10.4: Social Contexts in Adolescence
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Learning Objectives
By the end of this section, you will be able to:
- Describe the role of peers in social development
- Describe the role of romantic relationship s and dating in adolescence
- Discuss the influence of various media on adolescent development
- Describe the context of education and trends in academic achievement across adolescence
Seventeen-year-old Jasmine has been looking forward to the big school dance two weeks from now. She is particularly excited because this is the first time she is going with a date rather than with friends. She met her date while hanging out with mutual friends over the summer. Aside from a shared interest in art and sci-fi movies, they connected over their shared experience of being neurodiverse. Their friendship has grown into a more intimate relationship, and they recently kissed for the first time. This dance will be the first time their classmates will see them as a couple, and Jasmine’s excitement is mixed with a bit of pride and concern: “What will everyone think of the two of us together? Will they wonder if we’re a good match? What will we do after the dance?” She wonders whether she’s ready to commit to this person, to share her hopes and plans and fears with them. And she worries about whether there are unspoken expectations for getting more physically intimate; she doesn’t feel ready for more yet. Nevertheless, she is eager to see what new experiences lie ahead (Figure 10.9).
Many parts of development are informed by our own and others’ expectations based on the various social contexts in our lives. These include peers, friends, intimate relationships, plus the contexts of media and education. A key part of healthy adolescence is exploring and developing one’s identity across these contexts.
Peer Influences on Development
Brain development in adolescence supports a heightened interest in peers and other social cues, and an increased sensitivity to the rewards they can offer. The sophisticated new skills that come with these cognitive developments allow teens to apply increasingly advanced reasoning about social experiences, including hypothetical ones like, “Everyone is watching” (Elkind’s concept of the imaginary audience). Recall also that one of the many developmental tasks facing adolescents is a gradual turning outward from the family and toward society at large (Havighurst, 1973; Manning, 2002). Peers and peer relations become a transitional force allowing adolescents to do just that (Brown & Larson, 2009; Rubin et al., 2006).
Against the backdrop of these developments, society also purposefully restructures the environment of adolescents, who spend one-third or more of each weekday in school where they interact with their peers almost every day. Adolescence, then, is a time of heightened sociability, often beyond the direct supervision of parents or other adults. Through friendships as well as membership in peer groupings of different sizes, adolescents build and maintain a reputation, gain status within the larger group, and climb the social ladder.
Friendships
A friendship is an intimate, emotionally close relationship between two individuals (Brown & Larson, 2009). Friendships form based on similar interests such as music or sports and may dissipate if those interests change over time. However, as adolescence progresses, and as individuals actively explore and form their identity , friendships tend to become more stable and enduring. Intimacy is a key feature of friendship, and in a psychological sense it means making ourself vulnerable to another.
Especially in early and midadolescence, friendships can be exclusive and intense, relying on trust and mutual support. Later in adolescence, this intensity is often transferred to a romantic relationship (Costello et al., 2023; Wesche et al., 2023). Research in multiple countries has consistently found that males tend to share personal information with a single best friend, whereas females tend to disclose evenly among their close friends (Ko et al., 2015; Kitts & Leal, 2021). However, it does vary. For example, male students at a Japanese university reported sharing more personal information with close friends than female students did (Fankhauser, 2018). This was true overall and for specific topics. The study used two different measures of self-disclosure, both showing similar results, especially in cross-gender friendships. It also found that feeling close to a friend and trusting the friendship's stability were linked to more self-disclosure (Fankhauser, 2018). These findings highlight the role friendships serve: adolescents switch some of their needs for social and emotional support from their parents to close friends, and in turn these needs for intimacy are also brought into romantic relationships later on.
Cliques
A close group of three to a dozen or so friends is called a clique (Brown & Larson, 2009). Cliques serve many functions for developing adolescents. First, they break the larger social environment into one of more manageable size and offer a context in which much socialization (“hanging out”) occurs, both within and outside the school setting. They also provide a source of emotional support for members, as well as a sense of belonging and encouragement (McFarland et al., 2014). For example, a group of close-knit friends in a clique who share similar interests, such as skateboarding or a science club, can be there to listen and offer advice during challenging times. When a teen is stressed about an upcoming exam, their clique might organize a study session to help all members prepare, boosting both academic performance and emotional well-being. And they can offer encouragement and celebrate each other's successes, such as cheering on a member at a competition or congratulating them on a good achievement in the classroom.
An analysis of adolescents from about 170 secondary school classrooms asked students to identify the cliques in their school and nominate peers as members of each (Pattisellano et al., 2015). First, the study found the average size of a clique was just shy of six members (5.72, to be exact). Second, researchers discovered that some cliques have a status hierarchy, while others are more equality driven, or egalitarian (Pattisellano et al., 2015). Peer status matters in the larger social context of the adolescent world because both aggression and prosocial (helping) behavior are related to social standing. Thus, being a member of a higher-status clique could offer protection against aggression from others, while being a member of a low-status clique could be disadvantageous.
The term relational aggression refers to the practice of including or excluding others or otherwise threatening a sense of belonging such as by spreading gossip. It was associated more with egalitarian cliques. This makes sense, though; one purpose of a social hierarchy is to spell out exactly where everyone stands in relation to one another. In an egalitarian group this is not as easy to discern, and when members are striving for status, an increase in aggression can result. More prosocial behavior toward other members was found within hierarchical groups, as was increased aggression toward other cliques (Kwon & Lease, 2007, Zhao & Li, 2022). This result shows both the function and the power of cliques—to support those within the group, and to advocate for social standing against other groups.
Crowds
A larger social grouping in the social milieu of adolescents is called a crowd , and it can have many dozens of members, not all of whom are necessarily friends or even know each other. Crowds can be made up of different cliques and often form around various activities, interests, aspects of youth culture (such as anime), or members’ personality characteristics, social status, or reputation (Brown & Larson, 2009) (Figure 10.10). Common crowd names in U.S. high schools include “populars,” “jocks,” “brains,” and “normals” (Crabbe, et al., 2019). The names of crowds may change, but the presence of these common themes in crowds has been around for quite some time.
