Working with the Young and Pregnant

by Andrea Robertson

Providing prenatal education programs for young women can be very rewarding. Many hospitals are now incorporating a program especially designed to appeal to this particular group and these can be successful and fun whilst providing a change in pace for the educators and a worthwhile community service.

Before launching such a program the basic pre-planning must be undertaken, paying attention to the usual aspects of a needs analysis: surveying the size of the potential group (demographic data is vital here), talking to a selection of young women to gauge their interest and needs, seeking out an appropriate venue and time of day, choosing appropriate group leaders and working on the development of a program that will be useful and engaging for the participants.

Working with this group will certainly provide some challenges. They are not like the more usual couples that seek out preparation for parenthood classes, and this presents both opportunities and potential problems. Pregnant teenagers are often primarily focused on their personal needs such as having somewhere suitable to live with the baby, money worries, hassles with school and parents, changing relationships with the father of the baby and their friends and retaining some semblance of their former lifestyle. They are keen to know about baby care but may be less worried about the actual birth. For educators, this may take some getting used to ­ you may be more familiar with anxious parents who are interested in knowing more about the epidural than how to relate to friends after the baby comes!

It will also be important to avoid making assumptions about the group members. Teenage parents are frequently on the receiving end of prejudice and social stigmas, often revolving around the mixed messages about sexuality. While it is accepted that sex can be used to sell practically anything, indulging in sex, especially if it is perceived to be outside community norms is often very unacceptable. For teenagers, coming to terms with their own sexuality and developing their own moral codes can be very confusing and difficult, particularly when they are surrounded with sexual messages and confusing images. If a pregnancy results from the almost universal experimentation that is part of growing up, the teenage parent can find themselves in very difficult territory, with perhaps few support networks and many social pressures. It is no wonder they may be more worried about how they will survive than how they should ‘behave’ while the birth is in progress.

In earlier generations it was common for women to start bearing children in their teens and this was not considered unusual or even difficult in a physical sense. There is no reason to believe that this group will have inherently difficult births or that they will make poor parents. In fact, their age can be a distinct positive ­ they are often very willing to ‘buck the system’, less likely to be concerned about what others will think of their behaviour during labour and birth and they often relate very well to babies. Many midwives report that the easiest and most natural births they have witnessed have been when young women were involved ­ there appear to be few ‘hang-ups’ and they are much more willing to go with the flow rather than trying to live up to expectations (their own or someone else’s).

When you are planning the program, the basics will need to be modified for the needs of this particular group. Some suggestions for devising an appropriate format and content follow:

  • Overall approach ­ given that young people often have a rather jaundiced view of school, learning from peers may be more successful than setting yourself up as the ‘teacher’. This will also reduce the risk of being regarded as another ‘parent’ figure out to give advice from their very different perspective. Instead of setting a formal program of topics and scheduling times etc, try a more relaxed style, revolving around the topics selected by the group at each session. This will enable immediate needs to be met and make it clear that this is a learner centred group that is flexible and responsive to the participant’s changing needs. Don’t worry that some topics may be left out ­ you’ll be surprised at how much can be covered over time and it is more important to focus on the issues that are relevant to the group now than to make sure that you have covered your own agenda.
  • Choosing teaching activities ­ you will want to avoid anything that reminds the group of the classroom, so ‘chalk and talk’ sessions are out. Look for teaching strategies that involve all the senses: activities that involve drawing or writing, making things (collages, pregnancy diaries, nutritious meals, even baby or pregnancy clothes), using models (such as dolls, food samples, baby equipment), role playing, small group work, games (trivial pursuit, Q & A, labour line), discussion around videos, visits to useful resources such as the community health centre, social services office, playgroup, and involving visitors to the group such as the local breastfeeding counsellor.
  • Encourage a realistic view of parenthood. Incorporating other young parents with their babies into the group will foster this process and provoke much useful discussion. It will also avoid creating a ‘credibility gap’ between yourself and the group and your role can shift to that of a facilitator, perhaps through asking pertinent questions (“how has the baby affected your social life?” “What’s the worst/best aspect of being a parent?” “What has been the most useful form of help for you?” etc) to stimulate discussion.
  • Enabling the formation of social networks is a major goal, especially for this group of new parents. Sometimes there will not be enough teenaged parents to form a group and you will have to adopt a one-on-one educational strategy. Use your resources to identify others in a similar situation (aim for someone of a similar ethnic and social background, if possible) and make arrangements for them to get together ­ you may have to assist with transport initially. Knowing even one other young mother can make a difference, easing feelings of isolation through fostering mutually supportive friendships.
  • Providing food is a great way of encouraging attendance (you’ll need more than a biscuit with their cup of tea!) and also helps people to relax. For some, the meal they have at the group may be the only decent meal they have that day (or even that week) so it is worthwhile taking some care with it. Look for local sponsorship or seek appropriate funding for this aspect of the program.
  • Pay attention to your marketing strategies! Doing your homework and using the information gleaned through focus groups, talking to young parents (nab them in the post natal ward and ask about their views on prenatal education) and feedback from other similar groups will help you formulate an appropriate method for advertising your groups. Prepare catchy leaflets and posters and place them where your target group may see them. At first, you may have to issue a personal invitation, perhaps at clinic appointments and even offer to arrange transport to make it easy for them to attend. Many pregnant teens will not want to come alone, so encourage them to bring a friend, the baby’s father, her mother or anyone else she wants. Once at the group, make sure they have fun at that first session and feel welcome ­ make sure they have someone to talk to who will take them under their wing.

In many ways teenagers will face the same hassles and joys as new parents that we all do and in this respect they are not very different from the parents that come to your regular classes. However, young people do have very different outlooks and personal circumstances that must be considered and acknowledged in appropriate ways. They can be a stimulating group to work with and give you a welcome educational stretch from your more traditional prenatal classes. They are going to be growing up fast, and if you are willing, they can take you on a fascinating ride that will give you a whole new perspective on pregnancy, birth and new parenthood.

This article was first published in The Practising Midwife, Vol 4, No 2, February 2001

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