Topic 2.

6
PREGNANCY IN SPECIAL POPULATIONS
Special Populations
Adolescent pregnancy
Older women and pregnancy
Substance dependency and pregnancy
Canadian Statistics
regarding Pregnancy in
Special Populations
Substance Dependency
◦ 14% reported using ETOH during pregnancy
◦ 17% reported smoking during pregnancy
◦ 5% reported using illicit drug use

(from: SOGC Clinical Practice Guideline April 2011)

 Adolescents &
Pregnancy
•Define adolescence: 11-19 years of age. In the
process of growing up. It won’t happen to me.
•What contributes to teen pregnancy? Lack of
education, no protection, family beliefs
•What concerns do we have with this age group and
pregnancy? Aware of alcohol and drugs, healthy
pregnancy, cost
 Adolescents &
Pregnancy
Developmental Tasks
•Adolescents still developing
•Still working on their identity formation
•Body Image
•Not quite an adult
•Identity and autonomy are what they work towards
•Developing abstract thinking
•Sexual and vocational identity
•Interaction with peers is important
 Dual Developmental
Tasks for Adolescents
ADOLESCENTS PARENTING
•Self absorbed •Place child’s needs first
•Mixed feelings/emotions •Maternal role
•Identity formation •Changes with pregnancy
•body image important •Role re-assignment
•emancipation •Decision making skills for
•beginning abstract parenting
thinking/problem solving
Physical Concerns in
Adolescent Pregnancy
Complications of Pregnancy:
◦ PIH
◦ Iron Deficiency Anemia
◦ Preterm Labor
Physical Concerns in
Adolescent Pregnancy
Complications of labor, Birth and
Postpartum
◦ Cephalopelvic Disproportion

◦ PPH (Post partum hemorrhage)

◦ Inability to adapt/knowledge deficit

Adolescents giving
birth
Working with teen parents
•Terra Centre ( http://terracentre.ca/ )
•Need knowledge - may not understand birth process
•Need good support prenatally
•Needs support during birth
•Need follow-up after birth
•They do not need condemnation
 Women over 35 &
Pregnancy
More women >35 years having babies
◦ Why? Want a career, marriage later, change their
mind

Fertility decreases as we age

◦ Why? Chronic illness (diabetes, HTN, obesity),
decease in estrogen, decreased eggs
Women over 35 &
Pregnancy
-Developmental Tasks
•Develop generativity
• Generally want to expand their awareness,
give back to the community as they move
away from themselves
•May feel ambivalent during pregnancy
• May want to continue with outside activities,
yet also want to care for their bodies/baby
•Also caring for aging parents
Women over 35 &
Pregnancy
Complications

MOTHER BABY
Complications with •Down Syndrome
Pregnancy: /chromosomal issues
• Chronic illness (HBP) •Higher risk of death
• PIH
•Higher risk of morbidity due
• Fibroids
to mother’s chronic illness
• Gestational diabetes
Complications with
labor/delivery:
• Failure to progress
• PPH
Substance Use in
Pregnancy
•Many recreational drugs are abused
•Important to try and counsel woman to stop using
these substances
•Important to connect and try and give as much
prenatal care as possible
Scenario
Jaclyn is 23 years old and is four months pregnant. She is
visiting a health clinic for prenatal care for the first time.
During the health assessment she responds that she has
frequently consumed one or two drinks, almost every day,
when she comes home from work to unwind. There are
many social events on weeknights and weekends that
typically involve drinking.
Identify any problems or concerns in Jaclyn’s situation?
What information would you share with Jaclyn?