"Having a Baby Changes Everything" Reflective Functioning in Pregnant Adolescents

Reflective functioning (RF), the capacity to envision thoughts, feelings, needs and intentions within the self and others, is thought to be central to sensitive parenting, yet this capacity has been unexamined among pregnant adolescents. We explored how RF was related to the emotional experience of adolescent pregnancy. Design and Methods: This qualitative study was guided by interpretive description. Participants were 30 Latina and African-American adolescents (mean age 17.7 + 1.5 years) residing in a low-income urban community. All adolescents were interviewed with the Pregnancy Interview (a 22 question semi-structured interview) in their third trimester of pregnancy. Interview transcripts had been previously coded for levels of RF (1-9 with higher levels denoting higher reflectiveness), and this secondary analysis focused on the teens' experience of pregnancy and their emerging reflective capacities. We used a priori and inductive coding with all interviews and developed patterns and themes. Results: These interviews provided an in-depth understanding of the complex adolescent emotional experiences of pregnancy. We identified five themes that create a picture of how the participants reflected upon their pregnancies, unborn babies, emerging parental roles, and complicated relationships with family and partners. Conclusions and Practice Implications: Adolescent developmental issues and harsh family and neighborhood environments permeated the teens' experience of pregnancy and limited capacity for RF. Understanding distinctive features of RF in pregnant adolescents may contribute to developing conceptual models and tailored clinical approaches for enhancing parental reflectiveness and sensitivity in these vulnerable young women as they enter into the transition to parenthood.