What are the risks of pregnancy and childbirth for women and especially adolescents
“I got a call one night. Some childish voice on the phone said: I gave birth to a child, I am 13 years old, ” says the head of the Reintegration Center (orphanage) Kamala Agazade.
A 13-year-old girl gave birth to a baby on September 7 in Baku. She currently lives in an orphanage.
The girl hid her pregnancy even from her mother.
“For a 13-year-old girl, childbirth is a serious physiological and moral trauma, a huge stress ,” Kamala Agazade explains. – Especially considering that she gave birth at home, alone. When her mother came when the baby was already born, she immediately called an ambulance, and the girl was taken to the hospital. But the rehabilitation of a teenager who has experienced such a shock is very difficult.”
“The mortality rate in teenage pregnancy is very high. That is, even if the body already reached a certain level of development, this does not mean at all that it is ready for childbirth, ”says psychologist Melek Kerimova .
According to the World Health Organization (WHO), complications during pregnancy and childbirth are the leading cause of death among girls aged 15-19 worldwide. The Azerbaijan State Statistics Committee shows that 84 children were born to girls under the age of 16 in Azerbaijan last year.
At the same time, the available statistics reflect only those cases that become known to law enforcement agencies.
“Most often, I would even say in the vast majority of cases, teenage girls who become pregnant are victims of sexual violence, ” says the psychologist. – And unfortunately, when studying such situations, it turns out that one of the close relatives was the rapist. It could be an uncle, a cousin, or someone else close to the child. That is, in my practice, very rarely or almost never it was someone else.”
For this reason, it is family members who most often try to hide the pregnancy of a minor, and childbirth is normally carried out at home.
This fact is confirmed by the head of the orphanage for children.
“Last year there was a similar situation ,” says Agazade. “ A girl who was physically and sexually abused by her stepfather gave birth to a premature baby. When we reported this, there were many comments to me, they say – why are you making this public? And what should we do? Hide? After all, after the publication of each similar story, we receive messages from other girls who are in the same situation, and we can help them.”
Sexual abuse of minors, including sexual relations with children under the age of sixteen, is punishable by law in Azerbaijan .
But the law is the law, and society often reacts rather coldly to this kind of news. “So what? Our grandmothers gave birth at that age,” many say.
Even though pregnancy and childbirth often carry serious risks, including for mothers who have already come of age, every day about 830 women die from complications associated with pregnancy or childbirth in the world, according to a WHO report. In addition, we have virtually no statistics on what percentage of “early grandmothers” survived and gave birth to a healthy baby. And according to researchers , almost all the girls in the villages, somewhere before the middle of the 20th century, already had uterine prolapse from the age of 16, and at 30 they were already emaciated old women. And the first babies in a young family, as a rule, died because the parents were still “underdeveloped”.
With a vengeance
Adolescent mothers (aged 10-19) face a higher risk of eclampsia, postpartum endometritis and systemic infections than women aged 20-24, and children of adolescent mothers are at higher risk of low birth weight, prematurity and severe neonatal diseases, according to WHO.
“During pregnancy, all internal organs work with a vengeance. And the heart, and the liver, and the spleen, I’m not talking about the uterus yet, – explains the gynecologist Tarana Gasanova. – And this leads to the fact that if there is a chronic disease in one of these organs, it is activated during pregnancy. Or if the organs are not developed, then if the pregnant woman is not yet 18 years old, and she is in her teens, then these organs receive not even a double, but a triple load. They have to work with even greater force, which creates serious difficulties for them and risks for the body. This complicates their work, which causes even more damage to the developing organism and provokes various acute and chronic diseases.
During adolescence, the body is actively growing, and it needs enough calcium. And throughout pregnancy, a teenage mother is forced to share it with her child. At the same time, a lack of calcium is observed not only in the body of the expectant mother, but also in the fetus, which, in turn, leads to disturbances in the formation of the baby’s bones. In addition, during pregnancy, the uterus increases and begins to put pressure on the internal organs of the mother. Most of all at this time, the heart of a pregnant woman suffers, and if she previously had heart problems, then pregnancy will only aggravate the situation.
“If the pregnant woman is a minor, she must be under close medical supervision for all 9 months ,” emphasizes Tarana Gasanova . – But as far as I know, not all pregnant teenagers in Azerbaijan are under the supervision of a doctor. This fact is often hidden, and even births are taken at home.”
When establishing an early pregnancy, the doctor also has additional responsibility for the fate of the mother and her child. First, the issue of the possibility of carrying pregnancy and giving birth with minimal damage to health must be resolved and the decision must be strictly individual. The age of the girl and the gestational age are decisive. But any of the decisions taken is fraught with undesirable consequences, experts warn. When a pregnancy is terminated, difficulties are likely with subsequent conception, up to infertility, the hormonal background is disturbed, immunity decreases, the endocrine system is destabilized, the risk of uterine puncture due to its underdevelopment increases, there is a risk of developing serious inflammation, there is a possibility of incomplete removal of the fetal egg, the menstrual cycle is lost.
Having kept the pregnancy, the girl may also face problems and difficulties for which, due to her age, she is not ready either physically or mentally. Even seemingly ordinary toxicosis at this age may not be so harmless.
“ Pregnancy is often accompanied by toxicosis in the first and second trimester. And minors endure toxicosis much harder, ” says the gynecologist. – They are at risk due to toxicosis. It can also lead to a number of serious consequences .” Among them: the development of cardiovascular pathology in the mother, failure of the kidneys, delayed fetal development.
