HMN 2025: What is the Enhanced role for midwives, including home contraceptive care

New research from Monash University’s SPHERE Center of Research Excellence has found strong interest among Australian midwives for delivering contraceptive care during postnatal home visits.

This could include innovations such as home insertion of the contraceptive implant (Implanon NXT), which has been trialed internationally although has not yet been explored in Australia.

The new Monash study, “Implementability of contraceptive implant insertions during midwife postnatal home visits: an exploratory qualitative study,” published in Women and Birth, shows home provision of contraception is generally acceptable to midwives and potentially feasible.

Further research is now required to trial implant insertions during midwife postnatal home visits to determine acceptability and feasibility in real settings.

Such services could help overcome the range of barriers women face in accessing contraception after having a baby and may mitigate potential health risks for mothers by preventing closely spaced pregnancies and subsequent adverse outcomes.

Midwives interviewed for the study highlighted that providing contraception should form part of an ongoing, holistic dialog with mothers—one that integrates family planning with infant care.

Many of the midwives interviewed recognized that in-home services could help overcome common barriers faced by new parents in accessing care—such as limited mobility post-cesarean, childcare demands, rural isolation or low-income status.

The study also emphasized the critical need for normalizing contraceptive discussions, providing opportunities for contraception education and training for midwives, and ensuring leadership support along with a policy and training framework to ensure safe and effective provision of postnatal care.

In some countries, such as Sweden and the U.K., it is more common for midwives to offer contraceptive advice and provide contraception postnatally, including implant insertions. Lead researcher Dr. Jessica Botfield explains that this is not standard practice in Australia, where postnatal care typically centers on the baby.

“Closely spaced pregnancies, many of which are not planned, can place significant physical, mental, social and financial burdens on women and families. Despite this, many Australian women remain unaware of their fertility after having a baby, optimal spacing, or postnatal contraception options—including while breastfeeding,” Dr. Botfield said.

Dr. Botfield notes that the 21 midwives interviewed for this study saw potential benefits of midwife provision of contraception (including in women’s homes) for women, clinicians and the health care system as a whole.

However, they also stressed the importance of having clear policy frameworks, dedicated training, supportive leadership and opportunities to build competence and confidence in contraception discussions and procedures, including insertion of the contraceptive implant.

Midwife participants viewed the possibility of implant insertions during postnatal home visits as practical, cost-effective, and particularly beneficial for mothers in improving early access to contraception in the weeks after birth.

Most expressed interest in upskilling and providing this service to women, especially younger and early-career midwives, suggesting a useful basis for future workforce development.

The next stage, according to the study, is “further research trialing implant insertions during midwife postnatal home visits… to determine implementability in real settings.”