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PREGNANCY

Pregnancy among street-involved youth is an important issue because it offers challenges for both mother and child. In a 2010 Edmonton study of street involved youth ages 15-24, 43% had ever been pregnant, and about half of those pregnancies resulted in a live birth (Alberta Health Services, 2011).

 

The “early child health consequences of poverty and pregnancy are multiple, and often set a newborn child on a life-long course of disparities in health outcomes” (Larson, 2007, p. 673). Infants of poor mothers are at risk for premature birth, intrauterine growth restriction, and death. Whereas children are at risk for learning problems, behaviour problems, and poor school achievement (Larson, 2007).

HighRisk_pregnancy

Jess’s story below is a common one for young women on the streets. The stress of unstable living and financial circumstances, in addition to their lack of education and experience, make it hard to notice the symptoms of pregnancy early on. Once pregnancy is detected they often lack the supports needed to make healthy decisions around pregnancy options.

HighRisk_pregnancy_story

JESS’S STORY…

 

I woke up this morning and saw I finally got my period. I’m pretty happy about that ‘cause I was starting to get worried. It’s very light, which is a good thing ‘cause I don’t have any cash to buy tampons. It’s been a rough couple of months and I am so tired, sleeping on a different couch every night is starting to wipe me out. It’s not helping that I have to get up and pee during the night. I wonder if the free clinic can check me for a bladder infection.


 

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Most women experience some signs and symptoms of pregnancy as early as three weeks after conception. The likelihood of pregnancy increases if signs are present; but the absence of signs does not rule out pregnancy. A diagnosis of pregnancy CANNOT be made based on symptoms alone.

CONFIRMING PREGNANCY

Confirming a pregnancy early is important because it may prompt women to seek early medical care, understand their pregnancy options, including taking actions that benefit the health of the pregnancy. These actions include taking folic acid/prenatal vitamin, avoiding alcohol and/or substances and eating a healthy diet.

Service providers can ask these specific questions if pregnancy is suspected:

 

  • When was your last period? Was it normal?
  • Do you usually get regular periods (normal is between every 23-36 days)
  • Are you sexually active?
  • Do you use birth control (hormonal contraception and/or condoms)?
  • Do you take your birth control correctly and consistently?
  • Do you have any symptoms of pregnancy?
  • Is there a chance you might be pregnant?


 

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If a woman reports a missed period, involvement in sexual activity, imperfect/no use of birth control and suspicion of pregnancy, these are signs that a pregnancy test will be positive.

The most common signs and symptoms of early pregnancy are:

 

  • A missed period, especially if it has been more than a week.
  • Nausea with or without vomiting (“morning sickness”). This is typical during first 6-12 weeks of pregnancy and is often worse in the morning but can occur any time of day.
  • Breast tenderness, swelling, heaviness, tingling or soreness.
  • Increased frequency of urination.
  • Fatigue, which is most common in first trimester, less common in the second trimester.

Other common signs of early pregnancy are:

 

  • Irregular bleeding – some women have irregular bleeding on and off, or bleeding around the time that one would expect their period.
  • Food cravings and food aversions.
  • Mood changes.
  • Lightheadedness.
  • Bloating.
  • Constipation.
  • Heartburn.
  • Lower back pain.
  • Nasal congestion.
  • Uterine cramping.
  • Shortness of breath (not otherwise explained).


 

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Bleeding in early pregnancy that is heavier than a typical period or accompanied by pain may be a sign of miscarriage or ectopic pregnancy. If this occurs, it is important that the person goes to a health care provider.

HighRisk_pregnancy_test

Pregnancy Tests

Pregnancy tests test for the pregnancy hormone, human choronic gonadotropin (hCG), which can be measured in blood or urine. The blood test can detect hCG as early as 6-12 days after ovulation. Urine tests are generally less sensitive than the blood test.

 

Urine pregnancy tests can be done in the home, doctor’s office, or laboratory. A urine pregnancy test is usually done after missing a period. If the test is done too soon, the result may not be accurate. If the test is negative and the period does not come, the test should be repeated in one or two weeks.

 

If a home pregnancy test is done, make sure to follow the instructions on the kit carefully and that it hasn’t passed its expiry date. Use a first morning urine sample because that is when the level of hormone is highest.


 

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If there has been unprotected sex in the last five days using emergency contraception (EC) can help prevent pregnancy. There are three methods of EC: two types emergency contraceptive pills (ECPs); and Copper IUD.

