Lecture Four: Adolescent Pregnancy

1. Lecture Four: Adolescent Pregnancy NURS 2208 T. Dennis RNC, MSN

2. Objectives Discuss the incidence of and factors which contribute to adolescent pregnancy. Discuss the physiological and psychosocial consequences of pregnancy for the teen mom and dad. Discuss the developmental tasks interrupted by adolescent pregnancy. Identify data needed for the assessment of the pregnant adolescent. Formulate diagnosis and select interventions for the adolescent patient.

3. Physical Changes of Adolescence Puberty lasts from 1.5 to 6 years. Generally coincides with adolescence. Signs include a growth spurt, weight change, and the appearance of secondary sexual characteristics. First menstrual period usually evidenced in the last half of the maturing process (average age between 12 and 13).

4. Psychosocial Development Does not occur simultaneously with puberty (particularly cognitive development). Developmental tasks are significant during the transition from child hood to adulthood.

5. Developmental Tasks Developing an identity Gaining autonomy and independence Developing intimacy in a relationship Developing comfort with one�s own sexuality Developing a sense of achievement

6. Early Adolescence Age 14 and under Authority seen in parents Spends more time with friends Peer pressure (clothes, behavior) Rich fantasy life Struggling with body image (real and perceived) Egocentric, concrete thinker

7. Middle Adolescence Age 15 - 17 years Rebellious- possible experimenting with drugs, alcohol, and sex Seeks independence Turns to peers Believes he or she is invincible; does not recognize consequences Wants to be treated as an adult

8. Late Adolescence Age 18 - 19 years More at ease with individuality and decision-making Thinks abstractly and anticipates consequences More confident of personal identity Feels more in control

9. Statistics Over 1 million teenage girls in the United States become pregnant each year.

10. Statistics �.continued Most teen pregnancies are unplanned 1/3 are terminated by therapeutic abortion 14% end in miscarriage More than 1/2 choose to keep infants Very few choose adoption

11. Statistics�.continued Birth rate for adolescents dropped steadily from 1991 to 1996 US continues to have the highest rate of adolescent childbearing among industrialized nations..3 times that of France and 9 times that of Japan Sexual activity among adolescents is same

12. WHY��? Family influences Greater openness about sexuality Better access to contraceptives More comprehensive approach to sex education

13. Contributing Factors Peer pressure Popular media Sexually active early Poor birth control use Socially acceptable Punish parents Escape home To have someone to love Socioeconomic status Cultural beliefs and customs Sexual abuse Incestuous relationships

14. Partners of Adolescent Mothers Almost 1/2 of partners of pregnant teens are 20 years of age or older Similar to adolescent fathers socio-economically and developmentally Face negative reactions Sign paternity forms Participate in birth but may not be key May not continue relationship after infancy

15. Physiologic Risks Pre-term births (STD�s, Drugs, Alcohol) Low Birth Weight (LBW) infants Pregnancy Induced Hypertension (PIH) and sequelae Iron deficient anemia Cephalopelvic Disproportion (CPD)

16. Psychological Risks The most profound risk is the interruption of the progress in developmental tasks. Not only does the adolescent have to accomplish the tasks of adolescence but also the tasks associated with becoming a mother.

17. Sociologic Risks Prolonged dependence on parents High school drop out Never completes education Fails to establish a stable family Have more children during adolescence Majority of adolescent marriages end in divorce

18. What is the result? Family instability Disadvantaged neighborhoods Poor academic performance Higher rates of behavior problems Increased incidence of abuse and neglect 6.9 billion healthcare dollars spent More families on welfare

19. Responses and Social supports Varied�anger, excitement depending on family goals Mother of pregnant adolescent is typically first told Mother helps obtain healthcare May participate in childbirth classes, delivery and post-partum care May care for infant after hospitalization

20. Nursing Care Management Remember �adolescents think differently than adults. Adolescents tend to be more concrete thinkers than adults and tend not to plan ahead. Have more difficulty anticipating consequences. May have missed appointments. Must be highly motivated to access healthcare without a parent for pregnancy, STD�s or birth control.

