Disponible en castellano/ Disponível em língua portuguesa SciELO Brasil w w w .scielo.br/ rlae
EXI STENTI AL PHENOMENOLOGY AS A POSSI BI LI TY
TO UNDERSTAND PREGNANCY EXPERI ENCES I N TEENAGERS
Mar ia Salet e Bessa Jor ge1 Get úlio Vasconcelos Fiúza2 Mar ia Ver aci Oliv eir a Queir oz3
Jor g e MSB, Fiú za GV, Qu eir oz MVO. Ex ist en t ial p h en om en olog y as a p ossib ilit y t o u n d er st an d p r eg n an cy ex per ien ces in t een ager s. Rev Lat in o- am En fer m agem 2 0 0 6 n ov em br o- dezem br o; 1 4 ( 6 ) : 9 0 7 - 1 4 .
The research had as obj ect ive t o com prehend t he sense of pregnancy t o t he t eenager pregnant t rying t o get t he way of being and having be pregnant . I t was done four in- deep int erviews, using t he core quest ion: How do you feel being pr egnant ? The speeches and t heir m eanings w er e analysed by t he light of Heidegger ’s Phenom enology. I n get t ing closer t o t he phenom ena we get t he way im personal and not aut hent ic of t eenagers, t he co- pr esence in r elat ion t o t he boy fr iend and fam ily . They show n, st ill t he dr ead by t he child and by his healt h, worrying wit h t he fut ure t hat around t he care, due t hey deem t hem selves not t o have t he abilit y t o t his, which causes t he anguish and anxiet y of daily life, in t he new way of being. The com prehension of t his phenom ena is fundam ent al in t he care t o t he t eenager pregnant t o a full and hum anized act ion.
DESCRI PTORS: adolescent ; pr egnancy ; pr om ot ion of healt h
LA FENOMENOLOGI A EXI STENCI AL COMO POSI BI LI DAD DE
COMPRENSI ÓN DE LAS VI VENCI AS DEL EMBARAZO EN ADOLESCENTES
La in v est igación h a t en ido com o obj et iv o com pr en der el sen t ido del em bar azo par a la adolescen t e em bar azada, int ent ando capt ar el “ m odo- de- ser ” y su nuev o “ siendo- en el- m undo- est ando- em bar azada” . Han sido r ealizadas cuat r o ent r ev ist as en pr ofundidad, ut ilizando la cuest ión que nos guia: ¿Cóm o es par a t i est ar em bar zada? Los discur sos y sus significados han sido analizados a la luz de la Fenom enología heidegger iana. Ha quedado dem ost rado adem ás el t em or por el hij o y por la salud del m ism o, y la preocupación con el fut uro q u e in v olu cr a el cu id ar , j u st am en t e p or q u e j u zg an q u e n o p oseen h ab ilid ad es p ar a ello. Eso f av or ece la angust ia y la ansiedad pr opias de su cot idiano, en el nuev o- m odo- de- ser de la pr esencia. La com pr ensión de est e fenóm eno es fundam ent al en el cuidado de la adolescent e em bar azada, par a logr ar una acción int egr al y hum anizada en el cont r ol y la pr om oción de la salud del binom io m adr e- hij o.
DESCRI PTORES: adolescent e; em bar azo; pr om oción de la salud
A FENOMENOLOGI A EXI STENCI AL COMO POSSI BI LI DADE DE
COMPREENSÃO DAS VI VÊNCI AS DA GRAVI DEZ EM ADOLESCENTES
A p esq u isa t ev e com o ob j et iv o com p r een d er o sen t id o d a g r av id ez, p ar a a ad olescen t e g r áv id a, t en t an d o cap t ar o m o d o - d e- ser e seu n o v o - sen d o - n o - m u n d o - est an d o - g r áv i d a. Fo r am r eal i zad as q u at r o ent revist as em profundidade, ut ilizando- se a quest ão nort eadora: com o é para você est ar grávida? Os discursos e seus significados for am analisados à luz da fenom enologia heidegger iana. Na apr oxim ação com o fenôm eno, capt ou- se o m odo im pessoal e inaut ênt ico das adolescent es, a co- presença na relação com o nam orado e com a f am ília, in f lu en cian do as decisões sobr e a gr av idez. Ficou dem on st r ado, ain da, o t em or pelo f ilh o e pela saúde dele, a preocupação com os cuidados e o fut uro que circunda o cuidar por j ulgarem não possuir habilidade par a t al, o que ger a a angúst ia e a ansiedade pr ópr ias da cot idianidade no nov o- m odo- de- ser - da- pr esença. A com p r een são d esse f en ôm en o é f u n d am en t al n o cu id ad o à ad olescen t e g r áv id a p ar a u m a ação in t eg r al e hum anizada, no cont r ole e na pr om oção da saúde do binôm io m ãe- filho.
DESCRI TORES: adolescen t e; gr av idez; pr om oção da saú de
1
I NTRODUCTI ON
I
n n u r s i n g c a r e e x p e r i e n c e s i n v o l v i n g pregnant adolescent s, we observed t hat t his care does not t ake int o account t heir psychosocial and em ot ional aspect s in t his phase, t hat is, t heir special needs are not consider ed. How ever, it is k now n how im por t ant in div idu alized an d h u m an ized car e is for adolescen t m ot hers, wit h a view t o t heir healt h and t hat of t heir b ab ies.I n d i v i d u a l a n d h u m a n i zed ca r e sh o u l d b e delivered t o underst and t he subj ect ivit y of t he persons r ecei v i n g ca r e, p er cei v i n g t h em i n t h ei r d i f f er en t d i m e n si o n s, a s i t sh o u l d t r e a t h e a l t h i n t e g r a l l y, in clu din g psy ch obiological aspect s, as it cov er s t h e car e p r ocess t o p r om ot e, m ain t ain an d / or r ecov er hum an dignit y and wholeness( 1). I n t his sense, care is under st ood as an act ion t hat goes bey ond t echnical procedures and includes involvem ent and com m it m ent t o t he ot her, t hus becom ing a hum anized act ion.
