Negotiating motherhood: the struggles of teenage mothers

AIMS: This article presents the results of an ethnographic study exploring how teenagers negotiated motherhood. The main aims of the study were to explore how the young women negotiated motherhood and how they constructed their own identities and relationships through teenage parenting. BACKGROUND: Approximately 10% of all births occur to teenage mothers worldwide. This phenomenon is of concern because teenage mothers are reported to be disadvantaged financially, educationally, and cognitively in both the short and long term. Many teenage mothers find strength and fulfillment in their motherhood role but this does not come without cost to themselves or their children, as many teenagers are considered unsuitable to be parents and do not have adequate support. DESIGN: This interpretive study incorporated ethnographic practices and was guided by feminist principles. After ethical approval from the university, data was collected over a 12-month period from five homeless Australian sole-supporting teenage mothers. Methods used included observation, interviews, field notes, journalling, and discussions with key informants. FINDINGS: The five participants described stories of disrupted lives, unhappiness in childhood, turmoil during adolescence and a need to find love and connection in their lives. Analysis of the data revealed four major themes; transforming lives and opportunities for change, accommodating the challenges, tolerating the abandonment of supports and living publicly examined lives. CONCLUSIONS: It was concluded that becoming a sole-supporting mother during the teenage years was a difficult struggle for the young women, because of their youth, their lack of preparation for motherhood and their reliance on welfare supports. In addition, they experienced negative public attitudes directed towards them wherever they went, and this included their visits to community child health centres. Recommendations are made for nurses to take a different approach when working with teenage mothers to help ameliorate the negative impact of poor parenting.     

瘢痕子宫再次妊娠待产妇心理健康状况评价及其影响因素

目的探究瘢痕子宫再次妊娠待产妇心理健康状况及其影响因素。方法选择医院2016年11月—2019年11月收治的瘢痕子宫再次妊娠待产妇90例,根据待产妇心理健康状况评分,分为心理健康状况较差组20例,良好组70例。借助一般资料量表调查基础信息,选择症状自评量表(SCL-90)调查其心理健康状况,通过多因素Logistic回归分析筛选瘢痕子宫再次妊娠待产妇心理健康状况的影响因素。结果调查结果显示,瘢痕子宫再次妊娠待产妇心理健康状况评分为145.48±12.12分,总体心理健康状况良好。单因素分析显示,年龄、家庭经济水平、孕期身体状况、孕期并发症、妊娠反应、睡眠质量、社会支持、家庭关怀度、负性生活事件、不良妊娠经历、周围朋友瘢痕子宫再次妊娠不良妊娠结局对瘢痕子宫再次妊娠待产妇心理健康状况影响比较差异具有统计学意义(P<0.05);经多因素Logistic回归分析发现,瘢痕子宫再次妊娠待产妇心理健康状况的影响因素有孕期并发症、不良妊娠经历、负性生活事件、周围朋友瘢痕子宫再次妊娠不良妊娠结局、睡眠质量差、社会支持不足、家庭关怀度低(P<0.05)。结论瘢痕子宫再次妊娠待产妇总体心理状况良好,但仍有部分患者心理健康状况较差,且其影响因素复杂,临床应据此确定护理方案,强化护理干预。     

A follow-up case study on teenage pregnancy: "havin' a baby isn't a nightmare, but it's really hard"

Two adolescent mothers who participated in a previously published study on teenage pregnancy agreed to participate in follow-up interviews in their homes about 1 1/2 years after giving birth. A naturalistic, qualitative case study approach was used to examine the participants' views and perceptions related to adolescent pregnancy and childbearing. Both mothers reported general satisfaction with their lives as young mothers, but indicated that their attitudes about early maternity changed once they experienced the day-to-day realities of motherhood. Overall, the participants adequately managed single motherhood with support from family. Regrets and hopes for a better future, mended and broken relationships, and thinking about and avoiding or engaging in fighting behavior were themes that emerged from the data. In addition, some of the findings of this case study were compared and contrasted with the initial study (Spear, 2001), and implications for practice and research are discussed.     

