Use Case Jenny Rogers: PP GDM and contraception

Jenny Rogers is a 35yo English-speaking woman, with health exchange coverage. She is 60 days post-partum from a full-term (37 weeks), vaginal delivery at her local hospital. She is not using any contraception currently, and is breastfeeding, but also supplementing with formula. She had gestational diabetes during her two pregnancies and was medicated with insulin. Her infant, Justin, is doing well and also followed at the clinic.

Jenny received a reminder call 1 week ago for the well-child check (2 months) for Justin. The registration clerk also noted that Jenny had not had a post-partum check-up so scheduled a visit with the family nurse practitioner (FNP) after Justin’s visit.

Justin’s visit was uneventful—he is eating, sleeping and voiding well. No health concerns and received his two-month vaccinations.

Jenny’s visit included a GYN history, Social History, Medical History and vitals. Jenny’s blood sugar was 180 non-fasting, so some of the visit was spent talking about her previous insulin, diet, physical activity, etc and plans for follow-up and monitoring.

The FNP noted that Jenny had been using Depo before and between pregnancies and also noted that Jenny verbalized “I don’t want any more kids for at least 3 years because I may want to work a little more once my oldest is in full-time preschool”. Jenny also stated that Depo had worked well in the past, but she was “concerned about remembering to come every 12 weeks for my shot, because now I have two busy babies”.

The FNP discussed other options for Jenny, applying the MEC/SPR guidelines, taking into consideration Jenny’s possible continued diabetes and her lifestyle and her desire to wait for 3+ years to have additional children, if at all. They discussed that all FP methods are safe and effective for Jenny, and because Jenny has a friend who has an implant and is happy with it, Jenny decides to go with that method.

The FNP puts in an order for the implant and requests a future appointment in the next available slot (3 weeks out), for the implant and also follow-up on her blood sugars. Jenny is advised to use barrier methods during sexual activity until the implant is placed.

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