When considering adolescence as a t ransit ion period in people’s lives, it should be highlight ed t hat , in it self, it represent s a crossing of conflict s. This phase i s ch ar act er i zed b y t h e o n set o f sex u al r el at i o n s, m om ent s of uncert aint y, anxiet y, consolidat ion of self-i m a g e a n d s e l f - e s t e e m , e m o t self-i o n a l a n d m e n t a l m at ur ing, inquir ies about im posit ions, r ules, v alues, id en t it y an d f am ily. Each of t h ese f act or s im p oses cr ises on y ou n g people, w h ich ov er lap an d pr ov ok e int r aper sonal and int er per sonal conflict s( 2 ).
Adolescent crises are necessary and essent ial f o r t h e d e v e l o p m e n t o f h u m a n b e i n g s. Ho w e v e r, p r eg n an cy d u r in g ad olescen ce lead s t o p ot en t ially d e s t r u c t u r i n g c r i s e s , b e c a u s e i t a d d s a h e a v y em ot ional, physical and social bur den t hat is capable of im peding t he experience of im port ant psychosocial m at ur at ion st ages( 3).
S t u d y i n g a d o l e s c e n c e i s a c o m p l e x a n d dynam ic t ask, requiring t ot al and profound im m ersion int o t his w or ld- life, in or der t o allow r esear cher s t o g et closer t o t h e essen ce an d m ean in g t h is p h ase im pr esses on t hose ex per iencing it . At t his m om ent in adolescent s’ exist ence, a whirlpool of m ixed feelings an d em ot ion s occu r s, in clu siv ely b ecau se b ein g an ad o l escen t m ean s ex p er i en ci n g t h e m ad d en i n g o f a n a t o m y a n d t h e p s y c h o - b i o l o g i c a l - e x i s t e n t i a l aw ak ening of t heir self( 4).
Feelin g t h at t h ey ar e pr egn an t t en ds t o be v e r y d i f f i c u l t f o r a d o l e s c e n t g i r l s , a s t h e y f i n d t hem selv es suddenly for ced t o play a r ole t hey hav e
not been pr epar ed for, nor hav e t hey gone t hr ough t h e r i t e s o f p a s s a g e( 5 ). H e n c e , t h e i r p r e g n a n c y ex p er i en ce i s n o t r a r el y a cco m p a n i ed b y a g r ea t
dem and for em ot ional suppor t . Mor eov er, significant changes in t he adolescent ’s int eract ion wit h t he child’s
fat her or wit h t he fam ily favor feelings of guilt , sham e and uncer t aint y, due t o t heir supposed disobedience
of social law s, affect ing bot h t heir accept ance of t he child and t he decision t o have an abort ion( 2). Anot her sit uat ion discussed by t he aut hor s( 2) is t hat pr egnant ad olescen t s ar e p ossib ly p r ed est in ed t o ex p er ien ce
conflict s in t he cont inuat ion of t heir school life, as t hey en d u p d r o p p i n g o u t o f sch o o l b eca u se t h ey f eel discr im inat ed against by colleagues and t eacher s.
Th i s p h e n o m e n o n f r e q u e n t l y h a p p e n s because m any t eacher s ar e not pr oper ly pr epar ed t o
conduct t his k ind of discussion and end up adopt ing discr im inat or y behav ior, generally t ending t o exclude
pregnant girls from t he classroom in order t o preserve t he colleagues fr om a “ bad ex am ple”( 3).
Anot her significant aspect is t he r ole of t he
f am ily n et w or k , an d all im p licat ion s f or t h e social
cont ext , in which t he fem ale role em erges surrounded b y e l e m e n t s t h a t p r a g m a t i c a l l y n e e d t o b e i n c o r p o r a t e d i n t o d i s c u s s i o n s o n a d o l e s c e n t
p r e g n a n cy. He n ce , t h e h e l p t h e se y o u n g w o m e n receive, in t he m iddle of t heir physical, psychological
an d social m at u r in g p r ocess, b ecom es r elev an t t o ov er com e con f lict s, st r en g t h en in g t h em selv es w it h
ef f icaciou s m ech an ism s t o cope w it h t h e dif f icu lt ies t he cir cum st ances of life im pose.
Th e “ a d o l e sce n t p r e g n a n cy ” p h e n o m e n o n
can n o t b e i so l at ed f r o m a w i d er co n t ex t , t h at i s, decon t ex t u alized fr om t h e adolescen t s’ fam ilies an d
sociabilit y net works, in sum , from t he social net works c o n d i t i o n i n g t h e i r b i o g r a p h i c a n d s o c i o c u l t u r a l
t r a j e ct o r y. Ad o l e sce n t p r e g n a n cy e n t a i l s se r i o u s im plicat ions, which m ust be t aken int o account by t he ca r e t e a m . Th i s k i n d o f p h e n o m e n a n e e d s t o b e
con sider ed as possible psy ch ological, econ om ic an d social d am ag e, m ain ly in d ev elop in g cou n t r ies lik e Br a zi l , w h i ch f a ces a n eco n o m i c cr i si s t h e en t i r e
cont inent is going t hrough( 6).
