CALIFORNIA STATE UNIVERSITY, NORTHRIDGE
,,TEACHING
PREGNANT ADOLESCENT GIRLS ABOUT HEALTH:
A INSTRUCTIONAL RESOURCE GUIDE
A graduate project submitted in partial
satisfaction of the requirements for the
degree of Master of Pub I i c Hea I th.
by
Gwendlyn Jean Barry
MAY 1975
L
The
project of Gwendlyn Jean Barry is approved:
Committee Co-Chairman
Committee Co-Chairman
California State University, Northridge
May, 1975
ii
······l
DEDICATION
For his encouragement, understanding and love during
the years I went to school, I proudly dedicate this
graduate project to my husband, Dick.
'---------J
iii
TABLE OF CONTENTS
Page
vi
ACKNOWLEDGEMENTS
vii
ABSTRACT
CHAPTER
I.
II•
INTRODUCTION
REVIEW OF THE LITERATURE
9
Societal Attitudes .
9
The Statistical View
.11
The f\do Iescent
13
The Adolescent and Pregnancy
15
Sexuality and Sexual Behavior
16
Causes of Adolescent Pregnancy .
19
Unwed Teenager . . .
23
The Married Teenager
26
Medical Aspects
27
Teen-age Parent
I I I.
..
31
Working With Adolescents .
34
School Programs
37
RESOURCE GUIDE
Use and Features of Resource Guide
41
Content Area:
Reproductive System
44
Content Area:
Prenatal Care .
46
Content Area:
Nutrition . . .
48
iv
'
Page
CHAPTER
III•
IV.
v.
Content Area: Labor and Delivery .•
50
Content Area: PostPartum and Family Planning
53
Content Area: Infant Nutrition . • .
55
Content Area: Care of the Newborn
58
Teacher Resources
60
OVERV IE\v
62
RECOMMENDATIONS . .
66
68
BIBLIOGRAPHY
v
i
ACKNOWLEDGEMENTS
The author acknowledges with appreciation the contributions and
assistance of a II who made this project a rea I ity.
I am grateful to the members of my committee for their encouragement and support:
Dr. L. H. Glass and Dr. S. Eiseman.
A special thanks to many of the staff of the Ventura County
Health Department for their encouragement and assistance.
Thanks and appreciation are extended to the teachers and students
of the Simi Val ley and Oxnard School District Pregnant Minor programs
for their assistance.
My deepest appreciation to my husband, Dick and my children for
their encouragement, understanding and patience.
vi
ABSTRACT
TEACHING PREGNANT ADOLESCENT GIRLS
ABOUT HEALTH:
A INSTRUCTIONAL
RESOURCE GU IDE ·
by
Gwendlyn Jean Barry
Master of Public Health
May 1975
The purpose of this graduate project was to develop a resource
guide for the teaching of pregnant adolescents in the school-age pregnancy programs in Ventura County.
The guide was designed to cover the
basic areas of instruction for education for childbearing and the post
partum period.
The basic and common characteristics of the school-age pregnancy
programs in the County were identified.
Teachers, students and health
professionals were consulted in order to identify the needs of the
students.
Based upon these discussions a rough draft of the curricu-
lum was developed.
The curriculum was field tested in the Oxnard Union High School
District school-age pregnancy program.
.,
The curriculum was then re-
vised .
On the basis of the field trial of the curriculum it was
vii
recommended that: 1) the curriculum be field tested in other programs
in the county, 2) after further testing, the curriculum be evaluated,
3) the curriculum be expanded in the future to cover areas of child-
rearing.
As a result of the field trial the author contends that the
health and education needs of the pregnant adolescent must continue
.to be identified and be the primary focus of any health education
program.
viii
CHAPTER
lNTRODUCTION
For over a decade there has been an increased interest on the
part of educators, health professionals and others in the problems of
the pregnant adolescent.
More and more, school districts are beginning
to recognize the problem and dealing with it by developing educational
services for the girls during their pregnancy.
The trend in recent years has been for the pregnant teen-ager to
plan on raising her child.
adoption.
Fewer girls are putting the child up fot
This is creating a need for the preparation of these girls
for the new roles that pregnancy is putting them into.
The adolescent is a high pregnancy risk with the dual problem of
adjusting to adolescence in addition to pregnancy.
tion through education can be a positive
~actor
the needs of the girls for now and the future.
Primary interven-
in dealing with some of
However, the education-
al program must be designed to fit the needs of the adolescent.
Education for the pregnant female is not a new idea in our society.
Many communities for years have had Preparation for Parenthood
classes available for those who were interested.
But these have been
designed with the married adult couple in mind, a group that is often
better prepared agewise and psychologically for this education.
The pregnant adolescent presents a new chat lenge for the health
educator.
She has a need to understand what is happening to her from
both a physical and emotional standpoint.
But she is not readily
adaptable to the more traditional didactic method of the Preparation
for Parenthood classes.
2
The pregnant adolescent is going through an experience for which
she has had I ittle or no preparation.
She may have I ittle knowledge
of her physical self and no idea of what pregnancy and birth mean to
her and the infant she is carrying.
On April 24, 1969 the Ventura County Study Committee for a Program for Unwed Mothers met.
The purpose of the meeting was to deter-
mine if there was a need to provide special services to unwed pregnant
girls in Ventura County.
The committee was composed of school admin-
istrators, school nurses, the Maternal and Child Health Consultant
from the Health Department, various county agencies and concerned
citizens.
A comprehensive county-wide survey was undertaken to determine if
there was a need to provide special services for pregnant girls in
Ventura County.
The data showed that there was a total of 330 adoles-
cent pregnancies that were known in the 1969 school year.
Ventura County, located northwest of Los Angeles and south of
Santa Barbara, is about one and one-half the size of the state of
Rhode Island.
378,000.
The 1970 Census showed the county's population to be
Of this number 19.7% had Spanish surnames.
The County has
had a relatively young population since about 42.8% of its citizens
are under the age of twenty and 49.9% are under twenty-five.
Current
enrollment in private schools and public elementary and secondary
schools has exceeded 115,000, which is close to one-third of the
County's population.
In October of 1970 the first program for the school-age pregnant
girl opened its doors to students.
This program was located in the
.
community of Santa Paula.
School.
It was administered by the Continuation
By October of 1974, five school districts in Ventura County
had established programs for the pregnant school-age girl.
The pro-
grams in Ojai and Simi Val ley began on February 4, 1971 and are under
the supervision of Adult Education and are both housed in separate
faci I ities.
The program in the city of Ventura began in September,
1972 and is administered by the Educational Services Division, Depart-
ment of Special Services and Programs.
The most recent program to
begin was in September of 1974 in the Oxnard-Port Hueneme area.
It
is administered by the Division of Special Education/Special Services.
Santa Paula Program
This was the first program begun for the school-age pregnant girl
in Ventura County.
The program was designed to encourage the continu-
ing education of students who became pregnant.
The program was to in-
clude academic studies, health, hygiene, nutrition and other topics
relevant to students needs.
Students are advised of the program by the personnel in the local
high school.
Posters describing the program were also put around the
community when the program first began.
The teacher visits the homes
of prospective students before they attend the school in order to get
acquainted with them.
A student may continue in the program after she has delivered
until the semester is concluded.
She then has the option of staying
in the continuation school or returning to regular school.
The school currently has 12 students enrol led in the program. The
classroom is open to visits by students enrol led in the continuation
'
4
school and the atmosphere is warm and informal.
One of the future
goals of the school is to have a nursery available to the students.
Health related discussions are held with the students by the
teacher.
The present teacher has been with the program since the
Spring s.emester 1975 and is working to identify resources in the area
that wi I I be an aid in the health education area.
Simi Va II ey Program
·The Simi Val ley program began in February 1971, it is administered by the Adult Education Services.
there was one teacher.
When
th~
program first started
As the number of students increased, the teach-
ing staff has been increased to two.
The objectives and goals of the school's program are to:
1.
2.
3.
4.
Prevent dropouts
Help girls with their problems
Promote healthy parental attitudes
Provide training that wi I I aid the student in
becoming self-sufficient; thus having an impact
on the welfare rolls.
The Simi Val ley program is unique among the programs in the
County.
Students may stay in the program unti I graduation, if they
wish, or return to their regular school.
-Some of the students who are
currently in the program did nof attend during their pregnancy but
entered after the delivery of the child when they found they had a
conflict in attending school ful-l time and giving time to child care.
This is the only school program which offers nursery service for
the mothers who are in the program.
There is a paid attendant and a
student is assigned each day to work in the nursery.
Since the inception of the program there has been much interest
by the staff in covering various health education aspects for the
5
student.
Outside resources are used to present a variety of topics.
The program has changed over the years.
Since there is almost a half
and half mixture of students who have children and girls who are pregnant1 an effort has been made to meet the needs of both groups.
The
teachers f.eel very comfortable in showing films and having discussions
on prenatal care 1 labor and delivery.
Outside resources are often
used to cover areas such as child development 1 the sick child and other
areas in the health field in which the students have an expressed
interest.
Ventura Program
The Ventura program began in September of 1972.
The main goal of
the program is to provide a comprehensive 1 interim school experience
for girls in the Ventura Unified School District who find themselves
pregnant.
The school program consists of a flexible system of indi-
vidual and smal I group instruction.
Prospective students are advised of the program by school counselors and from other students.
The school has developed and distri-
buted a pamphlet to many areas of the community where there might be
a contact with a prospective student.
Students may stay in the program ti I I the end of the first semester following delivery of the chi I d.
The school does not have provi-
sions for child care 1 although a crib is available for emergency use
by the students.
The school staff feels that it is important to help the student
get back into school when she leaves the program.
They are very
supportive in helping the student achieve this goal.
6
Since the program's inception there has been a public health
nurse from the local health department who has participated in the
health education teaching.
The frequency with which the nurses have
been involved has varied from a weekly basis to once a month.
The
teacher of the program uses films from the health department and holds
informal discussion with the girls when questions arise.
The school staff believes bringing the outside world to the students is important.
Besides public health nurses, other persons
brought to the program have been representati.ves from the district
attorney's office, beauticians and speakers with other vocations.
Crafts are felt to be important for the students as a means of getting
involved and adjusting to the program.
Oxnard Program
This is the most recent program to have started in the County.
Community interest played an important part in getting this program
started after several years of discussion about having a program.
dents are advised of the program by school personnel.
system has some areas that need strengthening.
Stu-
The referral
There has been dis-
cussion of printing a pamphlet about the program, but nothing has been
done to this date.
Students are eligible to stay in the program until the end of the
semester following delivery of the child.
their regular school program.
care.
They are then returned to
The school has no provision for child
This has been a concern during the first semester and is an
identified problem.
Some students from the first class had difficul-
ties in returning to school because of child care problems.
The school
7
district is investigating possible funding to establish a nursery.
The program has included weekly sessions with the public health
social worker.
These are held on an informal basis and may range from
talking about feelings, to asking health questions.
The school uses
films on health related subjects to provide information and stimulate
discussion.
A public health nurse has been involved in the health education
teaching every two weeks the first semester of the program and on a
weekly basis the second semester.
The format is flexible so that stu-
dents questions always take precedence over the planned program.
At
the end of each session, a mutual decision is made about future topics.
As the earlier programs were devetoped the teachers met on a regular basis with Mrs. Georgiana Selstad, then the Maternal and Child
Health Coordinator for the Ventura County Health Department.
The pur-
pose of the meetings was to give the teachers an opportunity to exchange ideas and get support for some of the many social and emotional
problems they encountered with their students.
A tentative curriculum
was prepared by Mrs. Selstad for use by the teachers for health teaching.
These meetings continue to be held, on a irregular basis.
