Introduction

Underage gestation refers to girls undergoing pregnancy in their pre-

adolescent stage, defined as 13 – 19 years old. Most of these teenage moms

have not yet reached legal adulthood, but if old enough to be married – they are

considered emancipated minors.

A current statistics show that 30% of births come from the 15-24 year old

age group, which is about 17million Filipino women – supporting this is the fact

that the average menarch of girls in the Philippines starts with their 12-13 years.

This only means that if girls are getting pregnant at the age of 15, they have early

exposure and are probably actively engaged on the sexual scene. Causes of

these situations are relative. Lack of parental supervision is the most common

and seen these days. Parents sometimes fail to see that they are too much

acquainted with their careers to sustain the family and they forget to preserve or

teach certain values to their children that prevents early gestation.

Teens nowadays are surrounded with pressure from their peers, circles,

and various social groups. Exposed to these kinds of environments, they are

unconsciously urged to embrace the sexual panorama as a normal phase in their

life – which is definitely in the wrong proportion – taking in that they are only

minors and introduction to those surroundings brings about uncompromised

conception that will eventually lead to more complicated situations (e.g. poverty,

abortion).
 Pregnancy is a gift, but it is also a choice. Unexpected gestations are at

first hard to accept thinking of the compromised future of the mother and the

baby itself. It is not idealistic to have a family at a very young age specially in our

country’s situation, but if it comes, then one has to face it bravely accepting

responsibilities and trials that they should overcome, and let us not forget that

there is always a Divine supervision that guides us in our daily wages.

A. CAUSES

i. Environment

All teenage pregnancies are the result of sexual activity,

whether voluntary or involuntary. No matter what measures are taken

for birth control, the only 100% effective way to prevent pregnancy is

abstinence from all sexual activity. Some teenage girls become

pregnant while involved in long-term dating relationships. Other girls

become pregnant after hooking up. And, some girls may even

become pregnant as a result of a rape situation. (Option Line, 2008)

 Based on WHO statistics, almost 10 percent of girls become

mothers by age 16 years in low and middle-income countries with

the highest rates in sub-Saharan Africa and south-central and

south-eastern Asia.

However, the WHO said the contexts of adolescent pregnancies

are not always the same. Coerced sex, reported by 10 percent of girls who

first had sex before age 15 years, also contributes to unwanted adolescent

pregnancies. The WHO said teenage pregnancy is dangerous for the

mother, dangerous for the child and adversely affects communities.

The health body issued measures that needs to be done to

promote the sexual and reproductive health of adolescents and to prevent

adolescent mothers and their babies from dying in pregnancy. These

include:

- Information including comprehensive sex education;

access to a full range of sexual and reproductive health services

and contraception; safe and supportive environments free from

exploitation and abuse.

- Families and communities need to support adolescent

mothers. Men, parents, mothers-in-law and other decision makers

 at the household and community level should be involved to ensure

their support and acceptance for pregnant adolescents.

- Adolescent mothers’ access to education, livelihood skills

and information about how to prevent further pregnancies and their

ability to deal with domestic violence should be improved.

- Skilled health workers need to be able to provide a range of

services in outpatient and other clinical settings that will help save

the lives of pregnant mothers and their babies.

- Health workers should provide adolescents with an early

start to antenatal care and to options for continuing or terminating

the pregnancy. They should also be alert to special problems that

require particular attention among adolescents.

- Health workers should also develop a plan for birth with the

adolescent and her family, including the place of birth, availability of

transport and the costs involved.

The WHO said health systems need to be able to respond to the

special sexual and reproductive health needs of adolescents.

Adolescents aged 10 to 19 years that account for 11 percent of all

births worldwide, also account for 23 percent of the overall burden of

disease (disability- adjusted life years) due to pregnancy and childbirth.

 About 2.5 million adolescents have unsafe abortions every year,

and adolescents are more seriously affected by complications than are

older women.

Stillbirths and death in the first week of life are 50% higher among

babies born to mothers younger than 20 years than among babies born to

mothers 20- to 29-years-old. Deaths during the first month of life are 50 to

100 percent more frequent if the mother is an adolescent versus older,

and the younger the mother, the higher the risk.(PNA)

According to Ms. Mrs. Sancha Aguila, Pyschology teacher

and Guidance Counselor of the STC College Department, teenagers who

engage in premarital sex are usually those who come from broken homes

or those with struggling relationships within the family. Studies show that a

child raised by both parents in an intact family is less likely open to sexual

risk-taking than those raised by separated parents.

