'Pregnancy Changed me from a Kid to a Mom': A Qualitative Study of Teens' Resilient Beliefs about Pregnancy and Prenatal Health in the Context of Cumulative Adverse Experiences.

摘要

Teen pregnancy has been consistently perceived as a substantial social problem, despite recent declines and some equivocal evidence from longitudinal studies. The evidence for this framing has been gleaned from quantitative studies that demonstrate comparative decline in sociodemographic outcomes for the teens themselves and developmental and behavioral deficits for their children over time. Qualitative inquiry has provided an alternate perspective, one that provides teens with a voice, as their voices had been unheard until the last two decades. There are several areas largely unexplored with teens that have been studied with adult, higher-risk women. These are, first, teens' perspective and behavior during the prenatal period, which is vital for infant health and development and provides these young mothers-to-be with an opportunity to explore the meaning of this life-changing transition, how they feel toward their infants, and their future plans. The second is the impact of the interpersonal trauma and other cumulative forms of adversity pregnant teens have often experienced, on these perspectives.;The current qualitative study examined the perspectives of and behaviors around pregnancy in a sample of inner city pregnant teens receiving supportive home-visiting services from the Nurse-Family Partnership. Using a grounded theory approach, the study inductively explored the prenatal phase, and inquired about developmental (level of stability, quality of attachment, early interpersonal trauma) and current factors (fears and concerns, prenatal health behavior and attachment, mental health, help-seeking, wishes for the future). Twenty-three teens were interviewed over 18 months. Outcomes of this study revealed that teens generally felt very positively about their pregnancies and regarded this event to be a portal to a new and better life, and changed their health behavior and social activities accordingly. Teens also showed a high degree of resilient beliefs and behaviors, a spontaneous finding, maintaining hope and optimism and forming concrete plans for future parenting and stability. They also expressed much concern and fear about the lack of material resources, particularly housing. Mental health problems increased with exposure to trauma and stress. The salient finding here was that as interpersonal trauma exposure accumulated, the more positively teens felt about their pregnancies, the more resilient were their beliefs and behaviors, and the more mental health problems they endorsed. Teens with less exposure to trauma and stress had somewhat less positive views of pregnancy, more family and current support, better relationships with parents, more fears and concerns about their pregnancies, were somewhat less resilient, and had fewer mental health problems. Thus, teens who seem most enthusiastic and prepared are often those who have experienced the greatest amount of trauma and disrupted attachment, both of which may affect parenting capacity. Programmatic and policy responses focused on the need to include teens' historical narrative and a tableau of their current support in planning to assist them, rather than instantiating interventions which extend from a dominant discourse about what they need to succeed as parents.