A qualitative study of depressive symptoms and well-being among first-time mothers

Scand J Caring Sci; 2012; 26; 458–466 A qualitative study of depressive symptoms and well‐being among first‐time mothers Background and aim: Ten to 15% of women experience postpartum depression. First‐time mothers are particularly at risk. The present qualitative study aimed to gain insight in terms of why some women find the transition of becoming a mother to be so emotionally taxing that they feel some level of depressed mood, while others feel mostly content after having a baby. Method: Semi‐structured interviews were conducted with 12 self‐selected first‐time mothers. Participants described their pregnancy and birth experience, expectations and experiences with regard to the postpartum period, social support and what they considered important with regard to well‐being and depression in the postpartum period. Data were analysed by means of thematic analyses. Ethical approval was granted by the Regional Ethics Committee. Results: Two approaches to motherhood emerged, which we refer to as ‘relaxed’ and ‘controlled’. These approaches influenced how the mothers had envisioned the postpartum period, their need for mastery and how they experienced it emotionally. Social support and managing breastfeeding stood out as important with regard to well‐being and depressive symptoms. Conclusion: Frequent consultations with midwifes and public health nurses during the pregnancy and the postpartum period gives unique opportunities for preventive work. The consultations should to a greater extent focus on the woman’s expectations and needs, and the partner should be present for an open discussion on how they best support each other in this vulnerable period.     

The decision-making experience of mothers selecting waterbirth

Waterbirth has been a way of birth for 20 to 30 years abroad, while in Taiwan, only in the past three years have some women chosen water birth. This study aims to explore the decision-making experience of mothers selecting waterbirth. A phenomenological approach was employed in this study. Nine mothers who had given birth in water successfully in the midwife clinic in the past year were chosen and one-by-one, face-to-face interviews were conducted. The research tools included a basic information questionnaire, a semi-structured and open-ended interview guide, and an audio recorder to record the entire interviews. The content of the interviews was faithfully transcribed and analyzed with Giorgi's phenomenological method and Lincoln and Guba's qualitative credibility. Four main concepts concluded from the experience context of the studied women were: (1) Dissatisfaction with existing obstetric practices; (2) Demonstration of autonomy; (3) Consideration of relatives' attitude; and (4) Employing strategies to achieve goals. The result of this study can help nursing staff and the public to understand the decision-making experience of mothers selecting waterbirth, and help the contemplation of health care providers with respect to furnishing a more humanized birth environment in hospitals.     

Health literacy and the information needs and dilemmas of first-time mothers over 35 years

Aim and objectives. This paper aims to highlight the information‐based dilemmas of a particular group of healthcare patients, first‐time mothers over 35 years. Background. In recent years, there has been a proliferation of health‐related information and a move towards greater public access to health information as an important step towards patient education and empowerment. Information technologies, such as the Internet, have added considerable momentum to this trend. Many health professionals now consider the provision of detailed health information to patients as requisite for informed decision making. Within the literature there is some emphasis on the importance of patient understanding of information received; however, to date, few studies have considered information over‐consumption as problematic. Methods. Using in‐depth interviews, a sample of 22 first‐time mothers over 35 years was interviewed over three junctures: 35 weeks gestation, 10–14 days postpartum and six to eight months postpartum. Three focus group interviews of midwives and maternal and child health nurses were also conducted. This paper was undertaken as part of a larger project to evaluate the experience of first mothering over 35 years. Results. Mothers in this study were found to have access to large volumes of health information. This tendency was driven by both the women and the health professionals who cared for them. Midwives and maternal and child health nurses revealed a tendency to provide older first‐time mothers with considerable health information of a medical orientation, understanding that this is what the women required. However, despite common perceptions of empowerment, the consumption of medical‐type information proved frightening and many mothers described feeling overwhelmed by ‘knowing too much’. Conclusion. This study contributes to the limited understanding of the information needs of a growing group of childbearing women, first‐time mothers over 35 years. By providing an insight into the ‘downside’ of extensive health information, nursing staff, in particular, may consider the amount and type of information they distribute. Some suggestions are offered to health professionals to ameliorate the information‐based dilemmas of these women. Relevance to clinical practice. As the number of childbearing women over 35 years continues to grow, it is important for health professionals to understand the particular needs of this group. In doing so, doctors, midwives and maternal and child health nurses may be in a position to provide more meaningful maternal support.     