Public health nurses from the County Health Department have been
involved with health teaching in the programs for a period of time. In
the past the two schools that have had the most consistent involvement
with pub I ic health nurses have been in Ventura and Simi.
The frequen-
cy of the visits and the topics to be covered was decided by the individual pub I ic health nurse.
The teachers of the programs offer health instruction to the
8
students; also answer questions as they arise and uti I ize outside resources.
During the past few years health department personnel and teachers
in the programs have expressed a need for a more consistent health education program for the school-age pregnancy programs.
There has been
no effort made in this direction.
The goal of .this graduate project has been to design a core
health education program for Ventura County's school programs for the
pregnant adolescent.
The program design has _Included resources that
were available in the County.
CHAPTER II
REV I Ev/ OF THE LITERATURE
Throughout history, bearing a child out-of-wedlock has placed a
social stigma on the female.
From biblical times through ancient
history and even to the present day, this condition has found I ittle
favor ir the eyes of society.
It is stilI quite apparent that in the present day
the same attitude toward the unmarried mother and
her child as wei I as the unmarried father, either
in their original or derivate forms are retained.
We are alternatively punitive or sentimental, and
the community as a whole is I ittle closer to a real
understanding of the problem . . • In fact if one
observes pub! ic reactions today, one can hardly
escape the conclusion that it is not so much the
sexual relationship to which we object as the fact
of the baby. (50:6)
Personal emotions merging with public considerations, traditional
attitudes and dogmas create the present day setting which confronts
the unmarried mother and determines to a large extent the I imitations
within which the solutions to her difficulties must be sought.
Attitudes toward pregnancy vary with the time and place.
(50:9)
If
pregnancy is considered a normal part of female I ife, why is pregnancy
in school-age girls considered such a problem that American society
must devote study and resources to it?
Prior to the 1930's, the popular explanation reported for il legitimate births was mental deficiency and lack of morality.
During
the 1940's, i I legitimacy was viewed as a cultural phenomenon, restricted to racial, ethnic, or subcultural groups.
During the late
1950 1 s, it was realized that unwed mothers came from all walks of
9
10
I ife, and explanations for illegitimacy shifted to include changed
social attitudes, dating practices, and psychological reasons. (6:451)
Klerman and Keckel in their study of teen-age pregnancies and
school programs noted:
The pregnant school-age girl is a variance with many
of the expectations of the American middle class in
that she chooses to carry the pregnancy to completion
and then keep the baby. The girls who have abortions
or surrender their infants are not penalized permanently.
The 'problem' centers around school-age mothers who keep
their child. For many reasons society has labeled the
pregnant school-age girl and mother as deviant. (24:3)
Subtle factors, including economic and racial ones, place a stigma on early and/or out-of-wedlock pregnancies.
School-age pregnancies
frequently lead to welfare dependency, at least temporarily and often
for a prolonged period of time.
The mother has difficulty in finding
someone to care for the infant if she wishes to attend school or go to
work and difficulty in finding work if she does not have a high school
diploma.
(24:3)
Bernstein has said that a non-marital pregnancy can set in motion
a series of critical reactions in others that require drastic changes
in the day-to-day I iving arrangements for the pregnant girl.
During
the months she is waiting for the baby to be born and unti I she coneludes a plan for him, she may have to I ive by rules that negate many
pf the concepts that are normally considered important in the governing of one's own I ife.
Her identity as a prospective mother, as a
mother and as a woman seem in dubious status.
(4:11)
Shouse reports that abortion is being chosen more frequently and
adoption less frequently as alternatives to having and keeping a baby.
The mother-child dyad is becoming more common and acceptable in alI
11
strata of society; the single mother in alI age groups is less the object of public censure or social stigma.
There seems to be little
question by now that this increasingly frequent choice to keep one's
baby represents a genuine cultural change which is adding another
general alteration in the family unit as a basis of our social system.
(39:161)
THE STATISTICAL VIEW
Braen reported that one out of every four babies born is to a
mother under 20.
One out of eight thirteen-year-aids wi I I become
pregnant out-of-wedlock before the age of twenty.
four eighteen-year-aids is married.
One out of every
Thus the establishment of early
family I ife occurs in a high proportion of our population. (5:361)
Over 200,000 school-age girls give birth each year and their
numbers are increasing by about 3,000 each year.
A very large portion
of these young pregnant school-age girls remain in their own homes
during pregnancy.
homes.)
CNo more than five percent are served by maternity
Further, of the 200,000 school-age girls, only about fifteen
percent place their babies for adoption.
(4:361)
In 1973 the National Center for Statistics reported that more
than 600,000 babies would be born to mothers under twenty.
Of alI the
teenage birth's in the 1960's, an estimated thirty-four percent were
to women sti I I in school (seventeen and under).
In addition, teen-age
women tend to have their children in more rapid succession.
One quar-
ter of the teen-age mothers have more than one child before they reach
the age of twenty. (48:10)
Stepto et al., reported the incidence of maternal mortality has
12
declined in the United States in the past fifty years.
While preg-
nancy and delivery was more than twice as safe for women in 1970 than
in 1950 and more than twenty i"imes as safe than in 1930, the United
States rate is stilI higher than in other advanced countries. (43:131)
When.compared to the infant mortality of mothers twenty to
twenty-four, the infant mortality rate (the number of babies who die
per 1,000 I ive births) is three times as high when the mother is under
fifteen and some thirty percent higher when the mother is between the
ages of fifteen to nineteen.
When the teen-age mother has a second
child, the infant mortality rat9 almost doubles for those mothers
under twenty.
Babies born to teen-age mothers, therefore, have a
poorer chance of survival than do babies born to mothers who are
older.
(48:20)
In 1972 there were 40,171 potentially high risk children born in
California.
These are children born out-of-wedlock.
Assuming this
level remains the same by the time these children reach their eighteenth birthday, they wi I I have been joined by an additional 720,000
children born out-of-wedlock.
(42:131)
Berkov and Sklar in their study of i I legitimate births reported:
Year
15-19
20-24
25-34
1966
1967
1968
1969
1970
1971
1972
12,819
14,440
15,587
17,348
18,888
16,726
17,499
10,303
11,658
13,110
14,557
15,615
13,222
12,056
6,582
6,841
7,177
8,009
8,793
7,887
7,917
13
The number of i I legitimate births has declined from the peak of
1970.
There seems I ittle doubt that this decline is due to the in-
creased use of abortions.
(42:12)
Early childbearing is associated with early marriage, unstable
family
l~fe
and welfare dependency.
One-half of alI teen-age mar-
riages end in divorce, forty percent of alI teen-age births are out of
wedlock, and teen-age mothers have an attempted suicide rate seven
times that of teen-age girls without children.
(12:14)
Ballard has indicated that abortion and .marriage intervene to
reduce the number of out-of-wedlock births far below the actual numbers of out-of-wedlock conceptions.
Both of these solutions are im-
perfect, but often are accepted simply because they seem to be the
lesser of the evi Is avai !able.
Teen marriages especially of the
"shotgun" variety are notoriously unstable.
(2:353)
Osofsky indicated the greatest numeri"cal growth among adolescent
and adult non-white out-of-wedlock deliveries took place during the
late 1940's and the early 1950 1 s, with a slowdown thereafter.
During
the 1950's and 1960's there was proportionately more an increase in
the rate of white than non-white out-of-wedlock pregnancies.
AI I data
concerning out-of-wedlock pregnancies are based on reports of births
occurring out-of-wedlock.
The number of pregnancies conceived
out-~f­
wedlock but legitimized by marriage, escape inclusion in the statistics.
(31:445)
THE ADOLESCENT
At the time of the 1970 Census of Population there was in the
United States approximately 27.1 mi I I ion adolescents between the ages
14
of thirteen and nineteen:
13.7 mil I ion boys and 13.4 mil I ion girls.
(40:27)
Judd stated that adolescence refers not only to the biological
changes but also to psychological maturation and the changes in social
status •. It is a transition period where behavior is characterized by
instabi I ity, unpredictabi I ity and change.
A time where actions and
emotions are often more extreme, more intense and more unpredictable
than· ever before.
(21:466)
Vincent said that adolescence is at present a no-man's land. One
rarely says to the adolescent "why don't you act I ike an adolescent."
Rather one says "stop acting I ike a chi I d, or why don't you act I ike
an adult?"
Yet for about a decade they are in a period of something
cal led adolescence and one really doesn't I ike giving it status and
recognition by saying "act I ike an adolescent."
(15:13)
Our ambivalence is compounded by the·variance in which we accept
when an adolescent becomes an adult.
This ambivalence in our society
contributes in partj to their turning to sexual behavior as one way
in which they can act I ike adults ••• because that is part of the
adult world.
The degree in which they move in this direction is
simply in quest for a meaningful relationship with another person.
(15:13)
Adolescence is and always has been primarily a period of change
in the I ife of an individual.
A time the child becomes an adult,
swinging back and forth from one to another, mixing the characteristics of both.
Physically and emotionally he is maturing and the
force of his feeling has often the punch of a pile driver. (35:93)
LeBarre defined the major tasks of adolescence besides completion
of biological maturation as:
1.
2.
3.
4.
5.
6.
development of self-identity (who am I)
determination of one's sexual iden~ification
attainment of independence and separation
from one's parents
development of personal moral value system
choice of vocation and commitment to work
capacity for lasting relationships; for
tender and genital sex love in a heterosexual
rel_ationship
(25: 16)
THE ADOLESCENT AND PREGNANCY
Howard felt that all girls, married or u·nmarried, white or of
minority groups are high educational, medical, and social risks.
higher the risks the younger the girls.
have stemmed from societal neglect and
The
Other risks not age related
p~nitive
policies and practices.
( 19: 361 )
Davis reported that pregnancy complicates the attainment of developmental tasks for the adolescent.
"The unwanted pregnancy causes
difficulties in the establishment of satisfactory heterosexual relationships, it restricts further options available to the girl and increases the difficulty in breaking the family ties by her need for
help in caring for the chi I d." (10:584)
Bernstein stated "in many respects teen-age unmarried mothers
face the same tasks as do other unmarried mothers."
However, factors
peculiar to this developmental stage often present special problems in
the diagnosis and treatment of the condition.
The pregnant adolescent,
married or unmarried, must deal simultaneously with two developmental
tasks that ordinarily would have occurred in sequence and would have
stretched over a period of several years.
Biologically, her body has
16
to cope with the stresses of pregnancy before it has accommodated itself tully to the demands of puberty.
Psychologically, she has to cope
with the adult task of motherhood while sti I I acculturing herself to
the problems of adolescence.
(4:25)
Semmens indicated that the gravid teen-ager is faced with a
dilemma.
She wi I I have to admit to the tact that she is pregnant and
make the appropriate adjustment or she may attempt to avoid the issue
and seek some other means to deny the eventuality of childbirth.
Runaway, suicide, and abortion are three major means of denial. These
conditions usually occur when the girl feels her family wi I I not
accept nor understand the tact of her pregnancy.
(35:13)
Parents and other adults must remember that it is the adolescent
who is pregnant and it is she who must make the choices and decisions
regarding her pregnancy and her chi"ld.
Choices made during pregnancy
or adolescence can have more decisive and extensive effect on one's
total I ite than choices made at less critical phases in feminine I ife.
Otten these are the first important decisions she has made in her I ife.
She needs patient understanding so she can make reasoned decisions that
reflect her needs and are in the baby's best interests.
Parents of
pregnant adolescents can learn to respect the integrity of their grown
children and be of assistance when realistically possible through
their ongoing vested interest in them.
(39:177)
SEXUALITY AND SEXUAL BEHAVIOR
Settlage reported that evidence from recent studies showed that
considerable numbers of young teen-agers are sexually active and they
are not deterred by the tear of pregnancy or the absence of contra-
17
.
ceptives.