How do individuals become part of a crowd during adolescence? Crowds come together through both selection (people with similar values, interests, and experiences find each other) and socialization (members reinforce shared attitudes and behaviors to uphold their identity and sense of belonging). Research suggests that academic orientation, athleticism, and physical appearance are among the primary characteristics through which teens sort themselves from an early age onward (Brown & Larson, 2009), and that ethnic and racial group membership are not (Brown, et al., 2008). One way to think of crowds and cliques is that crowds exist as part of the large social backdrop of adolescence, while actual peer relationships occur within and between cliques and friendships.
For most adolescents, the way their peers view them is very important, and not being accepted can lead to problems like relational aggression and poor academic performance (Lorijn et al., 2022). Girls are especially likely to worry about conflicts and being rejected by their peers (Chesney-Lind & Irwin, 2008). Girls who feel rejected often seek attention and form cliques to feel accepted (Hamilton, 2010). Popular students may act aggressively because they believe their high status protects them from negative consequences. Within these cliques, teens join the same activities and spend free time together, creating a strong social network. In contrast, less popular students interact less with their classmates and have fewer close friends. Overall, teen friendships help organize social interactions in the classroom, affecting teen mental health and behavior (Long et al., 2021; Casper et al., 2020).
Peer Social Risks
Teens who struggle to find a social group often face significant isolation and loneliness , which are linked to various negative outcomes including increased risk of depression , anxiety , and low self-esteem (Laursen & Hartl, 2013). Social isolation can also hinder academic performance and school engagement, since the peer support that can encourage and motivate the individual is lacking (Wentzel, 2005). Feelings of exclusion can also arise, and the absence of support increases the likelihood of engaging in harmful behaviors as a coping mechanism (Hawkley & Capitanio, 2015). For example, teenagers who feel isolated and lack positive social connections often seek acceptance in alternative groups, which can include gangs (Dmitrieva et al., 2014). Gangs offer a sense of community and identity, though through engagement in deviant behaviors. Addressing social isolation in teens and providing positive social support systems through parents, teachers, mentors, and community programs are critical to prevent gang involvement as well as promote overall well-being and teen mental health.
Romantic Relationships and Dating
All the social, physical, emotional, and cognitive developments that occur during adolescence create new ways for us to relate to one another within a romantic relationship. A romantic relationship is a bond psychologically distinct from mere liking and includes components of affection, intimacy, exclusivity, and interdependence (Aron et al., 2006).
Most adolescents enter into at least one romantic relationship during their teenage years (Lenhardt, et al., 2015), as part of the larger trend of shifting their focus from their family of origin toward peers and the larger society (Collins, 2003; Brown, 2004; Sorensen, 2007). Romantic relationships offer the developing adolescent space to explore what it means to be vulnerable ( intimate ) and connected to another individual, and to find a new source of support and comfort from a peer (Jorgensen-Wells, et al., 2021). They also provide valuable experience in relating to others in a way that will become a major focus in early adulthood.
Attachment
Recall that our internal working models of relationships provide us with scripts, including what we can expect from a relationship and how others are likely to behave. With these models, adolescents bring their full relationship and attachment history into their first (and subsequent) romantic relationships.
According to Hazan & Shaver (1987), both the ability to enter romantic relationships and the quality of those relationships are also connected to an individual’s attachment history (4.4 Social Development in Infants and Toddlers). Individuals with a secure attachment history bring several assets to an adolescent romantic relationship. These include effective communication skills like listening and sharing, appropriate emotional expression, the ability to assert and negotiate needs and expectations, and the capacity to seek support from and provide it to a partner (Carroll et al., 2007; Halford, 2011) (Figure 10.11). Such individuals also show skill in approaching others, forming intimate connections, and benefiting from such connections. They exhibit greater warmth and understanding and use a more constructive approach to resolving disputes (Tan, et al., 2016), which is essential because conflicts within a romantic relationship often arouse strong emotions.
Adolescents who have developed insecure attachment styles, including anxious-preoccupied (termed “ambivalent” in childhood) and avoidant, bring different experiences, expectations, and skill sets to their first romantic relationships (Brar et al., 2023; Choi et al., 2022; Dinero et al., 2008; Stavropoulos et al., 2018). Those with an anxious-preoccupied attachment history are interested in forming romantic relationships and enter such relationships eagerly. However, because of the inconsistent support and confusing mix of disappointment and frustration in their previous relationships, they often lack the confidence that a romantic relationship will bring all the benefits they are hoping for. Instead, they may seek frequent reassurance from their partner about their commitment and support. Romantic partners in turn often experience this need for reassurance as clinginess and may try to distance themselves emotionally. Ironically, this reaction is exactly what the internal working model of someone with anxious-preoccupied attachment predicts. Any resulting distancing, rejection, or breakup reinforces that model.
Adolescents with an avoidant attachment history don’t expect much from a romantic relationship, are overly self-reliant, and approach close relationships with skepticism and worry. These expectations often color their experience of early romantic relationships: any instance of dissatisfaction leads them to withdraw, further reinforcing their internal working model (Stavropoulos, et al., 2018).
A central tenet of attachment theory , however, is that partnering with someone who has a secure attachment style can benefit individuals with an anxious-preoccupied or avoidant attachment history. For instance, research shows that teenagers who engage in positive peer relationships, receive mentoring, and experience supportive school environments can develop healthy attachments and show resilience despite early challenges with unhealthy attachment patterns (Grossmann et al., 2005). Thus, we see the potential for positive development and reworking of the insecurely attached individual’s internal working model within the context of romantic relationships.
Dating Violence and Unhealthy Relationships
Teen interpersonal health risks often stem from their socioemotional needs for dating and establishing romantic relationships with appropriate peers. Romantic relationships are crucial for socioemotional development because they help to develop intimacy skills and shape identity and autonomy (Connolly & McIsaac, 2009). However, they can also generate intense emotions and conflicts, sometimes with the potential for teen dating violence (TDV). The Centers for Disease Control and Prevention (2024) defines dating violence as a variety of unsafe behaviors inflicted on a partner. Psychological dating violence includes manipulative actions aimed at indirectly harming the partner. Physical dating violence can range from pushing and slapping to more severe acts like beating, kicking, or strangling. Sexual TDV includes forced sexual activities, from unwanted touching to forced penetration. Stalking is a pattern of repeated, unwanted attention and contact by a current or former partner that causes fear or safety concerns for an individual or someone close to them (CDC, 2024).
