Part 2 Lucy’s Story
2.3 Lucy case study 2: Adolescent pregnancy
Nicole Graham
Introduction to case study
Lucy is familiar with trauma and her life has changed in such a brief period. Now living with her older partner, she is excited to learn she is pregnant shortly after her 16th birthday.
Learning Objectives
By the end of this case study, you should be able to:
- Identify the biological, social, and psychological impacts of a pregnancy during adolescence.
- Explore the health risk factors that may present.
- Consider the psychological impact on a young woman who experiences the loss of pregnancy.
Scenario
As we mentioned in the previous case study, Lucy met her partner Lucas at 15. He was 21 at the time. Lucy as a young adolescent was physically well developed and she felt mature for her age. Within only a short couple of months, at 15 and 4 months of age, Lucy realised she was pregnant. She was excited at the thought of becoming a mum; she loved children and wanted to have someone who would love her unconditionally. She told her partner Lucas, who was supportive. When Lucy told her mother, she was met with concern and advice that pregnancy is not easy at 15. Lucy recalls not taking on her mother’s advice to have a termination. When she attended her first ultrasound, she left incredibly happy with the image of early pregnancy. With the little money she had she purchased second hand baby clothing. She was happy and was proud to tell people she was expecting her first child.
Lucas was concerned about money and the need to move into a bigger place. They were living in a shared caravan with one other man, a friend of Lucas’, with no privacy or room to move. Lucy and Lucas were confined to a bed and outdoor area within the caravan park. The caravan park itself was run down and considered ‘rough.’ Lucas, who worked for a local council as a labourer, would spend his time drinking after work. The more he drank, the more frustrated he became at their living conditions. Lucas had the support of his family, who also welcomed the news of Lucy’s pregnancy. His parents offered to rent them a holiday house they owned in Bundaberg for a small amount of money each week. The plan was for Lucy and Lucas to marry and eventually buy the home.
Lucy felt increasingly happy. Her life was coming together, just as she imagined it. At 8 weeks gestation, Lucy and Lucas moved into the house. Shortly after moving, Lucy noticed spots of blood on her underwear. She did not know what to do nor who to call. Lucas took her to the local hospital. During the consultation, she overheard a nurse say it would be a blessing if she lost the baby as she was so young. Lucy felt judged and angry. She insisted that Lucas take her home. The doctor stopped her as she was getting changed and talked Lucy into agreeing to an examination and further advice. The doctor referred her for an ultrasound and conducted an internal examination, confirming that the pregnancy was still viable with a strong foetal heartrate of 150 beats per minute. The doctor advised Lucy that she needed prenatal care and referred her to the midwifery unit. The doctor also encouraged her to reconnect with her parents for support from family. Lucy recalls she did not really take on board the information and left the hospital before the midwife came to see her.
Over the next 3 weeks Lucy felt full of energy. Life was returning to normal. She remembers it as an intense feeling of energy and restlessness. She began an intense exercise regime and ran twice a day. She also had difficulty sleeping, with many thoughts going through her mind. She used this time to craft and made items out of recycled materials, often going through her neighbour’s recycling bin for additional craft supplies. Her energy allowed her to prepare a nursery, which she decorated with abstract art and crafted decorative items. Lucas would often tell her to rest and that she needed to care for herself and baby. Lucy said she was doing just that and would often argue with Lucas that he did not understand that being pregnant brought intense energy.
This feeling changed around the 11-week gestation period when Lucy described a different feeling. She had been running when she experienced a pain, much like menstruation pain. It was different from the previous spotting. Lucy alerted a passer-by who called an ambulance. At the hospital, Lucy was advised that she was experiencing a spontaneous abortion and that she may require a dilation and curettage. Lucy refused to believe she had lost her baby and discharged herself against medical advice. Lucas picked her up and took her home. Lucy recalls feeling devastated and went to bed, a place she would remain for weeks. Lucy’s pregnancy had spontaneously aborted, with no further complications. Her room was dark, she stopped talking to Lucas and spent hours sleeping. She recalls Lucas getting agitated and telling her to get out of bed and eat. At one point he dragged her into a cold shower and slapped her across the face. Lucy recalls feeling like life had ended. She had no energy.