Data showed that many teen-age girls do not attempt to
prevent the sequelae of unprotected coitus; unwanted pregnancy, il legitimacy, forced marriage, interrupted education by seeking contraceptive services.
The request for services usually followed estab-
1ished sexual practice.
(36:225)
Tighe indicated that a major contributory factor to earlier
sexual activity is earlier fertility with many girls reporting menarche at ten or eleven years of age.
For adolescents a normal healthy
curiosity about one's self leads to sexual experimentation.
As sexual
desires begin to develop; a tendency toward experimentation becomes
greater.
(44:207)
Vincent related early sexual experience to what he cal led "the
hypocrisy of our society, in which we inadvertently encourage, if not
explicitly condone, the cause (il I icit coition) and explicitly censure
and condemn the result (il I icit pregnancy)."
sex in the mass media as a means to make a
American society uses
~rofit
and
y~t
is disturbed
when this stimulation increases sexual awareness and activity. (44:5)
Guttmacher stated that he believes that there is a change in the
sexual activity among youth.
He believes that there is more wide-
spread sexual intercourse among high-school and col lege students today
than a decade or two ago.
The greatest change is not that more young
men are involved, but that more young women are involved. (17:48)
Tighe felt that societal objection to sexual activity in the
unmarried is beginning to disappear; the resultant ambiguity is communicated to the adolescent.
Lack of firm standards and guidelines
are particularly difficult for the developing superego to manage and
l
18
probably enhances the earlier sexual experimentation.
Most adolescent
girls are not adequately equipped with physiological, psychological and
sociological facts to grasp the meaning of their own sexuality and its
repercussions for themselves and others.
(44:221)
The. Westinghouse Study indicated that the proportion of sexually
active teen-agers has been increasing in recent years.
Due to igno-
rance and lack of family planning information for pre-pregnant teenagers, girls are becoming increasingly involved in unwanted pregnancies.
fam i Iy
These unwanted pregnancies could
b~
avoided if widespread
pI ann i ng services were readily ava i Iab Ie to a II teenagers.
(47:40)
Jones indicated that going steady obviously is associated with
sexual intercourse and pregnancy.
Within the I imits of their study,
going steady was the only characteristic by which a high-risk group
could be identified.
Family income would hot seem to be useful as
there was an excess of pregnancy in both the high and low income
levels.
The results of the quiz used to measure the subjects know-
ledge of sex demonstrated that about half of the subjects did not
know what the probabi I ity of pregnancy was should unprotected sexual
intercourse occur or what days of the month were fertile days.
These
two points are critical for any girl to know if she wishes to have
sexual intercourse and not become pregnant.
(20:191)
Gordon indicated girls who become pregnant are commonly thought
to differ from other girls in being more promiscuous.
If promiscuity
is defined as having indiscriminate sexual intercourse with a large
number of persons, this allegation is not supported by the evidence.
19
Teen-age pregnancies generally result from relationships of considerable length and stabi I ity rather than from casual episodes of sexual
intercourse.
(15:41>
Kanter and Zelnick, in their study of contraceptive use, reported
that most young women who have had intercourse have used contraception
at sometime.
It appears that
~e--~Acreases,
~~G
for
onH~V-----~--------­
reason or another, did not use a method at an earlier age tend to
begin the occasional use of contraception.
Along with this is the
opposite tendency of those who had consistently used contraception to
have unprotected intercourse on some occasions.
a fair amount of risk-taking.
There is nevertheless,
Of the sexually active fifteen to nine-
teen year-old, fifty-three percent failed to use any kind of contraception the last time they had sexual intercourse, among the youngest
group ..• those under fifteen, the figure reaches seventy-one percent.
(23:21)
CAUSES OF ADOLESCENT PREGNANCY
Semmens has stated that there is no single answer to the question,
"Why are there so many teen-age pregnancies?"
A number of factors
contribute to the problem, including individual psychological conflicts, and insufficient education within the family and community
regarding the role of sex in family I ife.
(35:37)
Miller felt there are stages in a woman's reproductive career
when she is notably vulnerable to unwanted pregnancy.
The first stage
occurs during early adolescence ... when the girl is sti I I subfecund or
sterile.
She is in a transition period between a time when she does
not have to worry about getting pregnant and a time when this
20
potentiality must be a real concern.
During early adolescence when
fecundity is absent or low but contraceptive vigilance is incompletely
developed ... until the girl recognizes and acknowledges the beginning
of her sexual career.
(29:200-1)
According to Shouse, most girls who become pregnant think there
is no correlation between intercourse and pregnancy; no conscious
choice to become pregnant or become a parent.
The girls themselves
often prefer to view the outcome as having "gotten caught" or "I just
came up pregnant."
Even though they may dress and behave in ways
which are I ikely to attract young men, they are surprised and upset
when the outcome is pregnancy.
"Many girls use sex for nonsexual aims
such as gaining love and acceptance; expressing fear and anger about
her past, present, or future; proving her own adequacy as a female;
flaunting her disregard for parental and societal standards .. pregnancy
can be incidental to these aims."
(39:172-3)
Pauker reported that there are certain factors, that make it more
I ikely that one girl wil I become pregnant than another.
These are
largely social factors, such as race or socioeconomic status.
Even
here, however, the effect of these factors is to make the girls more
predisposed to intercourse, not more predisposed to pregnancy.
may seem an obvious point, but it appears its
many researchers."
ob~iousness
"This
is lost on
That girls who become pregnant are specifically
and psychologically motivated toward pregnancy is extremely doubtful.
(15:39)
Connel stated "the unwed pregnant teen-age girl possesses I imited
sex knowledge."
Her pregnancy results from a deep .emotional involve-
21
ment with the punitive father.
Early dating, lack of proper sex educa-
tion, and a lack of parental supervision are significant factors in the
causation of unwed pregnancy.
(8:1840)
Semmens and Lamers classified the causes of pregnancy according to
the degree of conscious participation of the girls.
gories they identified were:
The main cate-
1) intentional ••• when the pregnancy is
desired and plan? are made for conception; 2) accidental .•. conscious
partfcipation is minimal and obvious motivation toward pregnancy for
the purpose of producing a child is unconscious or unclear to the girl;
3) unknowing ... there is no apparent conscious intent of achieving the
state of pregnancy.
(35:13-18)
Klerman classified school-age pregnancies as 1) accidentally
pregnant; 2) the intentionally pregnant; ·3) the indifferent and the
forced.
The strongest hope of prevention he felt lay with the acci-
dentally pregnant.
He pointed out that some psychiatrists feel that
the desire to prove one's feminine identity is so strong that most if
notal I pregnancies are intentional although the thought may notalways be avai Iable to the conscious mind.
(24:5)
According to Abernathy, the high risk of umvanted pregnancy is
associated with a! ienation from the mother and an intimate exclusive
quasi-sexual father-daughter relationship.
In keeping with her aliena-
tion from the mother the high risk individual is unlikely to have
satisfying relationships with other women.
She feels that friendships
with women are not worth much, apparently a reflection of her own low
self-esteem.
Her reportedly most important relationships have been
with men; but often in these interactions feels fearful, dependant and
22
infanti I ized.
(1:6)
In most cases of teen-age pregnancies, according to Gordon, it is
extremely doubtful that the adolescent mother wanted to become pregnant.
Many researchers have attempted to show that pregnant girls are
psychologically motivated toward pregnancy, or have tried to verify
factors, such as promiscuity or specific psychological traits, that
distinguish pregnant from non-pregnant girls.
However, the evidence
has shown that the only trait pregnant teen-agers share, besides
sexual experience, is a lack of knowledge about the reproductive
process and birth control.
The pregnant girl's endeavors to reduce
her present psychological stress, are quite I ikely to result in postfacto rationalizations of her pregnancy, such as saying she actually
wanted to have a chi I d.
(15:37-8)
Pauker has suggested that the results of his studies do not
support the sweeping generalizations about out-of-wedlock pregnancy
often reported in the I iterature.
They offered strong evidence that
girls who become pregnant out-of-wedlock are no different than their
peers in significant psychological ways.
The evidence favored the
point of view that girls who become pregnant out-of-wedlock do not fit
one personality mold, nor do they show striking personality differences from other girls.
(33:63)
Pauker further stated there did not seem to be one explanation as
to the cause of out-of-wedlock pregnancy nor would just a few reasons
cover the entire group of women involved.
Studies seem to show that a
large share of the causation may be ascribed to chance; particularly
among the adolescent girl pregnant for the first time.
"The most
23
parsimonious explanation would seem to be that out-of-wedlock babies
are results neither of the stork nor of a desire for an out-of-wedlock
child, but rather the result of sexual intercourse."
With the occur-
renee of premarital intercourse among teen-agers, and with sexual intimacies often promoted by early dating and going steady there are bound
to be slip-ups in planning, errors in judgment, oversights, impulsive
acts and mistakes based on lack of knowledge.
"How many married wo-
men in this country have had an unexpected and often unwanted I ittle
blessing as the result of an oversight, or of a mistake in counting or
~
of taking a calculated Cor miscalculated risk)?"
(33:66)
THE UNWED TEEN-AGER
Wil Iiams has said that the most salient characteristic of schoolage mothers seems to be their youth.
While this statement seems trite,
the sterotype of "mother" makes it difficult for a great many people tc
envision a high school student in that role, and virtually everyone
seems to have difficulty envisioning elementary school students (some
of whom have babies and keep them) in this role.
mother is I ikely to be
ambival~nt
The school-age
about her relationship with others,
and inconsistent in her behavior and attitudes.
not be particularly wei 1-establ ished.
Her self-concept may
The insecurity is particularly
"I ikely to occur in young mothers who I ive with their parents.
There
appears to be a tendency for the grandmother to take over in caring
for the infant, making it more difficult for the mother to accept
parental responsibility, about which she may already be ambivalent.
(49: 72}
24
In a study of Aid to Financial Dependent Children CAFDC) mothers
the following characteristics were identified as those most common with
unmarried mothers:
The girls do not and cannot plan ahead.
There is almost a complete absence of friendships,
especially among female friends.
The majority of the girls have not had satisfying
school experiences.
The girls give the impression of dullness and
deprivation.
There is an extreme need for mothering.
The girls have no realization of their own
untouched potential for intellectual achievement
and skill.
Sexua I intercourse is an experi"ence that gives
these girls status among their peers.
There is I ittle knowledge about human anatomy
and the way in which the body functions.
Their ideas about marriage indicate that it is
not very important to them. (19:47-8)
1.
2.
3.
4.
5.
6.
7.
8.
9.
According to Young, if one factor can be considered fundamental in
the family backgrounds of unmarried mothers it is the consistent pattern of domination by one parent.
The greatest majority of unmarried
mothers come from homes dominated by the mother.
The basic pattern is
consistent in alI of them although it varies in degree.
The mother is
basically a woman who has never accepted her own femininity and whose
I ife adjustment is a constant struggle against the fact.
(50:40)
Burkhart reported that unwed mothers cannot be described in terms
of personality types, but some studies have indicated certain characteristics.
One of these is that the unwed mother may be combating
acute inner conflicts, in that the girl may have lost identity with a
tam i Iy group.
Pregnancy may be used as a Iever to marriage or a methoc
to retaliate for pent-up frustrations and bel I igerent feelings.
pregnancy may also be used as an escape from an inner change in
The
25
attitude and reactions to the family.
"It has been suggested that the
girl may be seeking nurture which has not been received in the family
group."
(6:451)
Young has stated that the unmarried mothers are by and large representative of the social, economic and educational backgrounds of
the population as a whole.
With the exceptions of groups showing a
considerable degree of social breakdown there is no evidence that any
particular economic or social group is more or less I ikely to have a
greater preponderance of out-of-wedlock pregnancies.