 

The ECP works best if taken within first 24 hours but can be used up to 5 days. Levonorgestrel ECPs can be bought at a pharmacy without a prescription, or found at many family doctors, walk in clinics or Alberta Health Services Sexual and Reproductive Health Clinics. For information on community resources, click here.  A newer type of ECP, ulipristal acetate is also available by prescription. The Copper IUD needs to be inserted into the uterus by a trained health care professional. Youth should be encouraged to call their local clinic to see if this if offered.

 

A person should do a pregnancy test if their period does not come within three weeks of using EC, or if the period is much lighter than normal. For more information on ECPs, click here.

PREGNANCY OPTIONS

If an unplanned pregnancy has been confirmed, a woman has three options.

 

  • Continuing with the pregnancy and choosing to parent.
  • Continuing with the pregnancy and choosing adoption.
  • Ending the pregnancy and choosing abortion.

Parenting

There are many resources that offer support to pregnant women choosing to go on to parent.  In addition to maintaining a healthy pregnancy, responsibilities for those who choose to parent include:

 

  • Planning for meeting the basic physical, emotional, medical, social and developmental needs of the child.
  • Preparing for lifestyle changes such as changes to daily routine or recreational activities.
  • Learning about healthy parenting.
  • Choosing childcare options if the parent(s) will be in school or at work.
  • Accessing supports.

HighRisk_pregnancy_parenting

Adoption

In Canada each province has its own rules and regulations regarding adoption. In Alberta, if a woman chooses to continue the pregnancy and place the child for adoption there are different types of adoptions to choose from:

Public adoption:

 

Public adoptions are arranged by government agencies such as The Government of Alberta Children and Youth Services. The services provided by the government agencies are confidential and free for birthparents. Depending on the province, the process will vary.

Private adoption:

 

Private adoption is any adoption that is not arranged by a public agency. Private adoptions include fees established by the private adoption agency that are paid by the adoptive parents. The services are offered free of charge for birth parents. Adoptions may be open, closed, or somewhere in between. Deciding to have an open or closed adoption is a personal choice which depends on the comfort levels of the birth parent(s) and adoptive parents.

Types of private adoptions include:

 

    • Direct adoption: A private direct adoption means that the birthparent(s) have chosen to place their child directly with a known family or within their own family. Private adoption agencies can assist with this process.
    • Open adoption: An open adoption refers to any situation where the adoptive parent(s) and the birth parent(s) know each other and exchange identifying information. Just how much information they exchange depends on the level of comfort of each person(s). With an open adoption, the birth parent(s) may choose how involved they wish to be in the child’s life including:
      > Meeting the adoptive parent(s).
      > Having an ongoing relationship with the adoptive parent(s) and the child.
      > Giving letters or photos.
      > Receiving photos of the child as the child grows.
    • Closed adoption: In a closed adoption, no identifying information is exchanged. It is unlikely that the birth parent(s) and the adoptive parent(s) meet. The birth parent(s) may ask that they receive no information once the child has been placed.

Abortion

In Alberta, a woman with a pregnancy between 6-20 weeks can self refer for an abortion.

Most abortions happen during the first 12 weeks of pregnancy. If the woman has Alberta Health Care, there are no fees for the procedure. Fees apply if the woman does not have Alberta Health Care.


 

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A woman and the people she chooses to support her can get help to review her pregnancy options in a non-judgmental way at any Alberta Health Services Sexual and Reproductive Health Clinic. For information on community resources, click here.


 

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If cost is a concern in accessing an abortion, people can contact an abortion service provider to discuss the concern.

HAVING A HEALTHY PREGNANCY

There are many ways to increase the chances of having a healthy baby, such as:

 

  • Getting prenatal care with a health care professional.
  • Developing healthy eating habits.
  • Staying active.
  • Getting plenty of sleep.
  • Limiting caffeine intake.
  • Checking with a healthcare provider before taking over-the-counter drugs or prescription medications.
  • Not using cigarettes, alcohol or drugs.

 

Having a healthy pregnancy and choosing to parent is important job which has rewards and challenges. There are many resources that can help have a healthy pregnancy.

SUBSTANCE USE AND PREGNANCY

Alcohol and most drugs taken during pregnancy will pass from the mother to the developing baby. Substances such as alcohol, street drugs, and tobacco will affect each pregnancy differently. The effect that a substance has on a fetus depends on:

 

  • What is taken.
  • When it is taken.
  • How much is taken.
  • How often it is taken.
  • Whether or not different substances are taken at the same time.
  • How the mother’s body reacts to the substance (Alberta Health Services, 2014a).


 

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Some people are able to stop using substances when they are pregnant. So finding out about a pregnancy early is very important in order to reduce harm.

