SEMINAR ON ADOLESCENT

PREGNANCY,ELDERLY
PREGNANCY,UNWED
MOTHERS,SEXUAL
ABUSE,SUBSTANCE ABUSE
MOTHERS

SUBMITTED TO, SUBMITTED BY,

Prof.Dr.S.Kalabharathi Mrs.R.Hemavathi
Principal college of nursing Msc(Nursing) ll year
HOD of OBG dept SCON,SIMATS
SCON,SIMATS
SEMINAR ON ADOLESCENT PREGNANCY,ELDERLY
PREGNANCY,UNWED MOTHERS,SEXUAL ABUSE,SUBSTANCE
ABUSE MOTHERS

1.ADOLESCENT PREGNANCY:

DEFINITION:

• Adolescent pregnancy is pregnancy in girls age 19 or younger. Adolescent

pregnancy is a complex issue with many reasons for concern. Kids age 12 -
14 years old are more likely than other adolescents to have unplanned
sexual intercourse . They are more likely to be talked into having into sex.

• Up to two-thirds of adolescent pregnancies occur in teens age 18 - 19 years

old.

RISK FACTORS:

• Younger age
 • Poor school performance

• Economic disadvantage

• Older male partner

• Single or teen parents

SYMPTOMS:

Pregnancy symptoms include:

 Abdominal distention
 Breast enlargement and breast tenderness
 Fatigue
 Light-headedness or actual fainting
 Missed period
 Nausea/vomiting
 Frequent urination

SIGNS AND INVESTIGATIONS: The adolescent may or may not admit to

being involved sexually. If the teen is pregnant, there are usually weight changes
(usually a gain, but there may be a loss if nausea and vomiting are significant).
Examination may show increased abdominal girth, and the health care provider
may be able to feel the fundus (the top of the enlarged uterus).

TREATMENT:

• Pelvic examination may reveal bluish or purple coloration of vaginal

walls, bluish or purple coloration and softening of the cervix, and softening and
enlargement of the uterus.

• A pregnancy test of urine and/or serum HCG are usually positive.

• A pregnancy ultrasound may be done to confirm or check accurate dates

for pregnancy.
• All options made available to the pregnant teen should be considered
carefully, including abortion, adoption, and raising the child with
community or family support.

• Discussion with the teen may require several visits with a health care
provider to explain all options in a non-judgmental manner and involve the
parents or the father of the baby as appropriate.

• Early and adequate prenatal

• care, preferably through a program that specializes in teenage pregnancies,

ensures a healthier baby.

• Pregnant teens need to be assessed for smoking, alcohol use, and drug use,
and they should be offered support to help them quit.

• Adequate nutrition can be encouraged through education and community

resources.

• Appropriate exercise and adequate sleep should also be emphasized.

• Contraceptive information and services are important after delivery to

prevent teens from becoming pregnant again.

• Pregnant teens and those who have recently given birth should be
encouraged and helped to remain in school or reenter educational programs
that give them the skills to be better parents, and provide for their child
financially and emotionally.

• Accessible and affordable child care is an important factor in teen mothers

continuing school or entering the work force.

PROGNOSIS:

• Having her first child during adolescence makes a woman more likely to
have more children overall. Teen mothers are about 2 years behind their
age group in completing their education.

• Women who have a baby during their teen years are more likely to live in
poverty
 • Teen mothers with a history of substance abuse are more likely to start
abusing by about 6 months after delivery.

• Teen mothers are more likely than older mothers to have a second child
within 2 years of their first child.

• Infants born to teenage mothers are at greater risk for developmental

problems.

• Girls born to teen mothers are more likely to become teen mothers
themselves, and boys born to teen mothers have a higher than average rate
of being arrested and jailed.

COMPLICATIONS:

 Placenta praevia

 Pregnancy-induced hypertension

 Premature delivery

 Significant anemia

 Toxemia

 Infants born to teens are 2 - 6 times more likely to have low birth

 weight than those born to mothers age 20 or older.

 Prematurity plays the greatest role in low birth weight, but intrauterine
growth retardation (inadequate growth of the fetus during pregnancy) is
also a factor.

2.ELDERLY PREGNANCY:

DEFINITION:

The elderly pregnancy mean a women get pregnant at or over the age of 35 years.
This definition may be adopted in the developing countries but it must be
remembered that the reproductive activity of the women in developing countries
starts at a much earlier age than that of the women in developed countries.
Although the age limit is being raised from 35-40 years in Britain and other
European countries , it may e wise to regard as an elderly primigravida, any
women who is pregnant for the 1st time at the age of 30years or more in
developing countries.

