Every year in the United States, there are an estimated 3.5 million unplanned pregnancies with nearly one third of these attributed to contraceptive failures. Despite the availability of effective contraceptive methods, far too many women still experience unwanted pregnancies. It has been estimated that emergency contraception, also referred to as postcoital contraception or "the morning after pill," can reduce the risk of pregnancy after unprotected intercourse by as much as 75%. When administered within 72 hours of unprotected intercourse, emergency contraception, inhibits implantation of a fertilized ovum. The most common method of emergency contraception, the administration of ethinyl estradiol and dL-norgestrel, was initially described by Yuzpe in 1977. In the past 20 years, multiple studies have demonstrated the effectiveness of commonly prescribed combination oral contraceptives containing ethinyl estradiol and levonorgestrel. For those women in whom estrogen is contraindicated, progestin-only pills or the synthetic androgen Danazol have been used with comparable effectiveness rates. For appropriately selected women, an intrauterine device such as the Paraguard T380A (Ortho Pharmaceuticals, Raritan, NJ) also may be inserted within 5-7 days after unprotected intercourse to reduce the risk of unintended pregnancy. Despite its success and safety, emergency contraception is underused by women and their health care providers. As providers of comprehensive health care, midwives should provide patients with accurate information concerning pregnancy prevention. For many women, obtaining emergency contraception is an entry into the health care system and provides them an opportunity to be educated about safer sex practices, contraception, and the importance of regular health screening. Regularly discussing emergency contraception with patients at routine health visits will enable them to participate fully in their health care decisions and diminish the physical, psychological, and societal stressors associated with unplanned pregnancy.
PIP: Midwives have substantial contact with women who are at risk of unintended pregnancy and are thus ideally placed to promote use of emergency contraception. Emergency contraception has the potential to reduce the risk of pregnancy after unprotected intercourse by as much as 75%. Potential candidates for this method are women who have missed multiple contraceptive pills, incorrectly used barrier methods, unsuccessfully relied on withdrawal, were exposed to a possible teratogen, or were sexually assaulted. Multiple studies have confirmed the effectiveness of postcoital regimens such as oral contraceptives containing ethinyl estradiol and levonorgestrel, progestin-only pills, the synthetic androgen Danazol, or IUD insertion. Nonetheless, emergency contraception remains underutilized in the US and other countries. There is a need for health care providers to begin to integrate this method into the routine education offered to women during comprehensive health care visits. Women who use barrier methods or spermicide alone as their primary birth control method may benefit from having emergency contraception readily available. Printed materials about emergency contraception should be placed in waiting rooms, and office staff should be prompted to schedule patients requesting the method immediately. Visits for emergency contraception offer a valuable opportunity to provide education about sexually transmitted diseases, safer sex practices, and the importance of consistent use of reliable contraception.