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Teenage Pregnancy

By:
JESSIEL E. VICENTE, RN

Specific Objectives
By the end of the session, participants will
be able to:
List factors contributing to adolescent
pregnancy
Discuss risks of too early pregnancy to teen
mothers and children
Discuss management and psychosocial
support to pregnant adolescent during
perinatal (prenatal, intra-partum,
postpartum) period

OUTLINE
Teen Pregnancy
Statistics
Risks
Factors contributing to TeenPregnancy
Management and psychosocial
support to pregnant teen
Assessment
Pre-natal Care
During Labor and Delivery
Post Partum Care

Teen Pregnancy...some stat!


Girls aged 15-19
years
Fertility rates: 53
births/1000
Urban: 42
Rural: 71
-2008 NDHS

Other countries in WPRO

Sheila

Marie
Dia

Sheila, 14 y/o ,
G1P1
Marie, 17 y/o,
G2P2
Dia, 13 y/o,
G2P1 (mother
of 1, 3- month
pregnant
5

Risks for Young Mothers


1. RISKS TO HEALTH
pregnancy-induced high blood pressure,
Low Birth Weight
Anemia
STI
bleeding
Premature Birth
Postpartum Depression
Maternal death is 2x more than adult

Some pregnant adolescents choose induced abortion

Risks for Young Mothers


In the Philippines:

22% of maternal
deaths are
from among
mothers aged
15 to 24 years
-

(2007)

Save the Children

Risks for Young Mothers


20% of those who
deliver at 15-17 y/o
will be pregnant again
in two years
Marital instability
(twice as likely to fail)

Lichter, D., Marriage as public policy.


2001, Progressive Policy Institute:
Washington, DC.

Risks for Young Mothers


2. ECONOMIC
Poor nutrition and health
for both the mother and
child.
Minimal or no support from

the childs father


Fewer opportunities for

employment esp. if
educational attainment
has been impaired

Risks for Young


Mothers / Parents
3. EMOTIONAL
Not emotionally mature
enough to be parents.

If marriage is forced,
has a higher probability
of ending in failure.

Children of TeenMoms are also


at Risk
Neonatal death rate: 3x higher
Prematurity: 14% vs 6% among
neonates born to women 25-29 yrs
Low birth weight: 4x higher
Congenital malform: 1.5 x higher

1. Martin, J.A., Hamilton, B.E., Ventura, S.J., Menacker, F. & Kirmeyer, S.,
Births: Final Data for 2004. National Vital Statistics Reports, 2006. 55(1).
2. Wolfe, B., & Perozek, M. , Teen children's health and health care use, in
Kids having kids: Economic and Social Costs of Teen Pregnancy, R. Maynard,
Editor. 1997, The Urban Institute Press: Washington, DC

Factors Contributing to Adolescent


Pregnancy (Neinstein, 5 ed)
Developmental Factors
th

Cognitive development: not future

oriented , sense of invulnerability (It


cant happen to me)
Early Puberty
Lack of basic social life skills selfawareness, critical thinking , decisionmaking skills

Factors Contributing to Adolescent


Pregnancy (Neinstein, 5 ed)
th

HOME

Mother / sibling pregnant as teen


Economic factors

EDUCATION

poor school performance


no vocational goals

ACTIVITY/ Peers

Peer pressure; peers with early pregnancy

DRUGS

Presence of other risk taking behaviors

Factors Contributing to Adolescent


Pregnancy (Neinstein, 5 ed)
th

SEXUALITY
Early dating
Sexual or physical abuse
Low rate of contraceptive use

SPIRITUALITY
Lack of religious affiliation

16

ASSESSMENT

Common Presentations
Missed menstrual Periods
Nausea and vomiting (morning
sickness)
Sudden, intense aversion to certain
foods
Sore nipples or breast
Unusual Fatigue
Frequent Urination

18

You Are Not Ready for Sex IF;


You think SEX=LOVE
You think you feel pressured
You think youre afraid to say no
You think its just easier to give
You think everybody else is doing it (they are
not)
Your instinct tells you not to
You dont know about pregnancy

19

You Are Not Ready for Sex IF;


You dont understand how birth control works
You dont think women can get pregnant the first
time ( yes she can)
It goes against your moral and religious beliefs
You think youll regret it in the morning
You feel embarrassed
Your doing it to prove something
You cant support a child/ yourself
20

Your idea about commitment is like a 3-day


video rental
You believe sex before marriage is wrong
You dont know how to protect yourself against
HIV
You dont know the signs and symptoms of STD
You think it will make your partner love you
You think it will make u love your partner
21

If you think it will keep you together


If you hope it will change your life
You dont want it to change your life
Your not ready for the relationship to change
Your drunk
You wish you were drunk/ your partner is drunk
Expect it to be perfect
Youll just die if its not perfect
22

You cant laugh together about awkward


elbows/clumsy clothes
You think HIV only happens to other people
You dont think teens get HIV (they do)
You dont know that abstinence is the only 100%
protection against HIV
You haven't talked about tomorrow
Youd be horrified if your parents find out
23

Your too scared to think clearly


You think it will make you popular
You think you owe it to your partner
You think its not okay to be a virgin
Your only thinking about yourself
You cant wait to tell everyone about it
You hope no one will hear about it
You wish the whole thing will not come up
24

TEENS, ITS
REALLY OKAY TO
WAIT.!!