One im por t ant quest ion em er ges am idst t his set of fact or s: how does t he pr egnant young w om an
per ceiv e adolescent pr egnancy ? How does she feel? I t is im port ant t o discuss t his aspect , as t he m om ent represent s a double crisis for t he young wom an going
Th e r e a r e m a n y u n c o n s c i o u s c o n f l i c t s , m aking it difficult for adolescent s t o handle t hem , as present sit uat ions j oin wit h anguish about t he fut ure, f ea r cr ea t ed b y t h ei r r esp o n si b i l i t y f o r t h e ch i l d , an x iet y abou t t h e ev olu t ion of pr egn an cy an d ev en fear of deat h. I t should be r em inded t hat pr oblem s e x p e r i e n ce d d u r i n g p r e g n a n cy o f t e n d i f f i cu l t t h e m ot her- child relat ion, which m ay lead t o m ist reat m ent furt her ahead and becom es even m ore com plex when t h e f a m i l y c o n t i n u e s t o r e j e c t t h e d a u g h t e r ’ s pr egn an cy( 7 ).
I n view of t his problem , it is fundam ent al for nur sing pr ofessionals t o under st and how adolescent s ex p er ien ce t h e p r eg n an cy p h en om en on , as w ell as t o seek w h at t h e f act of b ein g p r eg n an t m ean s t o t h em . I t is r elev an t t o p er ceiv e t h ese ex p er ien ces dur ing cont act s w it h t he adolescent s, at t em pt ing t o d i sco v er w h at t h ey h i d e, an d n o t o n l y w h at t h ey appear t o be t o t he car e pr ofessional.
Thus, t his st udy aim ed t o u n de r st a n d t h e m e a n i n g o f p r e g n a n c y f o r p r e g n a n t a d ole sce n t s, t r y in g t o cap t u r e t h eir w ay of b ein g and new being in t he world as a pregnant girl.
METHODOLOGI CAL TRAJECTORY
Th is ph en om en ological st u dy w as ex t r act ed fr om a r esear ch pr oj ect about adolescent pr egnancy, using a unit of m eaning t hat per m it t ed show ing t he d i f f er en t p o ssi b i l i t i es o f t h e Pr eg n an t Ad o l escen t -Bein g .
Th e ad o p t ed p h en o m en o l o g i cal m et h o d i s based on Heidegger ian cat egor ies, w hich allow ed for a h u m a n l o o k o n t h ese y o u n g g i r l s’ ex p er i en ces, m ak in g it easier t o r ecog n ize, in each of t h em , a p e r so n g o i n g t h r o u g h a u n i q u e e x p e r i e n ce . Th e appr ehension of t his ex per ience m ak es it possible t o underst and t he m eaning of pregnancy for t he pregnant ad olescen t .
Heidegger’s Phenom enology involves a series of con cept s based on a sem an t ically v er y r ich ow n language. This philosopher st rongly em phasizes poet ic language as a w ay of reaching t he essence of t hings as, accor din g t o h im , lan gu age is t h e h ou se of t h e Bein g; n ot m er e sequ en ces of w or ds, bu t essen t ial language in it s original and poet ic form . I t is t hrough language t hat m an opens up t o t he world; it is language t hat gives Being t o t hings; t herefore, t o reach t hings t hem selv es, w e should r each w or ds( 8).
Con sider in g t h e r e la t ion s of Be in g- t h e r e, of presences, it should be highlight ed t hat , essent ially, t hese r elat ions ar e only const it ut ed in t he being- in-t h e - w or ld. Th e au t h en t ic bein g is be in g- w it h t h e ot hers, m oving fr om t he ont ic t o t he ont ologic level of r elat ion s. Th e on t ic r ef er s t o ev er y t h in g t h at is im m ediat ely perceived and known, while t he ont ologic is relat ed t o t he fundam ent al charact erist ics t hat m ake p o ssi b l e d i f f er en t w a y s f o r so m et h i n g t o b eco m e m a n i f e s t , r e a l i z e d . I t i s t h e w o r l d o f u n i v e r s a l essen ces( 9 ).
Heidegger ’s phenom enological m et hod is t he her m eneut ics of t he int er pr et at ion of possibilit ies; it i s t h e i n t e r p r e t a t i o n o f t h e p r e s e n c e ’ s b e i n g . Underst anding is t he basis of int erpret at ion and, also, t h e b e i n g ’ s o p e n i n g t o t h e w o r l d . H e r m e n e u t i c Ph e n o m e n o l o g y i s t h e u n d e r s t a n d i n g a n d int er pr et at ion of t he pr esence’s possibilit ies of being; it is t h e con sider at ion of t h e bein g- in - t h e- w or ld, of t h e pr esen ce’s liv in g t oget h er w it h ot h er pr esen ces t hr ough co- pr esence( 9); it is t he inv est igat ion of t he expression of care, of t he posit ive preoccupat ion wit h t he ot her in t he search t o express t he pot ent ialit ies of t he being.
Th e r e s e a r c h a r e a w a s t h e A d o l e s c e n t Ser v ice of a pu blic m at er n it y in For t aleza, CE. Th e program st art ed in 1985 and offers care t o adolescent s ( pr egnant or not ) w it hin a “ hum anized” per spect iv e, m a k i n g i t a r ef er r a l ser v i ce f o r t h ese cl i en t s. I t s p r of ession al st af f con sist s of t h r ee p h y sician s, on e n u r se, on e psy ch ologist , f ou r n u r sin g aids an d on e secr et ar y.
