Placement of long-acting reversible contraception for minors who are mothers should not require parental consent

Decreasing unintended teenage pregnancy, especially repeat teenage pregnancy, is an important public health goal. Unfortunately, legal barriers in the USA impede this goal as all minors are unable to consent for birth control in 24 states, and only 10 of those states allow consent after the minor has given birth according to state statutory law. Placement of long-acting reversible contraception (LARC) is one of the most effective methods of preventing rapid repeat pregnancies. However, restrictions are placed on adolescents who may not have the option of parental consent if the parents are unwilling, or not present, to give consent. A predicament arises when healthcare professionals are willing to place the contraceptive for the patient, but cannot due to the restrictions and guidelines outlined by each state. Even though these adolescents are legally viewed as minors, adolescent mothers should be able to consent to the placement of LARC. Notably, adolescents have the legal ability to give consent for the healthcare of their child starting in the prenatal period. I argue that this ability should be extended to include adolescent consent for their own healthcare. Additionally, the procedure to place LARC is relatively low risk and highly effective, which is an opportune situation to allow minors to consent. Allowing adolescents to consent to LARC after delivery is a simple and effective way to decrease rapid repeat pregnancy rates in the USA.

A bile duct stent broken during repeat pregnancy in a post-liver transplant patient

A young female patient who developed anastomotic biliary stricture following an orthotopic liver transplantation was observed. A self-expandable metallic stent was placed to correct the stricture. At the 8th month of her repeat pregnancy, the stent broke asymptomatically into half. Fortunately, the second childbirth, like the first one, had no complications. Eighteen months later, due to obstruction of fragments by sludge and gallstones, re-stenting was performed with a coated biliary stent. Four years and five months later, recurrent jaundice occurred due to occlusion of the second stent. This was addressed by surgical removal of both stents. Two years after surgery, the bile ducts remain completely patent. We found only two cases in literature on a similar extremely rare biliary stenting complication. It has been suggested that stent deformation may be related to pregnancy. The feasibility of using stenting in benign biliary strictures in some clinical situations is discussed.

Associations between Adverse Childhood Experiences and Sexual Risk among Postpartum Women

Epidemiological evidence suggests that exposure to adverse childhood experiences (ACEs) is associated with sexual risk, especially during adolescence, and with maternal and child health outcomes for women of reproductive age. However, no work has examined how ACE exposure relates to sexual risk for women during the postpartum period. In a convenience sample of 460 postpartum women, we used linear and logistic regression to investigate associations between ACE exposure (measured using the Adverse Childhood Experiences Scale) and five sexual risk outcomes of importance to maternal health: contraceptive use, efficacy of contraceptive method elected, condom use, rapid repeat pregnancy, and incidence of sexually transmitted infections (STIs). On average, women in the sample were 25.55 years of age (standard deviation = 5.56); most identified as Black (60.4%), White (18%), or Latina (14.8%). Approximately 40% were exposed to adversity prior to age 18, with the modal number of experiences among those exposed as 1. Women exposed to ACEs were significantly less likely to use contraception; more likely to elect less-efficacious contraceptive methods; and used condoms less frequently (p = 0.041 to 0.008). ACE exposure was not associated with rapid repeat pregnancy or STI acquisition, p > 0.10. Screening for ACEs during pregnancy may be informative to target interventions to reduce risky sexual behavior during the postpartum period.

Maternal Childhood Experiences and Rapid Repeat Pregnancy in a Low-Income, Urban Cohort

Background Rapid repeat pregnancy (RRP; < 18 months between pregnancies) is associated with higher risk of adverse maternal and child health outcomes. Drawing from attachment theory, we sought to examine the association between maternal childhood neglect and RRP as well as identify a protective childhood experience—caregiving—that reduces the impact of childhood neglect for RRP. Methods Data for the current study came from a prospective clinic-based cohort study conducted in 2017–2018 in a South-Central U.S. state. The sample includes 111 pregnant women (ages 17–38) who had been pregnant more than once. Poisson regression analysis was used to examine the associations between maternal childhood experiences and number of RRP. Results On average, participants reported 1.02 RRP. Approximately 35% of the sample reported experiencing neglect during childhood. Controlling for sociodemographic, psychological, and childhood characteristics, childhood neglect was positively associated with RRP, whereas caregiving responsibilities during childhood was negatively associated with RRP. Interaction results indicate that the association between childhood neglect and RRP only holds for those who did not have caregiving responsibilities during childhood. Conclusions Study findings highlight the importance of childhood experiences for RRP. Further research is needed to explore the moderating effect of caregiving and its implications for (1) treatment of childhood neglect and (2) prevention of RRP.

Lessons Learned on Recruiting and Retaining Young Fathers in a Parenting and Repeat Pregnancy Prevention Program

Introduction Research shows that mainstream parenting and repeat pregnancy prevention programs generally do not effectively engage with fathers and that young men’s levels of participation in such services are low. To support practitioners in overcoming the barriers to recruiting and retaining young fathers, the current study aimed to gather lessons learned from one program’s state administrators, case managers, and young fathers about the most effective strategies for engaging this population in intensive case management. Methods Three focus groups were conducted. One focus group was held with the creators and managers of the Michigan Adolescent Pregnancy and Parenting Program MI-APPP at the state Department of Health and Human Services (n = 3). The other two groups were designed to jointly engage young fathers currently involved in intensive case management (n = 11) and their case managers (n = 5). A qualitative analysis of the focus group transcripts was conducted using a coding scheme developed from emerging themes in the transcripts and related literature. Results The findings highlight a selection of those strategies that focus group participants perceived to be most successful in improving male recruitment and retention in intensive ongoing case management. Among these strategies were centralizing feedback from young fathers in program decision making, offering opportunities for young fathers to connect, and challenging staff’s negative stereotypes about young fathers. Discussion Despite the small sample size, the results of this study nevertheless contribute to debates in the field regarding appropriate strategies for engaging young fathers by informing professional practice.