(50:18)
Gordon has indicated that if certain characteristics are indeed
more common among inexperienced girls than among experienced girls
then it follows that they would be more common among pregnant girls,
than among the general population.
The greater majority of unwed
teen-agers are probably different from alI other sexually active girls
only in the specific circumstances of being pregnant.
Differences in
their behavior and motivation are not I ikeiy to be significant.
(15:41)
According to Shouse, pregnant adolescents, and their families,
including their babies, boyfriends and husbands cannot be stereotyped.
There is as much variety in this population as there are geographical
regions, cultural differences and personality types in our society.
Therefore it is necessary to understand and deal with the pregnant
adolescent in terms of these differences and in terms of her own experiences and not from preconceived notions and gross generalities.
(39: 165)
26
THE MARRIED TEEN-AGER
According to Howard, marriage is commonly thought to be the solu- ·
tion to conception out-of-wedlock and young people are forced into
premature marriages for which they are financially, educationally, and
emotionally unprepared.
These marriages often isolate them from peers
and they end up many times in unhappy dependent situations with parents.
Often such marriages end in divorce.
(18:362)
LeBarre indicated, that very I ittle is actually known about
adolescent marriages and parenthood.
sparse.
The research I iterature is
Very few studies have been focused on the parental and mari-
tal experiences of teen-agers.
A creditable number of studies have
been made of illegitimacy and a few studies of marriages among col lege
students.
The net result is stilI a very fragmented picture.
{25:11)
Calderone characterized young marriages as: 1) the average age of
the bridegroom is between nineteen and twenty-one years, the bride is
more I ikely between fifteen and eighteen; 2) most of the girls marrying in their teens are juniors or seniors in high schoo I , most of the
grooms are high school seniors or of col lege age; 3) one out of every
six brides in the general population is pregnant at the time of marriage, approximately one-third to one-half of alI girls who marry
while in high school are pregnant at the time of the marriage. (7:443)
Ofsofsky felt the proportion of females conceiving out-of-wedlock,
but delivering in wedlock is rising and that marriage, especially
among the young, is frequently preceded by conception.
Landis found
that approximately fifty percent of marriages between two high school
students in California involved an already conceived pregnancy.(31:451)
27
Teen-agers with babies do not have the opportunity to develop
norma II y through ado Iescence before being thrust into adu It respons ibil ities.
In the married situation, there are great pressures on the
boy and girl to establish a household, support the child, and continue
schooling.
Often teen marriages end in divorce.
agers are forced into marriage.
Sometimes, the teen-
Other times they feel unsure of them-
selves or they are unable to cope with the difficulties of I iving together.
(47: 13)
An aspect of social economics and the adolescent mother is the
high incidence of divorce among those women who marry under twenty.
Many teen-age marriages are
a result
of premarital pregnancy, this is
certainly one of the reasons for the extremely high divorce rate among
teen-age marriages as compared with marriages occurring late in I ife.
A U. S. Bureau of the Census report released in October 1971 reported
that within twenty years of marriage twenty-seven percent of those
women who married before the age of twenty had been divorced as compared with fourteen percent of those who married later.
Further, dur-
ing the first two years of marriage the presence of a child doubled
the probability of divorce and increased the probabi I ity that these
mothers would require public assistance.
(47:24)
MEDICAL ASPECTS
Menken stated that teen-age childbearing is associated with a
long I ist of adverse health and social consequences for young mothers
and their infants.
For the teen-ager, however, it is often accom-
panied by problems quite different and far less benign than those experienced by older mothers.
(28:45)
28
Ba II ard indicated "vi rtua II y every pregnant ado Iescent shou Id be
considered as an 'accident looking for a place to happen' unless
proven otherwide."
A composite of the young patient at greatest ob-
stetrical risk would have the following characteristics:
nonwhite,
from lower socioeconomic class, unwed, poorly nourished and either
underweight or overweight, anemic and a I ready we I I into her second or
third trimester.
(2:363)
Howard felt although alI school-age pregnant girls are at risk,
the younger the girl, the greater the risk.
When socioeconomic back-
ground and ethnic origions are added, the risks are even greater.
The
girls are at biological risk if pregnancy occurs before the cessation
of growth.
(18:361-2)
Ballard reported there may be prolonged labor in the younger
adolescent that is directly related to teo-pelvic incompatabi I ity.
The dividing I ine between pelvic disproportion and adequacy seems to
occur at the age of fourteen or fifteen.
(2:344)
For the very young mother, according to Menken, the risks that
her baby wil I be sti I I born, or die soon after birth, or be born prematurely or with a serious physical or mental handicap are much higher
than for those women in their twenties.
Bearing a first child while
in her teens is I ikely to be a critical and highly adverse turning
point in a young woman's I ife.
(28:45)
Fetal mortality and neo-natal ity mortality rates are quite high
for girls under seventeen.
nancies.
These rates increase with repeated preg-
Unwed teens tend to postpone prenatal care.
They try to
conceal their pregnancy from their parents and school authorities and
29
thus fail to obtain valuable medical information and attention, sometimes injuring themselves and their unborn children.
(47:12)
Menken reported that infant mortality rates are extremely high
for mothers younger than fifteen, and dec! lnes to a minimum in either
the early or late twenties.
It increases fairly sharply thereafter.
When mortality rates among infants born to mothers younger than twenty
was ·compared to the mortality rates of those mothers who are aged
twenty to thirty, it can be seen that the differences are far greater
during the first month of I ife than in the remainder of the first year.
(28:47)
Ballard has stated, that at best, unwanted or i I !-advised pregnancy can be disruptive.
In the adolescent, it often is catastrophic,
even more so with the added tragic burden of extra perinatal loss due
mainly to prematurity.
Several factors which show a high degree of
association with prematurity are:
first birth, pre-eclampsia, imma-
turity,il legitimacy and the young age of the mother.
These can team
up together to mercilessly entrap and overwhelm the unwary teen-ager
into a miserable high-risk situation.
(2:360)
Because they are sti II growing, the girls seventeen years of age
or under have greater nutritional requirements in relation to body
size than do adult women.
The additional nutrient demands of preg-
nancy as wei I, Increase the risks to their baby.
Teen-age girls often
exhibit the least favorable dietary practices of alI ages of groups
studied.
The basis of their inadequate intake of nutrients center
around social and peer groups.
Their emphasis is on immediacy (today)
and appearance, with stress on a slim figure and I ittle thought of
30
future pregnancy.
(26)
Nutrition is probably the most important considerations in the
health of the teen-age pregnant girl.
The proper quality and quantity
of foods is crucial in any pregnancy because of the demands being made
upon the. mother's body.
It becomes particularly critical for the
young ado Iescent who is st i I I growing herse If wh i Ie she must a Iso
supply a growing.fetus.
Since the adolescent's diet is considered to
be of poorer quality than other age
pre-existing problem.
groups~
a pregnancy compounds a
(47:49)
Klerman has stated that girls
~ho
become pregnant before they are
seventeen years of age are at greatest biological and psychological
risk.
Pregnancy after this age should not present specific biological
hazards.
This conclusion is supported by natality and mortality data
indicating the course and outcome of pregnancies for girls seventeen
to twenty years of age resemble those of young mature women, that is
women twenty to twenty-four years.
Current information regarding the
danger of a early pregnancy to both mother and child imply that the
increased hazards, at least from the biological viewpoint, are largely
confined to the younger members of the school-age groups (under age
sixteen).
Furthermore, the excess risk may be due not only to biolo-
gical factors such as physical and hormonal immaturity but also to the
social, economic and psychological factors that are often associated
with school-age pregnancy.
(24:60)
Sal lard indicated that the average pregnant adolescent, a highrisk patient by definition, paradoxically receives less prenatal care
than does the older woman who is at less risk, as one can easily
31
predict the common characteristics of the pregnant adolescent go hand
in hand with less and less prenatal care.
The amount of prenatal care
and the time it begins is associated with the outcome of the pregnancy.
Late or I ittle care accompanies higher rates of toxemia, anemia, prematurity and mental retardation.
(2:348)
TEEN-AGE PARENT
School-age parents are inclined to idealize the idea of parenting
rather than being able to deal realistically with individual situations.
Ambivalence is one of the hal !marks of teen-age parenting.
When guilt and doubt about parenting roles are added to the natural
ambivalence of adolescence, it can be overwhelming.
The young girl
needs a tremendous amount of support for both being a young girl and
also having to take on the parenting role.
(38:20)
Lythcott reported that when an adolescent girl does assume the
parenting role their attitudes toward their children change over a
period of time.
During the first three months of the infants I ife she
regards the baby as a dol I.
As soon as the baby becomes a I ittle
person rather than an object it ceases to be fascinating.
tend to be a I ittle self-centered.
Adolescents
Some young mothers tend to regard
the baby as a possession rather thah_an individual.
It seems diffi-
cult for them to realize that the baby is an individual and is going
to have a I ife of its own.
(27:16)
Wi I Iiams reported when young mothers were asked to write a paper
about what they wanted their child to be I ike; one group responded
that they did not want them to be spoiled.
They wanted the child to
look neat, act straight and be a quiet patient child alI the time.
On
.. I
32
the positive side, young mothers have a great deal of energy and truly
enjoy playing with their children, making them a good candidate for
training in childrearing.
(49:72)
Barglow has stated emotionally more stable and mature girls tend
to become more involved in the mothering of their chi ldren ••. if an
infant has been named after someone outside the immediate family, there
was a
b~tter
chance the infant would be neglected by the family.
(3:674)
Gordon has indicated the detrimental affects on the child of the
teen-age mother is not I imited to the risk of death, neurological defects and retardation at birth.
The adolescent mother has frequently
not developed the maturity needed to do a good job of raising her
child in this sophisticated society.
Oppel and Royston reported find-
ings that mothers under eighteen are less I ikely than older mothers
to remain with their children.
If they keep their children, they are
less inclined to believe that children should be independent.
Their
children are more I ikely to be psychologically dependent on others
than children of older mothers.
(15:36)
Young felt young mothers face a weight of responsibility for
which many of them are i I !-prepared.
In our culture they rarely have
been given the experience of making decisions and carrying the responsibi I ity for the consequences on a gradually escalating progression of
importance.
The predominant trend in our society has been to keep
youth confined to the status of childhood for a period encompassing
the teens.
This excludes or postpones preparation for the responsi-
bility of parenthood.
(50:87)
33
Accordtng to Bernstei:n, the adolescent unmarried mother who keeps
her chi I d has to reconcile the conttnu ing demands of her respons i b iIittes as a mother with her needs as an adolescent.
task.
It is a difficult
Her needs as an adolescent may suffer because she finds her-
set f tn a socia I I tmbo.
tt is difficult to accommodate the baby's
schedule to the spontaneous activity that constitutes so much of the
adolescent socia·l I ife.
baby~
If she is unable to arrange care for the
she may have to drop out of school, becoming further removed
from contact with her contemporaries.
The potentially harmful effect
of such isolation on the unmarried mother and on her attitude toward
her baby hardly need to be spelled out.
(4:136)
According to Farber, the youthful mother is confronted with facets of her responsibtl ity very early.
First the total dependence of
an infant compels focus upon his needs without regard for hers.
immature mother may find it a burden she resents.
The
Secondly, the in-
cessant and continuous needs of the smal I child may seem I ike a prison
from which there is no escape, until the years that release her from
bondage h<we a I so robbed her of her youth.
Even her resentment wi I I
be condemned because tt violates the expectations of motherhood and
makes her a failure.
(13:87-90)
Many of the same kind of emotional and adjustment problems and.
the level of maturity identified in the studies of unwed mothers who
keep their children are also found among parents who abuse their
children.