Th e a d o l e s c e n t s g e n e r a l l y a t t e n d con su lt at ion s ar r an g ed on e d ay b ef or e an d , at t h e st art of each shift , t hey part icipat ed in t he inform at ion group, a m eet ing held by t he nurse or psychologist s. On t h is occasion , in f or m at ion is of f er ed ab ou t t h e ser v ice, t he w ay appoint m ent s t ak e place and ot her subj ect s of int erest t o t he group. A room is reserved for t he j oint m eet ing bet ween t he young girls and t he pr ofessionals. On t he pr enat al car e day for pr egnant ad olescen t s, t h e d iscu ssion f ocu ses on p r eg n an cy -r e l a t e d i s s u e s , -r a n g i n g f -r o m f e -r t i l i z a t i o n t o psychobiological changes, preparat ion for delivery and counseling about br east feeding and child car e.
ex clusion cr it er ion, as any y oung gir l had som et hing t o say about her pr egnancy ex per ience. The num ber of subj ect s was defined t hrough t heoret ical sam pling, t hat is, according t o t he sat urat ion sam pling process. Due t o t he hom ogeneit y of t he int erviewees’ individual ch ar act er ist ics, t h e collect ed dat a st ar t ed t o r epeat t h e m s e l v e s a n d w e r e a l r e a d y a n s w e r i n g t o t h e r esear ch obj ect iv es( 1 0 ).
Thus, four int erviews were held, as well as a m eet ing wit h each adolescent , held on t he consecut ive Thur sday, w hen t hey had an appoint m ent and w er e available. I nt erview s w ere scheduled in advance and, b ef o r e st ar t i n g t h e co n v er sat i o n , t h e ad o l escen t s received inform at ion about t he research, it s obj ect ives an d im por t an ce, as w ell as ot h er in for m at ion abou t et h ical p r ot ect ion . All ad olescen t s r ead an d sig n ed t he free and inform ed consent t erm and, t hen, st art ed t o t a l k a b o u t t h e i r e x p e r i e n c e s . We f o u n d t h a t part icipant s felt no const raint s, but were spont aneous in m an ifest in g t h eir ex per ien ces abou t t h e r esear ch subj ect . Thus, all legal det erm inat ions were respect ed as est ablished in Resolut ion 196/ 1996 by t he Nat ional Hea l t h Co u n ci l , w h i ch r u l es o n et h i ca l a sp ect s o f r esear ch inv olv ing hum an beings( 11). The st udy only st ar t ed af t er a f av or ab le op in ion b y t h e Resear ch Et hics Com m it t ee at Cear á Federal Univ er sit y.
Ph en om en olog ical in t er v iew s w er e u sed t o obt ain inform at ion, guided by t he quest ion: “w hat is it lik e f or y ou t o b e p r e g n a n t ?” Th e in t er v iew s w er e m ar k ed by con st an t r ef or m u lat ion s an d som e a d d i t i o n s t o c l a r i f y a n d d e e p e n t h e i n q u i r i e s . I nt er view s w er e r ecor ded and t r anscr ibed, r espect ing t h e p a r t i c i p a n t s ’ d e s c r i p t i o n s . A f t e r s u c c e s s i v e int erview readings, we ident ified t he unit s of m eaning t he phenom enon relat ed t o t he pregnant adolescent s’ ex per ien ces r em ain ed r est r ict ed t o.
A P P R O A CH T O T H E U N - V EI LED
PHENOMENON
Underst anding is t he w ay of penet rat ing int o t h e p o ssi b i l i t i e s o f t h e Be i n g , b y i n t e r p r e t i n g i t . Accor d in g t o Heid eg g er, t h is m ean s p er ceiv in g t h e possibilit ies pr oj ect ed by t he Being, capt ur ed by t he researcher( 9). I n t his ext ract , t he pregnant adolescent s sh ow t h e m ean in g of p r eg n an cy an d assu m e t h eir w ay of being an adolescent , w ay s of coping w it h an unexpect ed realit y and t he possibilit y of t he being- a-m ot h er ph en oa-m en on .
Ex per ience of pr egnancy and t he possibilit y of being a m ot her
Fo r s o m e a d o l e s c e n t s , t h e d i s c o v e r y o f p r e g n a n cy i s a su r p r i se , so m e t h i n g u n e x p e ct e d , ou t sid e t h eir p lan s; it is a m om en t w h en d if f er en t feelings and uncert aint ies em erge, which will influence t h e en t i r e p r eg n a n cy p er i o d . Th e i d ea o f g et t i n g p r eg n an t is som et h in g d ist an t , w h ich w ou ld n ev er h a p p e n t o h e r ; m a g i c a l t h i n k i n g i s f r e q u e n t l y m en t ion ed .
I t was a surprise, I never expect ed it , no way. And I
only used a condom som et im es, when it was close, so I only
used a condom at t he exact m om ent , som et im es. I didn’t even
t hink about t hat , I j ust want ed t o spend t im e wit h m y boyfriend,
go ou t w it h m y fr ien ds, h av e fu n , bu t I didn ’t t h in k abou t
pregnancy t hen [ ...] ( St at em ent B) .
W h e n t a l k i n g a b o u t t h e s u r p r i s e o f discov er ing she is pr egnant , t he y oung gir l ends up reproducing a com m on discourse, based on what she hears, explaining what happened as a fat alit y; t hat is
ch a t, t h e m an if est at ion of an im pe r son a l w a y of e x i s t i n g. W h a t i s e x p o s e d i n t h e c h a t e n t a i l s in cr easin gly br oad cir cles ( . . . ) . Th in gs ar e lik e t h is because t hat is how t hey ar e t alked about( 9). Am idst h er ex p er i en ce, t h e ad o l escen t b r i n g s v al u es an d p r in cip les t h at ar e com m on am on g h er p eer s an d needs t o reproduce t he chat . Thus, t he presence, lived im per sonally, r eliev es her fr om r esponsibilit y, as t he im personal way of being rem oves t he burden of each pr esence in her daily r ealit y.
