UCSF

Adult mothers with negative decision-making experiences during labor have increased risk for problems such as postpartum depression, yet little is known about adolescent mothers' experiences of decision-making during labor. Despite their developmentally unique decision-making processes, in the United States adolescent mothers have the decision-making rights of adults during labor. The purpose of this study was to develop theory exploring adolescent mothers' experiences of decision-making during labor and birth.

For this constructivist grounded theory study interviews were conducted with 18 adolescent mothers. Childbirth classes for adolescents in a West Coast urban area were also observed. Data collection and analysis were conducted concurrently using constant comparison, situational analysis, and dimensional analysis.

Adolescent mothers felt their decision-making during labor was setting the tone for early motherhood. Adolescents made decisions in the context of their belief that during labor they would go into mother mode and gain the strength to give birth and care for their child. Conditions affecting decision-making included the support available, expectations, communication and perceived locus of control. Key decision-making processes included `going natural' versus `going epidural'; being strong for the baby; and interpreting the perceived cues of others. Consequences included increased feelings of confidence for adolescents who felt their decisions reflected good mothering, and persistent feelings of regret and anxiety for adolescents who felt pressured into unwanted decisions.

Adolescent mothers reported feeling most supported when they had a supportive ally, yet often made decisions in the context of unpredictable availability and degree of support. Conditions influencing having a supportive ally included adolescents' familiarity with the support provider, the expertise of the support provider and the consistency of support. During decision-making, key processes of the supportive ally included facilitating communication, making space for decisions and validating hard choices. Adolescents who had a supportive ally for decision-making during labor and birth reported feeling empowered, while mothers without a supportive ally could feel silenced in decision-making.

Further research is needed to investigate the relationship between adolescent mothers' experiences of decision-making during labor and outcomes such as postpartum mood disorders, and should incorporate conceptual frameworks drawing from current theories of adolescent development and decision-making.