This is not to suggest a direct cause and effect relation-
ship between illegitimacy and child abuse, or that instances of abuse
and neglect are perpetrated by the mother only, unwed or not.
It
34
does, however, point up another possible hazardous condition which may
be forced upon the potential endangered child.
(42:9)
There is I tttle question that these young parents are undergoing
severe frustration, Delissovoy indicated.
"Their lack of knowledge
and experience, their unrealistic expectations of child development,
their general disappointment in their I ives and lack of economic resources serve to raise their irritability and lower their threshold of
tolerance."
The children of many adolescent marriages have a high
risk of joining the number of battered and abused babies.
(11:25)
Adolescent parents frequently have I imited knowledge or experience with young children.
tn addition to their inexperience and lack
of knowledge about childrearing, young mothers and fathers must cope
with the natural fears of new parents and the many developmental demands and stresses of adolescence.
those added responsibilities.
The infant concretely represents
If a young mother feels torn between
her own developmental needs and desires ·and those of her infants,
conflicts and gui It feelings may result.
(6:4)
WORKtNG WITH ADOLESCENTS
Young has stated, working with adolescent unmarried mothers and
the young fathers first of a I I requires an understanding of ado Ies~ents.
Without this there can be no help for them in a situation
which adds so tragically to their anxieties and confusions.
importance of the help cannot be overestimated.
only a time of change.
The
Adolescence is not
It also is a time of fundamental and far
reaching decisions for the individual.
(50:113)
35
When working with the pregnant teen-ager according to
Semmens~
it
should be remembered that she has difficulty in understanding and verbally expressing alI that she perceives 1 hopes and fears.
learn to accept the pregnancy and alI that it means to her.
She must
(35:13)
To understand these girls they need a more personal approach.
Smal I informal group discussions in which personal feelings and misconcept\ons can be explored seems to be the best method for providing
for their education.
(15:32)
Daniels, following her work with adolescents noted:
These girls are adolescents and their behavior both
in the groups and out of it, is often characterized
by the typical responses of the adolescent. Girls
at this stage are usually dependent on their peer
groups and their values. This is a normal reaction
of adolescence, yet for these girls it is a source
of difficulty and danger, since they have so few
familial values to guide them or to help them sort
out what part of the peer-group values they wi I I
accept or reject. AI I of the typical uncertainties
of adolescence then under! ie the behavior we so often
note; impulsiveness, lack of restraint, a 'not I istening' attitude toward adults and a belief that parents
and other adults do not understand them. (9:332)
Davis felt group experience is particularly appropriate for these
girls, in view of their close identification with their peers at this
stage of their development.
Objectives of the group meetings should
be to enhance the girl's physical and emotional development during
this time of stress, increase her understanding of her own· body and
that of the baby and prepare her emotionally, physically and practical ly for the motherhood role.
(10:582)
If the focus is on the transmission of actual content
and overlooks the basic affective components that
undergird the group, problems inevitably ensue. The
group may become passive, sitting and I istening but
36
with I ittle or no emotional involvement and therefore
not learning; or the group may communicate ag.reement
Intellectually and then store the information away
and wal I it off such as the body does with a foreign
object. Consequently, an unstructured approach seems
the most desirable in order to allow the group to
move at its own pace, and to individualize the teaching approach to the group's needs. (10:588)
Barglow has indicated formal learning capacity seems to diminish
as the end of pregnancy approaches, academic studies are best emphasized during the second trimester of pregnancy, after rapport has been
established with the students.
At the time of the tnird trimester,
there should be some shifting of emphasis to ·home arts and maternal
ski I I.
Curriculum flexibility is a valuable asset; for example, group
activities and learning that involve active student participation
could be scheduled later in the day to counteract physiological
fatigue.
(3:674)
Weigle reported in teaching child development to students they
could not focus too long or with a sustained interest on a formal
study of child.
Also, they appear to know very I ittle about infants
and frequently have unrealistic expectations.
The girls may suffer
from denial, repression, ignorance and fear, and many of their ideas
about chi ldrearing are based on old wives tales.
(46:23)
Davis reported that in some cases the student has only integrated
pieces of the information given and in attempting to assimilate It,·
she repeatedly seeks and asks for the same information from many
sources.
It is not unusual for the girls to present the same question
to the group week after week.
During the prenatal period such in-
quiries relate to such processes as conception, del Ivery, and anatomy
and physiology related to pregnancy.
This observation has a great
37
deal to tel I about teaching.
Simply relating information is not suffi-
cient, it is the integration of the data that is significant, and this
requires time and work.
Because the information presented is often
foreign to the girls, they must first develop a sense of trust in the
Ieader.
Davis stated further:
"The group needs to accommodate new i nfor-
mation to their present cognitive structure or stated differently, to
adjust dissonance."
Misinformation in the form of "old wives" tales
communicated by parents and others and then receiving new information;
one sees vascil lation and a tendency to hold onto old information concurrent with an attempt to integrate the new data.
(10:586)
Smith stated the adolescent is concerned with control over her
emotions as wei I as her body.
This is intensified during pregnancy.
The young girl feels helpless about what is happening to her and
anxious about what wil I be done to her.
Through anticipatory guid-
ance she may be helped to attain a sense of control over or mastery of
the tasks which confront her.
The processes of labor and delivery can
be made comprehensible and less frightening, so that she wi I I be able
to uti I ize the helpful information made avai Iable to her.
(40:210)
SCHOOL PROGRAMS
Howard reported during the first half of this century the situation with respect to school-age pregnant girls in the United States
remained relatively static.
occurred.
In the 1960's, significant changes
The federal government became concerned and involved in
early childbearing because:
1) data indicated in the early 1960's
despite our being the richest nation on earth, the infant mortality
38
was higher than a score of other nations and that the young age of
many of those giving births contributed substantially to that rate;
2) the country was increasingly angry about the large welfare burden
which it erroneously connected with
if
legitimacy; and 3) the school
dropout rate was a source of concern and dissatisfaction.
(17:474)
In response to those concerns the Children's Bureau established
a demonstration program that would continue girls in school and provide some closely-! inked health and counseling services.
Webster School in the District of Columbia was begun.
In 1963, the
The primary
objectives were to provide continuity in education with a curriculum
that met the special needs of the pregnant girl, reduce the risk of a
poor pregnancy outcome and enable the girl to cope with her immediate
situation.
C24:X)
The Webster School became a model for other programs which developed around an educational focus.
Since the mid-1960's comprehensive
programs have been developing alI over the United States in an attempt
to provide long neglected medical, social and educational services to
schoo 1-age mothers.
C24: 1 )
Braen, a consultant for a school-age pregnant program has
written:
Nattonwtde, over 160 cities have set interagency
efforts to provide comprehensive services to
school-age girls who I ive at home during pregnancy
and most often keep their baby. The agencies involved may be a combination of community organizations, such as the school system, city and county
health departments, welfare departments, and community action groups. No matter who takes part,
the programs generally have three goals in common:
1.
To increase the chances of a normal pregnancy
39
and childbirth and to protect the health of both
mother and infant.
2.
To help .the girls solve the personal problems
that may have led to their pregnancy or resulted from it and to direct them towards a
satisfying future.
3.
To help girls continue their education during
pregnancy and to increase the proportion of
girls who wi I I continue in school following
chi I db i rth.
Howard indicated there is no single program model.
Each commu-
nity in its own way is best working out how best to pattern its
services.
Despite alI the varied auspices and individualized funding
patterns, alI the programs have at least three common service components:
early and consistent prenatal care, continuing education on
a classroom basis, and counseling on an individual or group basis.
(17:473)
Ryan has stated it is essential that a program designed to meet
the needs of the adolescent girl consist of wei !-coordinated comprehensive services that relate to the whole being.
Multitudes of needs
and problems must be faced by the girl at a time in the adolescent
developmental stage when personality integration is one of the major
tasks.
(34:264)
When recruiting staffing for these programs there must be focus
pn attitudes about adolescence, sexuality and alternative I ife styles
in addition to professional competance.
If the prevai I ing attitude of
the service person is judgemental or detached, the opportunity may be
lost.
In acting as advocates for adolescents and as a I iaison with
others who may be involved with them, staff attitudes are easily
transferred.
If they are positive, they may be effective in altering
. 40
negative stereotypes.
(34:268)
Howard indicated although many of the programs started out as the
"School-age Unwed Mothers Program" or "Teen-age Unwed Mothers Service"
most of them soon dropped those titles.
Not only did unmarried girls
object to being labeled in this fashion but some of the girls attending the programs were married, yet sti I I needed the services.
More-
over, as programs became aware that the I ivel ihood of their success
was tied to creating a helpful climate for the girls in the community,
they found that words like "illegitimacy" and "unwed" created negative
images in the pub! ic mind.
gained prominence.
(17:476)
Thus the concept of school-age parents
USE AND FEATURES OF RESOURCE GUIDE
This guide on TEACHING PREGNANT ADOLESCENT GIRLS ABOUT HEALTH:
A INSTRUCTIONAL RESOURCE GUIDE has been designed for teachers, nurses
and other health professionals working with pregnant adolescents. The
resource unit was specially designed for use in Ventura County uti I izing the resources available there.
The purpose of the guide is to help the instructor organize information and learning opportunities that wi I I help prepare the student for the pregnancy experience.
The guide is geared to education
for childbearing and the post-partum peri9d for the pregnant adolescent.
RESOURCE GUIDE
The guide is composed of seven separate content areas covering
basic areas of childbearing and the post-partum period, including the
newborn.
The following features are incorporated under each content area:
(1) major concept, (2) objective related to the concept and content
area, (3) suggested content, (4) learning experiences, (5) recommended resources, (6) supplemental resources for teachers.
Content.
The content areas are designed to be separate units.
The areas may be used in the order in which they are given but the
sequence may be changed to meet the needs of the students.
Concept.
This is the big idea the student is directed toward
for the unit.
41
Objective.
This represents the behavior sought in the learner
following instruction.
In measurable terms they wil I aid the instructor in appraising
the knowledge the student has acquired or the ski I Is she has learned.
By achieving the objectives it is felt the student wi I I develop a
background for making wise decisions and cooperate meaningfully in
those areas of care which are not governed by strictly medical considerations.
Content.
covered.
For each unit there is suggested content material to be
The educational background of the instructor, students and
time available wi I I determine the breadth and depth of the coverage of
the content.
Learning Experiences.
The experiences are planned to actively
involve the students in the learning situation and enable them to
achieve the objectives.
The learning opportunities should be selected
which are most appropriate to the needs of.the students.
Resources.
The resources and I iterature I isted are avai Iable for
loan through the Ventura County Health Department.
In order to use
the films and filmstrips in conjunction with a unit of study it is
suggested that the materials be reserved in advance.
of the resources wi I I vary from time to time.
The avallabl I ity
Because materials are
added during the year, it is suggested that the instructor update the
I ist of resources periodically.
Teacher Resources.
The I ist includes materials that were used In
the preparation of this guide in addition to other related available
materials.
The materials can be obtained through the Ventura County
43
Health Department.
Other resources that the teacher may want to become acquainted
with are also suggested.
available.
New resources are continually being made
44
(X)NTENT AREA:
MAJOR CONCEPT:
REPRODUCTIVE SYSTEM
THE KNOiiLEDGE OF HUW\N REPRODUCTION- CAN ASSIST ONE TO
PEOt·'OTE A HEALTHIER ATTITUDE TOWAr'D THEIR OWN BODY,
OBJECTIVE:
Student can identity and discuss nQture and function of
major organs ot male and female reproductive system.
Suagested Content
1.
11.
Ill.