Many adolescents report experiencing violence in their romantic relationships. Data from the 2011–2021 Youth Risk Behavior Surveys show significant rates of these experiences among U.S. high school students, with notable disparities affecting females, racial and ethnic minorities, and sexual minority youths (Basile, 2020). In 2021, 8.5 percent reported physical dating violence, 9.7 percent reported sexual dating violence, 11.0 percent reported sexual violence, 15 percent experienced bullying at school, and 15.9 percent faced electronic bullying (Clayton, 2023). A meta-analysis by Wincentak et al. (2017) found that 20 percent of teens aged thirteen to eighteen years have experienced physical dating violence, and 9 percent have experienced sexual dating violence. Given how common dating violence is, and the severity of its effects including psychological distress, suicidal thoughts, and post-traumatic symptoms (Exner-Cortens et al., 2013; Hébert et al., 2017), it is now seen as a serious public health problem. A recent study of late-stage adolescents' views on romantic relationships found that while teens can identify healthy and unhealthy relationship traits, some find it hard to see jealousy and possessiveness as negative behaviors, often mistaking them for signs of strong interest (Brar et al., 2023). Programs promoting healthy dating behaviors, clarifying unhealthy traits, teaching respectful conflict resolution, and encouraging intervention in abusive situations can benefit all teens (Foshee et al., 2014).
Teen dating violence, sexual violence , and bullying during adolescence are linked to health and behavioral issues in adulthood. Victimized teens may engage in risky behaviors like substance misuse or develop eating disorders as coping mechanisms (Batchelder et al., 2022). Studies also indicate that TDV is longitudinally associated with increasing high-risk behaviors, such as marijuana and alcohol use, and poor mental health outcomes (Piolanti et al., 2023). Trauma can also impair academic performance and social relationships, leading to isolation (Cava et al., 2020) and further emotional distress. Addressing these risks requires comprehensive sex and relationship education, preventative socioemotional health services, and accessible intervention support to ensure teens can establish and maintain healthy, respectful relationships. For instance, the reality of TDV should be included in school curricula focused on sex and relationship education. Schools must commit to fostering a violence-free social environment and encourage bystander intervention (Banyard et al., 2020).
Link to Learning
To learn more about the signs of a healthy or unhealthy relationship, check out the youth.gov characteristics of healthy and unhealthy relationships for more information.
Media as Context for Development
Peer relationships rightly take center stage as an important context for adolescent development. However, media, including social media , are also a central feature of adolescent life and are intricately linked to social relationships. Teens' media diet, usually characterized by excessive screen time, often includes social media and messaging apps, which can lead to problematic behaviors like sexting , the transmission of sexually suggestive or explicit images via texts, and sexual harassment . Studies show that increased phone use is associated with higher risks of exposure to inappropriate content and cyberbullying, with negative impacts on teens' mental health and psychological well-being.
Media Diet
What do we know about the media diet of teenagers today? The most relevant indicator is screen time , which includes time spent watching videos online, playing or watching others play video games, using tablets for creative purposes, using virtual reality devices, browsing the internet, using social media apps, and reading e-books. Average daily screentime for teenagers in 2021 was eight hours and thirty-nine minutes, an increase from six hours and forty minutes daily in 2015 (Rideout et al., 2022).
Research shows that 77 percent of teens watch online videos every day and spend an average of ninety minutes a day using social media apps such as Instagram and Snapchat. The Pew Research Center reports that 19 percent of teens use YouTube “almost constantly,” and 16 percent use TikTok with the same level of intensity (Vogels, 2022) (Figure 10.12). Teens from lower-income households report the highest screen use, averaging seven hours and thirty-two minutes per day.
The COVID-19 pandemic of 2020–2023 markedly increased media use by teenagers. Contributing factors included societywide shutdowns of schools and other gathering places and social distancing protocols that made technology necessary for human interaction. Teenagers spent an average of more than eleven hours a day in front of screens during the pandemic, including for schooling; for more than 40 percent of them, this increase also meant more social media and video viewing (Hamilton et al., 2023; Marciano et al., 2022). Social media did let teens stay connected with one another during the pandemic, however, and its use then has been linked to lower stress, boredom, and loneliness among youth, in contrast to findings about social media use and adolescents’ psychological health post-pandemic (Marciano, et al., 2022).
There is a significant rise in anxiety , depression , and mental health issues among teenagers, which is linked to increased screen time and social media use. For example, the amount of media information about the pandemic itself increased teens’ feelings of anxiety. Researchers suggest that digital interactions contribute to a decline in face-to-face social skills and an increase in feelings of loneliness and inadequacy. They emphasize the need for reduced screen exposure to improve mental well-being in young people (Twenge, 2020; Haidt, 2024). When adolescents use their screen time as a replacement for social interactions, negative effects do emerge, such as a less positive body image, lower self-esteem, and an uptick in eating disorders (Ramsey, et al., 2023).
Psychological Effects
What do we know about the psychological effects of extensive media use? First, there are some positives. The primary purpose of all media is to communicate and entertain, facilitate interaction and engagement (especially over long distances), give exposure to new ideas and perspectives, and foster collaboration (American Academy of Pediatrics, 2016). Media sources also provide a way for isolated individuals to connect more easily with other people and resources, and an easier entry point to social interaction for those who may be shy or isolated. Some media are also extremely effective at advocating for certain positions or attitudes, so they can help spread positive and healthy information.
Psychologists, health professionals, and communications experts have also documented several physical health risks of media use. In a review of the literature, the American Academy of Pediatrics (2016) reports a fivefold increase in the chance of developing obesity among teens who watch more than five hours of media per day. One reason is an increase in snacking or passive eating during television viewing. Heavy media use can also increase sleep disturbance s in teens (and adults): the blue cast to the light of screens interferes with the body’s melatonin levels, and adolescents have different sleep needs than children. These physical health risks can in turn increase psychological and socioemotional health risks.
