Child Having a Child: A Teenage Pregnancy Case Study
Tina: Child Having a Child
Adolescent pregnancy continues to be a major social challenge for the United States. It has the highest rate of teenage pregnancy yearly as compared to other developed nations (Hockenberry, 2003). Adolescent pregnancy occurs across socioeconomic classes, in public and private schools, among all ethnic and religious backgrounds, and in all parts of the country. Tina, is just one of the thousands of teenage girls who have gotten pregnant and had a child. At 15, it cannot be denied that she is still in her transition from childhood to adulthood.
Adolescents are at high risk for preterm labor, probably because their uteruses are not fully grown. Because their own development is still immature, adolescents are prone to cephalopelvic disproportion during labor and birth. Adolescent labor does not differ from labor in the older women if cephalopelvic disproportion is absent (Pillitteri, 2003).
Young adolescents are more prone to postpartum hemorrhage than the average woman because if a girl’s uterus is not yet fully developed, it becomes overdistended by pregnancy. An overdistended uterus does not contract as readily as a normally distended uterus in the postpartum period. Adolescents also may have more frequent or deeper perineal and cervical lacerations than older women because of the size of the infant in relation to their body. On the other hand, young adolescents are generally healthy and have supple body tissue that allows for adequate perineal stretching. If a laceration does occur, it usually heals readily without complication (Pillitteri, 2003). At first, the vaginal discharge is grossly bloody and Tina should not get alarmed by this. Over the next 10 to 12 days, the color of the discharge changes to pale brown and finally to yellowish white. External sanitary pads may be used to absorb the discharge.
The clinical manifestations of the puerperium, the 6-week period following delivery, are numerous and variable but generally reflect reversal of the physiologic changes that occurred in pregnancy. Within the first 24 hours, it is normal for Tina’s pulse rate to drop and her temperature slightly elevated. It is also normal for Tina’s urine to be temporarily increased in volume and may contain protein and sugar. These events are mild and temporary and should not be confused with more serious conditions.
The immediate postpartum period may be an almost unreal time for an adolescent like Tina. Giving birth is such a stress and a major crisis that all women have difficulty integrating it into their life. it may be particularly difficult for the adolescent. The girl may “block out” the hours of labor as if they didn’t happen. Tina should be urged to talk about labor and birth to make the happening real to her; otherwise, postpartum depression can occur (Pillitteri, 2003).
Breast engorgement may become very painful during early lactation when the amount of milk is beginning to increase. Tina’s difficulty in breast feeding could be attributed to this. Analgesia, properly fitting support nursing brassiere, ice packs, and sympathetic competent nursing care will ease Tina’s temporary difficulty. Furthermore, Tina may have to manually express her milk just before nursing to allow the baby girl to get the swollen areola into her mouth. Excessive expression of milk between feedings encourages continued engorgement, therefore this should be done only to relieve discomfort. If Tina decides she is not going to breastfeed because of other reasons provided that the baby will still be properly fed, lactation can be suppressed by a variety of methods. However, nurses and even the whole health care community strongly encourages mothers to breastfeed their baby during the first few months after birth.
Breastfeeding provides optimal nutrition, protection against infection, and a safe, reliable food source for babies--attributes that are critical in emergencies (Barrett, 2006). Given adequate support and encouragement, Tina can nurse her baby girl successfully. The chief contraindication to this would be a lack of desire and interest on the part of Tina. If in the first place the mother does not have the desire to breastfeed the baby, then no amount of encouragement and support can make the mother overcome the difficulties of breastfeeding.
Unfortunately, most adolescent mothers are like Tina, they have difficulty breastfeeding or do not breastfeed at all. This is related to their perception of breast-feeding as something that will “tie-me-down” and the reality (in many instances) that they will be returning to school full-time soon after birth. Education about the importance of breastfeeding and tips for how to incorporate it into a busy lifestyle can increase the number of adolescents breastfeed (Pillitteri, 2003).
Adolescents show the same positive bonding behavior with their infants as their more mature counterparts. They may, however, lack knowledge of infant care. Although they may consider themselves to be knowledgeable in child care because they baby-sat for a neighbor’s child or a younger sibling, they can be overwhelmed in the postpartum period to realize that when the baby is their own, child care is not as simple as it once seemed. When the child cries, they cannot hand it to someone else; at the end of 4 hours, when they are tired of caring for the baby, they cannot leave and walk away.
Teenage pregnancy with early prenatal supervision is considered less harmful to both mother and child. Pregnant teens need special attention to nutrition, as well as health supervision and psychological support. It is important to assess how prepared each family is to care for their infant at home, to be sure the newborn remains safe. Tina, as well as her parents may need to make changes in their routine, such as shifting their usual dinner time or work schedule in order to take care of the newborn. Sleep schedules are certain to be disrupted, because infants wake during the night for about the first 4 months of life.
The nurse and other healthcare professionals should assess if local support organization within Tina’s community is available for referral. It should be suggested that Tina and her parents keep telephone numbers of support groups and lactation consultant available in case Tina needs additional help while she is at school. The rationale for this is that support can go a long way toward preventing a client from becoming discouraged.
A teaching plan is designed to help Tina through her postpartum concerns. Assessment factors to be considered in formulating a teaching plan for a client involves individual, significant others, socioeconomic, cultural, disease, nurse- related, nursing priorities, and discharge goals. On the individual level of Tina’s assessment, her age and emotional response to current situation are to be considered. Family development cycle as well as the marital status of Tina also has to be considered on the Significant others level. On the socioeconomic level, her family’s finances, the employment of family members, and social acceptability of the condition are to be considered. Ethnic background and beliefs regarding caring are cultural factors. Nursing priorities include reducing anxiety or fear, facilitate integration of self-concept and body-image changes, encourage effective coping skills, and promote safe environment/patient well-being.
A teaching plan is developed specifically for Tina’s difficulty on breastfeeding. Out of the many concerns in the postpartum period, this is chosen since proper nutrition is essential for the infant for optimal growth and development, especially in the first few months of life, because brain growth proceeds at such a rapid rate during this time. During feeding, a parent is close to the infant, and a baby is apt to be particularly sensitive to the parent’s demonstration of affection or lack of warmth. An infant who does not experience a warm relationship with a mother may fail to thrive as surely as one who is denied sufficient protein or calories.
Tina and her parents have to be taught how to recognize signs of hunger in a newborn, including restlessness, tense body posture, smacking lips, and tongue thrusting. Otherwise, younger and new mothers usually wait for the infant to cry, and this is actually a late sign of newborn hunger. The teaching plan is designed for Tina yet it also requires cooperation from her parents. At 15 years old, Tina still isn’t mature enough to do things on her own and thus needs the guidance and support of her parents.
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