Male-Reproductive System
1. externa I
a. penis
b. scrotum protects penis
c. testes and ho~nes
2. . I nterana I
a. bladder
b. seminferous tubules
c. prostate gland
d. seminal vesicles
e. epdidymts
f. vas deferens
_ 3. changes curing puberty
a. development secondary
sex characteristics
b. production semen
Learning Opportunities
~aterlals
Provide students diagrams of
male and fe~ale reproductive
system. Students wit I identify
and label major organs.
Fi lmstrlps:
HtJ"l-1'1 Physiolo~y: t!ale and
fe,-,ale F.e~rc:J~c:tive System,
Color, 53 1/.3 R?M Racord
Have students discuss secondary
sex characteristics and I ist-on
chalkboard.
Female Reproductive System
1. external
a. tabla majora
b. labia minora
c. urethral opening
d. cl itorls
e. vaginal opening
2. Internal
a. vagina, muscular tube
b. cervix
c. uterus size and shape
of pear non-pregnant
d. fa II o;:>i an tubes
ovaries. hormones and
8.
production of eggs
f. bladder
3. puber1y
a. development secondary
sex cr.aracteristlcs
b. ovulation
c. menstruationMenstruation
1. role pituitary gland
a. FSH, follicle
stimulating hormone
b. LH, luteninizing
hormone
c. estrogen
d. progesterone
2. menstrual cycle
a. growth of lining
b. ovulation
SuaQestod
Pamphlet:
A !3::>y Today, A t·1an
To..-.c.rrow, OptOt:li st
International, 1972
Birth Atlas.
~1atern i ty Center
Association, (NP)
Pamphlets:
The Miracle of You,
What It t!.ear.s To Ee A
Girl. Kimoerly Clark
Corporation, 1968
Your Years of Self
Oi scoverv, Kimber! y Clark
Corpcration, 1968
Given samples of 21 and 28 day
menstrual cycles, students wit I
calculate approximate time of
ovulction and di~cuss physical
and emotional changes that
occur during this period of
time.
45
CONTENT AREA:
REPRODUCTIVE SYSTEM
Succested Content
Learning
Orportu~i.tles
c.
3.
IV.
no tertii lzatlcn
of egg
d. shejding ot lining
e. normal cycles and
·variations
Menopause
a. ages of occurrence
b. climacteric, physiologic
cnanges
c. pregnancy
•
d. sexual activity
e. fact and fiction
Ferr.ale ~ledlcal Care
1. frequency of examination
2. source of care
3. examination
a. pap smear; what It
means
b. breast examination
4. self breast examination
a. hew often
b. reasons why
c. how to do.
Have students practice breast
examination on breast model.
SuoaC'sted
~·.Jtcrlals
46
CONTENT AREA:
PRENATAL CARE
MAJOR CONCEPT:
PROPER PRENATAL CARE CAN INFLUENCE THE OUTCOM'O OF A PREGNANCY.
OBJECTIVE:
Student will discuss the emotional and phy'slcal changes of pregnancy.
------~S~u~o~o~e~s~t~e~d~C~o~n~t~a~nt~---------------=L~e~a~r~n~ln~g~O~p~p~o~r~t~u~n~l~t~l~e~s----------------~S·.~sted ~~tcrlals
I•
~~ed
Ica I Checkups
1 •. importance
2.
3.
frequency
visit to doctor
a. medical history
b. Iaboratory work
c. physical examihatlon
d. pelvic examination
e. asking questions
Provide fetal stethoscope
to students for examination
on themselves. Note differences on heartbeat of fetus
and self.
Film:
Personal Care During
Pr~~nan~. U.S. Dept.
of Navy, 16=., color
18 rnin., 1964
11.· First Trimester
1.
2.
3.
4.
Ill.
IV.
V.
Second Trimester
1. developMent of fetus
2.
..quickening"
3.
physical changes
COmp I a I nts
nausea and vomiting
urinary frequency
breast tenderness
bac~ache and fatigue
Corr~n
2.
3.
4.
5.
6.
7.
8.
9.
VII.
Pamphlets:
How Does Your Baby Gro••?
Gerber Co. (N.P.)
Third Trimester
1. development of fetus
2. physical changes
1.
VI •.
signs and symptoms
hormonal changes
aevelopment of embryo
physical changes
E>"pectant f-'others GuIde
Gerber Company, 1974
Have ctass dTscuss'ton about
discomforts they are or are
r.ot having regarding pregnancy.
constip<~tlon
shortness of breath
indigestion
varicose veins
abdominal striae
General Health
1. rest
·
2. exercises
3. walking
4. body mechanics
Personal Hygiene
1. clothing
2. brassieres
3. shoes
4. bathing
5. douching
6. care of breasts
7. denta I care
8. sexua I Intercourse
9. medications
10. drugs
11. smoi<l ng
Teacher.wil I demonstrate baste
prenatal exercises. Students
wll 1 practice ·the basic exercises e.g. pelvic rocking.
Birth Atlas
Maternity Center
Association (N.P.)
47
CONTENT AREA:
PRENATAl CARE
Suosested Content
Le~~nlng Oppo~tuniTles
Sugqestt>d M<3terlals
VIII. Danger Signs
1.
2.
3.
4.
5.
6.
7.
dizziness
~lu~~ed vision
severe headaches
swelling of hands & feat
vaginal bleeding
leaking of water from
vagina
fever and chills
IX. EmoTional Aspects
1. first trimester
a. mood swings
b. commonly upset over
discovery
c. attitudes of family
and friends
d. primary focus on the
pregnancy not baby
2. second trimester
a. begin to focus on baby
b. calmest time
c. dependency needs
increase
d. more Interest In self
e. fantasies & daydreams
about the baby
3. third tri~ester
a. burde~ physiologically
b. negative feelings
toward pragnan~y
c. depression
Have class discussion on the
question: Do you feel these
reactions are normal and
COIM'On7
You a~d Your Contented
Ba!lv. Carnation Co.,
1974
48
CONTENT AREA:
NUTRITION
MAJOR CONCEPT.
FOOD IS BASIC TO LIFE. WISE FOOD SELECTION PRACTICES
CAN AFfECT THE HEALTH OF HJTHER AND CHILD.
OBJECTIVE:
Student applies knowledge ot"food groups i'n making food choices.
Sungested Content
I.
II.
Ill.
·.
IV.
Learntno Opportunities
Suggested Materials
Right Food Is Important
1. healthier pregnancy
2. fewer compl !cations
3. safer delivery
4. more I lkely to nurse
infant successfully
5. strong, healthy ba~y
Weight and Pregnancy
1. ge~erally 20-25 pound
weight gain
a. underweight gain more
b. overweight gain less
2. weight distribution
a. baby 6-8 pounds
b. fluids 2-3 pounds
c. placenta 1-1! pounds
d. breasts 1 pound
e. blood volume 3 pounds
. 3. weight control problems
a. skipping meals
b. poor food choices
c. fixing food improperly
d. snacking habits
4. nutritional requirements
and calorie control
Pregnancy & D~ily Needs
1. rni lk 1 quart
a. teenager more
2. meat (2-3) servings
3. vegetables & fruits
a. green & yellow (1)
b. other vegetables (2)
c. citrus (1) plus
d. breads & cer.eals (4)
Nutritional Building Blocks
1. protein sources
a. growth of fetus ..
2. carbohydrates & tats
a. fuel
3. vitamins tor vitality
a. ''A" for resistance
b. "B" appetite
c. "C" teeth & gt:ms
d. "D" utilization of
calcium, phosphorus
4. minerals
a. calcium-bones, teeth
growth of fetus
b. phosphorus for tissue
c. i ron-fe1"a I needs
Students will conduct a self
survey of 24 hour dietary
intake •. They wt II analyze
and discuss findings; graph
record ot weekly weight
changes.
Provide examples of problems
attendant on excessive weight
gain during pregnancy. Students
wi II list causes of. problem and
discuss possible solutions.
Filmstrip:
Your Food--Chance Or
Choice?
NaTional Dairy Council
Color, 13 min., 1971
Pamphlet:
What To Eat Before You
Are Dre~~~~t. ~hile You
t're:o~"nt, After The
Baoy Comes. National
Dairy Council, 1972
Are
Have students plan snacks that
will be good choices for their
nutrition break. Discuss
nutritional values. ·
For Parents To Be.
Dairy Council, 1972
49
CONTENT. AREA:
NUTRITION
Suggested Content
Y.
Nutrition During Lactation
1. 1,000 calorie Increase
2. wei I balanced diet
3. milk I quart or rrore
4. plenty of fluids
5. any foods In moderation
Learning Opportunities
Place students In groups of
three; they wi I I plan menus
for three days. Plans will be
presented to class for analysis
of food groups.
·
Suaqested Materials
50
CONTENT AREA:
~1AJOR
CONCEPT!
OBJECTIVE!
LABOR AND DELIVERY
WITH THE APPROPRIATE KNOWLEDGE, Ttl£
II.
Ill.
OF CHILOOIRfH CAN BE ReDUCED.
Student explains why anticipatory guidance· and discussion lncre11ses
understanding and reduces anxiety of childbirth.
Suggested Content
. I.
At~XIETY
Before De II very
1. "dry run" to hospital
2. financial plans
3. doctor for Infant
4. things to take
a. nightgown & slippers
b. robe & brassieres
c. grooming Items
5. bringing b3by home
·a. diapers, pins
b. underzh I rt
c. clothes
d. blanket
Learning Oooortunltles
Suggested
~~aterl
aI
Arrange for students to take
field trip to local hospital
and visit labor and delivery
room. Explain relationship
to anxiety reduction among
expeCTQnt mothers.
Copies of admission
instructions for mothers
entering local hospitals.
When to Expect the Baby
1. relationship to due data
2. signs time is closer
a. baby settles in pelvis
b. Braxton-Hicks I ncrea.sa
3. TRUE I abor
a. regular contractions
b. chance intervals
c. "pink show"
d. "bag of water" breaks
4. admission to hospital
11. progress examination
b. perineal prep & enema
What Happens During Labor
1. first stage of labor
a. cervix thins & dilates
b. contractions 5-10 min.
20 seconds
c. 11ctive phase 2-5 min.
30-50 seconds
d. 3 phases contractions
1. Increment (increase l
2. acme (height)
3. decrement (decrease)
e. relaxation between
f. transition phase
g. cerv_ix di iated
2. second stage of Iaber
a. baby passes through
birth can a i
b. "bear! ng down"
c. breathing techniques
d. rest & relax
e. episiotomy
f, crowning
g. birth
Students ~·ho have delivered
babies wil I relate both
positive and negative experiences.·
Offer suggestions for
reduction of p.roblems.
Film:
Labor & Delivery.
u. S. De;:>t. of Navy
16 mm., color, 36 min.
1964
51
CONTENT AREA:
LABOR AND DELIVERY
Suogested Content
3.
4.
IV.
V.
VI.
Le.Jrn I ng Opportun l·t l es
Suggested
~~:1terial
third stage of labor
a. del Ivery of placenta
(afterbirth)
b. expel led by contractions
c. contraction of uterus
del iverles
a. vaginal
b. forceps
c. caesarian section
d. breech
Anesthesia & Analgesia
1. analgesia-dulls response
to pain
2. general anesthesia
a. caesarian section
b. breech presentation
3. local or regional block
a. paracervical first
stage of labor
b. pudenal numbs area
to pain not touch
c. sadd I e reI axes perineum
d. epidural given during
labor
4. considerations In choice
a. safety
b. need
c. kind of labor & stage
of labor
d. kind of pelvis
e. size of bZ~by
t. baby's position
g. physician preference
Care of Newborn
1. irrtnedlate care
"· establish breathing
b. clamp cord
c. apgar scoring
d. care of eyes
e. identification
2. secondary care
a. weight & measurement
b. transfer to nursery
c. Iab tests
d. "feeding
Premature Birth
1. less than 5i pounds
2. causes ar~ mar.y
3. special nursery
4. length of stay
Teacher will conduct a question
and answ.er period on types of
anesthesia used In delivery ot
newborns.
