior to administration. Pre-made consent form in triage; or use a generic blank procedure consent and fill out yourself.
- •Procedure: Nexplanon insertion
- •Risks: bleeding, bruising, infection, damage to surrounding organs/structures, irregular bleeding patterns, migration with possible need for removal in OR, unplanned pregnancy.
- •Order Nexplanon through the Long-Acting Reversible Contraception (LARC) Program order set.
IUDs: either placed within 10 minutes after the placenta delivers, OR at 6 weeks postpartum. Offer a “bridge” method (Micronor or Depo-Provera; also consider emergency contraception options such as Plan B).
- •Estrogen-containing contraceptives are not started until 4–6 weeks postpartum.
- •POPs are prescribed at discharge through the discharge tab. Estrogen-containing meds can also be prescribed at discharge — change the starting date.
- •Patient resource: Bedsider.org for patients who are undecided.
1. Full (not Emergency) NC Medicaid: eligible for inpatient LARC.
- •Use Long-Acting Reversible Contraception (LARC) Program order set → Medicaid LARC.
- •Select Nexplanon. Lidocaine auto-selects.
2. No full NC Medicaid? Check hospital-donated supply. Patient qualifies if ANY of:
- •Teenage pregnancy
- •Lack of resources to come back for follow-up appointment
- •History of or current drug use
- •Mental health disorders
- •Medical condition that puts patient at significant risk with subsequent pregnancy:
- ◦HELLP syndrome
- ◦Maternal cardiac disease
- ◦Preterm birth
If yes: order desired contraception through the LARC Program order set, select non-Medicaid LARC, and page 970-2835 with patient information + which criterion was met.