Th e a d o l e s c e n t n o t r a r e l y s e e s h e r s e l f s u r r o u n d e d b y c o n t r a d i c t o r y f e e l i n g s w h e n s h e discov er s sh e is pr egn an t . Joy an d sadn ess appear, w ant ing and not w ant ing.
[ ...] m any m ot hers int end t o have children only w hen
t hey are 45, I t hink t hat [ ...] I ’m 17 and, I t hink it ’s norm al, for an
adolescent t o be pregnant because I ’ve always want ed t o be a
m ot her. But I wasn’t int ending t o be a m ot her now, it ’s j ust t hat
[ ...] what ever, it happened ( St at em ent A) .
I t ’s j ust t hat , I t hought about it bet t er , lat er , t hat
som e people knew. Then I t hought t hat it was good and t hat it
was bad, at t he sam e t im e, because, whet her you want it or not ,
you want it and, also, som etim es, you don’t want it [ ...] ( Statem ent
C).
w ho t ak e her being fr om her. The ot her s’ j udgm ent det erm ines t he presence’s daily possibilit ies of being, assu m ed as bein g- w it h , w it h ou t becom in g aw ar e of t his m anifest at ion( 9).
Th e a d o l e s c e n t ’ s i m p e r s o n a l w a y o f m an if est in g h er self is an at t em p t t o f lee f r om t h is n ew m om en t in h er ex ist en ce, as t h e p r esen ce, in t he inaut hent ic way of being, is drift ing from t he ot her, under his st r ong influence, w it hdr aw ing t he funct ion o f t h i n k i n g a b o u t h e r l i f e , b y h e r se l f, f r o m t h e p r esen ce.
The det er m inat ion of t he pr e se nce includes
b e in g - w it h. I t is on ly in t h e b ein g - w it h t h at t h e presence opens up t o it s possibilit ies in t he world and, t hus, t he world of t he presence is t he world shared in t he co- pr e se nce. Thus, t he pr esence is under st ood on t he basis of it s world, observing t he im pact of t he ot her’s opinion on t he young girl, m ainly in highlight ing her experience in t he inaut hent ic m ode of being( 9)
.
[ ...] in high school, I w as asham ed of going... I w as
asham ed of what m y friends would say... com m ent s appeared.
[ ...] I didn’t know what t o do... t hey asked if I was pregnant , and
I said t hat I didn’t know ... I didn’t know w hat t o answ er [ ...] . I
avoid having cont act wit h t hese persons ( St at em ent C) .
So, inaut hent ic life let s it self be dom inat ed b y t h e b e i n g - i n - t h e - w o r l d , a c c o r d i n g t o t h e det erm inat ions of m ass law. I n avoiding ot her people, t he young girl is avoiding foreign curiosit y, w hich is anot her daily m anifest at ion of t he im per sonal m ode. A s t o c o - p r e s e n c e, w e h i g h l i g h t t h e im por t ance of fam ily and boy fr iend for t he pr egnant adolescen t , elem en t s t h at ex er t a st r on g in f lu en ce, w h et h er in r elat ion t o t h e accept an ce of pr egn an cy o r i n d e c i s i o n s t o b e m a d e . Th e y a r e t h e t w o f u n d am en t al p oles t h at p er m eat e t h e ad olescen t s’ d iscou r se.
I t hought t hat , he ( t he fat her) w ould never accept it ,
because he said t hat if I got pregnant ... I kept on rem em bering
him , when I left t here [ ...] where I did a t est and it was posit ive.
He was going t o be, you know, asham ed, of m e, of m e being
pregnant , a daught er at 15, pregnant , from her boyfriend, wit hout
even being together... although I was concerned, about everything,
you know, about m y child’s fat her, about m y fat her... and t here
w as m y m ot her t oo, w hom I t hink w as sad, t hen... it ’s scary [ ...]
( St at em ent D) .
At t his m om ent , it is com m on for t he young girl t o feel alone, exact ly because people who st rongly influence her life, lik e her par ent s, ar e not pr esent . Alt hough t hey are st ill physically present , even wit hout leav in g h om e, sh e f eels alon e; it is f eelin g a m on g
t he ot hers wit hout being bet ween t he shoulders. Wit h respect t o t his m ode of being, Heidegger affirm s t hat t he det er m inat ion of t he pr esence in t he being- w it h proceeds, but being- wit h, in t he case of “ being am ong” t h e o t h e r p r e se n ce s, co m e s f r o m t h e m o d e o f
in d if f e r e n ce an d st r a n g e n e ss; b ei n g - al o n e i s a deficient m ode of being- wit h, and it s possibilit y proves t hat( 9). This feeling of being- alone can be evidenced in t he follow ing st at em ent .
Wit h m y m ot her, she was neut ral, she did not t alk, she
j ust shook her head, and I becam e sad, because not even her, you
know, want ed t o, you know, t o give m e m ore support , I was alone,
wit hout m y fat her or m y m ot her. She was t here, but she j ust
looked... she rem ained silent [ ...] ( St at em ent B) .
Th e f eelin g of gu ilt , w h ich t h e f am ily of t en im p oses on t h e y ou n g g ir l, of t en m ak es h er t h in k about t he possibilit y of an abor t ion. This appear s as an opt ion t o flee from t he init ial crisis t hat cam e about w h en sh e discov er ed pr egn an cy.