In a systematic review of fifty studies from seventeen countries, researchers found that social media use is linked to body image concerns, eating disorders, and poor mental health among young individuals aged ten to twenty-four years. Social media exposure may lead to negative body image perceptions and contribute to the rising prevalence of eating disorders, emphasizing the potential global public health significance of this issue (Dane & Bhatia, 2023). Higher media use is predictive of a long list of other negative impacts including increased alcohol and tobacco use (Lewycka et al., 2018), earlier initiation of sexual behaviors (Smith et al., 2016), desensitization (or normalization) of certain negative content such as self-harming and disordered eating, increased risk of cyberbullying (as target or perpetrator), and sexting (Bozzola et al., 2023).
Sexting and Sexual Harassment
According to the CDC (2019), "sexual violence can occur in person, online, or via technology, as in the cases of posting or sharing sexual pictures of someone without their consent, or non-consensual sexting." Technology allows people to reach an audience virtually anywhere and at any time, and it is increasingly simple to involve someone by using images and/or videos. Teens report considerable pressure to sext (Abeele et al., 2014; Lunde & Joleby, 2023). Fifteen percent reported having sent a sext and 25 percent had received one (Giordano, et al., 2022). A recent study looked at how common abusive sexting is among Portuguese teens and the psychological traits of those involved, like emotional issues, signs of psychopathy, and past trauma (Barroso et al., 2021). Among twelve- to twenty-year-old participants, about 4.8 percent admitted to abusive sexting and 4.3 percent reported being victims. Abusive sexting was more frequent among males and those in midadolescence, and both perpetrators and victims had higher rates of emotional and behavioral problems, childhood abuse, and aggression (Barroso et al., 2021).
Abusive messages can easily be forwarded to large groups of recipients without the subject’s permission. The age of consent , which varies state to state and country to country, is the minimum age at which an individual can legally make decisions to engage in sexual behavior. In some U.S. states, it is a crime to merely receive a sext from someone under the age of consent, depending on the age difference between sender and recipient. According to the Cyberbullying Research Center, in twenty-seven of fifty U.S. states and the District of Columbia, the legal age of consent for sexual acts is sixteen years old and a sexting law is in place. In nine states the legal age for sexting is seventeen years old, and in eleven states, the age of consent is eighteen years old (CRC, 2022). Many teenagers believe it is acceptable to exchange sexts with someone they are dating or are sexually involved with, but this is not legally true.
Sending sexts can lead to serious social consequences if the images are shared or spread widely (Strasburger et al., 2019). When sexting occurs outside legal boundaries or includes coercion and pressure, it constitutes another form of sexual abuse and harassment, posing significant psychological risks for teens. Victims often experience anxiety, depression, and other mental health issues as a result. According to the Cyberbullying Research Center, approximately 12 percent of U.S. adolescents have been coerced into sending explicit images, highlighting the prevalence of this form of sexual victimization (Patchin & Hinduja, 2020).
Another form of sexual harassment is the use of deepfakes , digitally manipulated videos or images that create realistic but false representations of individuals. Sexually explicit deepfakes are of growing concern. Sharing them can be devastating to adolescents (Kristof, 2024). Victims can experience anxiety, depression, and harm to their personal and professional lives (Rousay, 2023). Protecting teens against sexual deepfakes requires a multifaceted approach, including educating them about the risks of sharing personal images online, promoting sufficient digital literacy to recognize and report deepfakes, and advocating for stronger legal protections and enforcement against their creation and distribution (Citron, 2019).
Best Practices for Healthy Media Use
How can we mitigate the risks associated with heavy media use? The American Academy of Pediatrics (AAP) (2016) recommends that pediatricians partner with parents and educators to communicate the effects of media, both positive and negative. Health-care professionals should also emphasize healthy activity levels (maximum of one hour of screen time per day) and adequate sleep for teens, recommend that children and teens not sleep with their electronic devices in their rooms, and advocate for media literacy programs in school curricula, youth organization programming, and family discussions.
The U.S. Surgeon General’s advisory emphasizes making policy and program changes at the government level, like advocating for media literacy curricula in schools, requiring strict data privacy protections by tech companies that create apps used by teens, and continuing to research and develop usage guidelines (United States Department of Health & Human Services, 2023). Families are urged to develop a family media plan that sets boundaries for technology use at home and to create “tech-free” zones and time periods, such as family meals. Parents should also model appropriate media use for their children.
While phones can be a major source of distraction due to games and social media, they also offer valuable resources for media consumption, such as audiobooks, music, educational apps, and news. By setting clear guidelines and discussing the importance of balance, parents can help their teens develop healthy habits (AAP, 2016). Encouraging responsible use means setting time limits, promoting tech-free family times, and discussing the potential risks and benefits of various apps and online activities (Rideout & Robb, 2018). Recreational apps and games can also promote relaxation and improve cognitive skills like problem-solving and hand-eye coordination.
One particular form of media deserves a special focus: music . Listening to music is one of the hallmark behaviors of adolescence, and music is a part of youth culture that helps to connect each cohort. Robert Sapolsky (1998) posited that our interest in new music wanes at around age thirty-five years, and that the music we listen to in our teenage years largely forms the basis for our lifelong musical preferences. One study found that listening to music was the most common strategy teens use for self-regulation (Saarikallio & Erkkila, 2007). Other reasons for playing music are for entertainment, sensation-seeking, relaxing, discharge of energy, diversion, and solace (Baltazar, 2019). Developing a set of musical preferences is another way adolescents can explore and develop their identities. It’s likely that teens (and adults) curate playlists in part so they can have music ready to help them cope with their changing emotional states (Cook et al., 2019). After a frustrating day at school, for example, a fifteen-year-old may listen to some heavy-metal music, nodding to the ferocious beats and discharging some of that negative energy, elevating her mood.
Education and Academic Achievement in Adolescent Development
During adolescence, youth undergo significant cognitive development , including improvements in abstract thinking, problem-solving abilities, and critical reasoning skills. Therefore, educational materials and requirements should be appropriately challenging to stimulate cognitive growth without being overwhelming. Goodness of fit in education refers to the compatibility or alignment between the educational environment and the needs, abilities, and characteristics of individual students. We know that students come from diverse backgrounds; thus, an optimal learning experience would occur when these factors are appropriately matched with the educational context. For instance, offering a variety of teaching techniques and resources to accommodate diverse learning preferences and personal circumstances. Additionally, adolescents benefit from incorporating breaks and varied activities to maintain engagement and prevent fatigue. Academic achievement outcomes are multifaceted and heavily influenced by environmental contexts including family and sociocultural factors and individual disparities.
