Pregnancy Weight Gain

A column on the Boston Globe, titled "How much weight should women gain while pregnant?" discusses the various rules of thumb that are out there.

Take your pregnant daughter's pre-pregnancy weight and height to calculate her pre-pregnancy BMI. Then use that number to get an idea of the range of weight gain her doctor may suggest for her:

"In 1990, the gurus at the Institute of Medicine got worried about low birth weight babies and came up with guidelines that said that skinny women (who have a BMI, or body mass index, of less than 19.8) should gain 28 to 40 pounds. Normal women (BMI of 19.8 to 26.0) should gain 25 to 35 pounds, and heavy women (BMI of more than 26.0) should gain the least, 15 to 25 pounds."

Low birth weight babies are those babies born weighing less than 5 pounds 8 ounces. These babies may face serious medical challenges such as respiratory distress syndrome, bleeding in the brain, Patent ductus arteriosus (PDA) (a heart problem that can lead to heart failure), Necrotizing enterocolitis (NEC) (a problem with the intestines), and abnormal growth of blood vessels in the eye that can lead to vision loss.

So you see that any factors that contribute to a baby being born with low birth weight can be quite serious. The pregnant woman not gaining enough weight during pregnancy is just one factor that can contribute to the baby's low birth weight. Other factors include: Maternal high blood pressure, diabetes, and heart, lung and kidney problems; smoking; alcohol and drug use; infections in the mother or baby; problems with the placenta; and socio-economic factors. "Black women, and women under 17 and over 35 years of age are at increased risk" for giving birth to a low birth weight baby.

Bottom line: ask your daughter's doctor about her pregnancy weight gain at every visit. Your doctor should balance out all the factors your pregnant daughter faces to help point your daughter in the direction of a healthy pregnancy and a healthy baby.

Smoking and SIDS

US News & World report recently had an article titled "Mom's Smoking During Pregnancy Ups Preemie's SIDS Risk".

If your daughter smokes while she is pregnant, and then gives birth to a premature babie (born before 37 weeks), her baby "may be at higher risk of sudden infant death syndrome (SIDS) than premature infants born to nonsmoking moms".

Besides the risk of SIDS, "inability or delayed recovery from repeated low oxygen episodes can also be detrimental to brain development," Hasan noted. "There is increasing evidence that infants exposed to prenatal cigarette smoke are at high risk for developmental and behavioral disorders."

Help your pregnant daughter to stop smoking immediately, and also help her stay out of second-hand smoke. This may mean that your entire family needs to stop smoking around your daughter. If your daughter works at a restaurant or bar where there is smoking, help her find a different job during her pregnancy.

Pregorexia

The CBS Early Show had a segment recently on "pregorexia" - pregnancy anorexia. Watch the segment:



The CBS article says, "Mother's of average weight are advised to gain 25-35 pounds during pregnancy, Phillips adds. If you're overweight, you should aim for the lower end of that range, and if you're underweight before pregnancy you, should gain between 28-40 pounds. Moms of twins my gain 45 or more."

This article says, "The right level of exercise depends on how fit you were before pregnancy. Wear loose, comfortable clothes. Drink plenty of fluids and don't allow yourself to get overheated as this can be harmful to the baby. Take a gentle approach to exercises that put strain on joints and ligaments. Listen to your body. Dizziness and fatigue are not uncommon in the first trimester and some women lose their balance more easily later in the pregnancy. Don't exercise to lose weight during pregnancy as this may harm your baby. Don't exercise flat on your back as this can restrict the flow of blood to the womb. Don't use saunas or steam rooms. If your Body Mass Index was less than 19.8 before you became pregnant, you should aim for a weight gain of between 12.5 to 18kg, or 28 to 40lb."

How can new mothers lose extra weight after giving birth?

In an article called 'Celebrity Mamas Fuel Post-Baby Body Blues', "Most doctors don't advise extreme dieting or vigorous workouts immediately after giving birth. The La Leche League International, a breast-feeding support organization, recommends mothers not deliberately try to lose weight the first two months after having a baby to establish a good milk supply and let their bodies recover from childbirth. Women who want to lose weight still need between 1,500 and 1,800 calories a day to maintain good milk production, the organization says. On the flip side, nursing burns up to 500 calories a day so Junior can help you in your quest to shed pounds."

According to this article, new moms need help to get the sleep she needs! "One Harvard University study found women who sleep five hours or less when their babies are six months old are three times as likely to keep their baby weight six months later than moms who sleep seven hours a night."

Talk to your pregnant daughter about her body image. Does she worry about staying thin while pregnant? Is she eating properly for the health of the baby? Is she exercising to the point of exhaustion? Together, talk to her doctor about the appropriate kinds of exercise and diet for the health of her baby. Find out how much weight her doctor thinks she should be gaining during her pregnancy. What kind of help does your pregnant daughter need in order to get more sleep, eat better, and exercise appropriately?

Help your pregnant daughter with: Finding community resources

The other day we posted about the topic "How much should parents help their pregnant single daughter?"We've received this question is various forms. Another way this has been phrased is "How does a mom support her pregnant daughter?" Keywords we've seen on our statistics include phrases like "helping your pregnant daughter." That post focused on the minimum basics of safe housing, nutrition, and medical care. Today let's talk about some other help beyond the minimum basics.

Beyond the minimum basics of housing, nutrition, and medical care, parents of a pregnant teen or college student should consider how they might help with these goals:

1. Helping your daughter remain in school until graduation.
2. Preventing subsequent adolescent pregnancies.
3. Improving parenting skills.
4. Locating and using community resources. (Today's topic)
5. Stabilizing family support systems.
6. Strengthening employability skills and efforts to become economically self-sufficient.

Again, your motive of considering these kinds of help is not to reward your daughter's sexual activity and pregnancy outside of marriage, but to help get her on the road to independence and to help give your grandchild a better start in life. Today's topic is:

4. Locating and using community resources. The first thing that may leap to your mind is government services. There is usually a variety of things your local social services may be able to help your pregnant daughter with, but there are lots of other sources of help too.

