Teenage Fathers

Stresses During Gestation and Early Parenthood

Arthur B. Elster, MD, Susan Panzarine, RN, PhD

To determine the nature of the stresses experienced by teenage fathers, 20 youths (mean age,
17.6 years) were interviewed from one to four times during the prenatal period and at four to
six weeks following delivery. While all conceptions had occurred premaritally, most couples
had married by the time of delivery. A total of 44 interviews were performed: four during first
trimester, 12 during second trimester, 17 during third trimester, and 11postpartum. Stressors
reported by the subjects were grouped into four categories: vocational-educational concerns,
concerns about the health of the mother and/or the baby, concerns about future parenthood,
and problems with relationships. It was found that the intensity of these concerns changed
throughout pregnancy and the neonatal period. Subjects who had expected the pregnancy to
occur tended to report less stress during the third trimester than did teens who had not antic-

ipated conception.

IN A PREVIOUS PAPERS we reported the results

of an exploratory study investigating the emotional
depression. While not investigated in a systematic
manner, it appeared that the teens in this study had
and health educational needs of a selected group of three general areas of concern: role and responsibil-
16 prospective, unwed adolescent fathers. Based on .ity of fatherhood, relationship with partner, and
clinical assessments, these predominantly black, lower change in social support. This study provided general
’

socioeconomic adolescents were experiencing emo-
tional difficulty precipitated by pregnancy and pro-
spective parenthood. Nine were thought to be coping
well with the pregnancy, four were coping moder-
ately well, and three were coping poorly. A total of
six teens, all from the latter two categories, were re-
ferred for counseling because of moderate to severe
From the Department of Pediatrics, University of Utah College
of Medicine and Primary Children’s Medical Center, Salt Lake
City, Utah.
This research was funded by a university grant for faculty de-
velopment. Dr. Eister was partially funded by the W. T. Grant
Foundation and the ~3ffice of Adolescent Pregnancy Programs.
Correspondence to: Arthur Elster, M.D., Department of Pedi-
atrics, 50 North Medical Drive, Salt Lake City, UT 84132.
Presented in part at the scientific meeting of the Society for
Adolescent Medicine, New Orleans, April 1981. Received for pub-
lication September 1982, revised December 1982, and accepted
April 1983.
information about the problems some teen fathers
had adjusting emotionally to a pregnancy, but it did
not provide a detailed description of the stresses
which were experienced. The purpose of the present
study, therefore, was to investigate the nature of the
specific concerns surrounding pregnancy and par-
enthood. Our hypotheses were that, because of the
socialpressures surrounding adolescent pregnancy,
there would be stresses common to most young fa-
thers and that the intensity of these stresses would
change during pregnancy and the postnatal period.
-Methods
A convenience sample of 20 primigravida teen-
agers who had partners 18 years of age or less were
identified from three area high-risk prenatal clinics.
We informed the male partners of the study directly

