Preparation for Parenthood

The process of preparing for parenthood consists of a series of steps, each of which presents unique challenges and dilemmas. This chapter explores the stages of preparation, beginning with the decision to become a parent, and progressing through choices regarding modes of birth, the impact of new parenthood, and child care issues. Finally, the problems that parenthood presents in several less common circumstances are discussed.

Preparing for parenthood begins with the decision to become pregnant, or the discovery of pregnancy in an unplanned circumstance. Fifty years ago, unreliable or unavailable contraceptive methods resulted in parenthood for couples regardless of readiness. In addition, couples suffering from infertility or repeated miscarriages had few options and generally accepted their inability to become pregnant, ultimately seeking other parenting options, such as adoption. In recent decades, the availability of effective and reliable contraception and sterilization techniques has given many the opportunity to chose the timing of parenthood. Advanced reproductive technologies now enable many couples with infertility problems to achieve a desired pregnancy.

For some couples, the decision to become pregnant is carefully weighed against the impact that pregnancy and birth will have on their careers, lifestyles, financial status, and marital relationship. Others consider the repercussions of pregnancy and parenthood only briefly, or not at all. Despite a recent decline in the rate of unintended pregnancy among adolescents, college graduates, and wealthy women, the number of unintended pregnancies increased among less educated, poor, and minority women.¹

Statistical reports of birth and fertility rates reveal interesting childbearing trends. Historically the birth rate for teenagers increased at an annual rate of 5–7%, peaking in 1990.  Since then, the birth rate for teenagers hasdeclined 34%, a trend attributed to consistent contraception use and delay in sexual activity.^{2, 3}   However, in 2006 the birth rate in the United States for teenagers age 15–19 rose unexpectedly by 3%.⁴ Childbearing among women 30 years of age and older has also shown an increase (Fig. 1.). The pursuit of advanced education, careers and the necessity for two-income families has been largely responsible for the dramatic phenomenon of delayed childbearing.  In addition, all measures of unmarried childbearing has risen 9–12% per year. Births to unmarried women constituted 37% of all US births in 2005. The recent increases in nonmarital birth rates have been especially notable among women age 25 and older.⁵

Unplanned Parenting

The number of unplanned pregnancies continues to escalate despite the availability of effective contraceptive methods. Reasons for this phenomenon have been proposed by various theories, including the intrapsychic conflict theory, which postulates unconscious desires to manifest fertility; and theories of complex contraceptive risk-taking behavior. Adolescent pregnancy is a matter of great public concern, as the rate which had been falling since 1991, showed an increase in 2006. Parenthood at an early age, not only affects the educational and social prospects for the adolescent mother, but also infants born to teenage mothers are at risk for poor birth outcomes such as low birthweight and preterm birth.⁹ Research results have found that adolescent parents have high levels of stress, inadequate social support, poor knowledge of child development, and inappropriate childrearing attitudes.^{36, 37, 38} Most teenage mothers live at home with a parent or parents, the majority keeping their babies. The ability of an adolescent to parent in a manner that promotes optimal child development is difficult to evaluate and longitudinal studies are minimal.^{36, 39, 40, 41}

While most teen pregnancies can be established as unplanned, unplanned parenting among other age groups is more difficult to differentiate.  The recent rise in unmarried and nonmarital childbearing does not necessarily indicate that the pregnancies were unplanned, as delayed childbearing and a simultaneous rise in cohabitation make such statistics meaningless.

Elective Single Parenting

Elective single parenting has become more acceptable and popular in the past decade. Women who choose to become a parent without the involvement of a partner typically come from two groups: those who have become discouraged with or jaded toward men in general; and those whose advancing age necessitates their becoming pregnant while they are still biologically able. For some this represents an ethical dilemma: personal attitudes regarding the upholding of a traditional family structure interfere with willingness to make modern reproductive options, such as artificial insemination, available to these women.⁴² There is some concern about the financial stability of elective single mothers and the lack of male role models for their children, believing that these factors may stunt the child's social and cognitive development.⁴³ However, studies indicate that children raised by their mothers alone have no adverse effect on mothers' parenting ability or the psychological adjustment of the child.⁴⁴ Many centers of reproductive medicine require a psychological profile to evaluate factors underlying the desire for elective single parenting. 

