Adolescent Pregnancy & Parenthood
Terms in this set (39)
What are the risk factors for teen pregnancy?
Related to age (<15) and (late) entry into prenatal care; nutrition and exposure to substances
Poor weight gain
STIs and CPD
Later in life at risk for obesity & hypertension
Greater risk for LBW (related to issues above)
Risks associated with second or higher order pregnancies- more likely
Children with greater chance of emotional
& behavioral problems
Discuss the percentages of intended verses unintended pregnancies.
Intended pregnancies 18%
Unintended pregnancies resulting in an abortion 40%
Unintended pregnancies resulting in a live birth 42%
How do we prevent teen pregnancy?
1. Comprehensive Sexuality Education
2. Access to confidential reproductive health services for adolescents
3. Increasing Medicaid eligibility (Forte et al., 2011)
4. Practical & Social Determinant Approaches (Manlove, 2011)
o Expand/strengthen sex education
o Strengthen families
o Improve educational engagement/performance
o Reduce/delay sexual activity
o Address relationship context of adolescent sexual experiences
o Increase contraceptive use
Discuss the stages of teenage readiness for the use of contraception
Discuss the Approaches to Contraception for Primary Prevention and with Adolescent Mothers.
1. Discussion of prevention of STIs (When linked with pregnancy prevention can be very effective)
2. Emergency contraception counseling (Like Plan B)
3. Frequent follow-up to check on satisfaction, proper use and any side effects; ideal opportunity in frequent home visits
4. Negative pregnancy tests as opportunities for clinical care (Great time to intervene)
Discuss the secondary pregnancy prevention approaches with adolescent parents.
1. Need for decision-making (pre-delivery if possible) regarding choice and plans for contraception
2. Discussion in immediate post-partum period and selection of method
3. Discuss negotiations with partner- resuming sex or not
4. Consider Stages of Change assessment & counseling approach
Discuss the various methods of contraception and their side effects/comments.
Side Effects - Usually none; latex sensitivity; spermicide sensitivity
Comments - Most popular method reported by teens in NSFG (2010) survey
Side Effects - Nausea; vomiting; breast tenderness; headache
Comments - For failure, unintended, and broken condom
Side Effects - Nausea; breakthrough bleeding
Comments - Close follow up aids compliance; counsel about meds that reduce efficacy
Side Effects - Irregular bleeding; amenorrhea; galactorrhea; ? Weight gain
Comments - Nutritional and exercise counseling helpful for weight issues
Side Effects - Spotting; cramping; protect against STI exposure; need to check placement frequently
Comments - Recommended for parous teens, may be considered in nulliparous teens if unable to use other methods; lasts 5 years
Why are birth rates decreasing?
1. Significantly lower percentage of black females report sexual experience during teens (57->46%)
2. Increased rates of males reporting use of two methods of contraception (condoms & partner using hormonal method)
3. Increased rates of females using hormonal methods other than OCPs (DMP, Patch, etc)
What are the MOST common methods of contraception used by teens?
Pulling Out Method
What factors can influence the outcomes of a teen pregnancy?
1. Social support (especially family and specialized programs)
2. Subsequent pregnancies and births
3. Economic resources and education
4. Incomplete schooling
5. Social Isolation
6. Poverty enhances ALL of these PREVIOUS RISKS
*With support, many adolescent mothers do as well as older mothers in similar context
Discuss possible negative outcomes that may occur with teen pregnancy.
1. Poorer pregnancy outcomes associated with late entry into (or no) prenatal care
2. Increased risk of domestic violence (high rates of abuse/sex abuse in own histories)
3. Increased risk of neglect of children often related to lack of knowledge of normal developmental characteristics of infants/children
4. Substance abuse patterns: often substances are avoided during pregnancy, but resumed within 6 months post partum
5. Less vocalization/touching/smiling with infants
6. Discipline can be harsh; especially if mother is stressed and isolated
7. Higher risk for public assistance & ongoing poverty
What are INFANT outcomes that may occur with teen pregnancy?
1. Neonatal morbidity and mortality (LBW, prematurity, SIDS, accidents)
2. Infant illness and hospitalization
3. At higher risk for child abuse and neglect
4. Behavioral and school problems in school age years and adolescence
5. Intergenerational problems with self esteem, anger, depression; sons of teen mothers more likely to be incarcerated; children are more likely to become teen parents
What are some contributing factors that are associated with better Parent - Child Outcomes?