Community perspective on a model to reduce teenage pregnancy

DESIGN: Qualitative methodology was used to validate elements of an educational career youth developmental model (ECYDM) to reduce teenage pregnancy among African American teens in two inner city urban communities. The specific aims of the study were to gain understanding of the factors contributing to teenage pregnancy and to identify a pregnancy prevention programme relevant to the needs of African American youth. METHODS: Data were collected from a convenience purposive sample of 43 African American teens and adults. Teen participants included males and non-pregnant, pregnant, and parent females. Adult participants included parents, school staff, and community clergies. Data were collected using demographic questionnaires, structured individual and focus group interviews. Approval from the Institutional Review Board was obtained before conducting the study. FINDINGS: Findings supported elements of the ECYDM as a pregnancy prevention programme for African American teens in inner city urban communities. Participants identified an educational-career motivational programme that utilizes mentoring to teach, counsel, and provide information to improve youths' health, education, career, and social outcomes as the pregnancy prevention programme for youth in urban communities. CONCLUSIONS: These findings have important implications for future programme design and research. Teenage pregnancy must be addressed within the context of the individual, family, and community. Community partnership and collaboration of resources is necessary to reduce teenage pregnancy. Educational-career programmes are needed to provide information and knowledge to young men and women to make sound informed decisions. Continued qualitative research is also needed to gain understanding of pregnancy prevention programmes.     

Healthy babies for mothers with serious mental illness: A case management framework for mental health clinicians

Women with a serious mental illness (SMI), notably schizophrenia, bipolar disorder, and personality disorders are considered high risk for adverse pregnancy and birth outcomes, which in turn, are associated with poor neurodevelopment in the child. Failure to access antenatal care, poor adherence with folate supplementation, an unhealthy lifestyle, and inappropriate health decisions can contribute to poor outcomes. Many women with SMI continue contact with mental health services while pregnant. This primary prevention project aimed to develop a framework for community mental health clinicians to improve the reproductive health outcomes for women with SMI. The consultation process involved discussions with key stakeholders, an environmental scan to determine current service delivery issues, a literature review, and individual and group interviews with community mental health clinicians, consumers, general practitioners, and midwives. Three key elements underpin the framework: early detection and monitoring of pregnancy, providing reproductive choices, and implementing a ‘small known team approach’ in the management of the pregnant client. Specific modules within the framework focus upon establishing a professional support network, assessing the risk of pregnancy, the early detection of pregnancy, monitoring during pregnancy, preparing for birth, and planning for the postnatal period. Implementation of the framework has the potential to significantly improve obstetric and neonatal outcomes for this high‐risk group.     

The effect of school-based health clinics on teenage pregnancy and parenting outcomes: an integrated literature review.

Teenage pregnancy outcomes have become an increasing concern in the United States. Education and support of pregnant teens are critical factors that may determine good or poor pregnancy outcomes. Poor outcomes may include low birth weight, developmental delays, and poor academic performance. Although the number of teenagers experiencing pregnancy and parenting has declined in the U.S., school-based health clinics can be used to provide support and guidance designed to avoid the negative outcomes associated with teenage pregnancy and parenting. By having school-based health clinics, nurse practitioners and school nurses can provide much needed services to pregnant and parenting teens. These services should include educational support, counseling, and community resources. This inquiry provides a metasynthesis of the literature and will review, examine, and summarize the literature relating to the effect of school-based clinics on teenage pregnancy and parenting outcomes.     