First, see if you have a pregnancy help center near you. Contact OptionLine.org to be connected to your local pregnancy help center. They often can help your daughter by providing mentoring and education on: pregnancy, parenting, adoption and abortion. They may be able to help her with resources like maternity clothes, baby clothes, baby equipment, diapers and baby food. Pregnancy help centers often keep referral lists of other local resources that your family would find useful.

If you need help with medical care for your pregnant daughter or her child, see if she qualifies for Medicaid.

If you need help with groceries to encourage good nutrition for your pregnant daughter and her child, see if she qualifies for WIC (Women, Infants and Children).

If your daughter is not able to live with you or other family and friends during her pregnancy, see if there is a maternity home where she would like to live.

Look for support groups, Bible studies, and classes at local churches.

Find out what programs are available at local hospitals, public schools, and non-profit agencies. To find some local non-profit agencies, use the national United Way website to find your local United Way website; from there you can often browse through the membership directory to get ideas of agencies to call.

Non-voluntary Sexual Intercourse

According to the Fertility, Family Planning, and Reproductive Health of U.S. Women: Data from the 2002 National Survey of Family Growth. (PHS) 2006-1977. 174 pp.

In 2002, 8% of sexually experienced women 18–44 years of age reported that their first sexual intercourse was not voluntary.

+ Younger age at first sexual intercourse was associated with higher reporting of nonvoluntary first intercourse. 20% of women who first had intercourse before 15 years of age reported their first intercourse as not voluntary compared with 4% of women who first had intercourse at 20 years or over. This relationship between earlier first intercourse and higher reporting of nonvoluntary first intercourse is seen across Hispanic origin and race groups.

Nearly 23% of women aged 18–44 in 2002 had been forced to have intercourse at some time in their lives, about the same as seen in 1995.
+ About 5% of women were first forced to have intercourse at ages younger than 15 years; another 6% were first forced at ages 15–17 years and 4% at ages 18–19 years.
+ Women who were not living with both parents at age 14 were more likely to have experienced forced sexual intercourse at some time (31%) than women who lived with both parents (20%).

Talk to your daughter about these statistics. How old was she when she first had intercourse? Did she participate willingly? If not, make sure she gets counseling to heal this emotional wound, and medical care to check for STDs and any physical damage. If your pregnant daughter currently plans to be a single mother, brainstorm with her about ways that she can increase the protection of her child.


+ Of the women who reported that their FIRST sexual intercourse was not voluntary, 19% reported that they had been ‘‘pressured into it by his words or actions, but without threats of harm,’’ and this was the most common type of force.
+ The other types of force asked about, for example: 9% had been given alcohol or drugs, 8% reported ‘‘yes’’ to the item ‘‘Did what he said because he was bigger or grownup, and you were young,’’ 5% had been ‘‘physically held down,’’ and 3% had been ‘‘physically hurt or injured.’’

Talk with all your children about how they could try to get out of situations where they are being pressured to have sex by their partner's words or actions. What should they say? What should they do? Who should they later talk to about what happened?

Depression After Childbirth

We've written about postpartum depression previously, but it's a topic worth covering repeatedly.

A recent survey found that many Oklahoma women suffer from depression after childbirth. These results are likely very similar to what would be found in other areas too. Here is the text of a press release from the Oklahoma Department of Health, with commentary added:

One in four (25%) new mothers in Oklahoma report symptoms of maternal depression after giving birth, according to a recent study conducted by the Oklahoma State Department of Health (OSDH).

Using the Pregnancy Risk Assessment Monitoring System (PRAMS), an ongoing statewide survey of maternal behaviors and experiences, OSDH officials found that 40% of Oklahoma mothers did not discuss postpartum depression, or PPD, with their health care provider.

Of special concern were adolescent mothers, who were 2.5 times more likely to indicate symptoms of PPD as mothers age 35 and older.

“These findings are of major concern to health care professionals and should place families on alert to watch out for signs and symptoms of depression in new mothers,” said Secretary of Health and Commissioner of Health Dr. Michael Crutcher.

The symptoms of postpartum depression include:

• loss of interest in pleasure in life;
• change in appetite;
• less energy and motivation to do things;
• having a hard time falling asleep, staying asleep, or sleeping more than usual;
• increased crying and tearfulness;
• feeling worthless, hopeless or overly guilty;
• feeling restless, irritable or anxious;
• and having unexplained weight loss or gain.
• Additional symptoms include feeling like life isn’t worth living,
• having thoughts of hurting yourself or worrying about hurting the baby,
• or someone else hurting the baby.

Among the stressors found to increase the risk of depression symptoms are:

• arguing with a partner more than usual during pregnancy,
• having bills one cannot pay, and
• having an unintended pregnancy.
  

Additional highlights from the Oklahoma PRAMS survey on PPD include the following:

• Women ages 20 to 24 were twice as likely to indicate symptoms of depression when compared to women 35 or older.
• Women with infants placed in the Neonatal Intensive Care Unit (NICU) were at a higher risk for depression.
• Mothers are at special risk for postpartum depression when caring for infants born prematurely or infants with special health care needs.
• Women who did not receive a postpartum checkup were also at a higher risk for symptoms of postpartum depression when compared to women who did receive their postpartum checkup.
  

To address PPD, public health officials recommend the following:

Ask your daughter's doctor to screen your pregnant daughter for maternal depression before birth at a late-term prenatal visit.

Ask your daughter's doctor to screen your daughter for maternal depression at each doctor visit during the first year after the birth of her child.

Make sure your daughter understands the importance of returning for her postpartum checkup around six weeks after delivery.

If your daughter has an infant in the NICU, search for support groups near your home and in the hospital, and research more information on PPD.