1. Extended family support and the young mother completing her education and not having rapid subsequent child bearing
2. Co-residence with maternal extended family at least 2 years
3. Age of mother > 15
4. Mother able to complete school (without support, only 51% receive diploma by age 22
5. Delaying subsequent child births 2-2 1/2 years after first birth
Discuss the complex issue surrounding the involvement of the father in a teen pregnancy.
Involvement of baby's father (complicated issue) marriage and living together more likely to result in school failure & rapid subsequent pregnancies
Discuss the IDENTITY issue of teen mothers?
Still a time of Role experimentation
Lots of time still spent with peers
Specific parental roles and responsibilities
24/7 job description
*Sleep deprivation at a time when there is more need for sleep
(Behaviors Sometimes Observed)
Taking babies out to clubs/parties
Realization of the need to plan and thank/reciprocate for help with babysitting
Discuss Individuation in the context of teen mothers.
Relaxing of dependent ties with parents/family
Desire for more time with friends; mobility
1. Increased dependence on family for economic and child care support
2. Tied to home and family more because of baby
1. Experience of teen motherhood often described as "Life-saving"; restore daughter into family
2. 2 year window of coresidence with maternal family seems critical (subsequent childbearing and HS completion)
Discuss the cognitive development of teen mothers.
1. Concrete, present-oriented reasoning; brains not finished growing yet...
2. Egocentric focus on own issues/needs
1. Confusion between own thoughts/reasoning and that of baby; difficulty seeing child as separate from self
2. Maternal role requires future planning, thinking about consequences, anticipating child's behavior (safety)
1. Mother/child tantrums; He's a brat just like me (3 month old baby); She should know better than to fall off the bed, It's her own fault.
2. Issues of discipline, issues of spoiling infants;
"My baby loves coming to parent group; she sees her friends there"...
Discuss sexual development of teen mothers.
1. Adjustment to physical changes of puberty; may be uncomfortable and relatively uniformed about sexuality despite sexual activity
1. Adjustment to physical changes of pregnancy, post partum period and breast feeding
2. Confronting return to fertility/ need for contraception
1. Reactions to idea of breastfeeding as "nasty"- need to help it to become "ok"
2. Denial of need for contraception despite recent pregnancy
3. Sexual pressure; exploitation by partners
Discuss the attachment issues of teen mothers.
1. History and ongoing issues of attachment with own parents/caregivers
2. Family cycles of teen parenthood with other family members having raised the teen mother
3. Unresolved attachment issues between teen and her biological mother
1. Parental reflective functioning for enhancement of infant attachment
2. Learning about infant's mental states; emotions and individual needs; despite the teen's cognitive styles; video tapes; modeling and speaking for the baby help with this
What factors are involved in the transition of a teen into motherhood?
(Personal resources teen brings to motherhood)
age; cognitive maturity; mastery; depression
age; temperament; health; gender
(Contextual stress and support)
FAMILY; school; peers; f.o.b.; health professionals; recent losses
What is the importance of Grandmothers?
1. Young grandmothers; role strain (BC still raising their own kids.
2. Kin or fictive (Godmothers) kin; grandmother figures
3. Grandmother's role pivotal to well being of BOTH generations of children she cares for in household
4. Grandmother's parenting: first order and second order effects on babies
Discuss the ambivalence of young grandmothers.
1. In some families teen pregnancy and birth of an infant viewed as a second chance to bring daughter back into family
2. Grandmothers highly stressed often supporting family with several jobs or dealing with health/mental health issues
3. Limited sources of support- own mothers, co-workers, religion/prayer (Heavily relied upon)
Discuss the complex role of fathers in the teen pregnancy.
1. 50% of fathers of babies born to teen mothers are over 20 years of age
2. Often experience constraints of poverty, incomplete education, crime etc. which limit participation in paternal role
3. Multiple relationships; immature relationships; relationship with maternal family
4. Abusive relationships may begin prior to pregnancy and continue after birth. Abuse often linked to unintended pregnancies
What are the impacts on and from other family members/Extrafamilial Members?
1. Siblings of teen parents (at higher risk for teen pregnancy) (ChildTrends, 2009)
2. Female friends, associates, and cousins
3. Formal and informal peer groups; competitive parenting (Higginson,1998)
4. Other mentors and community members
What programs are associated with positive outcomes for teen parents and their children.
