Caring for the Pregnant Teenager

Did you know that complications during pregnancy and birth result in the second largest cause of death in 15 - 19-year-old females, globally? (McCarthy et al. 2014).

High rates of teenage pregnancy remain a worldwide public health concern. How can maternity care be improved to meet these challenges and provide optimal care for the pregnant teenager?

McCarthy et al. (2014) define teenage pregnancy as occurring between the ages of 13 - 19 years. The World Health Organization, on the other hand, suggest that teenage pregnancy occurs anywhere between 10 - 19 years of age based on the mothers’ age at delivery (Yasmin et al. 2014).

Who is Most at Risk of Teenage Pregnancy?

Research from both Australia (Marino et al. 2016) and the UK (Whitworth 2017) show that teenage mothers are more likely to experience violence, family disruption, and socioeconomic disadvantage prior to conception.

Negative impacts on educational achievements; social isolation; poverty; and increased challenges to physical and mental health are all more likely to occur to teenage mothers (Cantlay 2015).

Extensive research conducted by The Teenage Pregnancy Independent Advisory Group (2010), expands on these general points and suggests specific groups of teenagers who are at particularly high risk of early pregnancy. Their list includes:

• Young people excluded or truanting from school or underperforming in education;
• Young people in care or leaving care;
• Daughters of teenage mothers;
• Young people involved in crime;
• Some ethnic minority groups;
• Vulnerable young people; and
• Young women who have had a previous pregnancy.

Risk Assessment

Marino et al. (2016) suggest that outcomes on a range of peripartum measures are also worse for teenage mothers as well as their babies. Longer term risks for the mother are known to include depression and rapid repeat pregnancy. Yet other researchers point out that women aged under 20 have one of the lowest rates of maternal mortality of all age groups.

It’s a different picture, however, for the babies born to teenage mothers. Multiple research studies all point to the fact that babies born to mothers under the age of 20 are at higher risk of stillbirths, higher rates of perinatal deaths and higher rates of neonatal deaths (Morecambe Bay NHS Foundation Trust 2012).

Risks to the Teenage Mother

Teenage mothers are known to be:

• Three times more likely to get post-natal depression than older mothers;
• Face a higher risk of poor mental health for three years after the birth;
• Three times more likely to smoke during pregnancy than mothers over 35;
• One-third less likely to breastfeed; and
• Likely to struggle to complete their education and find it difficult to gain employment.
(Teenage Pregnancy Independent Advisory Group 2010)

Risks to the Baby

Babies born to teenage mothers are also known to have worse health outcomes than those born to older mothers. For example:

• They are more likely to be born prematurely, or at a low birth-weight;
• They are 60% more likely to die in the first year of life compared to babies of mothers aged 20-39; and
• They are twice as likely to be admitted to hospital as a result of an accident or gastroenteritis.
(Teenage Pregnancy Independent Advisory Group 2010)

Role of the Teenage Pregnancy Midwife

As well as the higher risk factors known to be associated with teenage birth, teenage parents, as well as their children, are at greater risk of social exclusion and lower health outcomes, physically and emotionally.

In practice, this means that becoming a teenage parent, whether planned or not, can be a time of great vulnerability and it’s essential that accessible and relevant support networks are in place (Morecambe Bay NHS Foundation Trust 2012).

This means that midwives, along with other members of the maternity team are ideally placed to help pregnant teenagers build up their confidence, and to help them navigate the many choices and life transitions that come with parenthood.

Midwives can help by:

• Explaining choices clearly and showing respect for the young person’s capacity to make decisions.
• Showing belief in their ability to develop effective parenting skills.
• Reassuring them that it’s normal for people of all ages to have mixed feelings at the prospect of parenthood.
• Avoiding stereotyped assumptions about the choices a young person is ‘likely’ to make.
(RCM 2015)

McCarthy et al. (2014) echoes these thoughts and suggests the following practical steps to improve pregnancy outcomes:

• Teenagers should be engaged in an open, sensitive discussion about pregnancy options, ideally with the support of their family or partner.
• Early liaison with a multidisciplinary team should be arranged to ensure adequate support and continuity of care.
• Long-acting reversible contraceptives should be offered postnatally to prevent rapid repeat pregnancy.

