The Health Dilemmas for Pregnant Girls
While policymakers agonize over how to stem the flow of teenage pregnancies, obstetricians face another dilemma: They must help a child give birth to a child as safely as possible.
Here are a few of the obstacles that teen moms-to-be and their doctors encounter.
The Moms: It’s very likely a pregnant teen has received inadequate prenatal care, so health problems affecting mother and fetus might have gone undetected.
In 1992, only 41% of teenagers younger than 15 who gave birth received medical care during their first trimester, according to the American College of Obstetricians and Gynecologists, citing government statistics and a survey by the Alan Guttmacher Institute. Only 58% of teenagers 15-19 received early prenatal care.
In comparison, 81% of women 25-29 who gave birth in 1992 had first-trimester care.
The Delivery: Whether a teenager is physically developed enough to give birth vaginally or must have a caesarean section is a decision that can only be made after a thorough evaluation.
It depends, among other factors, on how fully developed the pelvic bones are, says Dr. Ezra Davidson, professor and chairman of the Department of Obstetrics and Gynecology, the Drew University of Medicine and Science and the King/Drew Medical Center.
In general, he says, the pelvic bones are fully developed about four years after the onset of menstruation (which in U.S. girls occurs at an average age of 12.8 years). But some teenagers are able to deliver vaginally even if four years have not yet elapsed.
The status of the uterus plays a role, too, in whether vaginal delivery will be possible. “It takes a mature kind of [uterine] muscular response for labor to progress normally,” Davidson says. If the cervix does not open sufficiently, for instance, the teenager might not have adequate labor.
“Very short women, under 5 feet, are more likely to have a C-section,” Davidson says. “If weight is appropriate for height, that’s a better situation,” he adds.
The bottom line, Davidson says: “Most girls at 14 or 15 can deliver vaginally.”
The Babies: Regardless of delivery method, teen mothers are at higher risk of giving birth to a low-birth-weight baby (5 1/2 pounds or less), says Dr. Joseph Sanfilippo, professor of obstetrics and gynecology at the University of Louisville and vice chairman of the ACOG’s adolescent health committee.
In 1992, 13.2% of babies born to girls younger than 15 were of low birth weight; 9.3% of those born to 15- 19-year-olds were, according to ACOG.
Low-birth-weight babies are at higher risk for health problems, such as respiratory problems, infections and intestinal problems.
The Psyche: While physicians and others tend to medical needs of young mothers and their babies, social workers such as Adrienne Thomas, who works in the Teenage Pregnancy Clinic at Kaiser Permanente, Los Angeles, address psychological issues.
“Generally most of the girls are very excited, but also scared,” says Thomas. “They have the same concerns as older moms--being a good mother, regaining their figure.”
Anxiety is a given. “But the more knowledge they have, the better they feel,” she says. So, besides providing health services, the clinic provides instruction about maternal nutrition, childbirth, baby care, post-delivery contraception options and preparing for breast-feeding. There is also information about the dangers of alcohol and tobacco use during pregnancy.
* Doheny cannot answer mail personally but will attempt to respond in this column to questions of general interest. Please do not telephone. Write to Your Body, Life & Style, Los Angeles Times, Times Mirror Square, Los Angeles, CA 90053.