Outcomes
What kinds of outcomes in academic achievement does schooling produce? The high school graduation rate for the United States overall was 86 percent in the 2018–2019 school year (NCES, 2021). This number has increased consistently since it was first tracked at the national level in 2011. Group-level differences were observed, however. For Asian-American/Pacific Islander students, the rate is 93 percent, for White students 89 percent, for Hispanic students 82 percent, for Black students 80 percent, and for Native American students 74 percent.
The U.S. Department of Education’s National Center for Education Statistics (NCES) produces The Nation’s Report Card , a semiannual snapshot of fourth-, eighth-, and twelfth-grade achievement in mathematics and reading, among other subject areas (NCES, 2021). The most recently available data for twelfth grade are for 2019, one year prior to the onset of the COVID-19 pandemic. For mathematics, 60 percent of twelfth-grade students met or exceeded the basic competence level nationwide, while just 24 percent met or exceeded what the NCES calls a “proficient” level of achievement (Figure 10.13). This represented a slight decrease in achievement compared with each assessment dating back to 2009. Males and females achieved at roughly similar levels.
There were significant mathematics achievement gaps between students from different ethnoracial groups, as well as for students from households with different parental levels of schooling, and also for students who were English-language learners. For example, students whose native language was not English showed the largest mathematics achievement gap compared to native English speakers. Finally, the greater the educational attainment of parents, the higher the mathematics achievement of their children: adolescent children of college-educated parents scored higher on average than children whose parents did not graduate from high school. Educational attainment is one of the main components of socioeconomic status , an indicator of the level of social and economic resources a person or family has at their disposal. To support students, it is imperative that governments provide access to high-quality early childhood education programs to help level the playing field for students from disadvantaged backgrounds. Addressing disparities in disciplinary actions and providing culturally responsive curriculum and instruction can foster the academic success of marginalized and disadvantaged students. Finally, socioeconomically disadvantaged students often demonstrate remarkable resilience and perseverance and are highly motivated to succeed academically with the goal to improve their circumstances (Anyaka, 2017).
By twelfth grade, we see similar patterns emerging for reading achievement (Figure 10.14). The NCES reports slight declines in reading achievement levels between 2015 and 2019 for male students and for those whose parents had some education beyond high school (NCES, 2021). Otherwise, scores and achievement gaps between groups were stable for twelfth graders across that time period. Gaps include a difference in favor of students whose parents had graduated from college versus students from homes where the parents did not finish high school, and large achievement gaps between native English speakers and English language learners and between Asian and Black students.
Sociodemographic Factors in Achievement Disparities
When the COVID-19 pandemic began in March 2020, children in the United States experienced major disruptions in schooling, particularly in socially and economically vulnerable groups (Bansak & Starr, 2021; Bailey et al., 2021; Maldonado & DeWitte, 2022). Parents from families with low incomes were more likely to be essential workers exposed to the COVID-19 virus and less likely to have access to high-quality health care (Berube & Bateman, 2020). Additionally, these families were less likely than families with higher income to have reliable internet access and computers at home, which made it harder for children in these homes to participate in online education (Stelitano et al., 2020).
Children in families with low income are also more likely to join public schools that lack the resources needed to support teachers in delivering high-quality online instruction. Additionally, parents with low income are less able to provide extra instructional support through private tutoring and other enrichment activities (Lee et al., 2021). Research from China and Indonesia indicates that students in rural regions experienced more negative impacts after school closures during the pandemic compared to students in urban areas (e.g., Pasani et al., 2021).
Black teens are often aware of the racialized nature of achievement disparities. They are frequently reminded of these disparities in their schools as well as on social media (Hope et al., 2015). For example, a longitudinal study noted that adolescents’ structural attributions (i.e., awareness of systemic and institutional factors that contribute to disparities) for racial achievement gaps increased from grade 10 to grade 12 (Bañales et al., 2020). However, when Black students recognize that such factors are rooted in historical and ongoing patterns of discrimination and inequality within educational systems and broader society, it works as an adaptive mechanism for their psychological development. When perceiving the causes of achievement disparities as external rather than internal, they see that their ability level is not fixed, which can help students establish a growth mindset and improve academic outcomes.
Ability grouping, also known as tracking , is a practice in education where students are placed into different classes or groups based on their perceived academic abilities or achievement levels. This practice involves assigning students into “tracks” based on their prior achievement or ability level (Loveless, 2013), such as “honors,” “regular,” or “remedial” classes, with each track offering varying levels of curriculum difficulty and academic rigor. The primary goal of this placement is to create a more uniform learning environment, allowing teachers to tailor their instruction more effectively to students’ needs and enabling students to benefit from interactions with their peers (Steenbergen-Hu et al., 2016). However, it can promote educational inequalities, perpetuate stereotypes, and reinforce self-fulfilling prophecies, wherein students internalize and conform to expectations associated with their assigned track; this is especially seen among students belonging to ethnic minority groups and students of lower SES (e.g., Francis et al., 2017; Peterson et al., 2016). Furthermore, such separating of students based on “ability” contributes to achievement gaps between different social groups, as stereotype threat disproportionately affects marginalized students who are targets of negative stereotypes. Stereotype threat refers to the phenomenon where individuals experience anxiety or fear of confirming negative stereotypes about their social group, which can impair their performance in academic or other achievement-related tasks (Spencer et al., 2016).
Link to Learning
Do stereotypes affect your test scores? Learn about how it turns out that stereotypes can affect you, whether you believe in them or not.
Familial and Sociocultural Factors in Academic Achievement and Disparities
The role of family, peer, and cultural influences on academic achievement trajectories is multifaceted and complex as myriad factors influence students’ beliefs, behaviors, and experiences. At the familial level, there are SES, parental education level, parental involvement, as well as parental expectations. For example, the level of parental involvement in a child’s education, including monitoring homework, attending school events, and communicating with teachers, is strongly associated with academic success (Harper et al, 2012).