According to Gasanova, early pregnancy also affects the endocrine system, the development of which occurs just in adolescence:
“It is under the influence of the endocrine system that girls and boys reach puberty. In girls during this period, the ovaries and uterus begin to develop, which means that the girl can become pregnant. But this does not mean that the authorities are ready for this. They are still in the formative stage . ”
Impact on the endocrine system at this stage in the future can cause several pathologies:
“These pathologies may not appear immediately, but later. For example, cervical cancer. Research institutes in developed countries have investigated the causes of this type of cancer, and one of these factors turned out to be sexual activity at an early age – this affects the cervix, and the woman is at risk.
The gynecologist also notes that, as far as she knows, no research on cervical cancer has been carried out in Azerbaijan: “But if such a study is carried out, then, no doubt, its results will be very depressing”
Cervical cancer also ranks first among pregnancy-associated tumors. The incidence of this pathology is from 1 to 13 cases per 10,000 pregnancies.
According to the State Statistics Committee, in 2020, among women aged 15-49, the number of those who were first diagnosed with various types of uterine cancer was 703, and in 2021 – 850. This diagnosis is the second most common among women in Azerbaijan after cancer mammary gland.
Disease statistics among women aged 14-17 years are maintained, but only data related to cancer are published, or the information is of a general nature. For example, in 2020, 23 cases of malignant tumors were recorded in girls aged 14-17, and in 2021 this number remained unchanged. But it is not specified what types of cancer these 23 cases belonged to.
Among the possible complications, gynecologists also warn of the threat of uterine rupture, which is one of the most serious complications in obstetrics.
During and after childbirth
Gynecologist Tarana Gasanova warns that, in addition to the pregnancy period, certain complications threaten mothers during and after childbirth:
“These problems include, for example, inflammation of the mucous membrane of the uterus, that is, the endometrium, they are in a very serious risk group. Infertility is in second place, then the menstrual cycle is disturbed, I have come across this more than once. There are also various cystic formations in the eggs, various formations in the uterus.
Early pregnancy is also listed among the causes of labor or postpartum eclampsia. Eclampsia is a spasm of the transverse muscles that can occur in the second half of pregnancy, during childbirth and the postpartum period. The development of this condition occurs against the background of pathological processes launched by pregnancy, which lead to damage to blood vessels, kidneys and other vital organs.
But not only mothers, but also babies are threatened with various pathologies.
“The normal development of the fetus is very dependent on the health of the mother. For example, if a woman has some chronic diseases, then she should become pregnant only with the permission of a doctor and be under constant medical supervision. The doctor must control both childbirth and the postpartum period , ”explains the gynecologist and adds that the situation is aggravated when it is not even about a chronic illness, but about a developing organism. In such a situation, the developing organism cannot normally perform its functions:
“Due to the fact that the circulatory system cannot function normally, these girls are at high risk of premature birth, delayed labor and birth trauma in babies. Diseases in such children may not appear at first, but most problems make themselves felt closer to adolescence .
“In general, pregnancy and childbirth in themselves can be regarded as positive-negative stress ,” says psychologist Melek Kerimova.
“On the one hand, physiological changes are taking place in a woman’s body. And on the other hand, psychologically, a woman also begins to bear responsibility not only for her own body, but also for one more being. And, of course, a woman’s readiness for motherhood plays a role here, how much she wants to give birth to this child, all this is very important and also affects the mental and social development of the unborn child .
Early pregnancy implies that a parent should be a person who has not yet formed her or himself, has not matured psychologically, does not really know who she is or what she wants:
“A girl is in the process of transitioning from childhood to adolescence, she is just getting used to her new body, and then suddenly a pregnancy occurs, plunging her into even more uncertainty. And her unborn child will also have very low resistance to stress , ”explains the psychologist.
But the main problem is not even this, Melek Karimova believes:
“I have already said that girls most often get pregnant as a result of sexual violence. And unfortunately, in families, especially in the East, people first of all think about “not taking dirty linen out of public”. And the child cannot afford to speak openly with his parents, with his mother on this subject, he is afraid, considers this something shameful and is silent. Or it happens that the mother knows, but prefers to remain silent, as she considers it a shame for the family. And it even forces the daughter to be silent to the last. And here we are talking about the ruined fate of a girl who not only survived sexual violence, but faced complete misunderstanding on the part of her family, who, instead of resolving the issue, are trying to hide the “shame”. It can be quite difficult to get girls out of such a psychological trauma. For us psychologists, this can take years.”
Unpreparedness for pregnancy can lead to severe psychological consequences, and this also affects physiological processes, says psychologist Melek Kerimova:
“It happens that the pregnancy seems to be going well, but at the same time the woman thinks: “I don’t want to become a mother, I won’t be able to take care of the child”, or “I don’t consider myself entitled to give birth to a child, I won’t be able to become a good mother”, that is, it happens an unwanted pregnancy, and of course, psychologically it is more difficult to experience all this. And since the baby in the womb feels everything, this stressful state of the mother can be dangerous for the baby.”
And for girls who have not reached the come of age, in such a situation it is even more difficult.
“Imagine a girl who is still only in her teens, should already be thinking about pregnancy, about the child she is carrying, should be ready for this psychologically and physiologically – that’s all, this is wrong.”
With the support of “Mediaset”