Why are complications more common
in adolescent pregnancy and childbirth? Consequences of pregnancy and childbirth in adolescent girls
MARRIED |
UNMARRIED |
|
| Immediate • More likely to seek or receive ANC • May get safe MTP services • III health or death due to complications of pregnancy,
childbirth and post-partum period, especially birth injuries. Long Term |
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• Less likely to seek or receive ANC • May resort to illegal and unsafe abortions with associated complications. • III health or death due to complications of pregnancy, childbirth and post-partum period, especially birth injuries. • Guilt and depression due to social stigma
• Interruption of education/career |
Care of adolescents during pregnancy, childbirth and the postnatal
period
Adolescent pregnancies and deliveries require much more care than adult
pregnancies and all effort must be made to reduce the occurrence of
problems. This includes early diagnosis of pregnancy, effective antenatal
care, effective care during labour and delivery, and during the postpartum
period.
• Early diagnosis of pregnancy
Health service providers and other adults like family members in more
regular contact with the adolescent, have the shared responsibility
of creating an environment in which she feels able to share information
about her situation, especially if she is unmarried. She may not know
that she is pregnant because she may not remember the dates of her last
menstrual period, or because her periods are not regular. She may even
want to hide her pregnancy or seek ways of terminating it. Being aware
of these issues, and being on the lookout for telltale signs of early
pregnancy such as nausea will help ensure an early diagnosis of pregnancy
so that care is started early and complications are avoided.
• Antenatal care
At least four antenatal checkups are recommended for all pregnant ladies
under RCH Programme. This provision must be especially implemented for
teenage pregnancies because they need extra care.
Many complications can be detected any many can be avoided if the adolescent
is able to access good antenatal services. Pregnancy-induced hypertension
can easily be detected and uncomplicated hypertension can be managed
on an outpatient bsis. In case of more serious complications (such as
pre-eclampsia, eclampsia, and abruptio placentae), referral to a hospital
is essential. Anaemia and malaria too can be detected and treated during
routine antenatal care. Screening for STIs can lead to early treatment,
if required. Iron and folic acid supplements will prevent anaemia to
a large extent. Most importantly, antenatal visits could help identify
those adolescents, who are at risk of preterm labour, though interventions
to address this are limited.
• Antenatal care also provides a valuable opportunity for the
provision of information and counseling support that adolescents need.
This is especially important in the case of adolescents, especially
unmarried ones, because of their greater need for support.
• Counseling during pregnancy
Information and counseling support is the right of every pregnant woman
who reaches a health centre and pregnant adolescents have special needs
and questions and concerns of their own. They must be given an opportunity
to raise and discuss these issues.
Their needs must be matched with competent and sensitive counseling
support in terms o the socio-cultural environment that has to be faced
the options available in terms of the pregnancy; the access to health
services for routine antenatal care and in case of emergency; the danger
signs that need to be aware of, etc.
Counseling should also include care of the newborn including exclusive breast feeding and prevention of an early repeat pregnancy.
Since adolescents are more at risk of STIs including HIV/AIDS, voluntary counseling and testing services should be made available to them.
• Management of labour and delivery
If the pregnancy in an adolescent is normal and with no complications
and anaemia is treated adequately, labour starts at term, and the infant
is in cephalic presentation, labour is not at increased risk.
However, if the adolescent is severely anaemic, postpartum haemorrhage can be a dangerous possibility. In very young adolescents, pre-term labour as well as obstructed labour are more likely to occur. Such adolescents are at high risk and it is advisable to encourage hospital delivery. The family should be advised to make arrangements for transportation to the hospital, when needed.
Besides observing and monitoring, supporting the woman is very important and studies have shown that continuous empathetic support during labour, provided by a technically qualified nurse or midwife results in many benefits both to the mother and the baby.
• Postpartum care
This includes the prevention, early diagnosis and treatment of postnatal
complications in the mother and her baby. It also includes information
and counseling on breastfeeding, nutrition, contraception and care of
the baby. The adolescent mother will require special support on how
to care for herself and her baby.
Contraception: It is very important that too early repeat and unplanned pregnancies should not occur for lack of access to contraceptive services. The postpartum period presents a good opportunity for taking steps towards pregnancy prevention and for promoting dual protection by encouraging condom use.
Nutrition of the mother: the lactating adolescent needs adequate nutrition to meet her own as well as the extra needs required for breast-milk production.
Breastfeeding: WHO has made recommendations concerning breast feeding? A young adolescent, especially one who is single – would require extra support in achieving breastfeeding successfully.
Many adolescents need ongoing contact through home visits on their return with their babies, especially if they are unmarried. In the latter case, both they and the babies are at a higher risk of abuse and maltreatment. Family counseling is therefore vital and provides a lifeline to the adolescent and her baby.
Role of the health sector regarding pregnancy in adolescent girls
Avoid early marriage Work with community
If early marriage
Delay the first pregnancy>
If teenage pregnancy
Take Primitives measure
Make pregnancy safer
Complete ANC
Ensure institutional delivery
Provide postnatal care
SUMMARY
• Many factors contribute to adolescent pregnancy
• Adolescents have higher maternal mortality than adults
• Their babies also have higher mortality
• Many of the complications during pregnancy and delivery have worse outcomes in adolescents
• There are important issues for health-care providers to be aware of in caring for adolescents throughout pregnancy, labour, delivery and the postpartum period
Promoting sage pregnancy and childbearing in adolescence requires concerted actions beyond the health sector, like increasing the social and nutritional status of girls and increasing their access to education and job opportunities
Prevention of pregnancy in unmarried adolescent girls:
Provide health education
• Information regarding problems of pregnancy in adolescents
• Skills to say ‘NO’ to sex by creative thinking eg. Having periods, ignore; value system of family
• Train boys also to respect the decision of the girl if she says ‘NO’
• Inform about contraceptive choices
• Inform about available services and how to access them
• Inform about dangers of seeking help from unskilled people
• When pregnant discuss about the merits of involving parents / guardians in further management