Annotatated Bibliography

Volume 29 Number 1 January 2014 | International Journal of Childbirth Education | 57

Maintaining Their Future After Teen Pregnancy:

Strategies for Staying Physically and Mentally Fit by Joshua Kirven, PhD

Abstract: Being an adolescent comes with ongoing pressures of trying to fit in, body changes, multimedia messaging, and aca- demic expectations. Teenagers who exhib- it at-risk behaviors, such as consensual unprotected sexual activity, are making an informed choice and are aware of po- tential consequences such as STDs, HIV/ AIDS, and pregnancy. When pregnancy happens, most of the attention, concern, and resources are directed towards the female partner who is visually reflective and physically affected by the pregnancy. It is important that the mother receive parenting education, healthy lifestyle choices, coping strategies, and education success planning. Childbirth education and wellness tactics serve as a catalyst in providing services towards a successful pregnancy. An ongoing concern also is the accessibility of support services when un- der stress. This paper will focus on teen- age parents who want to continue with their future goals and maintain quality mental and physical health.

Keywords: teen pregnancy, obesity, healthy life choices, childbirth education, coping strategies

Introduction Why is it important that pregnant teens understand the

importance of childbirth education? Because although there has been a steady decline over the past decade, teen birth rates in the United States remain high enough to be consid- ered a public health problem. Pregnant teenagers are at a higher risk than healthy adult women in many ways. Teen- age girls have most likely not completed their own growth process. Adding pregnancy to a period of rapid growth and development of a teen certainly increases nutritional demands. In particular, the reproductive system is stressed as it is still in its own early development. In addition, not only is the mother at risk, but the health of the baby can also be jeopardized.

Being an adolescent involves stressors inside and outside the classroom. In the current social climate even a “normal day” poses challenges. When adolescents are ill-equipped with positive networks and activities, that idle time can lead to mistakes. Oftentimes, one time mistakes lead to teenage pregnancy (Patel & Sen, 2012). Although becoming pregnant is usually not the goal when teenagers have unprotected sex, it becomes a life-altering reality for many. Once pregnancy is confirmed, the expecting mother and hopefully father should start to become educated on prenatal care and positive parenting. Remorse and regret may often rise to the surface, putting a strain on the teenage relationship. Depression, obe- sity, and anxiety symptoms may occur, leading to unhealthy practices during and after pregnancy (East, Chien, & Barber, 2012). With puberty, hormones, social acceptance, and dating relationships all occurring simultaneously during ado- lescent years, pregnancy only exacerbates the problems with social wellness and life functioning for the teenager (Kirven & Dziegielewski, 2013). Unlike the pregnancy intentions of adult women, the modest research on adolescent pregnancy finds that not all are unintended or come as a surprise.

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Indeed, more than 20% of all teenage pregnancies in 2002 were intended (Kissin, Anderson, Kraft, Warner, & Jamieson, 2008). Also a recent study of urban females aged 15 to 19 years old exhibited that 12% of the respondents who were pregnant stated that they “wanted to get pregnant” (Kavana- ugh & Schwarz, 2009). Although some research has looked at how wanting a baby or ambivalence about having a baby affects adolescents’ likelihood of becoming pregnant, little is known about how planned or wanted pregnancy relates to the adolescent’s adjustment to parenting, healthy living, and future socialization (East et al., 2012). In contrast to pregnant adult women, for whom planned and wanted pregnancy is socially accepted and normalized, planned and wanted pregnancy for adolescents has been thought to suggest pre- existing problems, such as loneliness, low self-worth, and an emotional emptiness (Barber & East, 2009; East et al., 2012; Hamburg, 1986; Zabin, Astone, & Emerson, 1993).

Very little research exists examining whether adoles- cents’ pregnancy intentions or wantedness are related to their optimal thinking (Kirven, 2000) and positive psy-

chosocial functioning. Although purposefully wanting and intending to become pregnant might be a sign of prior psychosocial problems and coping among adolescents, it is still logical that an unwanted or unintended pregnancy per- petuates undesirable outcomes for adolescent mothers and their children. Therefore, being mentally and physically fit is a key factor to healthy wellness. To be sure, an unintended or unwanted pregnancy can be highly stressful, leading to poor eating habits, lack of exercise, and following through on prenatal and parenting education. To help reduce the stress of the pregnancy on the teenager, encouraging the continu- ation of positive relationships with the teen father and peers will foster healthy life choices and future planning, for the new mother as a successful student and parent.