I w as only t hinking about having an abor t ion, only
about having an abort ion. Because of m y fat her, I live wit h him ,
and he would never, I t hought , he would never accept it , he said
t hat if I got pregnant ... I cried all t he t im e, I was crying all t he
t im e, I was scared [ ...] I t hought about m y fat her, t hat he was
gonna fight , t alk all t he t im e, I was already crying a lot when I
left t he clinic, t he lab ( St at em ent D) .
At t he sam e t im e, t he young girl get s in t ouch w it h her deep self, in a slow and gradual w ay. And, t hus, she st ar t s t o see her self as r esponsible for her ex ist ence, slow ly discov er ing her self as a being w it h possibilit ies. That is w hen she at t em pt s t o face her act s, aut hent ically and assum e t hem .
I t ’s j ust t hat , aft er a w hile, you know , I st art ed t o
perceive t hat , dam n, what am I going t o do t hat for? Have an
abort ion? I ’m gonna have an abort ion for what , t o have a guilt y
conscience for t he rest of m y life?... no, I prefer t o have t he child,
face whoever I need, because nobody has anyt hing t o do wit h m y
life, even if I feel a bit asham ed, what ever. Didn’t I do it ? So now
I ’m gonna be responsible, no m at t er how irresponsible I am [ ...]
( St at em ent D) .
w eigh t for t h e adolescen t du r in g pr egn an cy. At t h is m o m e n t , s h e a s s e s s e s h e r r e l a t i o n w i t h f a m i l y m em bers different ly and, despit e t he negat ive im pact of discov er ing pr egnancy, accom panied by her being held r esponsible for w hat happened, t his m ak es t he fut ure m ot her really st art t o t ake care of her life and seek t o underst and her parent s’ feeling.
My m ot her [ ...] becam e, like, a bit sad but she had t o
accept it , she won’t be able t o do anyt hing, but she was m ore,
like, disappoint ed. I underst and his side now [ ...] we st art t o
underst and our fam ily bet t er, because I know t hat t hey are worried
about m e, I ’m gonna be like t hat t oo now [ ...] ( St at em ent A) .
Aft er t he m om ent of t he surprise, parent s st art t o accept t he pregnancy and shelt er t he girl, sharing plans w it h her about t he gr andchild w ho is about t o a r r i v e , w h i c h b r i n g s r e l i e f a n d c o m f o r t , m a i n l y because she feels shelt er ed by t hem .
I n t h e i m p e r so n a l m o d e, t h e p r e se n ce
“ r e s t s ” o n t h e o t h e r s , s i n c e s h e d o e s n o t t a k e r espon sibilit y f or h er self, at t r ibu t in g h er ex per ien ce t o t he co- presence, provoking a dependence on t he ot hers in t erm s of her act ions wit hin t he det erm inat ion of t h e be in g- w it h. Wh ile bein g- w it h , t h e pr esen ce essent ially occur s in funct ion of t he ot her s( 9).
I n h er b oy f r ien d , t h e p r eg n an t ad olescen t seek s “ h elp” t o t ak e an im por t an t decision : h av in g an abort ion or not , which is t he first quest ion asked in t hese circum st ances. I t is obvious t hat t he girl heavily depends on her boyfriend’s opinion, as t o t he decision t hat needs t o be m ade.
He ( t he boyfriend) want ed t o have t he baby, it ’s his
dream , he’s 20, he said we could raise it , t hat he was gonna work
[ ...] t hat I shouldn’t m ind what people said. So, I said it was OK
( St at em ent A) .
Am idst t his search for t he boyfriend’s support , t he gir l t hink s being suppor t ed by t he fat her of her child will be im port ant t o have her pregnancy accept ed by societ y, as sh e w ill n ot be a sin gle, st igm at ized m ot her, which st rongly influences how she experiences t h e p r e g n a n c y. On c e a g a i n , t h i s e x p r e s s e s t h e pr esence’s dependence on ot her pr esences and t heir opinions. I t is im port ant for t he adolescent t o answer t h e o t h e r s , s o a s t o d e c r e a s e c r i t i c i s m a g a i n s t ad olescen t p r eg n an cy.
I got pregnant from a responsible m an, and t hat ’s very
im port ant , because it wasn’t from anybody, he’s going t o assum e
t he child, like he assum ed m e. Of course, if he hadn’t been a m an,
assum ed m e, I , it would have been m uch m ore difficult , I was
going t o feel very asham ed and it would have been worse in m y
fam ily [ ...] ( St at em ent A) .
For t he young girl, her boyfriend’s support is qu it e com for t in g as a special m om en t , w h en sh e is pressured by t he fam ily, incorporat ing feelings of guilt and solit ude, m ainly im posed by her par ent s.
Th e p r e se n ce ’s d ep en d en ce on ot h er co-p r e se n ce s cr eat es in f lu en ce on t h e d et er m in at ion of t he be ing- w it h, in t he ot her ’s da ily life, on t he
p r e se n ce. “ Th is liv in g t og et h er t ot ally d ilu t es t h e pr esen ce it self in t h e m ode- of - bein g of t h e ot h er s, an d in su ch a w ay t h at t h e ot h er s d isap p ear ev en m o r e i n t h e i r p o s s i b i l i t y o f d i f f e r e n c e a n d ex pr ession ”( 9 ). Nob od y is h im / h er self, ev er y b od y is t he ot her s.