TYPES:

The two groups of women have emerged:

1. Multiparous women: have an additional child during the menopausal period

2. Primiparaous women: deliberate delay of childbearing.

OUTCOME OFPREGNANCY IN ELDERLY PREGNANCY:

 Adverse perinatal outcome more common

 More likely to have LBW infant, premature birth and multiple birth.
 Increased risk for maternal mortality due to haemorrhage , infection,
embolism, hypertensive disorders of pregnancy
 Increase maternal age leads to infertility and spontaneous abortion, GDM,
PIH, chromosomal abnormalities, genetic disorders , placental Previa,
preterm labour and surgical birth

COMPLICATIONS:

Tendency to abort •

Increased incidence of hypertension, pre eclampsia. This is understandable

because the older the women, gets the more likely to develop hypertension. • The
long period of infertility may induce the development of uterine fibroids which
may complicate the pregnancy.

Labour tends to be longer in the elderly primigravida than in the multipara.

Posterior position of the occiput are also common .Abnormal uterine action may
complicate labor.. • There is increased need for obstetric intervention because of
the rigid perineum and prolonged labor. The neonatal morbidity and mortality are
increased because of • prematurity, • prolonged labor and • the need to intervene,
as well as the increase evidence of congenital fetal abnormalities (eg: mangolism,
hydrocephaly, anencephaly etc. ) with increase maternal age
 UNWED MOTHER:

DEFINITION:

• Unwed mother is the lady who has become pregnant without legal
justification of physical intimacy between man and woman .

• In the traditional societies like India the physical relationship before

marriage or becoming mother before marriage is considered as a sin.

• Therefore the result of such women in the traditional societies is very bad.

Causes of unwed mother:

Poverty:

• The foundation of unwed mother lies somewhere in poverty.

• It is well known that very unfortunate parents due to their poverty sell their
daughter.

• The reality of this statement is well established by the newspaper and

news telecast on T V .

• Many of these girls end result is unwed mother.

Prostitution :

• Prostitute is an individual who for sake of some reward engage in illegal

sexual act with various individual either of same or opposite sex.

• The tragedy of this prostitutes is also being unwed mother.

Teen age mistake:

• Many teen age girls due to inefficient decision making make a mis

make them an unfortunate m unwed mother.

Improper sex education:

• Due to lack of improper sex education among teen agers and adolescent ,
the unwanted pregnancy is an emerging issue.
 Contraceptive failure:

• Contraceptive failure can also be a reason of unwed mother.

• If sexual relationship before marriage is made but used contraceptives does

not work them it result in an unwanted pregnancy making the lady an
unwed mother.

Consequences for mother:

Being mother before marriage , a mother has to face great consequences like
unwed mother is not socially acceptable in our traditional societies .

In traditional society it is believed as a curse, therefore it brings a lot of personal

disorganization in women who become unwed mother as she lack a support from
the family , relatives , society which makes her living quite hard.

Consequences for the family:

• The darkness of being unwed mother not only remain to mother but her family
also has to face it. • The society boycott the family of unwed mother and family
loose their relationship with the society which leads to isolation and hence result in
psychological trauma on family.

Economic problems :

• As unwed mother lacks support from family and society , therefore she faces
great economic problems.

Health problems:

• Both mother and child are at great risk of serious health problems. This may be
due to lack of support (emotional , Nutritional) both to mother and baby, unsafe
delivery practices which are usually conducted at unhygienic places to hide
unwanted pregnancy from society or due to improper guidance for rearing of child.

Support system available to unwed mother :

• Support system to unwed mother is more available in western societies than

traditional one.. For east few decades the government provides free food, free
medical support system , jobs to earn income , proper education facilities to unwed
mothers child.

Legal rights of unwed mothers Establish paternity :

• Unwed mother has a right to raise the case in the court to establish paternity for
her child against men who she is expected that he is father of her child.

Support to child :

• Once paternity is established, the mother can demand the support from father to
raise her child. The support can be in form of money or in some other form.

Custody of child :

• Even if paternity is established still has the right to undertake the custody of her
child if she want it.

PREVENTION:

Peer education : peer education should be implanted to provide education to those

who are not able to go school. Education regarding sexual and regarding sexual
and reproductive health can be provided to them by forming a group of peers.