Risk Factors Too often, teenage girls have poor eating habits and

do not take daily multivitamin supplements. Coupled with higher nutritional needs, this can lead to possible complica- tions such as reduced birth weight, type 2 diabetes, and poor aging of baby. Other risk factors that can lead to a poor outcome for pregnant teens include the following: • Extreme youth (younger than fifteen) and/or pregnancy

less than two years after the onset of menstruation • Poor nutrition or being under- or overweight before

pregnancy • Poor pregnancy weight gain • Bad health, including infections, sexually transmitted

diseases, preexisting anemia, smoking, or alcohol or drug use

• Poverty and lack of social support or appropriate healthcare

• Lack of general education and age-appropriate prenatal care and nutritional education in particular

• Rapid repeat pregnancies It is a known fact that pregnant teens are least likely,

out of all age groups, to get the proper prenatal care (Basch, 2011). The earlier that teens get prenatal care, the better chance they have for a healthy pregnancy, delivery, and baby. Pregnant teens are at a greater risk for complications during pregnancy including premature labor, anemia, and hyperten- sive disorders such as high blood pressure and preeclampsia (Strunk, 2008). Unfortunately, teenage mothers are also more likely to drop out of school and to experience financial hardship.

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New Life Dilemmas Teen pregnancy is associated with adverse educational,

health, and economic outcomes for mothers and children (Amato & Maynard, 2007). An unintended pregnancy can also bring about relationship dissolution with the baby’s fa- ther or the recognition of having a lifelong connection to the baby’s father, both of which can be distressing. Despite these assumptions and societal perceptions, there are teen fathers who want to be active parents in the growth and develop- ment of their child and achieve their personal goals (Deslau- riers, Devault, Groulx, & Savigny, 2012; Forste & Javis, 2007; Furtis, Nielsen, & Olmstead, 2010; Turnage, Jacinto & Kirven, 2003). In addition, the challenges associated with an unwanted or unintended pregnancy can impede a mother’s ability to be nurturing and responsive to her child (Barber & East, 2009) and contribute to adolescents’ high parent- ing stress, unhealthy life choices, and poor coping strategies leading to potential child neglect, maltreatment and abuse as part of the child’s life (Child Welfare Information Gateway, 2013). Therefore, active involvement from the father has even more value for both the mother and the child in having a healthy lifestyle. School-based programs that support both the mother and the father have the potential to help teens acquire the knowledge and skills to practice safe sex, avoid unintended pregnancy, and if pregnant, to complete high school, have positive relationships, maintain physical well- ness, and pursue postsecondary education (Basch, 2011).

Avoiding Obesity The growing numbers of pediatric obesity and weight

problems in childhood have steadily increased over the past two decades. Unfortunately, almost 32% of individuals between 2 and 19 years of age are overweight (Berlin, Luzier & Weeks, 2010). Pediatric weight problems place children at considerable risk for a multitude of cardiovascular-related and psychosocial problems such as heart disease, type 2 diabetes, stroke, poor self-esteem, body dissatisfaction, and social stigmatization. Minorities are especially at risk as well: 44% of Mexican American youths, 46% of African American youths, but only 29% of Caucasian youths are already over- weight or at risk of becoming obese. Continuous education to teen parents is necessary to combat the bombardment

of fast-food that is cheap and convenient but carries high saturated fat, calories, and sodium.

A small order of fries and a large hamburger at a fast food outlet has about 800 calories, and sweetened soft drinks, which are often sold with fast food meals, have been linked to obesity in several studies. Fast food is loaded with sodium, which increases the risk of high blood pressure and stroke.

Data from more than 17,000 adults and children showed that those who frequently consumed fast food had lower intakes of vitamins A and C, dietary fiber, milk and fruits and vegetables than subjects who did not eat fast food (Paeratakul, Ferdinand, Champagne, Ryan, & Bray, 2003). Consumption of carbonated soft drinks was more than double for the frequent fast food eaters, who also consumed more than twice the amount of fried potatoes as those who did not eat fast food (Paertakul et al., 2003). Filling up on fat-laden fast food and sugary soft drinks leaves little room for more nutritious fare that supports good health.

Recent research noted that low-income neighbor- hoods may be more at risk. Findings concluded that eating fast food more than twice a week doubled the incidence of insulin resistance, a risk factor for diabetes, in the 2005 study published in “Lancet,” and a 2010 Harvard report linked sweetened soft drinks with an increased risk of Type 2 diabe- tes and heart disease. Additionally, the risk of stroke may be related to the number of fast food restaurants in a neighbor- hood, according to Morgenstern et al. (2009). Morgenstern et al. found the risk of stroke increased by 1 percent for every fast food restaurant in a Texas neighborhood.

Success Interventions for the New Parent As points of intervention, the following positive sup-

ports are introduced: • Public Health Nursing. Encourage the teen mother to

actively participate in education and support groups that specialize with teens.

• Adolescent Family Life Program. Offer flexible outreach programs offering life skills, academic success planning, peer interaction, social life adaptation, teen parent sup- port groups, self-respect and responsibility.

• Family Planning. Provide ongoing parenting strategies, biological, extended family and non-biological support networks, healthy diet and lifestyle modeling, and effec- tive time management.

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• Parenting Classes. Give both parents methods and strat- egies and proper care in meeting the emotional, physical and social needs of baby.