孤独症儿童母亲心理健康状况的质性研究

目的了解孤独症儿童母亲的心理健康状况。方法采用质性研究中的现象学研究方法,对14名孤独症儿童的母亲进行深入访谈,并用现象学分析方法进行资料分析。结果提炼出3个主题:心理接受过程漫长而复杂,负性心身体验,不断调整以适应变化。结论孤独症儿童母亲的心理健康状况不容乐观,应采取针对性的干预措施,改善其心理健康状况从而促进孤独症儿童康复。     

The meaning of guilt and shame: A qualitative study of mothers who suffer from eating difficulties

The aim of this study was to illuminate and interpret guilt and shame expressed by mothers with eating difficulties (ED). The research question was: What is the meaning of guilt and shame experienced by mothers with ED? Experiences of guilt and shame in mothers with ED may be strong, yet concealed, and should be addressed when promoting women's mental health. The study design was explorative, and in‐depth interviews were conducted with eight mothers suffering from ED. The data were analysed by means of qualitative content analysis and interpreted according to a hermeneutic approach. The main theme ‘Struggling in silence with guilt and shame as a mother living with ED and trying to keep it secret’ was interpreted on two levels: emotional, ‘Feeling worried about failure and wanting to be successful’, and cognitive, ‘Having condemning thoughts about one's own sense of responsibility’. In addition, each theme contained two subthemes. Feelings and awareness of guilt and shame are strong; they vary between individuals and are intensified in mothers who suffer from ED. It is important for mental health nurses to help mothers with ED articulate such feelings in order to promote health.     

Developing a caregiving tradition in opposition to one's past: lessons from a longitudinal study of teenage mothers

Although teenage mothering has been exhaustively studied, the cross-sectional designs and the deficit-finding focus of empirical-rational studies have exaggerated the negative consequences of an early pregnancy and have obscured how teenage mothering is often a rite of passage to adulthood, particularly in the absence of middle-class resources and aspirations. In examining the experiences of young mothers, an 8-year longitudinal study sought to understand how teenage mothers extend and develop family caregiving traditions. The original sample included 16 families and 39 subjects. Multiple individual and family interviews were conducted once the teen's first-born infant reached 8 to 10 months of age, and then 4 and 8 years later. Data from all three study periods were analyzed using the interpretive method. The following analysis provides an in-depth account of how young mothers with an oppressive past strive to become the parents they want to be. In addition, the teen mother's difficulties and struggles of creating a more positive maternal legacy and the role that positive and negative examples of parenting play in fostering or hindering the development of a new caregiving tradition are described. Study findings have implications for how clinical practice and social policy can better assist mothers to become the mothers they want to be.     

Family and community support to adolescent mothers in Swaziland

BACKGROUND: Early pregnancy and unplanned childbirth have far-reaching physical, psychological and social consequences to the adolescent girl and her offspring and is therefore a public health problem for concern. At Mbabane Government Hospital 25% of the deliveries are by women aged 10-19 years. Little has been documented about family and community support for adolescent mothers in Swaziland. AIM: The aim of this study was to generate more systematic data on support to adolescent mothers and their newborns during the early postpartum period by families, communities and health professionals. METHODS: Thirty-one adolescent mothers were recruited from Mbabane Obstetric Unit after childbirth and were visited in their homes 7 days after delivery and interviewed about the family, community and health professional support experienced for themselves and their newborns. A semi-structured interview guide was used to obtain both quantitative and qualitative data. FINDINGS: Support from families, community and health professionals were generally poor, and pregnancies among adolescents were unplanned. There was poor or no communication, and information from parents and the community on sexuality and reproductive health had been grossly lacking. Peers were the primary source of information about sexuality and reproduction. Communities did not offer services aimed at providing adolescents with information and skills regarding safe sexual behaviour. CONCLUSIONS: Adolescents need contraceptive counselling and services in order to prevent pregnancies at a young age. Communication among parents and their daughters needs to be encouraged in order to monitor postpartum care and also to ensure continuity of maternity care.     

Anglo-American mothers and the prevention of postpartum depression

The purpose of this study was to assess for postpartum depression prevention activities of a group of 20 Anglo-American mothers who had given birth within the last year and who denied having postpartum depression. Results of open-ended interviewing and qualitative analysis indicated that in addition to the women being able to articulate a prescribed postpartum period, they also were the beneficiaries of protective measures and rituals, some degree of social seclusion, rest, assistance with tasks, and social recognition of their new social status as a mother. These results underscore the importance of social support for the prevention of postpartum depression and the need to educate mothers, families, and health care workers on their use and value.