Health risks and psychosocial outcomes of early childbearing: a review of the literature.

This article presents a review of the literature on the obstetric, medical, and neonatal health risks as well as psychosocial outcomes associated with early childbearing. An important concern in adolescent pregnancies is the increased risk for infant morbidity and mortality as a result of higher incidence of preterm births and low-birthweight infants. Implications for prenatal and postpartum nursing care are discussed. Promising new models to improve care of young mothers and their children, such as home visitation by public health nurses, are presented and features of successful intervention programs outlined.

Secondary data analysis: new perspective for adolescent research.

Adolescents are at high risk for preventable health problems, but realities of research funding and obtaining data from large samples make it difficult for many researchers to answer important questions. Secondary analysis of existing data sets is described as a reasonable alternative in spite of its limitations. Methods and available resources are identified along with suggestions for research priorities with adolescents.

A public health nursing early intervention program for adolescent mothers: outcomes from pregnancy through 6 weeks postpartum.

BACKGROUND: Adolescent pregnancy and parenting remain a major public concern because of their impact on maternal-child health and on the social and economic well-being of the nation. Federal welfare reform legislation has created an urgent need for community-based nursing intervention programs to improve health and social outcomes for disadvantaged adolescent mothers and to promote their self-sufficiency. OBJECTIVE: To evaluate the effects of an early intervention program (EIP) that uses a public health nursing model on health and social outcomes of adolescent mothers and their children and on the quality of mother-child interaction. METHODS: Pregnant adolescents referred to a county health department were randomly assigned to an experimental (EIP) or control (traditional public health nursing [TPHN]) group. The sample included 121 adolescents from predominantly minority and impoverished backgrounds who were followed from pregnancy through 6 weeks postpartum. Intense and comprehensive home visitation by public health nurses and preparation-for-motherhood classes were provided to adolescents in the EIP. Health outcomes were determined on the basis of medical record data. Other measures included maternal self-report on selected behaviors, nurse interviews, and the Nursing Child Assessment Teaching Scale (NCATS). RESULTS: Early findings indicate reduced premature birth and low-birth-weight (LBW) rates for young mothers receiving both forms of public health nursing care. No significant differences between groups were found for infant birth weight or type of delivery. Infants in the EIP had significantly fewer total days of birth-related hospitalization and rehospitalization than those in the TPHN group during the first 6 weeks of life (chi2(1) = 6.41; p = 0.01). Adolescents in the EIP demonstrated significantly more positive educational outcomes (e.g., lower school dropout rates) than those in the TPHN group (chi2(1) = 6.76; p < 0.009). CONCLUSIONS: The early findings of this study demonstrate that pregnant adolescents benefit from both traditional and more intense public health nursing care in terms of prenatal and perinatal outcomes. The EIP was associated with decreased infant morbidity during the first 6 weeks of life and decreased maternal school dropout. Long-term outcomes for the EIP are being evaluated.

The impact of physical or sexual abuse on chronic depression in adolescent mothers.

This longitudinal investigation explored the impact of a childhood history of physical and sexual abuse on perinatal depressive symptomatology, suicide attempts, and maternal behavior in an ethnically diverse sample of 95 adolescent mothers. Maternal role attainment theory and the cognitive-interpersonal theory of depression provided the conceptual framework for this study. This investigation helps to expand theory on adolescent maternal role attainment by identifying a relationship between history of abuse, depressive symptoms over time, and maternal role behavior problems. Findings do not indicate that a history of childhood maltreatment alone increases a young mother's risk for maternal-child interaction problems.

Depressed adolescent mothers' perceptions of their own maternal role.

Although there is a growing body of research in the area of adolescent pregnancy and parenting, little is known about the more personal experiences of these teens. Ethnographic research methods were used in the present study with the goal of narrowing existing gaps in knowledge about the affective component of adolescent mothers' role attainment. The sample consisted of 15 voluntary informants who reported depressive symptoms during pregnancy or postpartum. The findings suggest that for some adolescent mothers the experience of motherhood may help them improve their previously self-destructive lives. Many adolescent mothers have engaged in impulsive high-risk activities prior to their pregnancies. Through the establishment of a maternal identity and simultaneous development of a strong sense of maternal protectiveness these young women are making realistic, future-oriented decisions that are motivating them to leave gang life, finish high school, go to college, and get vocational training. However, a subset of adolescent mothers who experience chronic depressive mood along with social isolation in the postpartum period may be at increased risk for development of problematic maternal behaviors.

Strategies for reducing the risk of malpractice litigation in perinatal nursing.