Changes in attitudes among lesbian women and gay men during the past few decades have allowed many to consider the possibility of parenthood. Although some consider adoption, there is an increasing number of lesbian women seeking artificial insemination and gay men seeking women to carry their child. Several concerns have been addressed. The biased view of lesbian women and gay men that focuses on their sexuality instead of their personal capabilities may falsely lead some to believe that homosexual persons cannot be good parents, or that their children will not have appropriate sexual role models. Research indicates, however, that the sexual orientation of the parent seems to have no effect on the child's sexual preferences. In addition, gay and lesbian parents have been shown to provide effective parenting for their children and the children are not measurably different in terms of gender identity, personality  problems, or psychological development than children of heterosexual parents.^{45, 46, 47} Larger longitudinal studies of same sex parents, particularly gay men, are needed.

These new, nontraditional family forms are resisted by those concerned about the ongoing erosion of the family.  Many institutions require psychological screening prior to acceptance into a donor insemination program. Gay men have greater obstacles in that they must find a woman willing to be inseminated and carry the pregnancy for them, or adopt. Legal custody issues arise.  Although artificial insemination can minimize legal custody battles that must be fought by adoptive lesbian parents, the difficulty of finding a known donor or using a sperm bank presents a major problem.The legal, ethical, and health issues must be considered carefully by lesbian women and gay men who wish to become parents.^{48, 49} Health-care professionals must have an understanding of these issues and be attentive to their personal attitudes about this type of nontraditional parenting.

There is a growing number of women with disabilities who are interested in pregnancy and becoming mothers.   Technological advances in specialized adaptive equipment and an increase in social services offer greater opportunity for women with physical challenges to consider pregnancy, labor, birth and childrearing.  Women with functional limitations are more likely to be overweight, smoke, have hypertension, and experience mental health problems which complicate pregnancy.⁵⁰  There is very little research addressing the specific reproductive needs of women with disabilities. Evidence suggests that women with disabilities are  more likely to deliver preterm and low birthweight infants and have more hospital admissions during pregnancy, cesarean deliveries, and readmissions within 3 months of delivery.⁵¹  Recent journal articles have helped to increase awareness of health care providers in the specific issues.^{52, 53, 54}  Health-care professionals and the public must be educated to reduce the stereotypes of helplessness and passivity often associated with disabled women. Efforts have been made to provide public access, and technological advances have provided the opportunity for many women to function independently at work and at home.  Women who are disabled must consider the same financial and emotional factors of parenthood as nondisabled women that will impact their lives.  In order for parenthood to be a realistic option for these women, adjustments in living arrangements may be necessary, and a greater range of supportive services is often required. Thus, the financial cost of parenthood may be greater, the preparatory effort more involved, and the physical requirements more challenging among these women than among women without disabilities.⁵⁵

Many societal changes have had an impact on parenthood in the United States. Women are postponing childbearing and having fewer children. Subsequently, an increasing proportion of couples will have impaired fertility as a result of advancing age. Conditions affecting a woman's ability to conceive and bear children may be more difficult to treat as she becomes older.

More mothers than ever are in the workforce, and consequently more children are in alternative child-care settings. This is not likely to change, as two incomes are becoming increasingly necessary to meet household costs of living. The impact of increasing numbers of working mothers is far-reaching. Alternative child-care settings will increase in number, thus increasing the concern over their quality, size, and accessibility. Government representatives and employers must recognize the need for major changes in policy to assist working mothers and their children. There is a wide spectrum of choices available to women preparing for childbirth: birth attendant, birth setting, childbirth education classes, and various procedures and medications proffered during the birth itself. The trend for consumer involvement and control is likely to continue as women become more knowledgeable about their own health care. To meet the needs of childbearing women, prudent health-care providers and hospitals will keep abreast of consumer requests for birthing alternatives.

Single-parent families are more commonplace today because of high divorce rates, unplanned parenting, and elective single parenting. Nontraditional parenting arrangements chosen by single professional women and homosexual couples are occurring more frequently, challenging societal norms and changing definitions of parenthood and family.