Becoming a mother : teenage mothers ’ experiences of first pregnancy

The purpose of this study was firstly to explore and describe the experiences of teenage mothers of first pregnancy. Secondly, to develop guidelines of a support programme that is contextual and relevant to the needs of teenage mothers. The guidelines are aimed at assisting midwives in meeting the needs of teenage mothers. An exploratory, descriptive, contextual and qualitative design was used. The phenomenological approach was implemented to collect and analyze data from a purposively selected sample of fourteen (14) teenage mothers who were pregnant for the first time. The model of Guba and Lincoln (1985: 301-318) was implemented to ensure trustworthiness in this qualitative study. Five themes emerged from the analysis of the data. Guidelines and recommendations for support programme were developed.


Introduction
Pregnancy is viewed by psychologists as a time of crisis brought about by em otional, psychological and social stress which reflects the identity crisis of becoming a mother (Bribing, 1959 in Niven andWalker, 1996:45;Tarkka, Paunonen & Laippala, 2000:184).It has the distinction of being an event that is c u ltu ra lly , so cially and ph y sically transformative and must be viewed in the context in which it occurs (Schneider, 2002:238).The onset of pregnancy is an im portant transitional period during w hich w om en exp erien ce m any p h y sio lo g ic al, em otional and psychological changes in their lives (Mercer, 1986:52).For young women, preg n an cy w as found to m ark the transition from girlhood to womanhood (S eibold, 2004:173).M any teenage mothers who were pregnant for the first time at particular clinics at the Capricorn District, Limpopo Province, were still biologically immature and still at school.During pregnancy, the expectant mother undergoes m ajor physiological and psychological adjustments.Teenagers have less tim e o f assim ilating body changes from pubertal growth before having to in co -o p e rate changes occurring with pregnancy.Tarkka et al (2000: 184) were of the opinion that in the early pregnancy stage a woman might have bad feelings about her future motherhood, especially if she felt that the timing was wrong.The symptoms of teenage pregnancy are not d iffe ren t from that o f norm al pregnancy.These include missed period, fatigue, nausea and vom iting, breast enlargement and tenderness, weight gain and increased moodiness.Lack of inform ation regarding these physiological changes was displayed when statements like "I didn't know that missing menstrual period is a sign of pregnancy".With increasing body size, most of these teenage mothers thought they were fit.Since they placed greater emphasis on physical appearance and trim figure, they felt clumsy, unattractive, ugly or fat and experienced difficulty in accep tin g th eir im age.In sp ite o f ex p e rien cin g these sym ptom s, the pregnant teenager did not tell anyone about the pregnancy; and as such, they were often not noticed by family members.(Nolte, 1998:73;Seibold, 2004:178).Because their pregnancies were often not planned the teenage mothers felt shy and embarrassed.They therefore, wore bigger clothes to conceal the pregnancies.Bookings at the clinics were also only made when they were at an advanced stage of pregnancy, or confirmation of the pregnancy was mostly done by a general practitioner at approximately 32-36 weeks.Niven and Walker (1996:42) in d icated that attitu d es tow ards p regnancy varied from society to society.In some societies, teenage pregnancy was regarded as a source of embarrassment because of its association with sexuality and was therefore kept a secret for as long as possible.This could have negative implications for health care, which may not be provided for until late in the pregnancy, or if available, may not be utilized at all.The notion was further supported by Chandria, Schiavello, Ravi (2 0 0 2 :1 2 1 ) who pointed out that poor attendance to the antenatal clinic had potential adverse effects such as low birth w eight and in tra-u te rin e grow th retardation.
In this study, the researcher was of the o p in io n that when there was poor attendance to the antenatal clinic, teenage m others m issed the opportunity of receiving accurate information on basic physiological, psychological changes and advices on se lf care during pregnancy from the m idwives.It is assumed that these could contribute to negative experiences.T arkka et al (2 0 0 0:186) in the study on "The importance of the midwives in the first time mother's experience of childbirth", pointed out that the first time mothers experienced pregnancy and childbirth as something more negative than positive.Women were experts of their own lives, yet there was a lack of docum ented literature about experiences of their first pregnancy.They further pointed out that the mothers' experiences of pregnancies deserved more attention if appropriate and sensitive care was to be provided to women in South Africa.Rice and Naksook (1998:74) were of the notion that it is only when women voices were heard in all aspect of health care delivery that we might provide better and appropriate health care services for w om en at childbirth.