Sex education : • Well designed and well implemented sexual and reproductive
health education can be provided to young people , so that they can engage in a
safe and responsible sexual behavior

Supply of contraceptives : • Government has made easy access to contraceptives

therefore should take benefit of it and must take necessary step to prevent the
occurrence of unwed mother . Abolition of prostitution • Prostitution mostly result
in unwed mother. So in order to prevent this the prostitution should be banned or
prostitute should be informed about the use of contraceptives.

Role of a nurse As educator :

• Nurse should play a vital role in providing sex education to youngster to prevent
occurrence of unwed mother. Nurse can provide knowledge to youngster about the
evil effect of being unwed mother.
As an advocator : • As an advocator, she can advocates the rights of unwed
mother and can protect her from further exploitation . She must inform the mother
about her legal rights which are provided by government to them so that mother
can take benefit of them.

As a helper : • As a helper , she can help the mother to raise her child in the
society. Nurse must provide free services to the mothers which are provided by
government agencies to help them.

As a researcher : • As a researcher , she should make research in the best

preventive measure to avoid the occurrence of unwed mother.

SEXUAL ABUSE/ SEXUAL VIOLENCE

DEFINITION :

Any sexual act , attempt to obtain a sexual act, unwanted sexual comments or
advances or acts to traffic , or otherwise directed , against a persons sexuality using
coercion , by any person regardless o their relationship to the victim, in any setting
including but not limited to home and work. •

• Sexual violence includes rape , defined as physically forced or otherwise coerced

penetration – even if slight – of the vulva or anus using a penis, other body part or
an object.. The attempt to do so is known as attempted rape. Rape of a person by 2
or more perpetrators is known as gang rape.

FORMS AND CONTEXTS OF SEXUAL ABUSE:

• Rape within marriage or dating relationships

• Rape by strangers

• Systematic rape during armed conflict

• Unwanted sexual advances or sexual harassment , including demanding sex in

return for favours

• Sexual abuse of mentally or physically disabled people.

• Sexual abuse of children

• Forced marriage or cohabitation , including the marriage of the children.

• Denial of the rights to use the contraception or to adopt other measures to protect
against sexually transmitted diseases.

TYPES OF SEXUAL ABUSE:

• Non-consensual, forced physical sexual behavior (rape and sexual assault).

• Unwanted touching, either of a child or an adult.

• Sexual kissing, fondling, exposure of genitalia, and voyeurism, exhibitionis m

and up to sexual assault.

• Exposing a child to pornography.

• Saying sexually suggestive statements towards a child (child molestation).

• Also applies to non-consensual verbal sexual demands towards an adult.

• The use of a position of trust to compel otherwise unwanted sexual activity

without physical force (or can lead to attempted rape or sexual assault).

• Incest ( sexual deviancy ).

• Certain forms of sexual harassment.

• Spousal sexual abuse is a form of domestic violence. When the abuse involves
forced sex, it may constitute rape upon the other spouse, depending on the
jurisdiction, and may also constitute an assault.

• Sexual misconduct can occur where one person uses a position of authority to
compel another person to engage in an otherwise unwanted sexual activity.

• Sexual harassment in education might involve a student submitting to the sexual

advances of a person in authority in fear of being punished, for example by being
given a failing grade

SUBSTANCE ABUSE:
DEFINITION:

Substance abuse, also known as drug abuse, refers to a maladaptive pattern of use
of a substance (drug) that is not considered dependent. Substance abuse/drug abuse
is not limited to mood-altering or psycho-active drugs.

• Activity is also considered substance abuse when inappropriately used (as in

steroids for performance enhancement in sports).

• Therefore, mood-altering and psychoactive substances are not the only drugs of
abuse.

• Substance abuse often includes problems with impulse control and impulsivity.
The term "drug abuse" does not exclude dependency, but is otherwise used in a
similar manner in nonmedical contexts. The terms have a huge range of definitions
related to taking a psychoactive drug or performance enhancing drug for a non-
therapeutic or non-medical effect.

Some of the drugs most often associated with this term include • alcohol, •
amphetamines, • barbiturates, • benzodiazepines (particularlytemaze pam,
nimetazepam, and flunitrazepam ), • cocaine, • methaqualone, and • opioids.

CAUSES:

• Family history factors that influence a child's early development have been
shown to be related to an increased risk of drug abuse, such as – chaotic home
environment, – ineffective parenting, – lack of nurturing and parental attachment.