Perinatal nurses are involved in malpractice litigation most often as employees of a hospital being sued. Contemporary case examples from malpractice claims provide the foundation for examining how perinatal nurses can become the focus of such litigation. Increasing demand for individual nurse accountability, cost containment strategies that require nurses to broaden their scope of practice and to supervise unlicensed assistive personnel, increasing use of medical technologies, and the reality of compromised newborns and unexplained outcomes place perinatal nurses at risk for continued malpractice vulnerability. Specific strategies for risk reduction can be used by the individual nurse and the institution in relation to hospital policies and procedures, application of the nursing process, documentation, birth videos, and delegation of tasks to unlicensed assistive personnel.

An early intervention program for adolescent mothers: a nursing demonstration project.

OBJECTIVE: To improve health outcomes in a vulnerable population of adolescent mothers and their infants. DESIGN: Effects of an intensive early intervention program (EIP) are compared with those of traditional public health nursing (TPHN) care. SETTING: A large California county with urban and rural communities, an ethnically diverse population, and a high teen birth rate. PARTICIPANTS: One hundred twenty-one young mothers and their children from impoverished and predominantly minority backgrounds. INTERVENTIONS: During pregnancy and through 1 year postpartum, participants (n=63) in the EIP were provided with 4 prenatal classes and approximately 17 home visits by specially trained public health nurses. Interventions addressed health issues, sexuality and family planning, life skills, the maternal role, and social support systems. Participants in TPHN (n=58) received three home visits (for intake, prenatal care, and postpartum/well-baby care information). MAIN OUTCOME MEASURES: Antepartum, intrapartum, and newborn medical records; maternal responses to written questionnaires; and nurse interviews. RESULTS: Early program outcomes indicate reduced premature birth rates for both groups compared with national data on adolescent mothers, and fewer days of infant hospitalization during the first 6 weeks postpartum for the EIP participants. CONCLUSION: Public health nurse care (both traditional and intensive) significantly improved perinatal outcomes; the intensive intervention significantly reduced the number of infant hospitalization days.

Evaluating the outcomes of parent-child family life education.

Conducted in diverse sociocultural communities in Los Angeles County, the project implemented and evaluated a family life education program designed to prevent the negative outcomes of risky sexual behavior. A sample of 251 male and female early adolescents 9 through 14 years of age participated with their parents in this abstinence-based adolescent pregnancy prevention program. The project sought to improve parent-child communications and delay the onset of sex-related behaviors through direct involvement of parents in the education process. Naturally occurring community groups were randomly assigned by site to treatment or delayed treatment conditions in a longitudinal quasi-experimental evaluation design. The evaluation demonstrated significant improvements in communication between parents and children immediately following the intervention; however, these improvements were no longer present 12 months postintervention. The process and outcome evaluation methods employed in the study triangulated qualitative and quantitative data collection and analysis procedures. This combination provided other sources of data than the traditional outcome measures used in most evaluation studies, thus addressing some of the gaps in present program evaluations. Descriptions of the process evaluation, integrated with the outcome data, are intended to heighten nurses' awareness of the importance of this component of research and the rich qualitative data it may yield. The qualitative process components in the project captured the experience of the investigators when they encountered many of the complex challenges that confront researchers who implement and evaluate family life education programs among early adolescents. This experience provided the basis for suggested strategies that nurse clinicians and researchers can use in their work with early adolescents and their parents in clinical-, school-, and community-based settings.

"Sometimes you don't feel ready to be an adult or a mom:" the experience of adolescent pregnancy.

PROBLEM: To obtain a description of pregnant adolescents' responses to the preparation for motherhood class curriculum. METHODS: The design of this study was based in the anthropological tradition of qualitative research, ethnography; N = 36. FINDINGS: Within one category identified in this study, maternal role, three primary themes emerged: responsibility, respect, and reparation. CONCLUSIONS: The findings of this study indicate that for some adolescents, pregnancy implies a desire and an opportunity to heal childhood wounds if relevant psychotherapeutic interventions can be provided. Nurses can identify pregnant teens who are already suffering with depression and encourage them to seek counseling prior to the birth of their baby before they are experiencing the added stressors inherent in new motherhood.

AIDS risk behaviors, knowledge, and attitudes among pregnant adolescents and young mothers.

This study assessed AIDS risk behaviors, knowledge, and related attitudes of pregnant adolescents and young mothers (n = 151). Results revealed that a substantial portion of the sample engaged in sexual behaviors (e.g., unprotected sex and multiple sex partners) that increased their risk for acquiring HIV and possibly transmitting the disease to their children. Knowledge about major modes of HIV transmission was high; however, commonly held misconceptions were expressed concerning the spread of disease and methods of prevention. Results suggest that neither the experience of having an unplanned pregnancy nor knowing about HIV transmission was a sufficient motivator to reduce risk behaviors in this sample.

Evaluation of a reduced-frequency prenatal visit schedule for low-risk women at a free-standing birthing center.