Problem statement, research questions and objectives
Teenage mothers who are pregnant for the first tim e experience physical, psychological and emotional changes.The knowledge of these experiences could assist midwives in determining their needs and to develop guidelines for support program me.The study was co n d u cted in o rd er to answ er the research question outlined below: • What are the teenage mothers' experiences (physical, psychological, emotional and cultural) of their first pregnancies?

Objectives
The objectives of the study were to: • explore and describe teenage mothers' experiences of their first pregnancies.• develop guidelines for support programme that will assist midwives in meeting the needs of teenage mothers who are pregnant for the first time in the Capricorn District, Limpopo Province.

Paradigmatic perspective
The research was based on The Theory for Health Promotion in Nursing (Nursing Department RAU: 2000).This theory reflects the focus on the promotion of health of the individual, family, group and community.The four central components of the theory are the person, midwifery, environment and health.

Metatheoretical assumptions
Person A teenage mother who is pregnant for the first time is a whole person who embodies dimensions of body, mind and spirit.She functions in an integrated, interactive manner with her environment.

Midwifery
Midwifery is an interactive process in which a midwife as a sensitive therapeutic professional facilitates the promotion of health through the m obilization of resources.

Environment
A teenage mother who is pregnant for the first time has internal (body, mind and spirit) and external (physical, social and sp iritu al) environm ents, and she functions in an integrated, interactive manner with her environment.

Health
Health is a dynamic interactive process in the teenage m other's environment.This interaction with her environment reflects the relative health status of the mother.

Methodological assumptions
Due to the exploratory and descriptive nature of the research, the qualitative m ethod was used.The cen tral methodological assumption was based on fu n c tio n a l reasoning o f B otes (1995:13).This assumption entails that the research m ust be applicable to practice and must be useful.The major objective was to solve problems as they occur in practice in order to improve the service character of nursing.

Teenage mother
Teenage mother refers to a young woman who has reached puberty with an age ranging between 13-19 years and who is pregnant.

Experiences
The Oxford School Dictionary (Hawking 1998:225) defines experiences as "living through" what happens to one and how one responds or reacts.In this study ex p erien ces referred to p h y sical, psychological, emotional and cultural changes that the teenage mothers lived through during their first pregnancies.

First pregnancy
First pregnancy is referred to as the state from conception to delivery of the fetus [for the first time].The normal duration is 280 days (40 weeks or 9 months and 7 days) counted from the first day of the last normal menstrual period (Adams, 1995:129).This definition was adopted for the purpose of the study.

Research design and method
The re searc h study used was a qualitative, exploratory, descriptive and contextual design (Mouton, 1996:103-106).A phenomenological approach was used to study the experiences of teenage mothers' first pregnancies holistically, as it was lived (Polit & Hungler, 1997:651;Bums & Grove, 1993:30).

Population and sampling
Fourteen ( 14) teenage mothers who were preg n an t for the first tim e w ere purposively selected.These teenage mothers were selected during antenatal v isits at a p artic u la r clin ic in the C apricorn D istrict in the L im popo Province.The criteria for selection were: mother to be teenager, pregnant for the first time, be booked, and be 36 weeks of gestation or above.The purpose of the study was explained and inform ed consent obtained.The permission to conduct the study was obtained from the 88 Curationis May 2006 clinic m anagem ent.Interview s were conducted at the teenage mother's home within two days of contact.The principles of privacy and confidentiality were adhered to.