Ask your Medicaid provider if there are any maternal and infant health licensed clinical social work services available to your daughter.

Ask your doctor, nurse, and hospital staff for education about PPD awareness, referrals for treatment and follow-up care.

Encourage new mothers with signs and symptoms of depression to call the PSI national hotline 1-800-944-4PPD. Information is also available at http://www.postpartum.net.

Ask your daughter's school counselors what support they can provide for pregnant and postpartum adolescents to cope with the stress of motherhood, schoolwork and feelings of isolation.

State Medicaid Information

One of the things that visitors to this blog are looking for is information about medicaid eligibility for their pregnant daughter.

Here are links to as many state medicaid websites as we could find. If there was a page on the website that had information about medicaid for pregnant women, that's the page we linked to here.

Alabama Medicaid Agency

Medicaid in Arizona - Arizona Health Care Cost Containment System

Arkansas - Arkansas Medicaid

Medicaid in California - MediCal

Medicaid in Colorado - Department of Health Care Policy and Financing

Medicaid in Connecticut - Department of Social Services

Medicaid in Delaware - Department of Social Services

Medicaid in Florida - Agency for Health Care Administration

Medicaid in Georgia - Department of Community Health

Medicaid in Idaho - Department of Health and Welfare

Medicaid in Illinois - Department of Healthcare and Family Services

Medicaid in Indiana - Indiana Health Coverage Programs

Medicaid in Iowa - Iowa Medicaid Enterprise

Medicaid in Kansas - Kansas Medical Assistance Program

Medicaid in Kentucky - Cabinet for Health and Family Services

Medicaid in Louisiana - LaMOMS program

Medicaid in Maine - Office of MaineCare Services

Medicaid in Maryland - Maryland Children's Health Program (includes pregnant women of any age)

Medicaid in Massachusetts - MassHealth insurance

Medicaid in Michigan - Department of Community Health

Medicaid in Minnesota - Department of Human Services

Medicaid in Mississippi - Mississippi Division of Medicaid

Medicaid in Missouri - Department of Social Services

Medicaid in Montana - Department of Public Health and Human Services

Medicaid in Nebraska - Department of Health and Human Services

Medicaid in Nevada - Division of Welfare and Supportive Services

Medicaid in New Hampshire - Department of Health and Human Services

Medicaid in New Jersey - Medical Assistance and Health Services

Medicaid in New Mexico - New Mexico Human Services Department

Medicaid in New York - Department of Health

Medicaid in North Carolina - Division of Medical Assistance

Medicaid in North Dakota - Department of Human Services

Medicaid in Ohio - Department of Job and Family Services

Medicaid in Oklahoma - Oklahoma Health Care Authority

Medicaid in Oregon - Oregon Health Plan

Medicaid in Pennsylvania - Department of Public Welfare

Medicaid in Rhode Island - Medical Assistance Program RIte Care

Medicaid in South Carolina - Department of Health & Human Services

Medicaid in South Dakota - Department of Social Services

Medicaid in Tennessee - Bureau of TennCare

Medicaid in Texas - Texas Health and Human Services Commission

Medicaid in Utah - Utah Department of Health

Medicaid in Virginia - Department of Medical Assistance Services

Medicaid in Washington - Department of Social & Health Services

Medicaid in Washington DC - Department of Human Services

Medicaid in West Virginia - Bureau for Children and Families

Medicaid in Wisconsin - Department of Health and Family Services

Medicaid in Wyoming - Department of Health

Pap tests and STD testing

A few friends have recently had health scares with abnormal pap test results, so this topic has been on my mind.

According to this page (which defines the term "pap smear", explains why it is done, explains the risks, explains how the test is done, and discusses possible test results), women should have their first Pap test approximately 3 years after first sexual intercourse or by age 21, whichever comes first. This page on the same site says a woman should get a pap test "no later than 3 years" after becoming sexually active. Between ages 21-29, women should have a pap test every one-three years depending on their circumstances and health.

Your pregnant daughter should have a pap test done as part of her prenatal care so that any infections can be addressed before she gives birth. If any of your other daughters have been sexually active for three years but are not yet 21, see that they get a pap smear and STD testing too.

While a pap test may test for a few STDs, it also may not run those tests and it can not test for several other types of STDs. So sexually active men and women of all ages should be tested for STDs. Talk to your doctor about how often testing should be done. See this page for some details about STD testing. If you don't have insurance, check with your public health clinic to see what STD testing they offer and whether they offer pap tests.

Your Pregnant Daughter Should Be Tested for STDs

As you may know, there is a lot of misinformation out there about pregnancy and health. Talk with your daughter about this information, and make sure she gets the medical care that she needs. If you cannot afford a private OBGYN visit, your local public health office may be able to offer STD testing. From the CDC Fact Sheet:

Can pregnant women become infected with sexually transmitted diseases (STDs)?

Yes, women who are pregnant can become infected with the same sexually transmitted diseases (STDs) as women who are not pregnant. Pregnancy does not provide women or their babies any protection against STDs. The consequences of an STD can be significantly more serious, even life threatening, for a woman and her baby if the woman becomes infected with an STD while pregnant. It is important that women be aware of the harmful effects of STDs and know how to protect themselves and their children against infection.

How common are STDs in pregnant women in the United States?

Some STDs, such as genital herpes and bacterial vaginosis, are quite common in pregnant women in the United States. Other STDs, notably HIV and syphilis, are much less common in pregnant women. The table below shows the estimated number of pregnant women in the United States who are infected with specific STDs each year.

STDs Estimated Number of Pregnant Women
Bacterial vaginosis 1,080,000
Herpes simplex virus 2 880,000
Chlamydia 100,000
Trichomoniasis 124,000
Gonorrhea 13,200
Hepatitis B 16,000
HIV 6,400
Syphilis <1 ,000

How do STDs affect a pregnant woman and her baby?