OBJECTIVE: to evaluate the effectiveness of a reduced-frequency prenatal visit schedule by comparing perinatal outcomes, anxiety and maternal satisfaction with prenatal care. METHODS: pregnancy outcomes of infant and maternal morbidity and mortality, anxiety and satisfaction for 81 women receiving prenatal care at a free-standing birthing center according to either an alternative prenatal care visit schedule (APCVS) (n = 43) or the traditional prenatal care visit schedule (TPCVS) (n = 38) were examined in this prospective randomized study. Upon entry into prenatal care, all women were of low obstetrical risk status. RESULTS: major findings revealed no significant differences in selected perinatal outcomes between the two study groups. Women in the APCVS group reported significantly higher levels of satisfaction than women in the TPCVS group on both the satisfaction with provider subscale (F = 5.74, P = .02) and the satisfaction with the prenatal care system subscale (F = 2.01, P = .04). There were no statistically significant differences found in anxiety scores between women in the two study groups. CONCLUSIONS: low-risk women who followed the reduced-frequency visit schedule experienced no difference in perinatal outcomes or anxiety. Women in the reduced-frequency (APCVS) group reported an increased level of satisfaction with both provider and the prenatal care system.

Expanding horizons: from bedside nurse to expert witness.

Opportunities for perinatal and neonatal nurses to serve as expert witnesses are expanding, particularly in the area of medical malpractice. The article presents an overview of the role and qualifications of the nurse expert in medical malpractice cases. The phases of involvement in the legal process, from review of medical records to testifying in deposition and at trial, are described. Essential information is presented about factors to consider in formulating an expert opinion and strategies for testifying in medical malpractice lawsuits. A description is provided of the types of malpractice cases that may be on the horizon.

The impact of childhood maltreatment on young mothers' violent behavior toward themselves and others.

This report explores the impact of a history of physical and/or sexual child abuse on violent behavior in pregnant youth and adolescent mothers. The sample was composed of 58 pregnant adolescents and 93 young mothers. Logistic regression analyses were used to examine prediction of violent and self-injurious behaviors from presence or absence of childhood maltreatment, substance use variables, and selected sociodemographic factors. Of the subjects, 50% reported a history of child abuse, and nearly 10% reported having made a suicide attempt within the last 12 months. Subjects with a history of abuse were nearly seven times more likely to attempt suicide than those without. Nurses are in a key position to provide comprehensive preventive and health promotion services to pregnant youth with a history of abuse. Health care should include screening to identify victims of violence, evaluation for suicidal ideation and history of attempts, and psychotherapeutic counseling.

Predictors of depression symptoms in pregnant adolescents.

The purpose of this study involving a cross-cultural group of single, pregnant adolescents was to examine the association of depression with self-esteem, social support, discomforts of pregnancy, and selected sociodemographic variables. The sample comprised 62 pregnant adolescents recruited from a residential maternity home. Subjects ranged in age from 14 to 20 years (mean 16.67 years) and were predominantly Hispanic and black. All subjects completed the Center for Epidemiological Studies Depression Scale, Coopersmith's Self-Esteem Inventory, a physical discomfort checklist, and a sociodemographic questionnaire. A high level of depression symptoms was reported by the majority of participants. Nearly two thirds of the young women reported adequate levels of emotional support; however, the remaining subjects claimed inadequate levels. Results of the multiple regression analyses revealed that, of the predictor variables investigated, only the total self-esteem score was statistically significant (p = 0.0001) and explained 32.6% of the variance. In further statistical analysis a multifactor analysis of variance found social support to be a significant variable influencing depression. On the basis of these results, several recommendations for assessment and intervention with similar groups of pregnant adolescents are suggested, including screening for depression symptoms and development of treatment programs for affected youth.

Linkages between sexual risk taking, substance use, and AIDS knowledge among pregnant adolescents and young mothers.

This survey examined the relationships of sexual risk taking to substance use and AIDS knowledge in pregnant adolescents (n = 58) and nonpregnant young mothers (n = 93). Subjects were from predominantly minority backgrounds, were single, and ranged in age from 12 to 20 years (M = 16.64). A number of high-risk behaviors were reported, including substance use during pregnancy and early parenthood, unprotected sexual relations, and multiple (lifetime) sex partners. Current pregnancy status, history of marijuana use, and ethnicity were strong predictors of having had multiple sex partners. Odds ratios suggested that Black adolescents were many times more likely than Whites to have had multiple sex partners. Pregnant adolescents were less likely than young mothers (nonpregnant) to have had multiple sex partners but more likely to have unprotected sex (i.e., without use of a condom). Conversely, young mothers were more likely to have multiple sex partners and less likely to have unprotected sex than were pregnant adolescents. Those with a history of marijuana use were more likely to have had multiple sex partners than were adolescents who had never used this drug. AIDS knowledge was not a significant predictor of high-risk sexual behavior.