I n t he pr egnancy ex per ience, t he adolescent also expresses t he fear t hat will chase her t hroughout h er p r eg n an cy. Th e g ir l also m an if est s t h e f ear of g i v i n g b i r t h , m a i n l y i n t e r m s o f p a i n a n d , a l so , h ospit alizat ion an d deliv er y pr ocedu r es. Heidegger ’s p h i l o s o p h y e m p h a s i z e s t h a t f e a r i s a m o d e o f
disposit ion, w it h an opening t o be in g- a ble - t o- be, t o possibilit ies. Fear pr esen t s dif f er en t possibilit ies, w h i ch a r e : d r e a d , h o r r o r a n d t e r r o r. I n t h e se v ar iat ion s of t h e m om en t s t h at con st it u t e t h e f ear phenom enon, t he approxim at ion of realit y belongs t o t h e m eet in g st r u ct u r e of w h at is t h r eat en in g . Th e t hreat of som et hing t hat did not happen, but t hat can happen at any t im e, suddenly depr esses t he being-in- t he- w or ld of occupat ion. Fear can t ur n int o dr ead. Th u s, o n e n e e d s t o b e a b l e t o d i st i n g u i sh w h a t r epr esent s a t hr eat ; t he appr ox im at ion of w hat t his r ep r esen t s, as t h e u n k n ow n ar r iv es in t h e f or m of t error. At first , dread is som et hing known and fam iliar. I f, on t h e opposit e, t h e t h r eat is som et h in g t ot ally unfam iliar, fear t ur ns int o hor r or( 9).
Th u s, t h e y ou n g gir l’s m ode- of- bein g abou t t h e p ossib ilit y of d eliv er y is t h e d r e a d of f ear as, experiencing t he im persona l m ode in daily life, she oft en uses report s by ot her wom en who have already gone t hr ough t he exper ience, and w hich ent ail chat. Ot h er w om en ’s discou r se in f lu en ces t h e y ou n g gir l, m a k i n g h e r d r e a d t h e p o ssi b i l i t y o f e x p e r i e n ci n g d el i v er y.
I am also afraid of feeling som e kind of pain, which I
don’t want t o feel m uch, for days, days in hospit al, wit hout being
wit h anybody, j ust feeling pain ( St at em ent A) .
deliver y. I n chat , t her e is no com m it m ent t o w hat is being said, r em aining lim it ed t o t he super ficial. Chat is m u ch m or e r elat ed t o cu r iosit y, ab ou t t h e n ew , j um ping fr om one nov elt y t o anot her, w it hout t ak ing any int er est in under st anding( 12).
The adolescent m anifest s ex pect at ions about t he fut ur e, about her w ay of being a m ot her, about w h at is n ew an d abou t w h at r epr esen t s car e. I t is b eco m i n g a w a r e o f t h e n ew co n d i t i o n o f b ei n g a m ot her, of being r esponsible for a child, for anot her b ein g . Th is cr eat es a n g u ish in t h e ad olescen t , as t he unk now n is appr oaching, w it hout fam iliar it y w it h t h e n ew m ode of bein g; sh e seek s “ dist an ce” f r om w h a t s h e s u p p o s e s t o b e t h e o r i g i n o f t h i s “ in conv en ien ce”, w it h ou t any dir ect ion . Th is “ fligh t ”, h ow ev er, ex act ly b r in g s h er closer t o w h at sh e is fleeing from , t o her new condit ion and t o t he changes r e s u l t i n g f r o m t h i s m o d e o f b e i n g . Th e s e a r e ex pect at ions about t he unk now n.
When I t hink t hat , in a short t im e, I ’m gonna be w it h
t he baby here, it gives a st rong feeling, a fear, I don’t know,
som et h in g d if f er en t , b ecau se it ’s g on n a ch an g e so m u ch ,
everyt hing’s gonna be different and it ’s scary. You becom e m ad
if you t hink of it ! ( St at em ent B) .
And t he unknown m ainly appears wit h respect t o m ot herhood, t o t he adolescent ’s inexperience about f eelin g h er self a m ot h er, an d t h e im p licat ion s t h is en t ails for h er life. Sh e qu est ion s h er self abou t t h e feeling of m ot herhood, of being- a- m ot her. This reveals u n c e r t a i n t i e s a b o u t l i v i n g t o g e t h e r, a b o u t t h e ex p er ien ce of co - p r e se n ce.
I keep on im agining what it is like for you t o look at a
child and know t hat she was inside you one day...t hat you have a
bit of her, inside you, it m ust be funny, I ’ll only know what it ’s
like when she com es out ( St at em ent B) .
Living t his co- presence creat es fear, as t his new condit ion, t he way of being a m ot her, about which h e r i d e a s a r e o n l y b a se d o n o t h e r e x p e r i e n ce s, descr ibed b y ot her per sons she lives w it h. How ever, t his uncer t aint y and ex pect at ion ar e also per m eat ed by j oy about being- w it h t he child soon.
REFLECTI ON ABOUT THE STUDY
A d o l e s c e n t p r e g n a n c y i s a t h e m e t h a t per m eat es h ealt h pr of ession als’ daily r ealit y, w h ich aroused t he underst anding of t hese girls’ experiences on t he basis of t he int erpret at ion of t heir discourse in t he light of Heidegger ’s phenom enology.
When adolescent s r eflect on pr egnancy and t h e w ay of bein g a m ot h er, t h ey an aly ze gain s an d losses. Th ey h igh ligh t n ew an d im por t an t sit u at ion s and “ t ake hold” of t he new condit ions, assum ing it for t hem selves, st ar t ing t o t hink about t he w ay of being a m ot her, about t he way of being an adolescent , about t he way of being a wom an, about t he way of being a m ar r i ed d au g h t er. Th i s ap p r o p r i at i o n t ak es p l ace, t ak in g in t o accou n t t h e m u lt iple possibilit ies of t h e young gir l’s opening t o t he w or ld.