Psychosocial Considerations

One of the most common concerns of teenage mothers is the fear of being judged; while for young fathers, feelings of not being included in the care provided for their unborn child is frequently reported.

These experiences can result in feelings of rejection, which can deter young parents from using the full range of services offered to them.

A Challenge for the Maternity Team

Taken together, these factors can present a particular test for the maternity team, especially as additional life factors may need to be considered to prevent young mothers from being disadvantaged. For example:

• A teenage woman may not realise she is pregnant.
• She may need time to come to terms with being pregnant before she feels able to seek advice.
• She may attempt to conceal her pregnancy if she is concerned about the reactions of her friends and family.
• She may lack a stable home environment, or a home that she can permanently call her own.
• She may lack the finances to access health appointments, or care for herself adequately.
• A young teenage mother may also display child-like behaviour when under stress.
(Morecambe Bay NHS Foundation Trust 2012)

Conclusion

Even though teenage pregnancy rates are falling in many developed countries, they still represent an important public health problem and are considered to be high-risk pregnancies.

To help meet this challenge, Lehmann (2017), suggests that where possible community-based group antenatal care should be offered. This has been shown to help empower young women and improve their wellbeing through continuity of care and peer support. This, in turn, can help to improve emotional wellbeing and reduce feelings of vulnerability and isolation.

There is no doubt that modern maternity and neonatal care has already gone a long way in reducing adverse outcomes for the teenage mother and her baby.

The challenge remains for maternity teams to think of even more creative care packages that can give the pregnant teenager the best possible start on her journey towards motherhood.

Additional Resources

• 

  Raising Children Network

  Teenage pregnancy - supporting your child: Resources specifically for those supporting a teenage child who is pregnant.

References

• Cantlay, A 2015, 'Managing teenage pregnancy', InnovAiT: Education and inspiration for general practice, viewed 11 September 2018, http://journals.sagepub.com/doi/abs/10.1177/1755738015597458
• Lehmann, K 2017, 'Understanding the barriers: managing adolescent pregnancy', O & G Magazine, viewed 11 September 2018, https://www.ogmagazine.org.au/19/3-19/managing-adolescent-pregnancy/
• Marino, JL, Lewis, LN, Bateson, D et .al 2016, 'Teenage mothers', Australian Family Physician, 45(10), viewed 11 September 2018, https://search.informit.com.au/documentSummary;dn=376943452778983;res=IELHEA .
• McCarthy, FP, O’Brien, U & Kenny, LC 2014, 'The management of teenage pregnancy', BMJ, (349), pp. 5887, viewed 11 September 2018, https://www.bmj.com/content/349/bmj.g5887
• Morecambe Bay NHS Foundation Trust 2012, Teenage Pregnancy, viewed 11 September 2018, https://www.bestbeginnings.org.uk/Handlers/Download.ashx?IDMF=b8693fd7-cd24-46b7-91a2-0b3f350d4c02
• Royal College of Midwives 2015, 'Getting maternity services right for pregnant teenagers and young fathers', viewed 11 September 2018, https://www.rcm.org.uk/sites/default/files/Getting%20maternity%20services%20right%20for%20pregnant%20teenagers%20and%20young%20fathers%20pdf.pdf
• Teenage Pregnancy Independent Advisory Group 2010, 'Teenage pregnancy, You can make a real difference to teenage pregnancy', viewed 11 September 2018, http://www.youngpeopleshealth.org.uk/userfiles/GP_nov12_option1%281%29.pdf
• Whitworth, M, Cockerill, R & Lamb, H 2017, 'Antenatal management of teenage pregnancy', Science Direct, 27(2), pp. 50-56, viewed 11 September 2018, https://www.sciencedirect.com/science/article/pii/S1751721416302445
• Yasmin, G, Kumar, A & Parihar, B 2014, 'Teenage Pregnancy - Its Impact on Maternal and Fetal Outcome', International Journal of Scientific Study, 1(6), pp. 9-13, viewed 11 September 2018, https://pdfs.semanticscholar.org/a3ee/4c6416fd117df623af091e9e3d1308b271ae.pdf