8 Adolescent Pregnancy: Where Do We Start?
8.7 CONCLUSION
The Journal of Midwifery and Women’s Health provides several nutritional topics in their Share with Women series. You can go to their website at www.jmwh.org and print out information on weight gain during pregnancy, folic acid, eating safely during pregnancy, and others. These are provided courtesy of the American College of Nurse Midwives.
The March of Dimes produces many printed resources, in addition to their online materials, for nutrition education, including an easy to read booklet, video on healthy pregnancy for teens, and other fact sheets and materials. These may be accessed by going to the professional section on the website www.marchofdimes.org.
The Philadelphia Department of Public Health has produced a beautiful brochure supported by Title V, called “Healthy Foods, Healthy Baby.” It has great illustrations of two teenagers, and takes them through pregnancy and the decision to breastfeed, in 28 pages. There are sections on eating out, grocery shopping, weight gain, and nausea and vomiting. It includes weight chart and graph. The new nutrition pyramid information is included in the 2007 version. It is available for order at: http://www.phila.gov/health/
units/mcfh.
For those interested in implementing CenteringPregnancy (described above), the association provides handbooks, self-assessment surveys, and printed information along with recommendations for teaching aids as part of its initial training (www.centering-pregnancy.com).
A larger concern throughout the provision of services to adolescents may be the attitudes of providers. Are they viewed as “problems” since their pregnancy presents risks? Kenneth R. Ginsberg proposes that professionals look to the patient’s strengths, build on them, and reframe the issue in terms of what opportunities are present in the situation [43]. This framework is consistent with Motivational Negotiation [39] and the techniques presented in CenteringPregnancy [36–38]. For example, pregnancy gives a young woman and her partner the chance to expand their knowledge of nutrition so they can produce the healthiest child in the neighborhood. They can use that protein to make brain cells, and consume those vitamins to make a healthy immune system. Ginsberg [43] suggests that we consider resilience theory and move beyond the “problem” to recognize the competency and strengths of the young woman.
Chapter 8 / Adolescent Pregnancy: Where Do We Start? 111 3. Prescribe iron supplements (especially to vegetarian teens).
4. Recommend calcium supplements (Tums is easy!).
5. Provide easy-to-read nutrition resources.
6. Send your patients to WIC at their first visit.
7. Establish group opportunities for young mothers for education and support (or find ones already existing in your community, possibly the WIC office).
8. Graph weight gain for each young woman (visual learning) or better yet, provide her a chart to graph her own weight (see above for sources).
9. Provide material to explain the purpose of all weight gain (i.e. baby, placenta, fluids, etc.); ask body image questions.
10. Use your dietitian as a resource, s/he has lots of materials and ideas that may be useful.
11. Enjoy the interaction with the young!
A striking issue that becomes apparent in the review of materials for adolescent care is the lack of research in this area. There are obvious problems in doing randomized, controlled trials with pregnant adolescents since not just one, but two patients (mother and child) are affected, and both pose issues for informed consent. As providers, we need to seek methods to overcome these barriers to develop effective tools and processes to ensure the health and well-being of these individuals now and in the future. As we discover these answers, we can promote adolescents’ strengths, their new knowledge, and the confidence they build by successfully navigating this life passage.
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