Helping pregnant teenagers

Abstract

Teenagers who are pregnant face many difficult issues, and counseling by physicians can be an important source of help. We suggest guidelines for this counseling, beginning with a review of the scope and consequences of adolescent pregnancy. Communication strategies should be aimed at building rapport with techniques such as maintaining confidentiality, avoiding judgmental stances, and gearing communication to cognitive maturity. Techniques for exploring family relationships are useful because these relationships are key influences on subsequent decisions and behaviors. We discuss topics related to abortion and childbearing, such as safety, facilitation of balanced decision making, the use of prenatal care, and the formulation of long-term plans. Physicians who can effectively discuss these topics can help pregnant teenagers make informed decisions and improve their prospects for the future.

PIP: Pregnant teenagers are burdened with many difficult issues. Effective physician-counseling can help them with abortion decisions, early prenatal care when a teenager chooses to continue the pregnancy, and positive goal setting after childbirth. Prerequisites to building trust are ensuring confidentiality, patience, and a nonjudgmental attitude. Counseling must be geared to emotional and intellectual development. For example, teens aged 14-17 often cannot make the connection between current actions and future consequences, so they need explicit guidance in the realities of pregnancy and parenthood. Physicians must avoid imposing their personal views on abortion and unwed parenthood. They must not be authoritarian. They should explore a teen's family and social environment without stereotypical preconceptions to determine risks. Nonthreatening and open-ended questions can help open the way for discussions on family involvement (e.g., Do you enjoy being with your family?). When a teen is thinking about an abortion, the physician should provide information on the legality, availability, and timing of abortion. They should address the generally low medical risks of first trimester abortion. They should also examine the issue of parenthood versus abortion with the pregnant teen. The decision should be made by the pregnant teen herself rather than by the family or the physician. Denial, continual family concerns, fear of labor and delivery, financial barriers, ignorance of where to obtain prenatal care, and not understanding the importance of prenatal care are reasons teens delay seeking prenatal care. Counseling interventions should address fears about childbirth and misconceptions.