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if they came to clinic, or through written information
delivered by the girl if they did not attend the pre-
natal visits. Informed consent was obtained from the
parents of unmarried subjects who were less than age
18. Our intention was to interview the teens during
each trimester and at four to six weeks following
delivery. They were seen either in their home, or at
the University Hospital, by one of the primary in-
vestigators (SP) or a research assistant, both of whom
had extensive training in psychosocial nursing. The
interviews were directed at exploring the particular
stresses each subject was then experiencing. Areas of
potential concerns determined from our previous
study, which were not spontaneously evoked, were
queried by the interviewer. The sessions were audi-
otaped for later transcription.
Each stresor identified was graded for severity by
the interviewer on a prescribed scale from one (low)
to three (high). The level of severity was used to
determine an average score per time interval for each
stressor. Only current concerns were included in the
analysis; recollection about prior concerns was ex-
cluded.
The audiotaped recordings of nine unselected in-
terviews were reviewed independently by the two in-
terviewers to establish the degree of inter-rater re-
liability. There was 87 per cent agreement for the
identification of stress categories, and 71 per cent
agreement for ratings of stress severity.
Twenty prospective fathers participated in the
study. At their first interview, they averaged 17.6
years of age (range 17-18), while their partners av-
eraged 16.6 years of age (range 14-21 }. Eighteen
subjects (90%) were white, a finding consistent with
the racial distribution in Utah. While not assessed
objectively, the teens were predominantly from mid-
dle socioeconomic backgrounds. All pregnancies
were conceived out of wedlock; however, 15 couples
married some time during the prenatal period. These
figures are also consistent with statistics from the
State of Utah as a whole, in that approximately 70
per cent of infants born to teenage mothers are con-
ceived premaritally and only 20 per cent are actually
delivered out of wedlock (Unpublished data).
A total of 44 interviews were conducted. Four sub-
jects were studied during first trimester (at a mean
of 12 weeks’ gestation), i 1 during second trimester
(at a mean of 22.2 weeks’ gestation), 17 during third
trimester (at a mean of 32.7 weeks’ gestation), and
I l postpartum (at a mean of 4.5 weeks postpartum).
CBverall, five teens had a total of one interview, seven
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TABLE 1. Stressors Reported by Teenage Fathers (n =
20)
had two, seven had three, and one had four. We were
not successful in obtaining longitudinal data on all
subjects for several reasons: (1) We had difficulty con-
tacting male partners early in pregnancy because the
girls frequently entered prenatal care after the first
trimester. (2) We had to work through the pregnant
teens to communicate with the prospective fathers.
(3) Five subjects withdrew from the study-three
because of divorce or separation, one because the
couple moved, and one for an unknown reason. (4)
Four subjects were not interviewed postpartum due
to termination of the study.
Results
The stressors reported by the teenage fathers were
grouped into four major categories (Table 1). Group
One, vocational-educational concerns, consisted pri-
marily of general worries regarding how the subjects
were going to financially support their new family.
Specific concerns about maintaining or getting a job
and concerns about not finishing school were also
included in this group. Group Two centered around
concerns for the present health of the mother, im-
mediate health and future welfare of the child, and
what would happen during labor and delivery. Con-
cerns about how they would perform as parents, in-
cluding issues of discipline and childcare, comprised
Group Three. Group Four involved problems with
relationships, specifically problems with their part-
ner, friends, parents, and their feelings of alienation
from their church. Included in this group were such
stresses as jealousy of the attention the baby was re-
ceiving, envy of the freedom their peers had (also
separation from peers), and concerns for the health
of their parents due to the pregnancy.
701
 Because of the relatively small number of subjects,
statistical analyses of the changes in intensity of the
four groups over time were not calculated. Voca-
tional-educational stresses were greatest during first
trimester and appeared to remain at a relatively high
level through gestation and into the postpartum pe-
riod. Health concerns peaked during the third
trimester and appeared to drop off substantially after
delivery. Concerns about parenting arose during sec-
ond trimester, appeared to drop slightly during third
trimester, and seemed to increase again postpartum.
Problems with relationships were greatest during the
first trimester and appeared to drop off at each sub-
sequent interval. Since the number of items com-
prising each category differed, it was not possible to
compare the relative intensity among groups. It
should be noted, however, that relatively few fathers
reported any concern about parenthood. Thus, at
the third trimester interview, parenthood was noted
as a stressor by six of 17 subjects (35%), while vo-
cational-educational concerns were found for all 17
teens, health concerns were reported by 16 of 17
teens (94%), and problems with relationships were
reported by 13 of 17 teens (76%).
Both our clinical impression and results from our
previous work’ suggested that teens who report a
positive initial response (happy, proud, pleased) to
pregnancy experience a relatively easy adjustment.
We, therefore, investigated the relationship between
whether or not the pregnancy was expected and the
total stress score at the third trimester interview.
Eleven teens (58%) reported that the pregnancy had
been expected, 8 (42%) reported that it had not been
expected, and the information was not obtained from
one. There were no substantial differences between
groups with respect to age of subject or partner, or
marital status at delivery. The teens who had antic-
ipated the pregnancy, however, had dated their part-
ners for a somewhat longer time (18 months as com-
pared to 14 months) and had learned of the preg-