Distribute copies of birth
certificates to students.
Have students analyze and
discuss information that Is
need~d to complete the form.
Have local doctor come to
discuss anesthesia.
52
CONTENT AREA:
LABOR AND DEL I VERY
SuGgested Content
VII.
Care of t-bther
1. observatIon
a. palpation of fundus
b. observe perineal pads
2. vital signs
3. nutrition
4. early ambulatlon
a. 8-24 hours later
5. rest
6. breast .care
7. perineal care
8. episiotomy care
9. birth registration
of Infant
LE'a rn I ng Opportun ft Ios
Suggested Material
53
CONTENT AREA:
POST PARTU~1 PERIOD AND FAMILY PLANN lNG
MAJOR CONCEPT:
~~NY
OBJECTIVE:
Student will Identify changes of post-partum period and major methods of birth control.
PHYSICAL CHANGES CAN OCCUR D~RING THE SIX WEEKS AFTER DELIVERY
AND CAN AFFECT THE HEALTH OF THE t·lOTHER.
Suogcsted Content
I.
11.
Ill.
IV.
Anatomical Changes
1. uterus
a. same size for two days
b. involution
c. 5-6 weeks normal size
2. lochia
a. 1-3rd day blood
and mucous
b. changes to pink
c. 10th day almost
no color
3. abdominal muscles
a. striae less
b. involution lasts
three weeks
c. restore tone-rest,
exercise & diet
4. breasts
a. colostrum 2 days
b. 3-4 days milk comes
c. medication to dry
5. weight loss
a. 11-12 pounds delivery
b. 5 pounds soon
6. menstruation
a. return 6-8 weeks
b. several montbs normal
c. when breast feeding
7. eplsot0t:1y "stitches"
a. medicated sprays
b. sitz baths
8. sexual relations
a. 3-6 weeks
Learning Opportunities
Distribute ·diagrams of "changes"
that occur in post partum period.
Have students identify changes.
Provide students with samples
of menstrual calendar. Have
students practice how to keep
proper calendar of menstrual
cycle.
Emotional Aspects
1. Initially passive
2. "taking hold phase"
a. last about 10 days
b. anxiety, fatigue
3. postpartum "blues" ·
a. hormonal changes
b. Irritable, let down
4. more vulnerable to stress
5. infant adopted
a. miss child
b. time of stress
c. need activity a~d
someone to talk to
PostPartum Exam
1. · purpose & examination
2. start birth control
3. end post partum period
Post Natal E:<.erclses
1. deep abdominal breathing
2. touching chir. to chest
3. continue several months
Teacher will demonstrate post
partum exercises. Students
wil I practice postpartum
exercises, e.g. knee chest
poslti·on.
Suggested Materials
54
CONTENT AREA:
POSTPARTUM PERIOD AND FAMILY PLANNING
Suggested Content
FAMILY PLANNING:
1. Factor to Consider
1. physical condition
2. p.sychologiC31 aspects
3. effectiveness of method
11.
Ill.
IV.
V.
v·l.
Le3rnlng Opportunities
Sugoested M.3terl a Is
Have a discussion on the topic
of the impact of birth control
on one's mental-emotional state.
Ccntraceotive Flip
Chart. Ortho Co. CNP)
Coitus lnteruptus
1. mechanism of action
2. other considerations
3. use-effectiveness.
Rhythm Method
1. mechanism of action
2. calendar & temperature
3. use-effectiveness
Film:
Hope Is Not A tJ.ethod.
.Planned Parenthood,
16 mm., color, 15 min.
1972
Condoms
1. mechanism of action
2. no prescription
3. other considerations
4. use-effectiveness
Diaphragm
1. mechanism of action
2. fitted by· physician
3. high ~tivation for use
4. ot~.er consideratIons
5. use-effectiveness
Intrauterine Devices
1. mechanism of action
2. Inserted by physician
3. IUD's and pain
4. other considerations
5. use effectiveness
VII.
Spermicidal Preparations
1. mechanism of action
2. no prescription
3. types
4. other considerations
5. use-effectIveness
VIII.
Oral Contraceptives
1. mechanism of action
2. types available
3. need prescription
4. side effects
5. other considerations
6. use-effectlv?ness
Distribute s3~ples of available
contra<:eptiv;, devices. Ha·Je
students discuss functions of
each method.
Pamphlets:
ABC'S of Birth Control.
Planned Parenthood,
1971
fa~llv
cf
IX.
X.
Other Methods
1. permanent sterilization
2. morning after pill
3. injoctions
4. research being done.
Family Planning Services
1. priv~te physician
2. health dopart1"ent clinics
3. planned parenthood
Planning Methods
ContracQ~Tion.
U. S.
Department of HEW, 1972
55
CONTENT AREA:
INFANT NUTRITION
~~o\J.VR CONS_EPT:
PROPER NUTRITION CAN INFLUENCE THE HEALTH Of NEWBORN INFANTS.
OBJECTIVE:
Stu:lont can discuss and comp3re breast feciding and. formula feeding.
Susgested Content
L~arning O~oortunities
Su.]7ested Materials
BREAST FEEDING:
I.
II.
Ill.
Advantages for ~lother & Baby
1. correct composition
2. even temperature
3. I ess a I Ierg Ies
4. tree from bacteria
5. gives immunities •
6. aids uterir.e changes
7. time & work saving
8. emotionally satisfying
Bre.,st Feedl:1g Your E'a2Y_.
Ross Laboratories, 1969
Feedinq Your B~by At
Your Breas-r. tlational
Dairy Counci I, 1971
Breast Anatomy & Physiology
1. co~posed of fat &
-glandular tissue
2. 15-20 Iobes each breast ·
3. "acini" cells produce
breast mi I k
4. role areolar & sinuses
5. colostrum
a. "ideal first toed"
b. laxative affect
6. breast mi I k
a. 48-72 hours comes In
b. bluish cast looks thin
c. vitamins, protein
Care of Breasts
1. before delivery
2. proper brassiere
3. methods of preparation
4. creams and lotions
5. Inverted nipples
6. care when nursing
7. manual expression
V.
"How To" Breast Feed
1. frequency of feeding
2. eft to a good start
3. preparation beforehand
4. relaxation
5. "let down" reflex
6. putting baby to breast
7. "working together"
Problems and Concerns
1. engorgement care
2. leaking
3. breast .inflammation
4. sore nipples
5. insufficient breast ml lk
6. sagging breasts
7. menstruation & pregnancy
Film:
Breast Feeding Your Baby.
Ross Laboratories,
16mm., Color, 10 min.
Literature:"
Disadvantages
1. po~siDie diet control
and food restrictions
2. restrict activities till
milk supply established
3. father cannot feed
4. "tied down"
IV.
VI.
Provide a list of advantages
and disadvantages of breast
and bottle feeding. Students
analyze and discuss differences
of both methods.
feeding mother
discuss her experiences in
breast feeding. Discussion
to follow.
Hav~.breast
56
CONTENT AREA:
INFANT NUTRITION
Su·1'1ested Content
FORI·1U LA ~-IAK ING
I. Equipment Needed
1. large pan with cover
2. bottles
3. nipples & tops
4. brushes & tongs
5. measuring spoon & cups
11.
learn ina Opoortu~.~l~t~l~e~s~--------------~S~u~a~o~e~s~t~e~d~M~~~te~~~-~la~ls~--Have students demonstrate
acceptable methods of formula
preparation, Discuss value
of different methods,
Terminal Method
1. wash hands & collect
equl pment
2. · wash equIpment & rInse
3. mix formula
4. pour formula in bottles
5. put on nipple & tops
a. loosen tops
6. bottles on rack In pan
a. add 2-3 inches water
b. bring to boll & cover
c. boil for 25 minutes
d. cool, refrigerate
Film:
Baby Feedinr,s For t4ew
Ro~s Laboratories,
16 mm., Color, 25 min,
r.~others.
Pamphlets:
Ill.
Traditional or Asceptlc
1. wash hands & collect
equipment
2. put nipples & caps in
smal I pan with water
a. boil for 3 minutes
b. drain off water
c. store In pan
3. equ i pr.'.ent and tongs In
steri I i zer
a. 2-3 Inches water
b. bring to boil & cover
c. boil 10 minutes
4,
5.
6.
7.
IV.
Y.
use tongs to remove
a. touch nothing that
touches the formula
measure water & boil for
three minutes
a. add to formula
put formula in bottles·
cool, cap, refrlgerate
Formulas
1. ev9porated milk
2. co~merclal plain & iron
a. concentrated
b. ready-to-teed
c. dry
3. soy formulas
a. when used
4. specia.l formulas
Feeding Baby
1. environmental climate
2. feedings per day
3. time for feedings
4, amount of feedings
a, leftover formula
5. "bubb II ng baby"
a. frequency & positions
You & Formula Feeding.
Ross laboratories, 1971
Baby's Eatfna and Sleeping
Habits, Jcnnson & Johnson,
1974
Given prices of fo'rmula,
students will calculate
and evaluate·cost of
feeding Infant.·
Teacher will demonstrate
with infant bottle feeding
& burping techniques. Students wll I practice feedIng & burping with dol Is.
Have new mother share her
experiences in feeding her
child. Have class evaluate
procedures.
When Your Baby Is Bottle
red. National Dairy
Council, 1971
. 57
CONTENT AREA:
INFANT NUTRITION
Suagested Content
SOLID FOODS
1.
II.
Introduction to Solids
1. time to start
2. adjusting to solid food
3. one new food at a time
4. food before formula
5. hot or cold foods
6. cereal often first food
7. using mixed foods ·
8. feeding atmosphere
Giving the Foods
1. flexibl tity In times
2. foods and at lergles
a. egg white
b. wheat cerea I
c. citrus foods
3. need for Iron
4. cultural patterns
5. making food at home
6. role of desserts
7. t i nger foods
8. junior foods
9. beginning future diet
patterns
10. reading labels
Le:Jrn Ina Opportun ft Ies
Suggested
~~aterials
58
CONTENT AREA:
CARE OF THE NEWBORN
MAJOR CONCEPT:
THE NEEDS OF "NORI·IAL" NEWBOr..N'S ARE Sll·f'LE AND NOT
OBJECTIVE:
Student will demonstrate bathing of baby and plan for baby's noeds.
Suogested Content
I.
11.
Ill.
IV,
v.
VI,
VII.
VIII.
IX.
Layette and Equipment
1. what Is necessary
2. what Is nice to have
Laundering
1. wash new things first
2. wash clothes separately
3. use soap, not detergent
4. avoid bleaches
Learnlnq Opportunities
Film:
First Two Weeks of Life.
Johnson and Johnson,
16 mm., Color, 21 min.
Pamphlets:
Infant Care. Department
of HEW, 1973
Concerns to Mother
1. mongolian spot will fade
2. rashes are common
3. molding of head disappears
4, forcep marks
·
5. marbl lng of skin
6. birthmarks
.The Modern Baby.
Blue Cross, 1967
Caring For Your Baby.
Ross Laboratories,
Sleeping
1. up to 20 hours/day
2. need quiet place
3. adjust to noises
· 4. rest Iessness
5. change of position
1973
Bowel Habits
1. meconium
2. ·transitional
3. normal for breast/bottle
4. constipation
Care of Circumcision
1. heals 1-2 weeks
2. healing process
3. pros and cons.
Care of Umbll leal Cord
1. use of alcohol
2. cord comes off
Suogested Materials
Provide Students with different layette Items to look at.
Students wil I develop I ist of
Infants needs, lncludlng.for
bathing of Infant.