• Factors related to a child's socialization outside the family may also increase risk
of drug abuse, including – inappropriately aggressive or shy behavior in the
classroom, – poor social coping skills, – poor school performance, – association
with a deviant peer group or isolating self from peers altogether, – perception of
approval of drug-use behavior.

SYMPTOMS AND SIGNS :

• Depending on the actual compound, drug abuse including alcohol may lead to
health problems, social problems, morbidity, injuries, unprote cted sex, violence,
deaths, motor vehicle accidents, homicides, suicides, physic al dependence or
psychological addiction.

Medical Treatment:

Most substances abusers believe they can stop using drugs on their own, but a
majority who try do not succeed.

• Research shows that long-term drug use alters brain function and strengthens
compulsions to use drugs. This craving continues even after your drug use stops.

• Because of these ongoing cravings, the most important component of treatment,

also called recovery, is preventing relapse. Treating substance abuse depends on
both the person and the substance being used.

• In behavioral treatment, a counselor provides you with strategies to cope with

your drug cravings and ways to avoid relapse. Your doctor may prescribe
medications, such as nicotine patches and methadone, to control withdrawal
symptoms and drug cravings.

• Often, a drug user has an underlying behavioral disorder or other mental illness,
one that increases risk for substance abuse. Such disorders must be treated
medically and through counseling along with treatment of the drug abuse.

PREVENTION OF SUBSTANCE ABUSE :

• Substance abuse may start in childhood or adolescence. Abuse prevention efforts

in schools and community settings now focus on school-age groups.

• Programs seek to increase communication between parents and their children, to

teach resistance skills, and to provide information in order to correct children's
misperceptions about cigarettes, alcohol, and drugs and the consequences of their
use. Most importantly, officials seek to develop, through education and the media,
an environment of social disapproval from children's peers and families.

PROGNOSIS OF SUBSTANCE ABUSE:

Individuals who suffer from substance abuse tend to be more successful in

recovery when they are highly motivated to be in treatment, are actively engaged
in their own recovery, and receive intensive treatment services. Prognosis for
substance abuse recovery is further improved by being able to easily access
community-based social supports.

Journal references:

Relationship of Maternal Smoking During Pregnancy With Criminal Arrest

and Hospitalization for Substance Abuse in Male and Female Adult Offspring

Published Online:1 Jan 2002

American journal of psychiatry

OBJECTIVE: Maternal prenatal smoking has been found to be related to

externalizing behavior problems in male offspring, but this relationship has rarely
been examined in female offspring. Preliminary evidence suggests that maternal
prenatal smoking may be particularly related to antisocial behavior outcomes in
male offspring and substance abuse problems in female offspring. This study
attempted to replicate these findings in a large-scale, longitudinal community
cohort study

METHOD: Subjects were a birth cohort of 4,169 male and 3,943 female offspring
born between 1959 and 1961 in Copenhagen, Denmark. During the third trimester
of pregnancy, the subjects’ mothers self-reported the number of cigarettes smoked
on a daily basis. When the offspring were adults, their criminal arrest histories and
psychiatric hospitalizations for substance abuse were checked in national registers.
Additional data were collected concerning maternal rejection of the infant,
socioeconomic status, maternal age, pregnancy and delivery complications, use of
drugs in pregnancy, paternal criminal history, and parental psychiatric
hospitalization.

RESULTS: Results indicate a dose-response relationship between the amount of

maternal prenatal smoking and both criminal arrest and psychiatric hospitalization
for substance abuse in male and female offspring. These relationships remained
significant after potential demographic, parental, and perinatal risk confounds were
controlled. Hospitalization of offspring for substance abuse mediated the
relationship between maternal prenatal smoking and criminal arrest for female but
not for male  
CONCLUSIONS: Maternal prenatal smoking is related to criminal and substance
abuse outcomes in male and female offspring. Higher rates of index arrests for
female offspring may be related to their substance abuse problems.

Theory application: NOLA PENDER (Health promotion model)

BIBLIOGRAPHY:

 D.C.Dutta’s, textbook of obstetric”,8th edition,Hiralal konar,New

delhi,p232-240.
 Basker Nimma,midwifery and obstetrical nursing,2nd edition,jaypee
publication,New delhi,
 Brar kaur navdeep,Text book of advanced nursing practice,3rd
edition, jaypee publication,New delhi.