At the social level, school climate , disciplinary practices, peer pressure, and influence of academic motivation are some of the forces that can drive a teen’s academic achievement trajectory. School climate is defined as “the quality and character of school life,” which is derived from “patterns of people’s experiences of school life and reflects norms, goals, values, interpersonal relationships, teaching, learning and leadership practices, and organizational structures” (Cohen et al., 2009, p. 182). Research shows that a positive school climate helps protect against the negative contribution of poor SES background on academic achievement (Berkowitz et al., 2017).
A longitudinal study conducted in Los Angeles high schools found that students who experienced authoritative school environments, characterized by high levels of support and structure, exhibited higher levels of self-efficacy and grit in subsequent years (Wong et al., 2021). Additionally, these students reported fewer depressive symptoms, less hopelessness, and reduced stress at school and about the future over time. The study highlights the significant association between a supportive and warm school climate and improved social-emotional health among adolescents. It suggests that interventions focusing on enhancing relationships with teachers and implementing supportive disciplinary practices may be beneficial for promoting the social-emotional well-being of students (Wong et al., 2021). Additionally, one’s cultural capital , cultural values and beliefs about education, and cultural identity impact academic performance and achievement trajectory. Specifically, cultural resources such as language, knowledge, values, and traditions passed down within communities can influence students’ academic achievement (e.g., Andersen & Jaeger, 2015).
School absenteeism (i.e., temporary periods of unexcused school absence) and permanent school dropout are both complex issues influenced by various risk factors that can occur at the individual, family, social, school, and community levels. According to the NCES (2018), 13 to 15 percent of eighth to twelfth graders were absent at least three days a month, and approximately 6 percent were absent at least five days a month. A comprehensive report from the U.S. Department of Education (2016) revealed that students with disabilities exhibited higher rates of chronic absenteeism compared to their peers without disabilities. Similarly, Native American and Pacific Islander students displayed a greater tendency for chronic absenteeism when compared to students from other racial and ethnic backgrounds. Additionally, non-ELL students were found to have a higher likelihood of chronic absenteeism in comparison to their ELL counterparts (Garcia & Weiss, 2018).
Link to Learning
Several years ago, Cleveland Public Schools discovered that over half of their students were persistently absent, missing at least 10 percent of school. Although they have made consistent efforts to tackle the issue, similar to many school districts nationwide, there is still considerable work to be done. Learn more about this issue at PBS News: Reduce chronic absenteeism from school and what districts are doing to help students attend more consistently.
Understanding the reasons why teens drop out of high school is fundamental to improving intervention efforts to promote graduation. Risk factors for school absenteeism include negative attitudes toward school, problematic substance use, both externalizing and internalizing behaviors, and limited parent-school involvement (Gubbels et al., 2019). In terms of dropout, risk factors include a history of poor academic achievement, lower IQ, and learning difficulties (Gubbels et al., 2019). In addition, earlier research found extreme parental permissiveness to be associated with higher rates of dropping out (Rumberger et al., 1990). In a similar vein, researchers conducted a survey with young adults who left high school prior to completion. The researchers identified several influential stressors that increased the decision to leave school including mobility, family dynamics, peer influences, school engagement and environment, health issues, and involvement in crime. Issues related to school engagement and the overall school environment were among the most common reasons (McDermott et al., 2019). Hence, addressing the risk factors for school absenteeism and dropout requires a comprehensive, multifaceted approach that involves collaboration between schools, families, communities, and policymakers.
Interventions
Of note is a large-scale intervention undertaken in the United States in the 1950s and 1960s, namely the racial integration of schools (Pickren, 2004; Stanley, 2017). In Brown v. Board of Education (1954), the U.S. Supreme Court ruled that “separate but equal” educational access and services were inherently unequal and ordered an end to racial segregation in the U.S. education system. By the mid-1970s, the first Black students who were young children at the time of the original ruling and its reaffirmation ten years later showed dramatic increases in academic achievement on national standardized tests.
What this highlights is that large-scale improvements in social status and access to resources, along with a general push toward leveling the socioeconomic playing field, can have a big impact on learning for minority subgroups. This evidence points a path forward: as societies address equity gaps in a variety of domains of life, we should see generational increases in achievement levels (Hanushek et al., 2019). Over time, group-level achievement gaps should close with continued prevention and intervention efforts focused on creating equity.
The Brown decision is an example of a large-scale, societywide intervention. Psychologists working in educational settings also focus on identifying individual-level psychological factors that have some bearing on educational outcomes. Some key ones include self-determination theory (Ryan & Deci, 2017), expectancy-value theory (Harackiewicz et al., 2016), the stereotype threat process (Spencer et al., 2016), the concept of self-efficacy (Bandura, 1997; Schöber et al., 2018), and the collection of achievement motivation ideas currently known as growth mindset (Dweck, 2017). Across these diverse psychological processes and applications, one theme emerges: a student’s level of achievement motivation is strongly sensitive to the social environment. Adolescent learners in particular are highly attuned to the achievement-related messages they receive from their peers, teachers, parents, and broader culture.
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3.A: Interference (Answers)
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3.1. \(3.63°\) and \(7.27°\), respectively
3.2. a. 853 nm, 1097 nm;
b. 731 nm, 975 nm
3.3. a. too small;
b. up to \(8×10^{−5}\)
Conceptual Questions
1. No. Two independent light sources do not have coherent phase.
3. Because both the sodium lamps are not coherent pairs of light sources. Two lasers operating independently are also not coherent so no interference pattern results.
5. Monochromatic sources produce fringes at angles according to \(dsinθ=mλ\). With white light, each constituent wavelength will produce fringes at its own set of angles, blending into the fringes of adjacent wavelengths. This results in rainbow patterns.
7. Differing path lengths result in different phases at destination resulting in constructive or destructive interference accordingly. Reflection can cause a \(180°\) phase change, which also affects how waves interfere. Refraction into another medium changes the wavelength inside that medium such that a wave can emerge from the medium with a different phase compared to another wave that travelled the same distance in a different medium.