STDs can have many of the same consequences for pregnant women as women who are not pregnant. STDs can cause cervical cancer and other cancers, chronic hepatitis, pelvic inflammatory disease, infertility, and other complications. Many STDs in women are silent; that is, without signs or symptoms.

STDs can be passed from a pregnant woman to the baby before, during, or after the baby’s birth. Some STDs (like syphilis) cross the placenta and infect the baby while it is in the uterus (womb). Other STDs (like gonorrhea, chlamydia, hepatitis B, and genital herpes) can be transmitted from the mother to the baby during delivery as the baby passes through the birth canal. HIV can cross the placenta during pregnancy, infect the baby during the birth process, and unlike most other STDs, can infect the baby through breastfeeding.

A pregnant woman with an STD may also have early onset of labor, premature rupture of the membranes surrounding the baby in the uterus, and uterine infection after delivery.
The harmful effects of STDs in babies may include stillbirth (a baby that is born dead), low birth weight (less than five pounds), conjunctivitis (eye infection), pneumonia, neonatal sepsis (infection in the baby’s blood stream), neurologic damage, blindness, deafness, acute hepatitis, meningitis, chronic liver disease, and cirrhosis. Most of these problems can be prevented if the mother receives routine prenatal care, which includes screening tests for STDs starting early in pregnancy and repeated close to delivery, if necessary. Other problems can be treated if the infection is found at birth.

Should pregnant women be tested for STDs?

Yes, STDs affect women of every socioeconomic and educational level, age, race, ethnicity, and religion. The CDC 2006 Guidelines for Treatment of Sexually Transmitted Diseases recommend that pregnant women be screened on their first prenatal visit for STDs which may include:
Chlamydia
Gonorrhea
Hepatitis B
HIV
Syphilis

In addition, some experts recommend that women who have had a premature delivery in the past be screened and treated for bacterial vaginosis at the first prenatal visit. Pregnant women should ask their doctors about getting tested for these STDs, since some doctors do not routinely perform these tests. New and increasingly accurate tests continue to become available. Even if a woman has been tested in the past, she should be tested again when she becomes pregnant.

Can STDs be treated during pregnancy?

Chlamydia, gonorrhea, syphilis, trichomoniasis, and bacterial vaginosis (BV) can be treated and cured with antibiotics during pregnancy. There is no cure for viral STDs, such as genital herpes and HIV, but antiviral medication may be appropriate for pregnant women with herpes and definitely is for those with HIV. For women who have active genital herpes lesions at the time of delivery, a cesarean delivery (C-section) may be performed to protect the newborn against infection. C-section is also an option for some HIV-infected women. Women who test negative for hepatitis B may receive the hepatitis B vaccine during pregnancy.

How can women protect themselves from STD infection?
The surest way to avoid transmission of sexually transmitted diseases is to abstain from sexual contact, or to be in a long-term mutually monogamous relationship (like marriage) with a partner who has been tested and is known to be uninfected.

Women, Infants and Children (WIC)

Women, Infants and Children (WIC) is a program that helps families by educating them on nutrition and helping them buy some of the healthy food they need.

Who Does WIC help? WIC is for all kinds of families. It is a short-term assistance for pregnant women, new mothers, and children under the age of five. Men can apply for WIC benefits for their children. Young mothers living with their parents and going to school may qualify. Children with working parents may qualify.

How Do You Qualify? WIC helps families with limited income. Many working families may qualify. Contact your local WIC office to make an appointment and find out which documents you need to bring with you. At your appointment, WIC staff will check to see if you and your family qualify.

What Can I Get Through WIC? You can learn about nutrition and health to help you and your family eat well. You can received special checks to buy healthy foods such as milk, juice, eggs, cheese, cereal, dry beans and peas, peanut butter, infant formula, and baby cereal. Women who breastfeed can receive extra food checks. WIC personnel can also help you find health care and other community services. WIC also provides support and information about breastfeeding, and may be able to loan you a breast pump.

Benefits of Delaying Sexual Debut - Executive Summary

Obviously if your daughter is pregnant, she has engaged in sexual activity (whether she desired to be or not). But past sexual activity does not mean she has to continue to be sexually active. She can choose sexual integrity for her future actions. Sexual integrity encompasses much more than abstaining from sex outside of marriage. Sexual integrity also includes being faithful to her future spouse inside of marriage (both physically and mentally), staying away from things that can damage her sexuality and self-worth (like pornography, internet flirting, phone sex, internet sex, etc.), and practicing self control so that she is able to be pure at times when her future husband is sick or deployed or on business travel. Here is a recent press release (from the Institute for Youth Development) and Executive Summary of a review of medical literature reporting results from studies which show the benefits of waiting for sex until marriage.

Scientific Evidence Supports Sexual Abstinence as the Best Choice for Prevention

Review Emphasizes the Benefits of Delaying Sexual Debut for Youth

Washington, DC (May 30, 2008) With all of the sexually permissive messages aimed at today’s adolescents from the mass media, America’s parents have made it clear that they desire a strong abstinence message for their children’s reproductive health education. “When scientific evidence continues to reveal that sexual abstinence provides youth with the best physical, psychological, social, and financial health, it’s hard to disagree with the vast majority of parents,” said Shepherd Smith, President of the Institute for Youth Development. “Research shows us when teenagers delay sexual initiation they have better life outcomes. From academic achievement to healthy relationships, the data is clear: Abstinence is the best choice for youth.”

Christopher Doyle, Behavioral Research Analyst with the Institute for Youth Development and author of the Benefits of Delaying Sexual Debut, presents a compelling argument in this comprehensive review of scientific and medical research. “It presents a convincing argument for postponing sex, while encompassing some of the theories that have not received enough attention in the abstinence community, such as adolescent brain development and its consequences for decision making, society’s inconsistent messages on sexuality and how it affects teens’ behavior, the research behind self-control, and the importance of healthy relationships for successful marriage and well-being,” said Smith. “This comprehensive overview will undoubtedly benefit all those who work in the field of youth development.”