Data collection
Data was co llec te d through the phenomenological, unstructured in-depth interviews.One open-ended question was used; namely, "could you please tell me about your experiences o f first pregnancy?"Probing as a communication skill was used (De Vos, 2001:310).Permission was obtained to use a tape recorder to record interviews and field notes were recorded (Burns & Grove, 1993:578-581).Interviews were conducted until saturation was reached as was reflected in repeating themes (Strauss & Corbin, 1990:188).

Data analysis
Data was an aly zed by using the p ercep tiv e o f T esc h 's ap p ro ach in Creswell (1994:155;De Vos, 2001:343).The m ethod involved the follow ing steps: All transcripts were read carefully to get a sense o f the w hole.One interesting interview was picked, read through and ideas were jotted down on the margin as they came to mind.The researcher asked the following questions: what is it about?What is the underlying meaning?The tasks were completed for all interviews.A list of all topics was made and clustered them together in similar topics.The columns as major topics, unique topics and leftovers were formed.The most descriptive wording of topics was found and was tu rn ed into categories.Grouping of the topics that relate to each other was done by drawing lines to show interrelationships.A final category was made.Both the researcher and an independent coder an aly zed tran sc rip tio n s independently.Themes and categories emerged as the experiences of teenage mothers' first pregnancies.A literature control was conducted at the end of the study as a basis for com paring and contrasting findings of qualitative study (Creswell, 1994:23).

Trustworthiness
In th is study tru stw o rth in e ss was ensured by utilizing Guba and Lincoln's (1985:301-318) criteria.

Credibility
Credibility was established by prolonged engagem ent, wherein the researcher spent time with each pregnant teenager during antenatal visit to establish rapport and build a trusting relationship.The teenagers were further visited at their homes for data collection.Referential adequacy through the use of audiotape to record the findings provided a good record.

Transferability
Transferability was ensured through the e sta b lish m e n t o f a proper thick description of design methodology and accom panying literatu re control to maintain clarity.The purposive sampling was used to maximize ranging of specific information that could be obtained from and about the context by purposely selec tin g d iffe re n t lo catio n s and informants.

Dependability
Dependability was established through an enquiry audit w here a review er examined the documentation of critical incidents (docum ents and interview n o tes) and p ro d u cts (findings, interpretations and recommendations) and attested that it is supported data.

Research results and literature control
Five (5) main themes emerged as the experiences of teenage mothers who were pregnant for the first time: inadequate inform ation/know ledge, unplanned/ p lan n ed pregnancy, in effectiv e com m unication, under-utilization of hea lth reso u rces and adequate/ inadequate social support.The total n u m b er o f teenage m others who resp o n d ed in the sam e way was indicated in brackets.

