"No, You Need to Explain What You Are Doing": Obstetric Care Experiences and Preferences of Adolescent Mothers With a History of Childhood Trauma.

STUDY OBJECTIVE: To understand the pregnancy and childbirth experiences and preferences of adolescent mothers with a history of childhood trauma in order to develop trauma-informed care practice recommendations for this unique group. DESIGN: Mixed methods convergent parallel design involving completion of the Adverse Childhood Experiences (ACE) questionnaire, a survey of care experiences and preferences during pregnancy and delivery, and a one-on-one interview. SETTING: hHospital-based medical home program for pregnant and parenting adolescents. PARTICIPANTS: Adolescent and young adult mothers aged 12-22 years, receiving care between June 2018 and June 2019. RESULTS: A total of 29 adolescent mothers completed the questionnaire, out of a potential 38 in the program (76.3% participation). Five went on to complete an interview. The average age was 17.9 years (standard deviation 1.8 years). The mean ACE score was 5.1 out of 10, indicating childhood exposure to an average of 5 different types of potential trauma. A total of 19 participants (65.5%) reported being triggered during pregnancy or postpartum. Trauma memories were elicited during vaginal examinations in the clinic (27.6%) and in the hospital (27.6%), abdominal examinations (13.8%), measurement of vital signs (17.2%), and labor (17.2%). Ten participants (34.5%) felt that the providers delivering their baby knew how to help them cope with trauma memories. Themes that emerged included the following: acknowledgment of trauma by provider, avoiding re-telling of story, building a relationship with provider, choice and control in care, and providing coping strategies. CONCLUSION: A majority of adolescent mothers in our sample experienced trauma memories during pregnancy and postpartum medical interactions. Priorities for trauma-informed care in this population are described.

Demographic characteristics and needs of the Canadian urban adolescent mother and her child.

INTRODUCTION: There is a paucity of Canadian-based literature on urban adolescent mothers and their children. To inform clinical assessment and interventions and to mitigate the risks that adolescent mothers and their children face, it is essential to understand the characteristics of this high-risk population. METHODS: A retrospective review of 116 adolescent mothers attending an urban academic hospital-based outpatient clinic in Canada from 2005 to 2009 was conducted. The following information was collected: demographic characteristics, maternal maltreatment history, substance use, postpartum depression symptoms, and child socioemotional and developmental functioning. RESULTS: The mean maternal age was 16.1 years and the mean education level was grade 9. Ninety-nine percent of adolescent mothers were single, 47% had a history of child welfare involvement and 18% had previous involvement with the judicial system. More than one-half of participants reported a history of both maltreatment and substance abuse, and 20% of adolescent mothers scored in the clinical range for postpartum depression. A substantial proportion of children scored in the clinical range for behavioural problems, regulatory difficulties and suspected developmental delays. CONCLUSION: The present study serves to illustrate the high-risk nature of urban adolescent mothers. These observations can be used to improve clinical practice for health care providers in community and hospital-based settings working with this population.

INTRODUCTION: Peu de publications scientifiques canadiennes portent sur les mères adolescentes et leur enfant en milieu urbain. Pour attester les évaluations et interventions cliniques et réduire les risques que courent les mères adolescentes et leurs enfants, il est essentiel de comprendre les caractéristiques de cette population à haut risque. MÉTHODOLOGIE: Les chercheurs ont réalisé une analyse rétrospective auprès de 116 mères adolescentes qui fréquentaient la clinique ambulatoire d'un hôpital universitaire canadien en milieu urbain entre 2005 et 2009. L'information suivante a été colligée : caractéristiques démographiques, antécédents de maltraitance des mères, consommation de substances psychoactives, symptômes de dépression postpartum et fonctionnement socio-affectif et développemental des enfants. RÉSULTATS: Les mères avaient un âge moyen de 16,1 ans et un niveau de scolarité moyen de 9e année. De plus, 99 % des mères adolescentes étaient monoparentales, 47 % avaient déjà été en contact avec les services de protection de l'enfance et 18 % avaient déjà eu des démêlés avec la justice. Plus de la moitié avait des antécédents de maltraitance et de consommation de substances psychoactives, et 20 % obtenaient un score clinique de dépression postpartum. Une forte proportion d'enfants obtenait un score clinique de troubles de comportement, de troubles de régulation et de présomptions de retards de développement. CONCLUSION: La présente étude démontre le haut risque que courent les mères adolescentes en milieu urbain. Ces observations peuvent contribuer à améliorer la pratique clinique des travailleurs de la santé en milieu communautaire et hospitalier qui œuvrent auprès de cette population.