PIP: To facilitate acquired immunodeficiency syndrome (AIDS) prevention efforts, the relationships between sexual risk taking and both substance use and knowledge of AIDS were investigated in a sample of 58 pregnant adolescents and 93 teen mothers. The two major sexual risk-taking behaviors reported by subjects were sex without a condom (69% rate at last intercourse) and a history of multiple sex partners (average, 3.2 partners). 77% of teens had used alcohol and 60% had tried marijuana; current use rates were 41% and 23%, respectively. Significant predictors of a history of more than one sexual partner included current pregnancy, Black race, and history of marijuana use; these three variables explained 78% of cases. For unprotected intercourse, the only significant risk factor was current pregnancy (61% of cases). AIDS knowledge did not decrease the likelihood of engaging in either high-risk behavior. Compared to teen mothers, pregnant adolescents were less likely to have had multiple sex partners but more likely to have had unprotected intercourse. These findings provide support for the theory of problem-proneness behavior, which asserts that those who engage in one high-risk behavior (e.g., initiating sex at an early age) are likely to engage in other, ecologically linked behaviors (e.g., marijuana use). Interventions suggested by these results include stopping the progression of substance use (alcohol to marijuana to cocaine) among young mothers before experimentation with intravenous drugs occurs, social cognitive programs addressing hedonistic concerns about condom use, and education about the dangers of transmission of the AIDS virus to both mother and unborn child associated with unprotected sex during pregnancy.

The relationship between parental ratings of child behaviors, interaction, and the home environment.

PROBLEM: What is the relationship between child behaviors as perceived by the mother and father, mother-child interaction, and the home environment? SUBJECTS: A subsample of 28 families of healthy, full-term newborns recruited from a larger longitudinal study. METHODS: Mothers and fathers completed the Eyberg Child Behavior Inventory when their child was 24 months old. NCATS and HOME Inventory were administered. The Neonatal Perception Inventory was previously completed by the mother within 72 hours of birth and at 1 month postpartum. FINDINGS: Significant interparent correlations for intensity of child behaviors; however, the association for behaviors considered to be problematic was not significant. Fathers tended to report fewer behavior problems and less frequent occurrences. Several significant relationships were found between child behavior ratings, interaction, and the home environment. Gender of child and maternal employment status did not significantly influence parental perceptions of child behavior. CONCLUSIONS AND IMPLICATIONS FOR NURSING: While parents may share perceptions of child behaviors, they may differ in interpretation of whether those behaviors are problematic. Administering behavior inventories to both parents may help them identify and respect each other's differing opinions. These same inventories can be used to measure effects of interventions, and are adjuncts to direct behavioral observations of parent-child interaction.

Longitudinal effects of unimodal and multimodal stimulation on development and interaction of healthy infants.

The effects of unimodal and multimodal stimulation on mental, psychomotor, and behavioral development of healthy full-term infants were examined longitudinally. Subjects were randomly assigned to a control group or one of three experimental conditions: daily administration of a stroking procedure, placement on a multisensory hammock during sleep periods, or a combination of the two treatments. Interventions were conducted during the first 3 months of life. Data are presented on 49 infants who were available for 24-month follow up. The experimental conditions did not significantly affect scores on the Bayley Scales of Infant Development. Eyberg's Child Behavior Inventory, the Nursing Child Assessment Teaching Scales, or the HOME. These findings suggest that supplementary stimulation provided no benefits beyond those associated with natural caregiving and raise questions about the value of the interventions with nonrisk infants in middle-class families. Additional studies need to be conducted with larger samples of healthy infants to test sensory stimulation protocols before they are advocated for widespread consumer use.

Risk-taking behaviors and AIDS knowledge: experiences and beliefs of minority adolescent mothers.

Using a qualitative focus-group methodology, this study investigated risk-taking behaviors and AIDS knowledge among minority pregnant and parenting adolescents at risk for heterosexual and perinatal transmission of HIV. Seven focus groups were conducted with a total of 48 young women recruited from alternative schools and residential facilities for pregnant adolescents and young mothers in Southern California. Participants also completed a background questionnaire soliciting sociodemographic information and an AIDS knowledge test. The sample included 33 Latinas and 15 African-Americans, ranging in age from 12 to 19 years. There were bipolar findings regarding risk-taking behaviors. At one end of the continuum were young women with a history of one of more of the following behaviors: multiple sex partners, drug and alcohol use, carrying weapons, and participating in gang-related activities. Contrasting with these, were those who had one or two sex partners and no history of alcohol or drug abuse. A majority of the participants were having unprotected sex. A variety of factors affected condom use, including gender inequality, embarrassment, and personal preferences and values. Risk-taking was also influenced by lack of security and safety in daily living, emotion-focused coping and peer pressure.