25

IF
pregnancy
test is
POSITIVE..

26

during FIRST VISIT


Comprehensive
approach
Initial evaluation

Medical history
Chronic Illness
Medications
P.E. and Pelvic Exam
LABORATORY Exams

CBC, blood typing, Urinalysis,


Hepatitis B, VDRL (for syphilis)

during FIRST VISIT


Comprehensive approach
Address both medical and

psychosocial issues!
Nutrition
Smoking, alcohol, drugs
STI
Battering / abuse
Contraception
Delay or prevent repeat
pregnancy

.. During ALL VISITS


ASK, CHECK RECORDS:
Check duration of pregnancy (or AOG)
Where do you plan to deliver?
Any vaginal bleeding since last visit?
Is the baby moving? (after 4 months)
Check records for previous complications and
treatments received during this pregnancy
Any concerns?
ADVISE, MANAGE ACCORDINGLY
29

during 3rd TRIMESTER


Provide Contraceptive Counseling
to help delay future pregnancies

bec. 20% will have repeat


pregnancies within the two years

Include pregnant teens parent/s


or legal guardian and partner (if
appropriate) in the counselling
session
Will help in getting written
parental consent for FP access of
teen mom < 17 y/o

during 3rd TRIMESTER

Counsel on the importance of planning


future pregnancies
Sex after giving birth, and is not EBF,
can become pregnant as soon as 4
weeks after delivery
Impt. to think and decide what FP
method to use after delivery
if wants more children, advise at
least 2-3 years spacing for health of
mother and child
Counsel on pursuing development

school, livelihood skills training, etc

Decision1: Help TeenMom to


Choose!

WHO Medical Eligibility Criteria

Contraceptive choices for adolescents


(WHO recommendation, 2015)
Age
a) Menarche
to <40 years
b) >40 years

a) Menarche
to <18 years
b) 18 to 45
years
c) >45 years

a) Menarche
to <20 years
b) >20 years

COC P

CIC

POP

POI

Implant

IUD
Cu

LNG

Combined Hormonal Contraceptives in


adolescents
Age

COC

CIC

a) Menarche to <40 years

b) >40 years

Evidence: Evidence about whether CHC use affects fracture risk is


inconsistent, although 3 recent studies show no effect. CHC use may decrease
bone mineral density (BMD) in adolescents, especially in those choosing very
low dose formulations (<30 ug EE-containing COCs). CHC use has little to no
effect on BMD in premenopausal women, and may preserve bone mass in
those who are perimenopausal. BMD is a surrogate marker for fracture risk that
may not be valid for premenopausal women, and which, therefore, may not
accurately predict current or future (postmenopausal) fracture.

Adolescents and DMPA


Age

POP

DMPA

a) Menarche to <18 years

LNG/ETG
Implant
1

b) 18 to 45 years

c) >45 years

Evidence: Most studies have found that women lose bone mineral density
(BMD) during DMPA use, but recover BMD after discontinuation. Limited
evidence shows a weak association with fracture, although 1 large study
suggests that women who choose DMPA may be at higher risk for fracture
even prior to initiation of the method. It is unclear whether adult women with
long duration of DMPA use can regain BMD to baseline levels before entering
menopause and whether adolescents can reach peak bone mass after
discontinuation of DMPA. The relationship between these changes in BMD
during the reproductive years and future fracture risk is unknown. Studies
generally find no effect of POCs other than DMPA on BMD

Adolescents and IUD


Age

CU-IUD

LNG-IUD

a) Menarche to <20 years

b) > 20 years

Evidence: Risks of pregnancy, infection and perforation are low among IUD
users of any age. Heavy bleeding or removals for bleeding do not seem to be
associated with age. Young women using Cu-IUDs may have an increased risk
of expulsion compared with older Cu-IUD users.