Summary of research findings
F o u rteen teen ag e m others w ere interviewed; relevant quotations from interviews and literature control were cited.Teenage m others, who lacked inform ation regarding physiological changes that were brought about by pregnancy were interpreted as abnormal situation totaled ten (71%).Lee and Grubbs (1995:42), Graig and Ritcher-Strydom (1983:454), found that teenagers lacked factual know ledge regarding fertility and symptoms of pregnancy.Eight teenage mothers (57%) experienced m inor and unexpected disorders o f pregnancy that caused both discomfort and anxiety.Ladewig et al, (1998:202) supported these findings when they stated that "com m on discom fort of pregnancy resulting from physiologic and anatomic changes made them to feel uncom fortable, because it was not expected would make them anxious".T hree (21% ) m others had misconceptions and were performing practices that might be harmful to the baby and themselves.No literature was found in this regard.This might be due to the lack of information regarding the ch ild b irth process in the study participants.
Twelve (8 6 %) teenage m others had unplanned pregnancies that might be attributed to under or non-utilization of Reproductive Health services (RH), esp e cially co n tra cep tiv es.Some teenagers had inform ation about the availability and accessibility o f the services but displayed ignorance.For exam ple, statem ents such as contraceptives make them fat, therefore, don't like them or contraceptives make one's body jell-like were cited.Jewkes et al (2001:735) indicated that most sexually active teenagers take contraceptive breaks in order to see menses, and this time they fall pregnant.Studies that supported these findings concluded that teenagers had sex infrequently and didn't consider contraception (Ladewig et al, 1998:223).A lthough m ost teenage mothers had unplanned pregnancies, two (14% ) m others re p o rted that th eir pregnancies were planned.Niven & Walker, (1996:51) concurred and pointed out that pregnancy could still be a positive experience for a young girl.Eleven (76% ) teenage m others had difficulty to confide in any fam ily m em bers about th eir preg n an cies because of fear, not knowing that they were pregnant and denial.Some teenagers could not even realize that they were pregnant until five month, when they started to feel the fetal movem ents.Literature in corroboration of this reported that teenage mothers were scared, feared rejection or were in denial.Three (21%) teenage mothers did not communicate the problems they experienced during pregnancy to anyone.Mercer (1985:62) noted that teenagers are less likely to d escrib e ph y sical and em otional sym ptoms or identify com plications during pregnancy.
With regard to the utilization of the 89 Curationis May 2006 antenatal services, eight (57%) teenagers booked antenatal clinic at 28-32 weeks of pregnancy.The reason stated as being unaware of pregnancy, afraid to go to the clinic because of negative attitude of health workers or just book so that they could deliver at a hospital.Studies conducted by Lee & Grubbs (1995:38) show ed th at teenage m others who booked late might not have been aware th at they were pregnant; they also experienced fear of the unknown or lack o f fam ily support.C handra et al (2 0 0 2 :1 2 1 ) supported these findings by pointing out that teenagers who failed to utilize the health services did not have the opportunities to have adequate nutrition, social support services and did not benefit from early diagnosis and management of pregnancy associated complications that may adversely affect the outcome for her and for the fetus.
With regard to social and emotional support, ten (71%) teenage m others received adequate social and emotional support from their parents.Only four (28%) teenage mothers had minimal social and em otional su pport from th eir mothers.The teenage mothers indicated that their mothers were upset, scolding them; as result, they had guilt feelings.T hese findings w ere supported by studies conducted by Ladewig et al (1998:226) and Roles (1990:27,132) who indicated that mothers were upset, and they said things that they did not really believe in.Mothers also felt guilty and inadequate as parents.Eleven (76%) teenage m others got support from friends.Teenage mothers viewed those who were helpful or understanding of their situation as supportive.Three (21%) teenage mothers received no support from friends who isolated them.Roles (1990:26) mentioned that when friends find out about the pregnancy they might be scared and avoid the person.Eleven (76% ) of teenage m others received support from their partners.Only three (2 1 %) teenage mothers indicated that they did not receive support from their partners.Mercer (1986:57) stated that culturally men are not socialized to be actively involved with pregnancy and are not ready for such involvement.
It is clear from these findings that teenage mothers, who are pregnant for the first time, lack information regarding changes b ro u g h t about by pregnancy.The findings also emphasized the importance of utilizing Reproductive Health Services and prenatal care services.Teenage mothers also experienced variable social and emotional support from parents and partners.

Strengths and limitations of the study
The main strength of this study was its preliminary data on guidelines that were aimed at supporting teenagers to cope with pregnancy and the possibilities it offered for further research.The limitations were: • There was a difficulty in getting teenage mothers to express their experiences openly, which might be due to cultural orientation especially, when discussing reproductive issues.

•
The researcher was of the opinion that the word "experiences" was poorly understood; and as result clarification for operational meaning of the concept was made.

•
Teenage mothers were seen at their homes that were vastly distributed.At times the researcher would not find them at home or would find them having visitors, despite the fact that an appointment was made., 2002:246;Mercer, 1980Mercer, 1986:57;Niven & Walker, 19 Jacobson etal, 1995:233;).
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