Here is the Executive Summary.
Today’s adolescents have an array of challenges before them that previous generations never faced. Fifty years ago, there were only a handful of STIs; today, sexually active teens are at risk for acquiring over two dozen. At the same time, the age at first marriage has steadily risen by 20-25 percent, cohabitations have increased 6.5 times, and sex before wedlock has become the norm, not the exception. If that’s not enough, combine the 24 hour media circus with a billion dollar internet pornography industry, Victoria’s Secret at every shopping mall, and Hollywood’s sex-saturated messages broadcast in your living room, and you have a sex-on-demand culture being digested by our children every day.

As this review of literature shows, the range of benefits that postponing sex offers young people is scientifically proven, but in order for adolescents to embrace this message, these concepts need to be communicated effectively and often within public education. Surveys indicate that parents desire an abstinence message for their children; however, U.S. culture is simply not reinforcing this value, making it difficult for youth to understand the reasons why they should wait for sex. Thus, educational strategies should focus on the following conclusions that can be drawn from the benefits of delaying sexual debut.

Premarital sex has a negative impact on the physical health of adolescents, and typically hurts girls more than boys. Although sexually active young men are at risk to acquire STIs, females (especially younger girls) are more vulnerable to these infections because of their biological makeup. Girls are also more likely to suffer physical abuse in sexual relationships, and research indicates that adolescent females have a higher probability of contracting an STI when their romantic partner is substantially older. Typically, girls do not report using condoms as consistently as boys; and neither gender’s brain is developed enough to make reasoned, future- oriented decisions about contraception. Girls also tend to pay a much higher price than boys when it comes to teenage pregnancy, as they are often left to carry and raise the child on their own.

Some of these physical consequences may also play a role in the psychological health outcomes of sexually active youth. For example, adolescent girls who are abandoned by their boyfriend after learning of a pregnancy may become depressed with the prospect of raising a child alone. Women also tend to make more of an emotional investment in romantic relationships, which could lead them down the path of seeking love through sex; this in turn may result in the vicious cycle of repetition/compulsion. On the other hand, boys typically suffer psychological symptoms only when combining sexual activity with other high risk behaviors, such as drug and alcohol use; and both genders are more likely to think about and commit suicide if they have initiated sex, especially those at a young age. However, if young people wait to have sex until marriage, they avoid these risks, and stand to benefit from the social and financial advantages that abstinence offers.

One of the best social outcomes that results from abstinence is the occurrence of healthy relationships. When adolescents choose to wait, they avoid premarital sexual bonds with other partners. This in turn makes them far less likely to get involved in cohabitations, which is a major risk factor for future marital infidelity and divorce. Healthy marriages also benefit the well-being of each spouse (especially men), and provide a nurturing environment for children.

Another social benefit that stems from abstinence is increased financial stability. When adolescents avoid childbearing outside of marriage, they are able to focus their attention on educational pursuits and future careers, without having to sacrifice the time and money that a family demands. Although research has not demonstrated a clear causal relationship between early sex and delinquency, many studies show that when teenagers abstain, they are less likely to get enmeshed in a problem behavior syndrome that includes poor academic performance, substance use, and other risk behaviors. It may very well be that abstinence acts as a protective barrier, insulating teenagers from an array of harmful behaviors that have the potential to create future problems.

Although the data is not clear for every single outcome, research does demonstrate that delaying sexual debut has a significant impact on the physical, psychological, financial, and social health of young people. Parents and policy makers alike should continue to embrace abstinence as a primary message for sexual education, develop strategies based upon the existing data, while building upon new research that continues to evolve in adolescent sexual health.
--End of Executive Summary--

Read the entire review of literature HERE. (PDF file, Adobe Acrobat Reader required). I urge you to read this literature review and talk to your children about the research:

• Has your daughter suffered physical abuse at the hands of her romantic partners?
  
• Has your daughter been abandoned by the baby's father? If so, does the thought of raising her child alone make her feel depressed?
  
• How much of an emotional investment does she feel she makes in her romantic relationships? Does she feel she could be seeking love through sex?
  
• Has she combined sexual activity with other high risk behaviors, such as drug and alcohol use?
• Was she the person who initiated sex? How old was she at her first sexual encounter? Has she felt guilt about her sexual activity? Has she thought about suicide?
• What are her hopes and dreams about marriage?
• Does she feel she has emotional bonds to her sexual partners? If so, what impact does she imagine that will have on her future marriage?
• What are her thoughts and feelings about cohabitation, which is a major risk factor for future marital infidelity and divorce?

Make an effort to be more fair

A recent Newsweek article, "Getting Away With It", by Raina Kelley, summarizes research results that show that parents are indeed tougher on firstborns than on younger children. The articles says:

"As a result, the theory predicts that last-born and only children, knowing that they can get away with much more than their older brothers and sisters, are, on average, more likely to engage in risky behaviors," says University of Maryland economist Ginger Jin, one of three coauthors of the study.

This can spell trouble for your younger children as they become teens. The article continues:

As parents, you care about the welfare of your pregnant teenage daughter so you're going to help her out no matter what. You're not going to throw her and the baby out of the house. To a teen that looks like reward not punishment. So if your daughter can predict that you're going to help her, she is less likely to engage in safe behavior... But if there are lots of children in the house and the children aren't perfectly sure what their parents will do, they are much less likely to engage in behavior that will get them punished.

The article says that parents tend to punish older children who are engaging in risky behavior partly to set an example to the younger children, but that by the time the younger children reach that same age parents tend to fix the problem for the child instead of punishing. So make an extra effort with younger children to treat them consistently. If you've been overly harsh with older children, make an extra effort to be more fair instead of simply making examples out of them. Seek Godly counsel about your parenting decisions - there are a number of good parenting skills books out there for every phase of life; talk with your spouse before acting; bounce your ideas and frustrations off of mature Christian friends who can help you see other perspectives.