• Virtual Academic Learning. Maintain academic growth and achievement through online learning where feasible. Seek relevant courses that facilitate new parents to sustain academic success and graduation. Virtual classrooms allow students to attend classes and communicate with instructors and classmates just like a normal school experience, regardless of day-to-day obligations. Distance learning that is congruent with school curriculum along with supervision can serve as one resource in helping new teenage parents still achieve their future goals.

• Parental Stress Line. Prepare the parents for their own physical and emotional needs after delivery. Teach ef- fective coping strategies that curtail unhealthy, negative choices and establish stress intervention services hotlines. Also help the teenage parents and their family or support system make decisions in advance about who will care for the baby so that family conflicts are minimized and roles are clear.

Recommendations and Implications Sometimes mistakes happen; even mature parents and

adults are not immune to them. When they occur, it is important to take responsibility and begin to look forward. Teen parents need to know they are not outcasts, nor do they have to face this new life challenge alone. An ongoing con- cern that must be monitored is the risk of obesity after the baby is born. Obesity can raise the risk of chronic conditions such as heart disease, diabetes, stroke, arthritis and even some cancers. It is important that childbirth educators con- tinue to provide support through psychoeducational groups, teaching healthy choices and good nutrition as a way of life. According to recent estimates by Centers for Disease Control and Prevention, a third of all people living in the U.S. are obese. These numbers reflect an immediate problem needing to be addressed by helping professionals. Research suggests that adolescent obesity is associated with serious medical problems including cardiovascular disease, colon cancer, and diabetes, and has psychosocial consequences such as higher body dissatisfaction, lower educational attainment, and higher rates of poverty.

It is important for the new mother to take care of her- self although she is experiencing a new life adjustment. Key lifestyle adjustments can be: Eat a balanced and healthy diet, exercise regularly, and get enough sleep. The mother should never sacrifice her health because she feels too busy to take care of herself. A combination of a healthy diet, regular exer- cise, and plenty of sleep helps relieve stress. Helping profes- sionals and childbirth educators can be professional assets for teenage parents in introducing an innovative curriculum that focuses on strengths, resources, support networks, healthy choices, and parenting responsibility.

Summary It is essential that teens get involved in childbirth educa-

tion classes that are specifically developed for the teenage population. These classes can teach teenagers vital informa- tion concerning pregnancy, good nutrition, and a healthy lifestyle, as well as the processes of giving birth and the factors involved in being a parent. Classes like this can also act as a support group.

Commitment is a powerful internal strength. When one commits to something, he/she is embracing the ability to do things we would not ordinarily do. Just a short time ago a teen’s biggest concerns might have been hanging out with her friends and wondering what clothes to wear. Now she is dealing with morning sickness and scheduling prenatal visits, factors which can lead to a new type of stress.

Most unmarried teens do not plan on becoming preg- nant, and they are often terrified when it happens. Many, particularly younger teens, keep the news of their pregnan- cies secret because they fear the anger and disappointment of their parents. Some might even deny to themselves that they are pregnant — which makes it even more important for parents to step in and find medical care for their teen as early in the pregnancy as possible. Younger teens’ pregnan- cies, in particular, are considered high risk because their bod- ies have not finished growing and are not yet fully mature.

Teenage boys who are going to become fathers also need the involvement of their parents. Although some boys may welcome the chance to be involved with their chil- dren, others feel frightened and guilty and may need to be encouraged to face their responsibilities and be supported to not only face their responsibilities but learn to be positive fathers. Further research needs to be explored in this arena. We as helping professionals and childbirth educators can

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prove invaluable to teenage parents by giving them support and life skill tools so they can flourish as positive parents.

Some steps childbirth educators and helping profession- als can assist with are promoting the childbearing experience as a normal, natural, healthy process to reduce anxiety and stress. Also educators can assist teenage mothers to discover the importance of modeling a healthy lifestyle through exer- cise, diet, time management, and study habits. In addition, educators and professionals can teach coping strategies to the new mother and her family and supports that facilitate normal, natural, healthy pregnancy, birth, breastfeeding, and early parenting. It is important that in providing support, cultural sensitivity concerns be acknowledged. In conclu- sion, these adaptations by childbirth educators and helping professionals can strengthen the teenage mother’s confidence in moving forward physically and mentally in her successfully reaching her life goals as parent and continuing student.

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Basch, C. E. (2011). Teen pregnancy and the achievement gap among urban minority youth. Journal of School Health, 81(10), 614-618. doi:10.1111/j.1746- 1561.2011.00635.x

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Dr. Joshua Kirven is an educator, practicing social worker and community consultant in the areas of community-based care, strengths-based intervention and inclusion practices. He contin- ues to work with communities, municipalities, schools, health centers, child welfare agencies and non-profit organizations. Dr. Kirven is currently an Assistant Professor in the School of Social Work at Cleveland State University.

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