US adolescent mothers face higher risks of postpartum depression and traumatic experiences than adult mothers, and have developmentally unique needs and decision making patterns. While a poor experience of decision making during labor and birth has been shown to increase the risk of postpartum depression and birth-related post-traumatic stress disorder in adult women, it is unknown how US adolescent mothers experience decision making during labor and birth. Better understanding of how adolescent mothers experience decision making during labor and birth could help guide efforts to decrease the risk of poor postpartum outcomes in this vulnerable population. The purpose of this study is to develop a mid-range theory of adolescent mothers’ experiences of decision making during labor and birth.
A constructivist grounded theory design using individual, semi-structured interviews and participant observations is employed, using methods from Clarke (situational analysis) and Schatzman (dimensional analysis). 20 participants attending clinics and/or schools providing specialized services for adolescent parents in an urban area of the Western United States were interviewed 1 to 2 times. Observations took place in a childbirth class for adolescents. Findings are developed through constant comparison, theoretical sampling, and member reflection until theoretical saturation is reached. Rigor is maintained through reflexivity, peer analysis, data triangulation, and use of an audit trail.
US adolescent mothers desire to be engaged in decision making during labor and birth. However, their knowledge regarding available options and their right to participate in healthcare decision making are variable. Mothers' decisions are guided by what they feel is best for their baby, and are sometimes at odds with heathcare providers' recommendations. Most mothers in this study express a preference for “going natural,” or having a vaginal birth without pain medication, in order to prove their worth as mothers as well as avoid health risks they perceive could result from epidural anesthesia. Some mothers opt for epidural anesthesia in order to “stay calm” to protect their baby from the harm they perceive will result from a mother’s emotional upset. Mothers describe often feeling unheard or overlooked when family members or care providers made decisions for them, and report that at times they do not receive sufficient or timely information from providers. Mothers express resilience in their response to decision making experiences that are frequently negative, and rely on support from family, friends, and/or doulas to help them navigate decision making during labor.
Adolescent mothers show surprising resilience in coping with frequently negative experiences of decision making during labor and birth. However, they also assign significance to the way in which a mother chooses to go through birth, in particular her ability to cope with the pain and fear of labor. The lack of emotional support and involvement in decision making some adolescent mothers experience during labor and birth may represent a missed opportunity to provide crucial support for their perceived competence and self-efficacy as new mothers.