PREGNANCY To Be or Not to Be

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       To Be or Not to Be
  Prudence Twigg, PhDc, APRN-BC
Adult/Gerontological Nurse Practitioner
            Online Resources
Resource Center for Adolescent Pregnancy
 Prevention (ReCAPP):
 Read section on “Theories & Approaches:
 Adolescent Development”
Read “Beginning too soon: Adolescent sexual
 behavior, pregnancy, and parenthood”
    Teen Sex/Pregnancy Statistics
• A sexually active teen who does not use contraceptives
  has a 90% chance of pregnancy within 1 year.
• 25% of HS 9th grade girls (boys 27%) have had sex
  and 52% of HS senior girls (boys 57%) have had sex.
• 40% of all girls get pregnant before age 20.
• 71% of teen pregnancies are unintended.
• Race/ethnicity, income, family structure together
  account for only 10% of differences in younger teens
  and 3% in older teens.
• US has highest teen pregnancy rate among developed
  countries… probably because we teach abstinence and
  other countries teach birth control
    Pregnancy Outcomes for Teens
•   51% give birth
•   35% choose abortion
•   14% miscarry
•   1% place children for adoption
       Risks of Teen Pregnancy
• Delay in prenatal care
• Poor maternal weight gain, pregnancy
  induced hypertension, anemia, STI
• Associated with
  –   Not returning to school
  –   Increased dependence on govt support
  –   Increased infant mortality
  –   Lower birth weight
         Factors Contributing
          to Teen Pregnancy
• Early initiation of sex
  – Partner > 3 years older (>50% of fathers of
    babies born to 15-17 yo girls are adult men).
  – Sexually active peers
  – Mother or sibling with teen birth
  – Being raised by one parent
• Unprotected sex
        Factors Contributing to
          Contraception Use
• Motivation to avoid pregnancy.
• Believe that unprotected sex will lead to
• Have accurate information about contraception.
• Have positive attitudes toward contraception.
• Believe they can use contraception effectively
  (self efficacy).
• High self esteem.
  Recommendations to Reduce
     Teen Pregnancy Rate
• School based programs
  – Education
     • Abstinence (in public high schools)
     • Contraception
     • STI prevention
  – Distribution of birth control, condoms
Developmental Tasks of Pregnancy
       (Reva Rubin, 1967)
 Safe Passage: prenatal care, avoidance of harmful
   substances, worry
 Ensuring Acceptance of the Child: gender
   preferences, partner issues, female friends and
 Binding into Unknown Child: bonding but
   separation, fantasies, nesting
 Learning to Give of Self: gains/losses
 #1 cause of death of pregnant women is homicide
   (by father)
 Stages of Prenatal Development
• Germinal: 10 days to 2 weeks
• Embryonic: 2 to 8 weeks (~1 ½ inches)
• Fetal: 8 weeks until birth (G&D)

            Prenatal Influences
•   Heredity
•   Maternal Nutrition
•   Maternal Infections
•   Teratogens
    – Radiation
    – Drugs
    – Pollutants
            Nutritional Needs
•   Calories: ~300 higher/day
•   Protein: 1.5 g/kg (compared to 0.8-1g/kg)
•   Calcium: 1000-1500 mg/day
•   Iron: 30-60 mg/day supplementation
•   Folic acid: 400 mcg/day (pre-natal) to
    prevent neural tube defects
                     Mother’s Experience
• Weight gain
   – 1st : 2-4 lbs    2nd& 3rd : ~ 0.8 to 1 lb/week
• Cardiac: heart rate, cardiac output, compression of vena
• Hematologic: blood volume, anemia
• GI: 1st : N/V, 3rd : GERD
• General: fatigue, back pain, urinary frequency, breast
  enlargement, stretch marks, warmth, hemorrhoids, varicose
  veins, constipation, sleep disruption, pica (sometimes,
  eating and craving things that aren’t food)
• Nausea and vomitting during first trimester.
• 3rd trimester, baby pushes up on stomach causing acid reflux
      Parenting After Delivery
“Taking in”: telling the story, interacting with
“Taking on”: care of the baby
“Letting go”: first babysitter, return to work

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