Obviously we need balance here. In what ways could you show that you love the person, but not their behavior? In what ways can you show that you disapprove of sex outside of marriage, but that you don't want your grandchild aborted? That you love your pregnant daughter, but that there are also consequences to every action in life? If your teen or college-aged daughter is having sex, what consequences have you imposed on her for this risky behavior? Or are you rewarding her for her risky behavior by protecting her from consequences? In what ways are you attempting to help her deal with negative peer pressure, and the influence of friends and media to engage in risky behavior?

Facts on Teen Abortion Risks

It may seem that a quick solution to your single daughter's pregnancy is a quiet abortion. But there are some long-term risks you need to talk about. Ask your daughter if she has had an abortion in her past. If so, talk to her about these risks...does she need counseling to help her recovery from the abortion trauma? The following list of risks to teens was published by The Elliot Institute:

• Teenagers are 6 times more likely to attempt suicide if they have had an abortion in the last six months than are teens who have not had an abortion.[1]
  
• Teens who abort are up to 4 times more likely to commit suicide than adults who abort,[2] and a history of abortion is likely to be associated with adolescent suicidal thinking.[1]
  
• Teens who abort are more likely to develop psychological problems,[3] and are nearly three times more likely to be admitted to mental health hospitals than teens in general.[4]
  
• About 40% of teen abortions take place with no parental involvement,[5] leaving parents in the dark about subsequent emotional or physical problems.
  
• Teens are 5 times more likely to seek subsequent help for psychological and emotional problems compared to their peers who carry “unwanted pregnancies” to term.[6]
  
• Teens are 3 times more likely to report subsequent trouble sleeping, and nine times more likely to report subsequent marijuana use after abortion.[6]
  
• Among studies comparing abortion vs. carrying to term, worse outcomes are associated with abortion, even when the pregnancy is unplanned.[6]
  

For more facts on teens and abortion, click here (Adobe Reader required).

Citations

1. B. Garfinkel, et al., “Stress, Depression and Suicide: A Study of Adolescents in Minnesota ,” Responding to High Risk Youth (University of Minnesota: Minnesota Extension Service, 1986)
2. M. Gissler, et. al., “Suicides After Pregnancy in Finland : 1987-94: register linkage study,” British Medical Journal, 313: 1431-1434, 1996; and N. Campbell , et. al., “Abortion in Adolescence,” Adolescence, 23:813-823, 1988.
3. W. Franz & D. Reardon, “Differential Impact of Abortion on adolescents and adults,” Adolescence, 27 (105), 172, 1992.
4. R. Somers, “Risk of Admission to Psychiatric Institutions Among Danish Women Who Experienced Induced Abortion: An Analysis Based on National Report Linkage” (Ph.D. Dissertation, Los Angeles: University of California, 1979, Disseration Abstracts International, Public Health 2621-B, Order No. 7926066)
5. “Teenage Pregnancy: Overall Trends and State-by-State Information,” Report by the Alan Guttmacher Institute, Washington , DC .
6. PK Coleman, “Resolution of Unwanted Pregnancy During Adolescence Through Abortion Versus Childbirth: Individual and Family Predictors and Psychological Consequences,” (2006).

A Generation at Risk

How Teens Are Coerced and Manipulated Into Abortion

by Amy Sobie & David C. Reardon

Editor's Note: The following article is excerpted from the Jan.-March 2000 issue of The Post-Abortion Review.

Gaylene was 14 when she became pregnant. Too embarrassed to go directly to her parents, she turned to her high school guidance counselor for advice. She writes:

[The school counselor] was sympathetic and understanding. He felt there was no need to worry my family. He also explained about having a child, how tough it would be on me and that I wouldn’t be able to do what I wanted to do. He said that the child would suffer because I was much too young to be a parent. He pointed out that the best thing for me to do was to abort the fetus at this stage so no one would be hurt. No mention was made of talking to my parents about this or carrying the baby to term. He indicated that adoption would be difficult and not an option for me.

. . . I felt as though I had no control over what was happening to me. I started to question what I was doing, but in my logic I’d refer back to what the counselor had told me, and then I would think he was right. But still today, I feel like I did not decide to have the abortion.¹

Gaylene’s traumatic reaction to her abortion experience included suicide attempts, alcoholism, drugs, crime, involvement in a cult and a major break with her family.

Sadly, Gaylene’s story is not unique. For teens, the possibility of developing psychological and emotional problems after abortion is substantially higher than for more mature women.² One reason that teenagers are more vulnerable is because their psychological defense mechanisms are not fully developed. Their emotional immaturity leaves them more susceptible to events and circumstances that can profoundly damage their view of the world, other people, and themselves. Consequently, abortion can be especially harmful for teens because this major, traumatic experience occurs at a critical time in the development of their self-identity.³

Researchers have found that teenagers who have abortions face a number of higher risks. For example, teens are more likely to feel pressured into abortion, to report being misinformed in pre-abortion counseling and to experience more severe psychological stress after abortion.⁴ They are also more likely to experience more intense feelings of guilt, depression and isolation after an abortion.⁵ In addition, while suicidal tendencies are higher for all women after abortion, teens are at an even greater risk for post-abortion suicide.⁶

Further, a study of teens with "unwanted" pregnancies found that teens who aborted were more likely to have subsequent trouble sleeping, to report using marijuana after abortion and to undergo treatment for psychological and emotional problems compared to those who carried to term.⁷

Deception and Misinformation

Many teens are simply not mature enough to understand the information they need to make such a life-impacting choice. As a result, in many cases they are not able to freely consent to an abortion.

