Considerations for Adolescent Mothers: Trauma-Informed and Integrated Care

Adolescent pregnancies and teen birth rates are shown to be correlated with significant physical, emotional, and social risks in the United States (Mickler & Tellestrup, 2025) and in many countries across the world. In 2019, 21 million pregnancies were reported in women aged 15 to 19 years worldwide with approximately 50% of the pregnancies reported to be unintended and resulting in an estimated 12 million births (World Health Organization, 2024). Out of these unintended pregnancies, 55% of them ended in abortion (Sully et al., 2019). While abortions are generally safe, risks of complications increase in low and middle-income countries, along with U.S. states that prohibit and criminalize abortion. This presents a critical issue for adolescents who often experience limited access to reproductive education and healthcare, exposing the vulnerabilities of unintended pregnancies during teenage years. While research has indicated that adolescent pregnancies can increase the risk of physical and psychological trauma, clinical practices have not yet shifted to prioritize an integrated healthcare model that addresses these risks (Jeha et al., 2015). As a result, adolescent mothers are almost three times more likely to develop depressive symptoms during pregnancy and postpartum compared to adult mothers (Figueiredo et al., 2007). It is imperative for healthcare professionals to address the specific challenges that exist for this population while establishing an integrated healthcare model that supports both the mother and infant during the postpartum period. As such, this article advocates for a trauma-informed framework when treating adolescent mothers in medical and behavioral healthcare settings.

Adolescent Shifts with Pregnancy 

Adolescent motherhood presents a unique set of psychological, social, and developmental considerations that require a distinguished model of care. It’s important for healthcare providers to be cognizant of the developmental shifts that influence how adolescents respond to prenatal treatment and to interactions in clinical settings. Adolescents undergo significant cognitive changes, including the emergence of advanced abstract thinking, improved decision-making skills, and heightened egocentrism, all of which facilitate identity formation and increased self-awareness (Erikson, 1959/1980). They are also highly sensitive to physical appearance and body image. For adolescent mothers, the rapid physical changes of pregnancy can exacerbate body image concerns, potentially trigger disordered eating habits and impact overall wellbeing (Janas-Kozik et al., 2021; Przybylowicz & Danielewicz, 2021). These developmental changes are crucial in the transition into adulthood, and stunted growth or delays during this period because of pregnancy can amplify stress reactivity, increasing the risk of postpartum mental health concerns and maladaptive behavioral patterns later in life (Adepegba, 2025).

A key social transition that takes place in adolescence involves the shift of reliance on validation and support from parents/caregivers to greater dependence on peer relationships (Erikson, 1959/1980). This process may be interrupted as a result of pregnancy, as adolescent mothers often experience a disruption in education and limited social support (Fontoura-Matias et al., 2024). Pregnancy in adolescence is also associated with a history of trauma and high levels of comorbid traumatic experiences, including interpersonal violence (IPV), physical violence, emotional adversity, loss of caregivers or siblings, and community violence (Killian-Farrell et al., 2020). The combination of traumatic experiences and insufficient social support can increase a mother’s vulnerability to postpartum mental health concerns, further compromising maternal and infant wellbeing. Specifically, adolescent victims of IPV are at an increased risk for adverse health outcomes for infants, including premature birth, low birth weight, and inconsistent access to regular primary care for both the child and mother (Madkour et al., 2013). Without adequate understanding of the specific stressors faced by adolescent mothers and proper intervention, these challenges can perpetuate intergenerational trauma by negatively influencing attachment bonds and infant developmental outcomes, further cultivating mistrust in the healthcare system (Graf & Schechter, 2024). These developmental, physical, social, and psychological risks demonstrate the necessity for an integrated healthcare model and trauma-informed care when treating such a vulnerable population.

Methodology 

To better understand how the issues identified in the literature are observed in medical practice, a semi-structured interview was conducted with Ms. Carly Perlmutter, a registered nurse currently working at an outpatient integrated healthcare clinic for complex family planning and adolescent gynecology specialties in New York City. Ms. Perlmutter’s clinic is an academic institution that treats patients with diverse socioeconomic backgrounds that are typically referred to by general practitioners (e.g., primary care physicians and hospital staff) across the tri-state area. Interview questions consisted of open-ended prompts designed to understand present trauma-informed clinical practices when treating adolescent mothers. In reviewing the interview responses, Ms. Perlmutter offered challenges in her role and that of the clinic as well as recommendations to provide better care for this population.

Challenges Faced by Adolescent Mothers

Ms. Perlmutter revealed that the most significant barriers to treatment that many of her adolescent patients’ face is their limited health literacy and inconsistent follow-up care. Rapid developmental shifts combined with unexpected life events like an unplanned pregnancy can create an internal conflict for many adolescents, making acceptance difficult. The distress of these experiences undermines health awareness and leads to incompliant care. Research has indicated that mental health concerns and attitudes surrounding pregnancy in adolescent mothers has led to negative mental health outcomes and feeling unsupported or disempowered in caretaking postpartum (Osok et al., 2018). 

