Sixteen women were purposively selected based on the selection criteria. All participants were English speaking, Caucasian and aged between 16 and 19 years. Twelve participants lived in a regional centre and four participants in rural towns. Two participants were attending school. Four of the participants were having their second child. Four participants had their partners participate in the interview, one included her mother. The interviews were on average 14.5 minutes, with a range of 9.4 minutes to 22.5 minutes.
Four themes (Table 1), emerged: perceived value of pregnancy care; interactions with the maternity service; provision of woman-centred care; and their support systems during their pregnancy.
Valuing pregnancy care
The participants all recognised the importance of antenatal care and identified concern for the wellbeing and health of their baby as a primary motivation for attending antenatal care. Many of the women emphasised the need to ensure that their baby’s interests were served above their own, as highlighted by one woman’s comment.
I don't really say no to it because it's more so not for me (sic) it's for the baby's health. Yeah, I don't really have a right to say no (Participant 8, regional).
While all of the women were motivated to attend antenatal care, some of the women reported only recognising the value of antenatal care following complications in a previous pregnancy. One of the women talked about the lack of awareness and motivation to attend antenatal care during her first pregnancy in which her baby died.
…But with losing my first and then the becoming pregnant so quickly after that one, I was like well I need to knuckle down and go more often. (Participant 4, regional)
These women talked about a lack of understanding of the relevance of antenatal care to their age group and a perception that teenagers are not susceptible to pregnancy-related complications.
Participants commented that teenage women may be reluctant to attend antenatal clinics because they perceived care providers as being authoritarian and they disliked being told what to do. The women also suggested that teenage women may not engage with antenatal care due to fear or denial. Some of the women commented that at times they had feeling self-conscious and uncomfortable if they perceived people were staring at them or singling them out. Feelings of shame and stigma associated with pregnancy can delay teenagers seeking antenatal care and getting important screening and education early in pregnancy.
… sometimes you feel like people are going to judge you because of how young you are, and because you’re not married, you’re not with your baby daddy (sic) or whatever they’re called. So, you have that resentment of coming to somewhere where people are going to stare at you be like what the hell. Why are you here so young? (Participant 12, rural)
Several of the women commented on the need to filter the amount and nature of information to avoid overwhelming themselves and increasing their anxiety. Some of the women avoided childbirth education because they found it scary and would rather cope with events as they arise. These women suggested that providing chunks of information relevant to their stage may make it easier for women to digest and cope.
I try not to - but I try to get a little bit of information, but not too much; not enough to like freak myself out, and not enough for me to be like oh - and like, yeah, it's just doing my head in and stuff. (Participant 7, regional)
Several of the participants identified the influence of their family and friendson their decision to participate. One woman’s partner described how family support could influence antenatal attendance.
“Also like I'm speaking on the partner's behalf, sometimes a partner might decide that they're too tired from work and that sort of thing because there's been a couple of appointments where I haven't been able to make it to… I feel as though some partners might say you're fine, there's no need to go, the baby's kicking. (Partner- Participant 9, regional)
Women reported finding their antenatal appointments interesting and they valued the ability to follow their baby’s milestones. Several women commented that hearing their baby’s heartbeat motivated them to attend as they found it both reassuring and enjoyable. Some of the women identified the need to monitor their own health during pregnancy. They also valued the antenatal support in managing their pregnancy and in preparing for parenthood.
Interactions with maternity service
The young women reported valuing the respectful, welcoming demeanour of maternity service staff and trusting them to have the best interests of both their baby and the women at heart.
Just the friendly staff, they've always got a smile on their face. Yeah, it's always warming to come in here. They just - they've just got that friendly sort of vibe about them so I know that I can trust them. (Participant 11, regional)
The young women were positive about the physical environment in the maternity services, appreciating the layout that catered for children and the calm environment. One of the women suggested a simple change to the antenatal clinic waiting room would make it easier for women to engage with each other.
I would just love for … the mums to be more involved. I know not everyone does want to be involved but maybe the chairs, they all sit facing one way. If they were sitting facing a different way you might be more likely to start a conversation with the lady sitting over there. (Participant 9, regional)
The women reported a variety of geographical, financial, social, and scheduling barriers and facilitators to accessing antenatal care. None of the women had driving licenses and relied on family, friends or public transport to get to appointments.
She said that it costs nothing, and we were right to get it, and she bulk billed us. Then we got the bill for the company that she used. If I knew that it was going to charge us, even if it was going to charge us a little bit, I would have, that would have been fine. But $135, we just couldn't afford it at the time.” (Participant 3, regional)
The women identified choices for appointment times and the option to manage appointments via text and fit in with their school schedule as facilitators to attending antenatal care.
I usually get an appointment in the morning so then I'm out of here by the time, lunch time at school, so I can get back to school but I think they're pretty good. (Participant 1, rural)
Most of the women had a sense of individualized care and felt listened to and comfortable asking questions. The young women valued being given choices and being included in the decision-making around their care.
I'm always let known of the things that they're going to do and the decisions they're going to make, and they're always like is there anything that you want to input? Yeah, I definitely feel very included in what goes on with the care here. (Participant 4, regional)
Health professionals’ ability to communicate in a non-judgmental and non-threatening manner was important to the women. One young woman compared her experience with the young mum’s midwife to her previous antenatal care. Her comments highlighted that the delivery and content of information is key to engaging with young women during their pregnancy.
I don't know it's just the vibe and she's [Young Mum’s midwife] always got a smile and is always polite. She doesn't come across creepy or anything. (Participant 8, regional)
The midwives’ communication skills contributed to the young women’s perceptions of an equal power relationship. The women appreciated not being pressured in to making decisions and the ability of staff to value their questions. Many women found the use of texting invaluable, allowing them to get timely responses and reassurance when they needed it.
…They don't sit … and act like they've got more knowledge. I mean they clearly do, but they sit there and communicate with you and they speak in way that you're able to understand instead of just reading what they would have read from a textbook to you. (Participant 9, regional)
All of the young women valued knowing the midwives and doctors and that the care was consistent.
Many of the young women came from fractured families and had experienced social isolation that impacted on their confidence to attend childbirth education and maternal and child health centres as they felt uncomfortable in group situations. A desire for connections with young mothers was common.
… after I had my son and you go to see the maternal child health nurse and they try and get you to go to a mothers’ group, I chose not to because I was scared about going there and being the youngest person there, and everyone being 30 and having a nice car and owning a house, and I was the odd one out. So, I didn't go. I wished that I would have had some more support system I guess… (Participant 13, rural)
Some of the women and their partners commented on their diminished social life and reliance on each other. One of the partners talked about his isolation from his family due to cultural and generational differences. He highlighted the value talking to another young partners for support.
It'd be good… for another young guy like me to be able to talk to them and say look how have you been able to cope? Have you found it stressful, have you adjusted yet? Just being able to talk like that. (Partner- Participant 9, regional)
All the young women felt that meeting with other young mothers would be beneficial to help them engage with antenatal care.
All participants had some form of support from family, friends, health professionals, support or support groups. Schools provided another form of assistance, providing information and enabling the young women to continue with their education.
… the school has been amazing. I couldn't thank them enough for the support they've given me. They're pretty much willing to do anything they can to help me finish school. (Participant 1, regional)