Adolescents and emergency contraception


Adolescents and adult women of reproductive
age may need emergency contraception at
some point to avoid unintended pregnancy.
All women and girls, regardless of age, can use
emergency contraceptive pills.
Cu-IUD can be inserted within 5 days of
unprotected intercourse for emergency
contraception

Conclusion

Adolescents are generally medically


eligible to use ALL effective, reversible
forms of contraception and emergency
contraception

during 3rd TRIMESTER


Preparation of birth&
emergency plan
SBA that will assist in delivery?
Name of facility?
Expenses / mode of payment?
Transportation?
Donors for possible blood
transfusion?

during 3rd TRIMESTER


What to pack
Maternal record
Clean cloths for wrapping the

baby
Clothes for mother and baby
Sanitary pads after birth
Food and water
Some money

Advise on danger signs


Go to hospital / health center immediately,
WITHOUT waiting:
Vaginal bleeding
Convulsions
Severe headache, dizziness, blurring of vision
Fever and chills and too weak to get out of bed
Severe abdominal pain

Go as soon as possible

Fever, Feels ill

Pallor or anemia

Abdominal pain

Vaginal
discharge

Swelling of legs, hands and /or face

Painful
urination

Absence of / or reduced fetal

Watery vaginal

Getting ready
Recognition of signs of labor
advise to go to facility or contact SBA if any

of the ff. signs


I. A bloody sticky discharge
II. Painful contractions every 20 minutes or
less
III. Waters have broken

Walk-through
Where to go

Taking Care of Me
Nutrition
Exercise
Use of alcohol, tobacco and
drugs

Planning for the Future


Going Back to
School
Counseling on
Relationships
VAWC

Parenting

LABOR & DELIVERY


Cardinal Rule: Never leave the adolescent
alone!
Support, Comfort, & Explain what is
happening or going to happen. They help:
break the cycle of fear that produces tension

which increases the intensity of pain.


Increase cooperation from the adolescent

Friends, adolescents partner, family members,


or anyone the adolescent identifies can and
should be encouraged in providing physical
care and emotional support.

Provider characteristics for managing


adolescents during the birthing
process
Patience, understanding, explanations,
compassion, and caring attitude are required
during this period:

SHOUTING is never acceptable

Use firm but caring speech to get the


adolescents attention.

General support functions for the


laboring adolescent
Ensure privacy
Keep the adolescent clean and dry.
promotes relaxation; reduces risk of infection.
Clean away any blood, feces, and amniotic fluid

from the genital area.

Provide mouth care


encourage to brush her teeth; offer mouthwash, if

available; apply ointment to the lips; offer sips of


cool water or ice chips;

General support functions for the


laboring adolescent

Encourage the adolescent to empty


her bladder frequently every 2
hours
Remember that medication is a relief
measure and offer it wisely.

During False Labor


Facilitate relaxation and/or sleep.
Provide diversions to help pass the
time,

e.g. light sedation, warm bath, warm shower, hot


drinks (tea with sugar, milk, chocolate), or have a
family member or support person to give a back rub.

Encourage walking, it will stimulate


true labor or relieve false labor.

Early Labor
Provide comfortable chairs for the adolescent
and her support person(s)
Encourage the adolescent to walk around.
Offer light meals (fruits, porridge) and liquids
(water, juices, tea).

IF COMFORTABLE, counsel on delaying


repeat pregnancy or birth spacing.
Discuss methods that can be provided during

the postpartum period 10 minutes after


delivery of placenta to 6 weeks
Secure consent if < 17 y/o

Active Labor
Do not leave the adolescent alone.
Strong, rapid contractions can make her feel

frightened.
Help her cope with her fears and discomfort.

When touching her, touch her gently.


Position the adolescent comfortably using
pillows or rolls of linen.
Encourage her to lie on her side.
Guide her with breathing techniques as her
labor progresses

Active Labor
Provide IV fluids, if indicated.
Help the client and her support person get
in position for pushing
Talk to the adolescent during the actual
birth to minimize tension and fear from the
intense sensations and to gain her
cooperation for a controlled birth.

IMMEDIATE POSTPARTUM CARE


Provide care for the mother and
newborn
TEEN MOTHER

Assess amount of vaginal bleeding


Encourage TeenMom to eat and drink
Ask the companion to stay with the
TeenMom
Encourage to TeenMom to pass urine
NEWBORN

Eye care;
Keep baby warm and in skin-to-skin contact
with the mother
Encourage the mother to initiate
breastfeeding

IMMEDIATE POSTPARTUM CARE


Review TeenMoms record if she
has indicated (with signed consent
if < 17 y/o ) any FP method
Check if she been appropriately
counseled on any method.
If chosen PPIUD, properly screen,

and insert IUD (copper T) 10


minutes after delivery of
placenta

. 6 weeks POSTPARTUM PERIOD


Counsel on
Going Back to School or
vocational skills
Preventing a repeat
pregnancy
counsel and provide services
on modern FP
Counseling on
Relationships
VAWC
Parenting

Taking Care of Baby

Breastfeeding
Infant Care
Well-baby check-ups
Normal infant behavior

the perinatal outcome of teenage


pregnancies is comparable to that of older
women
.if good psychosocial support and adequate
perinatal care is provided.
The Obstetric Performance of Teenage Women: A Reappraisal, Journal of Pediatrics,OB& Gyne, May-June
2000

WE should be

advocates
for pregnant teen

Have a Good
Day :D !