21. Nursing Assessment Family and personal health history Developmental level (age appropriate) Medical history Menstrual history Obstetric and Gynecologic history Substance abuse history Social/emotional/financial support systems Father�s degree of involvement

22. Nursing Diagnosis Altered Nutrition: Less than body requirements related to poor eating habits Self-esteem Disturbance related to unanticipated pregnancy.

23. Nutritional Concerns Nutritionally at risk by ADA Teens are more likely to be underweight Low weight gain Consider the number of years since menarche�adolescents who become pregnant fewer than 4 years after menarche are at a high biologic risk because of their physiologic and anatomic immaturity.

24. Specific Nutrient Concerns Adequate Iron Intake�iron supplements of 30 to 60 mg of elemental iron. Vitamin C enhances iron absorption. Calcium Supplement for clients with aversions or allergies to milk or milk products. Folic acid. A low-dose vitamin and mineral supplement may be necessary.

25. Nursing Plan and Implementation Community-Based Care Early prenatal care Early Intervention Program Right from the Start Medicaid Perinatal Case Management (PCM) Pregnancy Related Services (PRS) WIC Counseling and Education

26. Issues of Confidentiality Emancipated minors: An adolescent may be considered emancipated if he or she is self-supporting, living away from home, married, pregnant, a parent or in the military. Has the right and responsibility to consent to healthcare. Has a right to confidentiality and respect.

27. Developing a Trusting Relationship Important�.motivate the adolescent to attend her prenatal visits as scheduled with the physician or the clinic. Be attentive and positive�she may not come back. First pelvic�..educate, be considerate, use a mirror. Honesty, respect and a caring attitude can make the difference in self-esteem and self-care.

28. Promote Self-Esteem Education, explanations and rationale of the prenatal course fosters a feeling of control over the pregnancy process. Actively involving the client in plan of care gives a sense of participation and responsibility. Focus on healthcare habits that affect the client and the fetus.

29. Promote Physical Well-Being Baseline weight and Blood pressure Baseline hemoglobin and hematocrit Nutrition education about weight gain and iron deficient anemia PIH is the most prevalent medical complication of pregnant adolescents Serology test (increased incidence of STI�s)

30. Promotion of Family Adaptation Assess family situation Determine level of involvement of family , father and mother Include in prenatal visits, classes, ultrasounds and delivery process Include in post-partum education

31. Facilitation of Prenatal Education Mainstreaming in schools Growth and development classes Keep teaching simple,direct and important to immediate needs Keep class age specific (more responsive to own age group) Use a variety of teaching strategies (Breathing techniques, exercises, models)

32. Hospital Based Care Adolescent�s mother is often present during labor and birth Sexual partner (may be father/may not)/Girlfriends present Ask the mother who her support person is for the labor process Be a sustained presence Prior to discharge, focus on contraception Educate concerning community resources

33. Support During Birth Each labor is different Has there been prenatal care? Attitudes and feelings about pregnancy? Age specific needs met/unmet? Expectations and fears? Cultural influences? Social support? Adoption?

34. Interventions Education: teach adolescent clients in a format focusing directly on issues important to them (acne, good looks, weight control, etc.). Review prenatal history Close observation Monitor Fetus Recognize risk factors (PIH, CPD, LBW infants, Drug abuse, STIs) Provide support and positive reinforcement

35. Prevention of Adolescent Pregnancy 1980�s Abstinence Only Programs funded National campaign to prevent Teen pregnancy in 1996 supported by professional organizations Community Challenges�agreeing to disagree Address poverty, low educational achievement, poor self-esteem, and high-risk factors

36. Post-Partum Care of the Adolescent Assess maternal/infant interaction Assess roles of support people Plan for discharge Community health service (PRS) Contraceptive education Provide care at the bedside Give positive feedback Provide group classes/support groups

37. Questions? Angel Davis is 15 years old and has come to the clinic for her third prenatal visit. She tells the nurse, � I�ve been thinking about this pregnancy thing and I think it will be neat to have a little baby. This baby will be mine to love and love me back.� How should the nurse respond to the client? �Babies are a lot of work� �Tell me how you think things may change after the baby is born.� �I know, I can�t wait for you to deliver.� �Do your mom and dad agree with this idea?�

38. References Whitney, E., Rolfes, S. 1996. Understanding Nutrition. West Publishing Company: St. Paul, MN (pg. 43,81-82).