Characteristics of the Newborn
1. head-shape & fontanels
2. skin-ory, thin, milia
3. face-broad nose, reflexes
4. body not proportioned
5. breast engorgemant
6. vaginal discharge (girls)
7. legs and teet
8. eyes-sight, color
What to Expect
1. hiccups
2. frequent sneezing
3. fussy periods
4. crying
a. reasons
b. use of pacifiers
CO~f'LEX.
Given a practical situation,·
students wll I discuss reasons
why babies cry and what might
be done to meet the baby's
needs.
59
CONTENT AREA:
X.
CARE OF THE NEWBORN
What Baby Needs
1. warmth
2. comfort
:5. love
4. food
5. touching & talking
Teacher will demonstrate bath
for baby, using I ive Infant,
while students will practice
on bathing dolls.
BATHING THE BABY:
I. Equipment Needed
1. plastic tub or slpk
2.· mild soap
:5. cotton ba II s
4. wash cloth & towel
5. use-lotions & powders
11.
Atmosphere
1•. warm room
2. relaxed confident mother
:5. baths and babies
4. bathing times
Ill.
Preparing for Bath
1. gathering equipment
2. water temperature check
· :5, final check for supplies
4. get baby last
IV.
Bathing the Baby
1. sponge bath
2. tub bath
a. face
b. head "soft spot"
c. body
d. genitals
V.
Safety During Bath
1. never leave baby alone
2. water temperature
:5. no cotton tipped sticks
4. removal of jewelry
5. closing of safety pins
VI.
Diapers
1. dl fferent types
a. disposable
b. gauze
c. blrd's eye
d. flannel
2. diaper service
:5. laundering
a. wash separately
b. presoak! ng
c. no bleach or detergents
d. softeners
e. vinegar to last rinse
4. d i fterent fo Ids
5. cost and amount needed
a. 3-4 dozen wash own
b. diaper service
c. disposC>ble
6. d taper rash
a. causes
b. bacteria & ammonia
c. plastic pants
d. care of
Film:
Baths and Babies.
Johnson & Johnson, 16mm.
Color, 20 min., 1964
Pamphlet:
Keeoln~ Baby Clean.
Johnson & Johnson
1974
Give students a price list of
Items necessary for baby care.
Students wil I calculate the
cost of buying own diapers,
having diaoer service or using
disposable diapers. Weigh ·
advantages and disadvantages
of each.
TEACHER RESOURCES
Human Reproduction Unit:
1.
Miller, Benjamin. Masculinity and Feminity.
Miff I in Company, 1971
Boston: Houghton
2.
Whelan, Elizabeth and Quadland, Michael. Human Reproduction
and Family Planning: A Programmed Text. Syntex Laboratories,
1972
3.
Ziegel, Erna and VanBlarcom, Carolyn.
New York: Macmi I Ian Company, 1972
Obstetric Nursing.
Prenatal Care:
1~
Koschnick, Kay.
1975
Having A Baby.
New York: New Readers Press,
2.
Maternity Center Association. Guide For Expectant Parents.
New York: Grosset & Dunlap, 1969
3.
Wiedenbach, Ernestine. Family Centered Nursing.
G. P. Putnam's Sons, 1958
4.
Ziegel, Erna and VanBlarcom, Carolyn.
New York: Macmillan Company, 1972
New York:
Obstetric Nursing.
Nutrition:
1.
McWil Iiams, Margaret and Stare, Fredrick.
New York: John Wiley & Son, Inc., 1973
2.
Ziegel, Erna and VanBlarcom, Carolyn.
New York: Macmi~lan Company, 1972
Living Nutrition.
Obstetric Nursing.
Labor and Delivery:
1.
Bean, Constance. Methods of Childbirth.
and Company, 1974
2.
Maternity Center Association. Guide For Expectant Parents.
New York: Grosset & Dunlap, 1969
3.
Scirra, John. Conception, Birth & Contraception.
McGraw Hi I I Book Company, 1969
60
New York: Doubleday
New York:
61
PostPartum and Family Planning:
1.
Demarest, John and Scirra. Conception, Birth & Contraception.
New York: McGraw Hi I I Book Company, 1969
2.
Ortho Pharmaceutical Company. Understanding Conception and
Contraception. New Jersey, 1970
3.
Whelan, Elizabeth and Quadland, Michael.
and Family Planning: A Programmed Text.
1972
Human Reproduction
Syntex Laboratories,
Infant Nutrition:
1.
Bean, Constance. Methods of Childbirth.
and Company, 1974
New York: Doubleday
2.
Maternity Center Association. Guide for Expectant Parents.
New York: Grosset & Dunlap, 1969
3.
Ziegel, Erna and VanBlarcom, Carolyn,
New York: Macmillan Company, 1972
Obstetric Nursing.
Care of Newborn:
1.
Koschnick, Kay.
1975
Having A Baby.
New York: New Readers Press,
2.
Ziegel, Erna and VanBlarcom, Carolyn.
New York: Macmll lan Company, 1972
Obstetric Nursing.
CHAPTER IV
OVERVIEW
In October of 1974 the author began working with the Oxnard
school-age pregnancy program.
In August a meeting was held with the
teacher of the program and one of the school's administrative staff
plus a member of Ventura County's health education staff.
At this
meeting the kinds of things the school might want in the area of
health education was explored.
No definite format was settled upon.
In October the teacher of the program indicated that she would
I ike to begin having some health education sessions for the students
who were enrol led in the program.
The areas that might be covered
were discussed, this included prenatal care, labor and delivery and
family planning.
As several of the students in the class were due to deliver
shortly, the teacher indicated that she
w~uld
I ike to have the area
of labor and delivery discussed very soon.
It was agreed that the author would be meeting with the students
twice a month.
Because of work commitments with the program in Simi,
primarily students who had delivered, a more frequent schedule could
not be made.
The Pub I ic Health Social Worker would meet on a weekly basis with
the students to have discussions on whatever areas the students were
interested in.
In answer to the need to begin the program immediately the first
session scheduled was to be on prenatal care.
In retrospect, it prob-
ably would have been better if the first session did not have an
62
63
agenda.
The goal of this session should have been to become better
acquainted with the students and at the same time to get an idea of
.I
what their needs were and where they were in their knowledge and
feelings.
During the first semester period, meetings were held with the
teacher and social worker.
There was mutual concern in getting as
much student involvement as possible.
These meetings proved helpful.
Notes were compared about the questions the students asked and a
better idea of what the students needed was developed.
The health education sessions attempted to el icite from the students what things they would I ike discussed.
suggestions were not forthcoming.
By late December, there was a turn-
ing point and students participated more.
focus was on the infant.
More often than not,
At that time the area of
Other factors that may have facilitated
participation was that the students as a group were beginning to
develop more cohesion.
There was an increased attempt to get student
involvement on a participation basis rather than a discussion basis.
By the second semester a rough format had been established of
what things needed to be covered with the students.
When the semester
began there were only two students remaining from the first semester.
The second semester students had an entirely different group person·al ity.
They appeared to be more mature and definitely were more out-
going.
The first session was spent getting acquainted and talking about
areas that might be covered during the semester.
With the help of the
students a tentative format was set for covering certain areas.
The
64
only dates that had a definite time commitment were those that would
involve the use of films; as these needed to be reserved.
At this time over one-half of the core curriculum has been covered but not in the format in which it was planned.
From the beginning
the students were encouraged to ask questions, this meant that the
areas were covered in a nonstructured manner.
The premise was that if
questions were asked about an area not planned for the day, that indicated a need that should be met.
An example of this was the coverage of anatomy and physiology
which was planned for the first educational session.
The session
started with the use of the Birth Atlas and the plan to review male
and female anatomy.
When the session was over, as much time had been
spent discussing family planning questions as had been spent on anatomy.
The anatomy and physiology has since been incorporated through-
out the following sessions when discussions on prenatal care, labor
and del !very took place.
The weekly sessions were scheduled to last an hour.
In some in-
stances the students were restless and the time was shortened.
At
other times when the hour was up there were stilI questions and the
class time would be longer.
A problem that has not been satisfactorily resolved is when students enter the program later in the semester or are absent.
necessary films are not always avai fable.
The
Reading material is given
to the student but this is not a satisfactory solution.
In using the curriculum as written it was impossible to cover
any of the areas completely in a one-hour session.
This possibly
65
could be achieved if arrangements could be made with the classroom
teacher to show the film at another time and have the sessions mostly
didactic and structured.
CHAPTER
V
RECOMMENDATIONS
The resource guide that has been developed should be considered
as a core guide.
As the majority of the students are going to raise
their babies there is a need to further expand this to include areas
such as child growth and development and parenting.
The resource guide should be tested in several of the schools and
then evaluated to see if
the areas that it covers.
~he
needs of the
student~ ar~
being met in
As the resource guide was developed using
the materials currently available there is a need for this portlon to
be updated as more materials are available or become unattainable.
The lack of materials that are specific for this age group is a
problem.
There is a need to have material avai Iable that is geared to
the younger mother.
The I iterature avai !able is more often geared to
the adult population.
One of the greatest difficulties has been in obtaining more films
than originally planned for in the semester.
The films are loaned out
to many high schools and other·areas so they must be reserved wei I in
advance.
It is difficult to be flexible in showing of the films. Dup-
1icate copies used exclusively for pregnant minor school programs,
,parenthood preparation classes and county prenatal classes need to be
made available.
This would cut the number of groups desiring to use
any one particular film and allow more flexibi I ity in showing films to
this population.
Each of the county's programs is under a different school district
and there is no attempt to coordinate the ordering of educational
66
67
materials for the schools.
There is a need for a master I ist of what
each school has available in their program; enabling the other programs
in the county to be aware of other resources.
A sharing of resources
between the school would be of advantage to the students and teachers
and could save the schools money so they wouldn't need to duplicate
more expensive items.
BIBLIOGRAPHY
1.
Abernathy, Virginia. "I I legitimate Conception Among Teenagers,"
American Journal of Pub I ic Health. Vol. 64, July 1974.
2.
Ballard, Walter and Gold, Edwin.
Reproduction in the Adolescent."
cology, Vol. 2, June 1971.
3.
Barglow, Peter. "Some Psychiatric Aspects of I I legitimate Pregnancy in Early Adolescence," Paper presented at 1967 American
Orthopsychiatric Assoc., Washington D.C.
4.
Bernstein, Rose. Helping the Unwed Mother.
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5.
Braen, Bernard. "The School-Age Pregnant Girl, The Problem and
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6.
Burkhart, Joan and Whatley, AI ice. "The Unwed Mother Imp I i cations for Family Life Education," Journal of School Health.
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7.
Calderone, Mary. "The Married Teenager." Journal of International Col lege of Surgeons, Vol. 43, April 1965.
8.
Conne I I, E I i zabeth. "Pregnancy, The Teen-ager and Sex Education," American Journal of Pub! ic Health, Vol. 61, September
1971.
9.
Daniels, Ada. "Reaching Unwed Adolescent Mothers,"
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"Medical and Health Aspects of
Clinical Obstetrics and Gyne-
New York; Associa-
American
10.
Davis, Lucille and Grace, Helen. "Anticipatory Counseling of
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11.
Delissovoy, Vladimir. "Child Care by Adolescent Parents,"
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12.
Early, Gene. "Adolescent Sexual Attitudes and Behavior,"
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Farber, Seymour and Wi I son, Roger.
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68
Teenage Marriage and Divorce,
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Howard, Marion.
nant Teenager,"
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Jones, Peter, et al. "Pregnancy Among High School Students,"
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Kanter, John and Zelnick, Melvin. "Contraceptive and Pregnancy
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Menken, Jane. "The Health and Social Consequences of Teenage
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Miller, William. "Psychological Vulnerability to Unwanted
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30.
Nelson, Shirley.
Apri I 1973.
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Children Today, March-
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