9. Phase changes occur upon reflection at the top of glass cover and the top of glass slide only.
11. The surface of the ham being moist means there is a thin layer of fluid, resulting in thin-film interference. Because the exact thickness of the film varies across the piece of ham, which is illuminated by white light, different wavelengths produce bright fringes at different locations, resulting in rainbow colors.
13. Other wavelengths will not generally satisfy \(t=\frac{λ/n}{4}\) for the same value of t so reflections will result in completely destructive interference. For an incidence angle \(θ\), the path length inside the coating will be increased by a factor \(1/cosθ\) so the new condition for destructive interference becomes \(\frac{t}{cosθ}=\frac{λ/n}{4}\).
15. In one arm, place a transparent chamber to be filled with the gas. See Example 3.6.
Problems
17. \(0.997°\)
19. \(0.290μm\)
21. \(5.77×10^{−7}m=577nm\)
23. 62.5; since m must be an integer, the highest order is then \(m=62\).
25. \(1.44μm\)
27. a. \(20.3°\);
b. \(4.98°\);
c. 5.76, the highest order is \(m=5\).
29. a. 2.37 cm;
b. 1.78 cm
31. 560 nm
33. 1.2 mm
35. a. \(0.40°,0.53°\);
b. \(4.6×10^{−3}m\)
37. 1:9
39. 532 nm (green)
41. \(8.39×10^{−8}m=83.9nm\)
43. 620 nm (orange)
45. 380 nm
47. a. Assuming n for the plane is greater than 1.20, then there are two phase changes: 0.833 cm.
b. It is too thick, and the plane would be too heavy.
c. It is unreasonable to think the layer of material could be any thickness when used on a real aircraft.
49. \(4.55×10^{−4}m\)
51. \(D=2.53×10^{−6}m\)
Additional Problems
53. \(0.29°\) and \(0.86°\)
55. a. 4.26 cm;
b. 2.84 cm
57. 6
59. 0.20 m
61. 0.0839 mm
63. a. 9.8, 10.4, 11.7, and 15.7 cm;
b. 3.9 cm
65. \(0.0575°\)
67. 700 nm
69. 189 nm
71. a. green (504 nm);
b. magenta (white minus green)
73. 1.29
75. \(52.7μm\) and \(53.0μm\)
77. 125 nm
79. 413 nm and 689 nm
81. \(73.9μm\)
83. 47
85. \(8.5μm\)
87. \(0.013°C\)
Challenge Problems
89. Bright and dark fringes switch places.
91. The path length must be less than one-fourth of the shortest visible wavelength in oil. The thickness of the oil is half the path length, so it must be less than one-eighth of the shortest visible wavelength in oil. If we take 380 nm to be the shortest visible wavelength in air, 33.9 nm.
93. \(4.42×10^{−5}m\)
95. for one phase change: 950 nm (infrared); for three phase changes: 317 nm (ultraviolet); Therefore, the oil film will appear black, since the reflected light is not in the visible part of the spectrum.


2.6: Making the Offer
- Explain the steps in making the offer to the candidate.
Oftentimes once the decision is made to hire a candidate, HR professionals feel their job is finished. But making the offer to the chosen candidate can be equally as important as the interview process. If the offer is not handled properly, you can lose the candidate, or if the candidates takes the job, he or she could start off on the wrong foot.
According to Paul Falcone, vice president for human resources at the Fortune 500 company Time Warner, detailed information should be asked of the candidate before the offer is even made (Falcone, 2011). He says that as soon as the offer is made, power is shifted to the candidate. To handle this, he suggests asking salary questions in the interview, including the following:
- “If we were to make a job offer today, when would you be in a position to accept or reject the offer?” If the candidate answers “right now,” this indicates they do not have other job offers on the table or if they do, you are their first choice.
- “At what point, dollar wise, would you accept our job offer and at what point, dollar wise would you reject the offer?” The advantage of using this strategy is that it gets to the point of understanding the candidate’s expectations. If the interviewee does not respond right away, you can clarify by asking, “I am asking this question because I would like to gauge your interest level. Share with me the ideal salary offer versus at what point you would be willing to walk away from this opportunity.”
Asking these questions can assist in qualifying candidates, based on salary expectations. For example, if a candidate requests 20 percent more than you are able to pay for the job, this discussion can be had before the offer is even made, perhaps making this candidate no longer viable.
Once you have determined in the interview process that the salary expectation is in the range of what you can offer, the first step is to make the offer as soon as the decision is made. In a tight labor market, waiting a week or two may impact your ability to hire your first choice. You probably already have a salary range in mind and can begin to narrow down the offer based on the individual’s KSAOs. Based on the range of salary you can offer, consider the following questions when making the offer to a candidate:
- What is the scarcity of the particular skills set?
- What are the “going” wages in your geographic area?
- What are the current economic conditions?
- What is the current pay for similar positions in your organization?
- What is your organizational compensation strategy?
- What is the fair market value of the job?
- What is the level of the job within the organization?
- What are your budget constraints?
- How soon will the employee be productive in the organization?
- Are there other candidates equally qualified that might have lower salary expectations?
- What are the national and regional unemployment rates?
- If you cannot pay more, can you offer other perks such as a signing bonus or flexible work schedule?
Once the offer has been made, it is reasonable to give the candidate some time to decide, but not too long, as this can result in losing other candidates should this candidate reject the job offer. It is likely the candidate may come back and ask for higher salary or benefits. Some tips to successfully negotiate are included below and in the following Video:
- Be prepared. Know exactly what you can and can’t offer.
- Explain the career growth the organization can provide.
- Address the benefits of the candidate’s joining the organization.
- Discuss the entire offer, including other benefits offered to the employee.
- View the negotiation as a win-win situation.
- Be able to provide salary research of similar positions and competitors for the same job title.
- Use the trading technique. For example, “I cannot offer you the salary you are requesting right now, but what if we were able to review salary at your six-month performance review, assuming ____ objectives are met?”
