1 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 35 Teen Pregnancy

2 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Objectives 1. Discuss approaches that could be used in working with the adolescent patient. 2. Identify trends in adolescent pregnancy, births, abortions, and adoption in the United States. 3. Discuss reasons that may affect whether a teenager becomes pregnant. 4. Explain some of the deterrents to the establishment of paternity among young fathers.

3 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Objectives, Cont’d 5. Develop nursing interventions for the prevention of pregnancy problems that adolescents are at risk of experiencing. 6. Identify nursing activities that may contribute to the prevention of adolescent pregnancy.

4 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Adolescent Health Care in the United States  Main causes of teen mortality in the United States are high-risk behaviors  Motor vehicle accidents (usually including alcohol)  Homicide  Suicide  Accidental injuries  Teens often engage in behaviors that put them at risk for life-threatening diseases:  HIV, STIs, smoking, sedentary lifestyle

5 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. The Adolescent Patient  Limited experience in independently seeking health care  When they do seek care, it is often to discuss birth control methods.  Need assistance negotiating complex health care systems  Need to know their concerns are being heard  Nurse needs to pay attention to what the teen fails to verbalize  Potential knowledge deficit and embarrassment regarding discussions of reproductive health care

6 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Trends in Adolescent Sexual Behavior, Pregnancy, and Childbearing  In 2006, 750,000 teens became pregnant  Teen birthrates increase by age  Highest rates occurring among 19 year olds  Births by teens make up 11% of all births in the United States  Teen birth rate began to rise in 2006 for first time since 1991  In 2006, 27% of teen pregnancies were ended by elective abortion, a decrease from 46% in 1986

7 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Background Factors  Sexual activity and use of birth control  Sexual debut  Peer pressure and partner pressure  Other factors  Sexual victimization  Coercive sex or statutory rape  Family structure  Parenting styles

8 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Young Men and Paternity  Of sexually active teen males, 14% have gotten a partner pregnant and 4% become fathers.  Not all teen males are aware that a partner became pregnant.  Not all teen males are aware of the outcome of the pregnancy.  Establishing paternity  Varied reactions when they learn their partner is pregnant

9 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Early Identification of the Pregnant Teen  Reasons some teens delay seeking pregnancy services  Fail to recognize signs of pregnancy (such as breast tenderness and a late period)  Falsely hope the pregnancy will just go away  Keep pregnancy a secret from family members  Pregnancy counseling  Availability of abortion services vary from community to community.  Information about adoption

10 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Special Issues in Caring for the Pregnant Teen Violence Initiation of Prenatal Care Low–Birth-Weight Infants and Preterm Delivery Nutrition Infant Care Repeat Pregnancy Schooling and Educational Needs

11 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Violence  Teens are more likely to experience violence during their pregnancy  Violence in pregnancy associated with:  Increased risk for substance abuse  Poor compliance with prenatal care  Poor birth outcome  Intimate partner violence

12 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Initiation of Prenatal Care  Teens report greatest barrier to care is real or perceived cost  Other barriers include:  Denial of pregnancy  Fear of telling parents  Transportation  Dislike of provider’s care  Offensive attitudes among clinic staff toward pregnant teens  Nurse is important liaison between clinic personnel and the young woman

13 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Low–Birth-Weight Infants and Preterm Delivery  Teens are more likely than adult women to deliver infants weighing less than 5.5 pounds or to deliver before 37 weeks of gestation.  Low–birth-weight and premature infants at greater risk for:  Death in first year of life  Long-term physical, emotional, and cognitive problems

14 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Nutrition  Fast food; frequent snacking of high-calorie, high fat foods; and hectic social schedules limit nutritious food choices for teens.  Gynecological age  Weight gain during pregnancy is strongest predictor of infant birth weight  Iron deficiency anemia

15 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Infant Care  Most teens unprepared for the reality of 24- hour care of an infant  May lack self-confidence and knowledge required to positively interact with their infants  May have unrealistic expectations about their children’s development  Teen parents often lack knowledge about infant growth and development  Abusive parenting

16 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Repeat Pregancy  Teen mothers who have a closely spaced second pregnancy have poorer birth, educational, and economic outcomes than teens who do not have a closely spaced repeat pregnancy.  In 2007, 19% of teen births were repeat births  Family planning discussions

17 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Schooling and Educational Needs  Teen parents may have limited school success before the pregnancy.  When demands of child-rearing and mother’s maturity level added in, school may be even less of a priority  51% of teen mothers earn a high school diploma compared with 89% of women who did not have a birth during the teen years.  Schools prohibited from excluding students because they are pregnant  Fewer than 2% of teen mothers obtain a college degree by age of 30.

18 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Teen Pregnancy and the Nurse  Home-based interventions  Community-based interventions