Even some pro-abortion groups have acknowledged that teenagers need extra guidance when it comes to abortion. For example, a Planned Parenthood counseling guide stated that teenagers have few or limited problem solving skills; are more likely than adults to lack responsibility; are more vulnerable; are more anxious and distrustful; are lacking in knowledge; and have difficulty in communicating. As a result, “counselors need to be aware of and appreciate the fact that pregnancy counseling with teenagers can be very different from counseling adults . . . pregnancy counseling with teens is often a crisis situation.”⁸

Unfortunately, while Planned Parenthood counselors recognize the vulnerability of teens, they oppose laws that would give the parents of teens the opportunity to help them understand the risks of and alternatives to abortion. For counselors who seek to promote abortion as the best or even only solution, keeping teens away from loved ones who would counsel against abortion is an important part of maximizing their own influence.

This is why so many teens feel under such immense pressure to abort. Over and over, women who had abortion as teenagers use phrases like the following to explain how they ended up having an unwanted abortion.

My school counselor (Planned Parenthood counselor, teacher, pastor, boyfriend’s mom, etc.) told me that if I didn’t want my parents to find out, I would have to have an abortion . . .

My boyfriend threatened me if I didn’t abort.

Everyone told me I was too young to have a baby and that my only alternative was abortion.

Pressure to abort can also include coercion, emotional blackmail and violence from a sexual predator or even parents who want to make sure their daughter has an abortion.⁹

In addition, a secret abortion always disrupts family relationships. To protect their secret, teenagers must be constantly on the alert against any evidence or mood that may invite unwanted questions. They must hide feelings of depression, sadness, and even thoughts of suicide that might otherwise alert their parents to the problem. If they cannot repress these feelings, the source must remain hidden or their emotions transformed into anger and rebellion. This overarching need for secrecy accentuates their feelings of shame and will often lead to withdrawal from family intimacy and excursions into drugs, alcohol and destructive relationships.

Any of these problems can dramatically exacerbate normal family tensions. Kept in the dark, parents cannot know that their child is struggling to cope with his or her abortion experience. With no frame of reference for understanding their child’s disturbed behavior, parents are likely to become increasingly frustrated at being held at a distance. In turn, the parents’ frustrations are likely to fuel the distrust or rebellious nature of the teen because they “simply don’t understand” what he or she is going through.

Targeting Teens

Unfortunately school counselors, social workers and others in positions of authority can exert tremendous influence over a vulnerable teenager, steering and even coercing her into an unwanted abortion.

For example, William Hickey, a high school guidance counselor in Hatboro , Pennsylvania , was sued by the parents of a 16-year-old girl for circumventing the state’s parental consent law by arranging for the teen to have a secret abortion in New Jersey . The girl’s parents, Howard and Marie Carter, subsequently filed a lawsuit against Hickey and the Hatboro-Horsham school district, charging that Hickey pressured their daughter to have an abortion despite her expressed doubts and beliefs against abortion.

The Carters said that Hickey “engaged in a course of conduct which was inherently coercive, was intended to and did exert undue influence upon [a minor], and ensured that she refrain from discussing with her parents her pregnancy and whether to obtain an abortion.” They said that when their daughter told Hickey she had doubts about undergoing an abortion, he told her, “Someday you’ll look back on this and laugh.”

The lawsuit also stated that school officials refused to cooperate when asked to investigate the situation. Instead, the Carters say they were told that the school district “has deep pockets” to defend itself from a lawsuit. The case was eventually settled out of court.⁹

Other examples of manipulation and coercion abound. In 2002, a judge found Planned Parenthood negligent for failing to report the case of an abortion performed on a 13-year-old girl who was being sexually abused by her foster brother. The 23-year-old man took the girl to a Planned Parenthood abortion clinic in 1998, but Planned Parenthood did not notify authorities until the girl returned six months later for a second abortion. A lawsuit alleged that the girl was subjected to repeated abuse and a second abortion because Planned Parenthood failed to notify authorities of possible abuse when she had her first abortion. Her abuser was sentenced to five years in prison and lifetime probation.¹⁰

Conclusion

Unfortunately, there are few safeguards currently in place to protect teenagers from coerced abortions. As we pointed out in a previous issue, in states where parental consent is needed for an abortion, the judicial bypass system is seriously flawed.

Without a mechanism to provide for cross-examination of witnesses and the introduction of witnesses who would testify that the abortion is not in the girl’s best interests, how can judges make an informed decision? How can we be sure that the adults seeking permission for the young girl to abort without notifying her parents are not themselves manipulating or pressuring the girl to choose abortion?

In addition, as the Carter case discussed above demonstrates, even in states that require parental consent, it is all too easy for those pushing abortion to simply transport the girl across the state line. The Child Custody Protection Act would make it a federal crime for anyone except a parent or legal guardian to take a girl out of state for an abortion in order to avoid involvement in the situation by the girl’s parents.