Outside of developmental considerations, social and environmental factors can shape how pregnant adolescents interact in healthcare settings. Ms. Perlmutter stated that many of her patients have histories with interpersonal violence, relating to a tendency to experience strong physical and/or emotional reactions during gynecological exams (i.e., clenching, yelling, moving to the top of the exam table to avoid being touched). Additionally, she highlighted the systemic barriers present within the healthcare system that disproportionately effect pregnant adolescents. Existing research has underscored the significant impact of lacking access and/or having limited awareness of available resources (i.e., transportation, mental health treatment, prenatal and postpartum care services) on pregnant adolescents and their ability to be an active participant in their healthcare. One study found that limited knowledge of mental health treatment, lack of trust in healthcare, internalized stigma, and limited social support prevented pregnant adolescents from seeking help and maintaining treatment adherence (Oladeji et al., 2025). This is even more impactful for low and middle-income socioeconomic statuses and minority patients, as mothers from these populations are more likely to experience complications related to pregnancy (Joseph et al., 2021). 

Clinical Implications and Recommendations

Challenges specific to the treatment of pregnant adolescents can be addressed by implementing an integrated healthcare model that builds on existing principles and incorporates various modalities to further strengthen care and support positive outcomes in the postpartum period. Ms. Perlmutter engages with adolescent patients using a trauma-informed approach that emphasizes trust, safety, and collaboration while recognizing the unique challenges faced by this vulnerable population. She encouraged providers to engage with patients in a manner that promotes accountability and autonomy by helping the patient develop a greater understanding of their health. This can be achieved by implementing the teach back method within extended appointment times, where patients are encouraged to explain their health information or treatment plan in their own words (Mahmoodi, 2025). Ms. Perlmutter indicated that adolescents are more likely to self-disclose victimization than adult patients, likely due to the environment created by their practitioners. Positive encounters such as these in healthcare settings can offer validation and support from trusted providers, fostering prosocial identity development to provide an easier transition into adulthood and motherhood.

When working with pregnant adolescents, medical professionals, like Ms. Perlmutter, are typically the first to acknowledge and recognize the effects of systemic barriers to prenatal mental health treatment. Ms. Perlmutter noted that her practice maintains a strong relationship with the institution’s social work network “to manage and provide safety to our patients while they are in our care and beyond” (C. Perlmutter, personal communication, September 13, 2025). Standard of care practices for maternal care clinics should expand toward partnerships with mental health professionals, behavioral health facilities, pediatrician offices, schools, and other community agencies to provide additional opportunities for continuous care. Medical professionals should receive annual, trauma-informed, culturally competent training that discusses these barriers and explores ways to address them with adolescent patients in treatment settings. This should include training on mental health screening instruments tailored to adolescents. These tools should assess a variety of mental health concerns – including anxiety, trauma, and risky social behaviors – as well as their impact on functioning. Commonly used screening measures such as the Edinburgh Postnatal Depression Scales (EPDS) or the Patient Health Questionnaire (PHQ-9) may not fully encapsulate the unique mental health struggles that adolescents face. Furthermore, mental health screenings should be a continuous process implemented throughout treatment, especially considering the intense, fluctuating emotions associated with both adolescence and pregnancy.

Ethical considerations arise when a medical provider screens a pregnant adolescent for mental health concerns without a clear, developmentally appropriate plan for care, especially if the patient reports worsening mental health symptoms in relation to pregnancy. Given the complexity of informed consent, providers must be aware of local laws and best ethical practices regarding minor consent for medical and mental health treatment and the intricacy of parental/guardian involvement. At Ms. Perlmutter’s practice, patients within the age bracket of receiving sexual health care without parental consent are asked if they wish to involve a caregiver in their appointments and treatment planning. Additionally, patients within this age range are given access to an electronic health record system that allows them to communicate patient autonomy and allows practitioners to engage in patient-centered care while maintaining ethical and legal practices. 

When adopted correctly, healthcare professionals can uniquely enhance treatment for adolescent mothers through an integrated healthcare model rooted in trauma-informed care, ethical practices, and continuous emphasis on mental wellness that extends into the postpartum period. 

Discussion

Given the prevalence of adolescent pregnancies, it’s impossible for medical and mental health professionals to ignore the unique vulnerabilities that exist within this population. Ms. Perlmutter’s clinical observations highlight the real-world challenges pregnant adolescents face, reinforcing the influence of developmental factors, emotional processes, and traumatic events during this period. She stated that her practice strives to “create an environment that is nonjudgmental, compassionate, and a safe place for adolescent patients establishing autonomy in their healthcare” (C. Perlmutter, personal communication, September 13, 2025). The enactment of a trauma-informed, integrated healthcare model grounded in ethical and legal practices can promote continuity of care and overall trust in the healthcare system, reducing the risk for postpartum depression and fostering health adjustment for mother and child.