Alcohol

Drinking alcohol at any time during a pregnancy can harm the developing baby.  It is unknown if any amount of alcohol is safe.  It is safest not to drink when pregnant.  Damage done by alcohol to the organs and brain cannot be fixed.

Babies exposed to alcohol before birth may have:

 

  • Fetal alcohol spectrum disorder (FASD).
  • Brain development problems.
  • Learning problems.
  • Face and head deformities.
  • Organ, bone and muscle defects.
  • Slow growth.
  • Difficulty understanding consequences.
  • Low birth weight.
  • Withdrawal symptoms.
  • Risk of mental health disorders (Alberta Health Services, 2014b).

Street Drugs

Using street drugs such as marijuana, cocaine, heroin, MDMA and meth at any time during pregnancy, can harm the developing baby. No amount of these substances are safe to use during pregnancy.

Babies exposed to drugs before being born may have:

 

  • Addiction to the substance.
  • Withdrawal symptoms.
  • Brain damage.
  • Difficulty being comforted.
  • Inability to respond to mother.
  • Higher risk of sudden infant death syndrome (SIDS).
  • Slower growth.
  • Trouble paying attention and learning difficulties (UCSF Medical Center, 2002-2015).


 

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Some pregnant youth use marijuana to reduce morning sickness. This is not safe for the pregnancy. Marijuana stays in the fat cells of the unborn baby for 30 days, interfering with fetal growth and health (UCSF Medical Center, 2002-2015).

Tobacco

It is best to quit smoking early in pregnancy; but quitting at any time during the pregnancy is helpful. Cutting back the amount can also lower risks to the developing baby.

Tobacco use and exposure to second hand smoke during pregnancy can:

 

  • Increase the risk of Sudden Infant Death Syndrome (Alberta Health Services, 2014c).
  • Increase health and learning problems in childhood (UCSF Medical Center, 2002-2015).

RESOURCES & REFERENCES

RESOURCES

 

For more information on pregnancy, see: Society of Obstetricians and Gynaecologists of Canada

 

For more information about early pregnancy, see:
http://sexualityandu.ca/en/games-and-apps/am-i-pregnant

 

For prenatal information and support for pregnant women living on a low income or teens of any income, see:

http://www.albertahealthservices.ca/services.asp?pid=service&rid=1568

 

For a resource for those experiencing pregnancy and street involvement, see:
http://streetworks.ca/pdfs/pregnancy-book-inside.pdf

 

For more information about pregnancy, labour, birth and new parenting, see:
http://healthyparentshealthychildren.ca/
www.myhealth.alberta.ca

 

For more information on adoptions, see:
www.adoption.ca

 

For more information on abortion, see:
http://www.nafcanada.org/

 

For information on abortions in Alberta, see:

http://www.albertahealthservices.ca/services.asp?pid=service&rid=2131

www.kensingtonclinic.com

 

REFERENCES

 

Alberta Health Services. (2011). E-SYS. Enhanced street youth surveillance Edmonton site results (1999-2010). Edmonton AB: Communicable Disease Control, Alberta Health Services.

 

Alberta Health Services. (2014a). Healthy parents healthy children a practical guide to pregnancy and being a parent: Drugs, alcohol and Tobacco. Retrieved from, http://www.healthyparentshealthychildren.ca/starting-off-healthy/being-healthy-and-preventing-injuries/drugs-alcohol-and-tobacco/

 

Alberta Health Services.  (2014b). Healthy parents healthy children a practical guide to pregnancy and being a parent: Alcohol. Retrieved from http://www.healthyparentshealthychildren.ca/starting-off-healthy/being-healthy-and-preventing-injuries/drugs-alcohol-and-tobacco/alcohol/

 

AHS Healthy Parents Healthy Children. (2014c). Healthy parents healthy children a practical guide to pregnancy and being a parent: Tobacco. Retrieved from, http://www.healthyparentshealthychildren.ca/starting-off-healthy/being-healthy-and-preventing-injuries/drugs-alcohol-and-tobacco/tobacco/

 

Bastian, L.A., & Brown, H.L. (2010). Diagnosis and clinical manifestations of early pregnancy. UpToDate. Retrieved from, http://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-early-pregnancy

 

Calgary Sexual Health Center. (2008). Pregnant and undecided? A resource for women facing an unintended pregnancy. Calgary: Author.

 

Larson, C. P. (2007). Poverty during pregnancy: Its effects on child health outcomes. Paediatrics & Child Health, 12(8), 673-677.

 

UCSF Medical Center. (2002-2015). Substance use during pregnancy. Retrieved from, http://www.ucsfhealth.org/education/substance_use_during_pregnancy/