Lucas eventually called a doctor who attended Lucy at their house. The doctor prescribed amitriptyline, an antidepressant, and told Lucy it was normal to experience grief after a pregnancy loss. Within what she describes as days, Lucy felt an intense surge of energy. She was happy the medication worked so quickly. She had not told anyone she had lost her baby and continued as normal. Lucas didn’t understand, but respected Lucy’s wishes. She attempted to become pregnant again so no-one would know. Lucy was upset each month she did not become pregnant. Lucy knew this could not continue as people were asking her about her health and that of the baby. She told her family and friends about the tragedy of losing the baby around the time she would have been 7 months pregnant. She offered no explanation to her family and friends, nor gave any details about the timing. She asked that they not speak of it again.
Case study questions
- Identify the biological, social, and psychological stressors for both Lucy and Lucas.
- What health education might have supported Lucy during her pregnancy and at the time she presented to hospital?
- Given Lucy’s prior history of trauma, what engagement strategies might help develop and maintain a therapeutic relationship?
- After the pregnancy loss, what further support might be beneficial to both Lucy and Lucas?
Key information and links to other resources
Galeotti et al. (2022) recognise in a scoping review that miscarriage can have both short- and long-term emotional impacts for both men and women. They further suggest that hospitals and staff need to act to improve the emotional support of women and men who are experiencing a tragic loss of pregnancy. Lack of compassion, insensitive communication, excessive wait times for assessment, procedures, treatment and lack of privacy were the key contributors of stress and anxiety for both parents (Galeotti et al., 2022). The resources below can help clinicians become more trauma-informed when faced with the tragedy of miscarriage.
Sources of information relevant to this case study
- Raising Children: Teenage pregnancy: A guide for parents of pregnant teenagers
- Sands miscarriage, stillbirth & newborn death support: A father’s grief
- Beyond Blue
Thinking point
Young parents experience higher rates of stereotyping and discrimination. The Australian Human Rights Commission (2017) conducted a project investigating the rights and needs of young parents and their children, finding that young parents and their children are very vulnerable to poorer physical health and have elevated risks to their emotional and social wellbeing. Despite these challenges, the report finds that young parents are very motivated to provide the best care for their children (Australian Human Rights Commission, 2017).
Review the data in the report and document the significant challenges encountered by young parents. Identify how many barriers could be overcome with the support of an interdisciplinary health care team.
- Australian Human Rights Commission. (2017). The rights and needs of young parents and their children: A summary of key findings from the Children’s Rights Report 2017. https://humanrights.gov.au/our-work/publications/summary-childrens-rights-report-2017
Thinking point
There has been an increase in stories of pregnancy loss in the media, which is potentially encouraging more people to discuss their own individual experiences (Budin, 2021). Queensland Health has developed a Clinical Care Guideline (2022) for early pregnancy loss, which highlights not only the physical health assessment and treatment response, but also psychological support and sensitive handling of foetal tissue and/or remains.
Review the clinical care guidelines in relation to a presentation like Lucy’s; identify the clinical care recommendations; and reflect on how you could enhance the process through taking a trauma-informed approach.
- Queensland Health. (2023). Queensland clinical guidelines: Translating evidence into best clinical practice. https://www.health.qld.gov.au/qcg
Case study 2 summary
Through this case study you have had the opportunity to learn more about both Lucy’s and Lucas’ pregnancy experiences and traumatic loss. You have learned how this event had a significant impact on Lucy’s mental health. You have been able to identify the variety of impacts across physical, social, and psychological wellbeing and considered how you may need to adapt your engagement strategies to suit individual needs.
References
Australian Human Rights Commission. (2017). The rights and needs of young parents and their children: A summary of key findings from the Children’s Rights Report 2017. https://humanrights.gov.au/our-work/publications/summary-childrens-rights-report-2017
Budin, W. C. (2020). In This Issue-Confronting Pregnancy Loss. The Journal of Perinatal Education, 29(1), 3–5. https://doi.org/10.1891/1058-1243.29.1.3
Galeotti, M., Mitchell, G., Tomlinson, M., & Aventin, Á. (2022). Factors affecting the emotional wellbeing of women and men who experience miscarriage in hospital settings: A scoping review. BMC Pregnancy and Childbirth, 22, Article 270. https://doi.org/10.1186/s12884-022-04585-3
Queensland Clinical Guidelines. (2022). Early pregnancy loss (Document number MN22.29-V6-R27). https://www.health.qld.gov.au/__data/assets/pdf_file/0033/139947/g-epl.pdf