Th e t e c h n i q u e - r e p r o d u c i n g a t t i t u d e , t h e occupat ion wit h t hings in t he world, wit h daily act ivit ies, oft en im pede professionals from perceiving what young gir ls w ant t o k now , w hat t hey t hink about t heir new living condit ion, t heir expect at ions and anxiet ies about t h e m o m en t t h ey ex p er i en ce. I n t h i s st u d y, t h ey dem onst r at ed int er est in k now ing about t he deliv er y, knowing how t o t ake care of t he child. I t was not enough j ust t o know t hat t heir child’s heart was beat ing, t hat he would be born on t hat day. That is im port ant for t he young girls, but t hey want ed m ore, t hey needed t o be under st ood, based on t he ex per ience of list ening t o t heir feelings and anguish about early pregnancy.
I n this study, we m anaged to capture som e of t h e pr egn an t adolescen t s’ ex per ien ces: m om en t s of authenticity and, also, their determ ination about Being-a- m ot her. Thus, t he presence is ext ended on t he basis of it s co- presence wit h t he ot hers, who are significant to their lives as a way of Being with possibilities. I f the professional underst ands t he adolescent ’ m anifest at ions in ex per ien cin g pr egn an cy an d Bein g- a- m ot h er, t h is in cr eases t h e possibilit ies of of f er in g in div idu al an d hum anized care to the young girls. However, it is known t h at t h e daily r ealit y of t ech n ical act ion s dist an ces p r of ession als f r om t h e r ealit y ex p er ien ced b y each subj ect ( client ) , which is why t hey need t o overcom e t hese at t it udes and k now how t o const r uct w ay s of underst anding t he exist ence of each Being- present in t he universe of t heir professional relat ions.
REFERENCES
1. Waldow VR. O cuidado na saúde: as relações ent re o eu, o out r o e o cosm os. Pet r ópolis: Vozes; 2 0 0 5 .
2 . God in h o RA, Scelp JRB, Par ad a CMGL, Ber t on celo NMF. Adolescen t es e gr áv idas: on de bu scam apoio? Rev Lat in o-am En fer m agem 2 0 0 0 abr il; 8 ( 2 ) : 2 5 - 3 2 .
3 . Car id ad e A. Sex u alid ad e: cor p o e m et áf or a. São Pau lo ( SP) : I glu ; 1 9 9 6 .
4 . Cav alcan t i APLS, Zen i AP, Pin h eir o, FPLS, Bar b osa EMS. Aspect os psicossociais de adolescent es gest ant es at endidas em um serviço público de cidade de Recife. I n: Ram os FRSR, Mon t icelli M, Nit sch k e, RG, or gan izador es. Pr oj et o Acolh er : um encont r o da Enfer m agem com o adolescent e br asileir o. Br asília ( DF) : ABEn / Gov er n o Feder al; 2 0 0 0 .
5 . M a r t i n s A L, S i l v a A B F, Z a g o n e l I PS , S o a r e s V M N . Mor t alidade m at er na x gr avidez na adolescência: um desafio para a Enferm agem . I n: Ram os FRSR, Mont icelli M, Nit schke, RG, o r g a n i z a d o r e s . Pr o j e t o A c o l h e r : u m e n c o n t r o d a En f er m ag em com o ad ol escen t e b r asi l ei r o. Br asíl i a ( DF) : ABEn / Gov er n o Fed er al; 2 0 0 0 .
6 . Cam pos MAB. Gr av idez na adolescência: a im posição de u m a n ov a r ealid ad e. Rev Ped iat r ia At u al 2 0 0 0 n ov em b r o-d ezem b r o; 1 3 ( 1 1 ) : 2 5 - 6 .
7. Branco VMC. Gravidez na adolescência: um problem a para q u em ? Rev At en ção Pr im ár ia à Saú d e 2 0 0 0 m ar ço- j u n h o; 3 ( 5 ) : 4 4 - 5 .
8 . Mor eir a RVO, Bar r et o JAE, Mach ad o RC d e C, An d r ad e TPP d e. A r econ st r u ção d a m et af ísica at r av és d o m ét od o fenom enológico. I n: Barret o JAE, Moreira RVO, organizadores. O elefant e e os cegos. Fort aleza ( CE) : Casa José de Alencar/ Pr ogr am a Edit or ial; 1 9 9 9 .
9 . Heid eg g er M. Ser e t em p o: p ar t e I . São Pau lo: Vozes; 2 0 0 2 .
1 0 . Tu rat o ER. Trat ado da m et odologia da pesquisa clínico-q u a l i t a t i v a : co n st r u çã o t eó r i co - ep i st em o l ó g i ca d i scu ssã o co m p a r a d a e a p l i ca çã o n a s á r ea s d a sa ú d e e h u m a n a s. Pet r óp olis: Vozes; 2 0 0 3 .
11. Minist ér io da Saúde ( BR) . Conselho Nacional de Saúde. D i r e t r i z e s e n o r m a s r e g u l a m e n t a d o r a s d e p e s q u i s a e n v o l v e n d o se r e s h u m a n o s. Br a síl i a ( D F) : Mi n i st é r i o d a Saú d e; 1 9 9 6 .
12. Machado CE. Ser pr ofissional de saúde em um a unidade n e o n a t a l d e a l t o e m é d i o r i sco : o v i sív e l e o i n v i sív e l [ d i sse r t a çã o ] . Fo r t a l e za ( CE) : Un i v e r si d a d e Est a d u a l d o Ce a r á / UECE; 2 0 0 4 .