“In the presence of harmonious interpersonal relationships within

the family, teenagers will be guided accordingly,” said Aguila. She

suggests that family meetings are very helpful in order to clarify issues

and concerns of each member.

Teenagers are at their most vulnerable stage in life and this

is the point where they need love, protection and guidance the most. As

for Veronica and Shane, they already have a list of what-and-what-nots as

 beginner parents, learning from what they have gone through. (Philstar,

Patena, Sept. 2009)

B. EFECTS

i. Physiological

a. Anatomical Review of Gestational Changes

Major Physiological Changes During Pregnancy

Signs and Symptoms Causes
FIRST TRIMESTER
Amenorrhea Fertilization and implantation of egg
Increased hormone levels
Morning Sickness Increased serum hormone levels
 (HCG)
Breast Changes Increased Estrogen levels
Enlargement
Tenderness
Darkened and Enlarged Nipples
Urinary frequency Pressure of Uterus on the bladder
Fatigue Increased Nutritional Demands
Decreased nutritional intake resulting

from morning sickness

SECOND TRIMESTER
Integumentary changes Increased levels of melanocyte

producing hormones
Pigmented nipple and breast
Hyper-pigmentation of abdominal

line (Linea Nigra)

Mottling of cheeks or forehead

(chloasma or “mask of pregnancy)

Local of generalized pruritus
Hypertrophy of gums causing Proliferation of interdental papillary

gingival swelling and bleeding blood vessels, resulting in local

inflammation and hyperplasia

Increasing size of uterine fundus Growth of fetus
Sensation of movement or gas- Fetal Movement

like movements (quickening)

Braxton – Hicks Contractions Expanding Uterus and preparation of

Uterus for labor

THIRD TRIMESTER
Increased Colostrum Hormonal Influence; preparation of

breasts for lactation

Increased Urinary frequency Pressure on bladder from enlarged

fetus

Table1.1 Major Physiological Changes During Pregnancy ( Potter-Perry, 2008)

The First Trimester (Weeks 1–12)

The first trimester of pregnancy lasts from conception until 12 weeks gestation

(pregnancy length). Women usually don’t realize they are pregnant until at least

two weeks into the first trimester, when they miss their period. During the first

trimester, your growing baby is developing at an amazing rate.

Development. A baby starts out as a few cells (called an "embryo" until it

reaches its eighth week, and thereafter a "fetus"), and proceeds to develop the

basis for all of the mechanisms it will need within the first trimester. Development

begins when the fertilized egg attaches itself to the wall of the uterus in a process

called "implantation". If all goes well, the fetus will be approximately 6 to 7.5 cm

in length, and weigh a little over 1 ounce by the end of the first trimester.

The Second Trimester (Weeks 13–27)

For many women, the middle part of pregnancy (the second trimester) is the

most comfortable pregnant period. The second trimester is a good time to

prepare yourself and your home for the arrival of the new baby. This is the time

to begin preparing a nursery or other space for the baby, to learn about breast

feeding, and to study books about early childcare.

Development. The second trimester marks a period during which the developing

fetus becomes active, and begins to move, kick and swallow. ArouThe Third

Trimester (Weeks 28–40)

The final stage of pregnancy, weeks 28 through 40, is often marked by excited

expectation of the baby’s arrival. At this stage, it is a good idea to have your

hospital overnight bag packed and ready to go.

Development. The growing fetus begins to be aware of its surroundings as the

third trimester gets underway. Early in the third trimester, the fetus begins to

open and close its eyes and suck its thumb. He or she also begins to respond to

light and sound. As the fetus continues to grow, it has less and less room to

move around. Some women report being able to identify the shape of an elbow

or a heel poking into their abdomen. At the end of this trimester, (and the end of

the pregnancy), the fetus moves into the position for birth, which usually means

he or she moves into a "head down" position lower in the mother's abdomen,

nearer to her pelvis.

nd the fifth month of pregnancy, the fetus gains the ability to turn from side to

side or head over heels. It is usually around this point in the pregnancy (between

the 18th and 22nd weeks) that most women experience "quickening", or the

ability to feel fetal movement. It is also during this stage that the fetus begins to

sleep at regular intervals. By the end of the second trimester the fetus is around

8 to 12 inches long and weighs up to 1 pound.