Even this will only protect a few teens, however. Sadly, in many cases it is the parents who are pressuring or coercing their teenage daughters into abortion. Planned Parenthood, however, is remarkably silent regarding the problem of protecting teens from pressure or manipulation by parents who favor abortion. The only way to protect these teens is to pass laws that will make abortionists liable for failing to protect women, especially teens, from coerced abortions.

~~~

Originally published in The Post-Abortion Review 8(1) Winter 2000. Copyright 2000 Elliot Institute.

Citations

1. Reardon, D., Aborted Women, Silent No More ( Springfield , IL : Acorn Books, 2002) 37-38.
2. Rue, V. & Speckhard, A, “Post Abortion Trauma: Incidence & Diagnostic Considerations,” Medicine & Mind, 6: 57-75 (1991).
3. Deutsch, M., “Personality Factors, Self-Concept, and Family Variables Related to First Time and Repeat Abortion-Seeking Behavior in Adolescent Women.” Unpublished Doctoral Dissertation, Washington , D.C. : American University , 1982.
4. Franz, W. & Reardon, D., “Differential Impact of Abortion on Adolescents & Adults,” Adolescence, 27(105):162-172.
5. Biro, F., Wildey, L., Hillard, P., & Rauh, J., “Acute and Long-Term Consequences of Adolescents Who Choose Abortions,” Pediatric Annals, 15(10):667-672 (1986).
6. Mika Gissler, Elina Hemminki, Jouko Lonnqvist, "Suicides after pregnancy in Finland : 1987-94: register linkage study," British Medical Journal 313:14314, 1996; Campbell, N., Franco, K. & Jurs, S., “Abortion in Adolescence,” Adolescence, 23:813-823 (1988).
7. PK Coleman, “Resolution of Unwanted Pregnancy During Adolescence Through Abortion Versus Childbirth: Individual and Family Predictors and Psychological Consequences,” (2006).

8. Saltzman, L. & Policar, M., The Complete Guide to Pregnancy Testing and Counseling (Alameda, CA: Planned Parenthood, 1985) 113-114.

9. For more examples, see the book Giving Sorrow Words.
9. "Settlement announced in Pennsylvania Teen Abortion Case," press release from the American Center for Law & Justice, March 15, 2000.

10. "Planned Parenthood Found Negligent in Reporting Molested Teen's Abortion," Pro-Life Infonet, Dec. 26, 2002.

Pregnancy Myths and Urban Legends

There's a whole lot of misunderstanding about conception and pregnancy out there in the world. Some conception and pregnancy stories are true and some are not. For example, we often hear the young women believe that they can not get pregnant during their first sexual act. This is not true! The truth is that if an egg is available, then there's an opportunity for sperm to fertilize the egg regardless of whether its the girl's first sex act or not.

To see if some claimed story is true or not, you can see if it is a known urban legend by checking sources like Snopes.com Pregnancy Urban Legends.

You can also learn more about pregnancy myths at reliable medical sites. Some WebMD articles to read include:
"Separating Pregnancy Myths and Facts".
"Exercise During Pregnancy: Myth versus Fact".
"Sex and Pregnancy Myths".

Why? Why? Why?!

Little children are not the only ones who constantly ask "Why?" The number one search phrase leading to this blog is also "Why", and it's also a question that haunts parents as they try to make sense of their single daughter's pregnancy.

The question is phrased lots of different ways (as taken from our stat logs):

• Why teens get pregnant
• Why do teens want to get pregnant
• Why do teenagers get pregnant
• Reason why teens get pregnant
• Why do so many teens get pregnant
• Why do teens get pregnancy [sic]
• Why do so many teenage girls get pregnant
• Why do teenagers get early pregnancy
• Book on why teenagers get pregnant
• Why girls get pregnant early
• Why do teens get pregnant at an early age
• Why do teens get pregnant early
• Reasons teens get pregnant
• The reasons teens get pregnant

The basic answer to all of these queries is "the reason teens get pregnant is that they are having sex." It may seem obvious to some, but not to others. We recently worked with a young couple where the girl was pregnant and all the boy could say (over and over and over) was "It was only sex! It was only sex!" He just could not get his mind around the fact that sex and pregnancy are intimately joined.

Our media has worked very hard to create the falsehood that sex is recreation only, that there are no consequences physically (pregnancy, STDs), emotionally (broken hearts and trouble trusting in future relationships), and spiritually (continuous intentional sin for singles having sex will lead to a hardened spirit). The 2005 "Sex on TV 4" report says

Across all scenes with sexual content in the teen sample, only 5% mention any risk and responsibility topics (see Table 22), almost the identical percentage observed for television overall (4%). Of the three categories of sexual risk and responsibility messages, the most common is sexual precaution, with 3% of sexual scenes addressing this topic, followed by the depiction of risks and/or negative consequences of sex (2%), and sexual patience (1%).

So in analyzing TV shows popular with teens, only 5% of scenes mention the fact that there are consequences to sex. The most common approach is simply to talk about contraceptives or prevention of STDs. The second approach is depiction of risks and/or negative consequences of sexual behavior. And the least common approach is to talk about abstinence or delaying sex ('sexual patience'). The "Sex on TV 4" report notes that "Sexual encounters that are presented without any of these elements certainly convey a much different message to the audience, and in
particular to young viewers, than portrayals that include them."

In chapter 2 "The Importance of First Words", in our book "How To Survive Your Teen's Pregnancy", we have a list of other possible reasons that may be a factor in a single daughter's pregnancy. One possible reason on that list is that your daughter may have been a victim of someone who exploited her innocence. A 2004 study found that 44% of high school students think that boys at their school often or sometimes push girls to drink alcohol or take drugs in order to get the girls to have sex or do other sexual things (from the "National Survey of American Attitudes on Substance Abuse IX: Teen Dating Practices and Sexual Activity" by the National Center on Addiction and Substance Abuse (CASA) at Columbia University (http://www.casacolumbia.org/)).

Whether or not your daughter is pregnant, brainstorm with her all the factors that contribute to her sexual activity. See if the two of you can figure out "WHY" she is having sex. Is she being pressured or exploited? Is she hoping to "buy" love by giving sex? Has she been tested for STDs with each new sexual partner? Get your daughter the medical and emotional help she needs to make better choices going forward.

Premature birth, low birth weight

The Northwest Herald, a local newspaper for McHenry County, Illinois, recently had an article titled "Pop Culture, Reality Contrast on Teen Pregnancy". One comment in the article is the following:

Pregnant teens are less likely than older women to receive good prenatal care and are more likely to be depressed during the pregnancy, said Carlos Mendez, an obstetrician and gynecologist with Centegra Health System. Teenagers’ babies are more likely to be born prematurely, to have low birth weight, and to die shortly after birth, he said.

Please help your pregnant teen or college student get prenatal care as soon as possible. Be alert to signs of depression in your daughter, and talk to her about her feelings. With your daughter, do research on how she can improve the health of her baby before birth so that her child is less likely to be born prematurely and less likely to have low birth weight.