*Adolescent Pregnancy

*Overview of Adolescence

*Content on physical development of the adolescent is covered in the PPT Adolescence based on Chapter 19 of Hockenberry.

*Teen-age Pregnancy adds a whole new set of risks because the adolescent is still developing physically and psychologically

*See birth rates: Figure 17-1 p. 379 Olds, 9th ed.

*Early Adolescence (14 yrs and <)

*Rapid physical changes:self-centeredness but locus of control is external—parents and school authorities

*Egocentric and concrete thinker

*Fantasy thinker, doesn’t foresee consequences of behavior

*Middle Adolescence (15-17 years)

*Challenges authority—often experiment with drugs, alcohol, thinks she is invincible

*Locus of control still external—now peers and support group

*Fluctuates between wanting to be adult but fearing responsibility

*Moving from concrete thinker to formal operational thought

*Late Adolescence (18-19 years)

*Thinks abstractly and anticipates consequences

*More confident of personal identity

* Factors Contributing to Adolescent Pregnancy

*Socioeconomic and Cultural Factors

*Poverty, Race

*Low educational achievement

*High-Risk Behaviors

*Sense of invulnerability

*46% of all teens 15-19 years have had sex (AGI, 2010)

*Media influence—TV, internet, movies, etc.

*Varied sexual practices—multiple partners, STI’s , inconsistent use of contraceptives

*Psychosocial Factors

*Teen may have underlying desire to retaliate against parent, her form of delinquency, but may improve her health choices

*Higher risk of mental illness in the future

*Int’l Perspective—culture may encourage early pregnancy

*Risks to Adolescent Mother

*Physiologic: preterm births, LBW babies, pre-eclampsia/eclampsia, iron deficiency anemia, CPD. Early and consistent prenatal care is essential to a safe care and early intervention!

*Psychologic: the risk of interruption of progress in her developmental tasks of establishing her own identity (see Table 17-3); different for early, middle, vs late adolescence

*Key to care:

*Be non-judgmental in approach

*Ensure confidentiality

* Integrate teen’s mother/parents in plan of care.

*Evaluate support system and encourage building relationships

*Risks to Adolescent Mother (cont’d)

*Sociologic—teen pregnancy may result in prolonged dependence on parents, dropping out of school, poorer job opportunities, single parenting, larger family

*Dating violence may be perceived as ‘normal’ in young teen

*Cost to taxpayers: $7 billion each year (Pinkleton et al, 2008)

*Risks to her Child—high rates of family instability,

*behavioral problems,

*developmental delays, poor success in school,

*higher rates of abuse and neglect, and

*may in turn become adolescent parent.

*Partners of Adolescent Mothers

*Research shows that 2/3 of adolescent dads are in their 20’s

*Many are in serious, supportive relationship with teen mom, engaged in the whole pregnancy, and present for labor and delivery

*Relationships among teens often deteriorate over time partly due to conflicts with baby’s grandparents, financial struggles

*Fathers are included in birth certificate, and legal paternity helps with benefits for baby

*Some teen moms may want nothing to do w/dad, esp. in cases of rape, incest, or exploited sex. RN must investigate to protect mom and baby—social services referral is indicated.

*Nursing Care Management

*Assessment :

*Hx family & personal physical health, OB hx, gyne hx, substance abuse hx

*Developmental health and acceptance of pg

*Family & social support network + or --

*Father of baby’s involvement

*Nursing Dx: (possibilities)

*Imbalanced Nutrition: less than body requirement R/T poor eating habits

*Risk for Situational Low Self-esteem R/T unanticipated pregnancy

*Nursing Care Management

*Nsg Plan and Implementation—early isessential. Establish trust and rapport!

*Community-Based Nursing Care—helps provide coordinated care that pulls in all resources available: WIC, Medicaid-if eligible, Social Services and support, teen parenting classes.Nursing coordinates teaching at appropriate cognitive and developmental level

*Social media—Facebook—may be a good venue for teaching

* Issues of confidentiality & consent for care—review emancipated minor (p. 387) status!

*Development of a trusting relationship with the teen mom—be gentle if this is first pelvic exam. Explain and describe all procedures simply and calmly.

*Nursing Care Management

*Promotion of Self-Esteem & Problem-Solving Skills—

* Involve in all decision-making re: plan of care.

*Provide overview of pregnancy; always focus on effect of pregnancy on teen mom because of egocentrism.

*Promotion of Physical Well-being—

*Careful monitoring of weight and BP is critical

*Discuss realistic weight gain:pp.408-410 and Table 18-1 Dietary References Intake pp. 396-397 for adolescent.

*Figures as high as 50Cal/kg/day for active young adolescents

* Iron supplements—30-60mg of iron/day indicated to prevent anemia

*Adequate Calcium also essential to prevent hypertension and pre-eclampsia, LBW infant. May need to supplement

*Assess teen’s eating habits over time not just 24-hr period. Individualize and focus on mom’s health to keep her fit.

*Nutritional Needs

*Protein 71 gms /day

*Carbohydrate 175 g/day

*Calcium 1300 mg/day

*Iron 27 mg/ day

*Nursing Care Management

*Promotion of Physical Well-being—cont’d

*Screen early for STI’s—gonorrhea, chlamydia, candida, Trichomonas, & Gardnerella, syphilis, HIV.

*Discuss substance abuse: tobacco, alcohol, drugs, caffeine.

*Monitor fetal growth: McDonald’s rule, US, quickening, etc.

*Promotion of Family Adaptation

*Assess family system at 1st prenatal visit. Include pt’s mother as much as she & pt want. Strive to renew or re-establish positive relationship

*Assess pt’s mother & father’s involvement

* Integrate baby’s father—prenatal visits, prenatal classes, US, health teaching.

*Facilitation of Prenatal Education—prenatal educ’n in HS with school nurse. Keep mainstreamed AMAP. Offer teen birthing classes. Include content on breastfeeding.

*Nursing Care Management

*Hospital-based Nursing Care: respect & support essential

* Importance of sustained presence—teen mom’s choice

*Provide education to help with choices. Integrate teen dad as much as he wants to be involved.

* Integrate non-pharmacological interventions. Doula might be a great advocate to the adolescent.

*Educate! Educate! Educate! In the postpartum period.

*Safe and effective contraception must be discussed prior to discharge: condoms plus OC, or IUD( ACOG approved 2007), or long-acting OC.

*Discuss community resources to support her—WIC, Lactation Consultant, sx of PP Depression

*Return to high school—home tutor required by state of IL for 6 weeks

Prevention is everything!