Early Signs of Teen Pregnancy

There are many pregnancy signs for teens. In some cases these early signs of

teen pregnancy may occur for reasons other than pregnancy. For example, if a
teen is unusually stressed or active, she may experience one or more pregnancy

signs common in teens. Early signs and symptoms of teen pregnancy include:

• a missed period

• nausea or vomiting

• frequent urination

• tenderness and fullness of breasts

• fatigue

• changes in appetite

ii. Psychosocial

Major Psychosocial Changes During Pregnancy

Category Implications
Body Image Morning sickness and fatigue may

contribute to poor body image

Client may feel big, awkward and
 unattractive during the 3rd trimester

when fetus is growing more rapidly

Increase in breast size may make

women feel more feminine and

sexually appealing
May take extra time with hygiene

and grooming, trying new hairstyles

and make-up
Begins to”show” during the second

trimester and starts to plan

maternity wardrobe
General feeling if wel-being when

woman can feel the baby move and

hear heartbeat
Role Changes Both partners thing about and can

have feelings of uncertainty about

impending role changes

May have feelings of ambivalence

about becoming parents and

concerns about ability to be parents

Sexuality Need reassurance that sexual

activity will not harm fetus

Desire for sexual activity may be

influenced by body changes

May desire cuddling and holding

rather than sexual intercourse

Coping Mechanisms Need reassurance that childbirth

and child rearing are natural and

 positive experiences but can also

be stressful
Often unable to cope with particular

stressors such as finding new

housing, preparing the nursery, or

participating in child-birth classes

Stresses during pueperium May return home from hospital

fatigued and unfamiliar with infant

care
May experience physical discomfort

of feelings of anxiety or depression

May be necessary for woman to

return to work soon after delivery

with subsequent feelings of guilt,

anxiety, or possibly – sense of

freedom or relief.

C. Complications

a. Physiological

The pregnant teen must see a doctor even

though it might feel scary to confide in an adult.

A doctor must respect patient confidentiality. A

physician can help explore options and can

rule out possible complications such as an

 ectopic pregnancy. This is considered as pre-

natal assessments and check-ups for the

baby’s health as well as the mother.

There are special risks to a baby when the mother is not fully mature. Because

most teenagers are not phsycially, emotionally, or financially ready to carry and

care for a child, their babies tend to have low birth weight and are predisposed to

a variety of illnesses. A teenage mother will need the full support of her family to

live a healthy lifestyle for her and her baby.

Teen pregnancy has reached a 20-year low; however, teens give birth to

approximately 500,000 babies each year. Teenagers often do not use

contraceptives, and unfortunately, nearly two thirds of all teenage pregnancies

are unintended.

The vast majority of teen mothers are not married, but few give up children for

adoption or care by others. For this reason, the mothers often must drop out of

school and cannot hold full-time employment. They must suddenly assume the

responsibility of raising a child before they are ready, emotionally or financially.

Risks

Compared with mothers in older age groups, teenage mothers are at greater risk

of having medical complications. Because the teenage mother is more likely to

receive little or no prenatal care, she often becomes anemic and is more likely to

develop preeclampsia, a severe condition associated with high blood pressure.

Vitamin deficiencies are more common, and the teenage mother's weight

gain is likely to be inadequate. Since the teenage mother is still growing herself,

she needs to eat properly not only for her own growth but for normal growth of

the fetus.

Pelvic bones do not reach their maximum size until about the age of 18;

therefore, the pelvis of the teenage mother may not have grown enough to allow

vaginal delivery of a normal-size baby. For this reason, the incidence of cesarean

section is higher in teenage mothers -- a baby that can be delivered vaginally

when the mother is 20 is often too large to have been delivered vaginally when

she was 14 years old.

Babies born to teenage mothers are more likely to die in the first year of life

compared with babies born to mothers older than 20 years of age. Since the

teenage mother is less likely to eat correctly during pregnancy, her baby often

has a low birth weight (less than 51/2 pounds), making it more likely the baby will

become ill.