(Dedicated services for adolescent mothers)
1. Mother-baby primary care models; good follow-up & Nagging (O Sullivan, 1993; Flanagan et al., 2004)
2. Comprehensive services for mother and baby 2 years post partum (East & Felice, 1996)
(Maternal Family Support for at least 2 years)
1. Grandmother support (Roye & Balk, 1996)
(Assisting young mothers to stay in school)
1. Special schools or programs for pregnant students
2. School based child care programs
What are the other TEEN FRIENDLY support programs available for teen mothers?
School-based pregnancy and parenting support programs (child care critical)
GED/adult ed programs (child care)
School-based health care centers
Adolescent clinics/ prenatal /postnatal health clinics
Community advocate/ big sister/mentor programs
What other programs for teens have excellent outcomes?
HOME VISITATION PROGRAMS
Discuss home visiting programs
(RN home visitation prenatally- 2 years (Nurse Family Partnership model)
1. Less child abuse, neglect
2. better parent-child relationships
3. less child behavior problems, into adolescence
4. fewer teen parents in next generation
5. Limited effects on depression/mental health concerns
(Other models with teens)
1. Early Head Start
2. Pregnant & Parenting Teen Program (Schaffer et al., 2011)
3. D Koniak-Griffin (Public Health RNs)
4. Trained lay visitors less effective (Barnet et al, 2007; 2011)
5. Minding the Baby (YSN/YCSC)
What are 3 LOCAL Models for teen support?
Minding the Baby
Polly T. McCabe Center
Elizabeth Celotto Child Care Center at Wilbur Cross High school
Discuss MINDING THE BABY program.
1. Intensive prevention model- two home visitors; weekly visits mid-pregnancy through child's 2nd birthday
2. Reflective parenting approach integrated with health care and mental health treatment in home
3. Preliminary findings in RCT indicate positive trends with C/S rates, infant attachment and health, no DCF involvement, very low rates rapid subsequent childbearing, etc.
Discuss the Poly T. McCabe Center Services for teen mom's.
Prenatal childbirth education classes
Post partum parenting classes
Child care assistance program; Nurture Room and transitional day care
Outreach and follow-up
Liaison with health care agencies
Liaison with other parenting programs
What are the components of curriculums for teen mother support programs?
Address students as adolescents and new mothers
Provide information and strategies for both roles
Work toward promoting success with the two most powerful predictors for teens and their children (beliefs, attitudes and concrete services)
1. Completing school
2. Preventing subsequent childbirths in adolescence
What are the outcomes of the programs for teen mothers?
Fewer pre-term births and LBW infants
Better high school completion rates
Less rapid subsequent pregnancies and child bearing
Children with better outcomes: school success and less likely to become adolescent parent
Recent trend; increased rates of breastfeeding
Discuss the implications of the high school based child care center model.
1. support health & development of children
2. enhance parent-child relationships
3. be effective model for educational success and delaying subsequent childbearing in teen mothers
4. cost/benefit ratio needs more study
*Good model for those teens who are able to attend school on a fairly regular basis
Discuss a good method of communicating with teen mothers.
Interviewing an adolescent mother in a visit, make the interaction "teen friendly" - use basic adolescent interviewing skills; develop trust; talk about the easy things that focus on the parent first before changing to the baby; explain the parts of the interview and visit; why are you asking the questions you ask
What are good techniques of talking to teen mothers?
1. Concrete, simple, present-oriented information; teachable moments/demonstrations; modeling
2. Basic information; watch jargon; ask for questions
3. Child development and age-appropriate expectations; demonstration if possible; use teachable moments in visit (infant pulling mother's earrings)
4. Safety, discipline are hot issues
5. Feeding and breast-feeding patterns and any needed interventions
Discuss techniques for getting teen mothers to DE-Center and be more in tune with the needs of their baby.
1. Taking the perspective of the baby...speaking for the baby (Carter et al., 1991); speaking through the baby and speaking for the "mother"
2. Rehearsing negotiations (Trad, 1995)
3. Help to make abstract concepts more visible & concrete for the young mother
4. Use of home videotaped interactions and watch together while providing feedback
What is important to do as the health care provider of a teen mother?
Be an ADVOCATE
Discuss the model for pediatric care of teen parents and their children.
Reduce risk of repeat adolescent childbearing (contraceptive care/counseling)
Parents to be encouraged to stay in school
Monitor safety and development of both mother and child
Monitor and encourage support/involvement of grandparents and father
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