nancy slightly earlier in gestation (7 weeks as
compared to 9 weeks postconception). Third trimes-
ter interviews were obtained on nine of the expected
group and seven of the unexpected group. Stress
scores averaged 7.0 (S.D. -~- 3. 1) for the former and
9.0 (S.D. ± 2.8) for the latter.
Discussion
Our study provides additional insight into the na-
ture of the problems experienced by prospective ad-
olescent fathers. Stress in this group of young men
was produced by vocational-educational concerns,
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concerns for the health of the mother and/or of the
baby, about parenthood, and problems with
concerns
relationships. This group of stressors, therefore, was
similar to the concerns of young prospective fathers
from our previous study who had different demo-
graphic characteristics. In one of the few other stud-
ies investigating psychosocial characteristics of teen-
age fathers, Hendricks3 found that black, unmarried
adolescent fathers from low socioeconomic back-
grounds (n 47) also identified some of their con-
=
cerns as financial responsibilities,
parenting skills, ed-
ucation, employment, transportation, relationship
with girlfriends, and
facing life in general. There
appears to be a reproducible pattern, therefore, in
the types of stressors affecting young fathers, re-
gardless of race, marital status, or socioeconomic sta-
tus. This is consistent with the hypothesis that the
social situation surrounding adolescent pregnancy
produces concerns which are common to teen fa-
thers.
That social role transition to parenthood is a stress-
ful situation is suggested by the reports of somatic
symptoms and psychiatric problems experienced by
adult prospective fathers and by more objective stud-
ies of this transitional period among adults. 1-7 While
many of the concerns reported by teenage fathers are
probably similar to those experienced by older men
who are experiencing their first fatherhood, the pre-
mature role transition results in youth experiencing
additional stresses.
Our second major finding was that the stressors on
young fathers changed in intensity throughout preg-
nancy and the early postnatal period. Premarital con-
ception precipitated a crisis situation among the pro-
spective fathers, their partners, and their parents. We
speculate that, with the discovery of the pregnancy,
adolescent fathers were probably initially faced with
the adverse social reactions associated with premarital,
school-age conception; after marriage, however, prob-
lems arising from the marital relationship and sepa-
ration from peer group developed. The results from
several studies 8-10 indicate that couples who married
during adolescence were found to have had a greater
rate of marital discord and divorce than couples who
married at an older age.
The discovery of the pregnancy and the commit-
ment to remain involved with the relationship also
precipitated concerns about schooling and financial
stability. It was not surprising that this group of
stressors remained elevated, because, by virtue of
their age and, thus, level of education, these fathers
were not adequately prepared financially to support
a family. Results of studies correlating age at family
 formation to educational achievement and vocational
’
status substantiate this immediate concerns The
younger the father at the time his first child is born
the less formal education he will complete.
Concerns about labor and delivery, mother’s
health, and infant’s health were found only during
the middle to the end of pregnancy. While this was
probably due to the inherent nature of the category,
it may also suggest, however, that these young fathers
were not thinking ahead about potential problems
which could affect their infant. Associated with this
speculation was the somewhat surprising finding that
parenting concerns were of relatively low magnitude.
The other, more crisis-oriented, problems possibly
preoccupied these fathers, interfering with their per-
ceiving a role as a parent.
Prospective fathers who reported they expected
a pregnancy to occur tended to have fewer concerns
late in the pregnancy than did teens who had not
anticipated conception. The difference was not re-
lated to how long the prospective fathers had known
about the pregnancy. Because they had dated their
partners for longer and had been told of the preg-
nancy earlier, there was some indication that the for-
mer group had more stable relationships with their
partners prior to conception. In our previous study
of unwed fathers, we found that teens who initially
viewed their partner’s pregnancy in a positive man-
ner adjusted better emotionally to pregnancy and
prospective parenthood than did those who reported
having initial ambivalent or negative feelings. Our
present data are consistent with these findings. Ap-
parently some teens are emotionally prepared to ac-
cept the consequences of having unprotected sexual
intercourse and, therefore, experience less of a crisis
situation than others if pregnancy occurs.
Other psychological and social factors which we
did not measure, such as degree of developmental
maturity, amount of social support, and parental at-
titudes, may also have affected the type and intensity
of the stressors experienced by our subjects. 13 Future
studies should investigate the adolescent father and
his entire ecological system.
While we are concerned with the emotional prob-
lems of young fathers, we are also concerned with
the welfare of their children. How well teenage fa-
thers manage the simultaneous crises of pregnancy,
prospective parenthood, and frequently, marriage
may influence both their own and their partner’s
parental behavior.14.15 Studies have demonstrated
that stress and inadequate social support adversely
affect the parental behavior of adult mothers.16-20
We can help young fathers by involving them in
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the clinical services provided to the pregnant teen-
ager. Instead of having them remain in the waiting
area, they should be encouraged to accompany their
partner into the examination room. Health care
counseling is, therefore, provided to the couple, thus
improving the teen fathers’ knowledge and also their
feeling of involvement in the pregnancy. By viewing
adolescent pregnancy from a broader psychosocial
perspective, more realistic and effective management
plans can be developed to help both partners.
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