Treatment
The teenage mother should be encouraged to seek prenatal care early in

pregnancy, eat a nutritious diet, take prescribed vitamins and iron supplements,

and engage in healthy physical activity. Though a supportive family can help the

teenage mother cope with her new responsibilities, social service agencies may

be needed to help her find ways to finish school and seek employment.

Delivery

The average length of pregnancy is 40 weeks, or 280 days, from the first day of

the last normal menstrual period. The due date, or expected date of delivery, for

a pregnancy is calculated simply by adding nine months and seven days to the

first day of a woman's last normal menstrual period. For example, if the first day

of the last menstrual period was January 1, the expected date of delivery is nine

months and seven days later -- on October 8. (Some physicians use the term

expected date of confinement, or EDC, to describe the due date.)

In reality, the majority of women do not actually give birth on the due date. About

80 percent of babies are born within ten days of the due date-either ten days

before or ten days after. As long as the delivery occurs between 37 and 42

weeks, the pregnancy is considered full term.

If the mother goes into labor before the due date, the baby could be in serious
danger. In the next page, you will find out what to do if you go into premature

labor.

b. Psychosocial

An unplanned pregnancy is a traumatic event and a teenage woman needs

empathetic support. Pressure from parents, medical staff, friends and partners

can exacerbate her stress. Her options include:

• Abortion – 16 per cent of Australian women seeking abortion are

teenagers. There is no age restriction on abortion as long as the woman

has a clear understanding of the purpose, nature, risks, effects and

alternatives.

• Adoption – relatively few women relinquish their children for adoption

anymore, although adoption agencies and the demand for babies still

exist.

• Foster care – the child lives with a foster family until the teenage mother

feels ready to cope as the primary carer.

Parenting – the stigma of single parenthood has passed, which means that

keeping the child is more common than in the past. Social problems faced by

teenage mothers

The social stigma of being a single parent no longer exists in most parts of the

Australian community and the availability of pensions means that parenting is a

viable option. Many teenagers believe looking after a baby will be the happiest
time of their lives. This is true for some, but keeping the child may have

unforeseen consequences, such as:

• Reduced education and employment opportunities

• Alienation from family and friends

• Poverty

• Increased risk of mental health issues

• Increased risk of child abuse and neglect

• The child may not receive adequate guidance due to parental life

inexperience

• The child is more likely to become a teenage parent themselves.

• Counseling options

Pregnancy counseling is generally available in all Australian states and

territories. Ideally, counseling should support the young woman in making

a free and fully informed decision about her options and provide

information on abortion, adoption and parenting. Many teenagers feel

uncomfortable or unable to talk with family, so professional counseling

offers a valuable and much-needed resource.

Conclusion

Teenage Pregnancy may not always be a problem per se, although it may

complex issues with our society. However, it is clear that, given support, young

parents can be confident in their abilities to parent.

 Becoming a parent may also refocus their lives as their responsibilities for

the baby are realized positive aspirations and directions often emerge.

Some young parents find a new determination to seek success, not only

as full time parents but also as individuals who are confident, socially included

citizens in our society.

It is also clear that support offered to these young people must be

ongoing, consistent, socially included citizens in our society.

It is also clear that the support offered to these young people must be ongoing,

consistent, flexible, based on the needs of the individual, grounded in the clear

evidence based principals and continually evaluated.

References

• Women and Gender ( A feminist Psychology) , Second Edition Rhoda

Unger and Mary Crawford

• Midwifery Best Practice, Volume 3 Edited by Sara Wickham ,2005

• Maternal And Child Health Nursing: Care of the Childbearing and

Childbearing Family, Vol. I & II, Adele Pilliteri 2007

• Fundamentals of Nursing, 8th Ed., Kozier and Erb, 2008

Internet References

• www. Philstar.com (February 2009 Articles)

• www.inquirer.net (September 2008 Articles)

• Optionline.org (Pregnancy Organization), est. 2009

• www.merck.com/mmpe (Medical Library)

• www.pregnancycenters.org/cause-teen-pregnancy.asp

• WHO Online Articles 2008-2009