Managing pregnancy in adolescents

Counseling adolescents with pregnancy requires careful language, expectations of ambivalence, and other key behaviors, as discussed by Mackenzie Shields Hodak, DNP, CRNP, at the 44th National Conference on Pediatric Health Care on March 17, 2023.

Role-based training was designed in pregnancy options counseling (POC) for pediatric residents. The training aimed to increase POC knowledge and improve related skills, evaluating participants’ knowledge before, immediately after, and 6 months after training, with results of trained interns compared with those of untrained senior residents.

Performance was similar between untrained interns and untrained senior residents, while a major improvement in performance was seen in trained interns. Scores were improved after training, staying high after 6 months.

Hodak discussed considerations in POC unique to adolescents, such as confidentiality, consent, challenges to reproductive care, presenting later to care, and policy from the American Academy of Pediatrics.

For appropriate language, health literacy should be kept in mind. The pregnancy should also be disclosed, and options should be provided to the patient clearly and neutrally. Ambivalence should be expected in response, and providers should recognize their own biases.

Adolescents discovering their pregnancy can be supported through OARS: open questions, affirmation, reflective listening, summary. Providers should acknowledge societal and familial pressures these individuals might face, and follow-up with them in the future.

For the next steps, materials such as hand outs and videos should be provided to patients for later reference. A check-in should occur after 1 week, and further steps should be planned out.

Further recommendations from Hodak include not saying congratulations, not assuming the pregnancy is unplanned, finding a balance between acknowledging difficulty and reassuring the patient, discussing the basics of prenatal care, accurately answering any questions possible, and providing OB/GYN referrals.

Reference

Hodak MS. Pregnancy options counseling with adolescents: a multidisciplinary evidence- based approach. Presented at: 44th National Conference on Pediatric Health Care. March 15-19, Orlando, Florida.