Once the phone call is made and the candidate accepts the offer, an e-mail or formal letter should follow, outlining details of the employment agreement. The employment agreement or offer letter should include the following:
- Job title
- Salary
- Other compensation, such as bonuses or stock options
- Benefits, such as health-care coverage, 401(k)
- Vacation time/paid holidays
- Start date
- Noncompete agreement expectations
- Additional considerations such as relocation expenses
Once the pay and benefits package has been successfully negotiated and the offer letter (or e-mail) sent, you should clarify acceptance details in writing and receive confirmation of the start date. It is not unusual for people in higher-level positions to need a month or even two to transition from their old jobs. During this period, make sure to stay in touch and even complete the new hire paperwork in the meantime.
Pirates of the Caribbean Negotiation Analysis
This lively video, using the movie Pirates of the Caribbean , offers great analysis and tips on how to successfully negotiate just about anything.
- The HR professional’s job isn’t finished once the selection is made. The next step is to actually make the offer. This step is important, because if it isn’t done properly, you could lose the candidate or have ill feelings at the onset of the employment relationship.
- Once you have made the decision to hire someone, make the offer to the candidate right away. Normally this is done through a phone call and a follow-up e-mail, outlining the details of the offer.
- It is not unusual for someone to negotiate salary or benefits. Know how far you can negotiate and also be aware of how your current employees will be affected if you offer this person a higher salary.
- If you are having trouble coming to an agreement, be creative in what you can offer; for example, offer flextime instead of higher pay.
- Research “salary negotiation” on the Internet. What tips are provided for job seekers? Do you think these same tips could apply to the HR professional? Why or why not?
References
Falcone, P., “The New Hire: Five Questions to Ask before Making the Job Offer,” n.d., Monster.com, accessed July 13, 2011, http://hiring.monster.com/hr/hr-best-practices/recruiting-hiring-advice/acquiring-job-candidates/making-a-job-offer.aspx .


28.5: Changes During Pregnancy, Labor, and Birth
By the end of this section, you will be able to:
- Explain how estrogen, progesterone, and hCG are involved in maintaining pregnancy
- List the contributors to weight gain during pregnancy
- Describe the major changes to the maternal digestive, circulatory, and integumentary systems during pregnancy
- Summarize the events leading to labor
- Identify and describe each of the three stages of childbirth
A full-term pregnancy lasts approximately 270 days (approximately 38.5 weeks) from conception to birth. Because it is easier to remember the first day of the last menstrual period (LMP) than to estimate the date of conception, obstetricians set the due date as 284 days (approximately 40.5 weeks) from the LMP. This assumes that conception occurred on day 14 of the menstrual cycle, which is usually a good approximation. The 40 weeks of an average pregnancy are usually discussed in terms of three trimesters , each approximately 13 weeks. During the second and third trimesters, the pre-pregnancy uterus—about the size of a fist—grows dramatically to contain the fetus, causing a number of anatomical changes in the pregnant person (Figure \(\PageIndex{1}\)).
Effects of Hormones
Virtually all of the effects of pregnancy can be attributed in some way to the influence of hormones—particularly estrogens, progesterone, and hCG. During weeks 7–12 from the LMP, the pregnancy hormones are primarily generated by the corpus luteum. Progesterone secreted by the corpus luteum stimulates the production of decidual cells of the endometrium that nourish the blastocyst before placentation. As the placenta develops and the corpus luteum degenerates during weeks 12–17, the placenta gradually takes over as the endocrine organ of pregnancy.
The placenta converts weak androgens secreted by the maternal and fetal adrenal glands to estrogens, which are necessary for pregnancy to progress. Estrogen levels climb throughout the pregnancy, increasing 30-fold by childbirth. Estrogens have the following actions:
- They suppress FSH and LH production, effectively preventing ovulation. (This function is the biological basis of hormonal birth control pills.)
- They induce the growth of fetal tissues and are necessary for the maturation of the fetal lungs and liver.
- They promote fetal viability by regulating progesterone production and triggering fetal synthesis of cortisol, which helps with the maturation of the lungs, liver, and endocrine organs such as the thyroid gland and adrenal gland.
- They stimulate maternal tissue growth, leading to uterine enlargement and mammary duct expansion and branching.
Relaxin, another hormone secreted by the corpus luteum and then by the placenta, helps prepare the body for childbirth. It increases the elasticity of the symphysis pubis joint and pelvic ligaments, making room for the growing fetus and allowing expansion of the pelvic outlet for childbirth. Relaxin also helps dilate the cervix during labor.
The placenta takes over the synthesis and secretion of progesterone throughout pregnancy as the corpus luteum degenerates. Like estrogen, progesterone suppresses FSH and LH. It also inhibits uterine contractions, protecting the fetus from preterm birth. This hormone decreases in late gestation, allowing uterine contractions to intensify and eventually progress to true labor. The placenta also produces hCG. In addition to promoting survival of the corpus luteum, hCG stimulates the male fetal gonads to secrete testosterone, which is essential for the development of the male reproductive system.
The anterior pituitary enlarges and ramps up its hormone production during pregnancy, raising the levels of thyrotropin, prolactin, and adrenocorticotropic hormone (ACTH). Thyrotropin, in conjunction with placental hormones, increases the production of thyroid hormone, which raises the maternal metabolic rate. This can markedly augment a pregnant person's appetite and cause hot flashes. Prolactin stimulates enlargement of the mammary glands in preparation for milk production. ACTH stimulates maternal cortisol secretion, which contributes to fetal protein synthesis. In addition to the pituitary hormones, increased parathyroid levels mobilize calcium from maternal bones for fetal use.
Weight Gain
The second and third trimesters of pregnancy are associated with dramatic changes in maternal anatomy and physiology. The most obvious anatomical sign of pregnancy is the dramatic enlargement of the abdominal region, coupled with weight gain. This weight results from the growing fetus as well as the enlarged uterus, amniotic fluid, and placenta. Additional breast tissue and dramatically increased blood volume also contribute to weight gain (Table \(\PageIndex{1}\)). Surprisingly, fat storage accounts for only approximately 2.3 kg (5 lbs) in a normal pregnancy and serves as a reserve for the increased metabolic demand of breastfeeding.
During the first trimester, a pregnant person does not need to consume additional calories to maintain a healthy pregnancy. However, a weight gain of approximately 0.45 kg (1 lb) per month is common. During the second and third trimesters, the appetite increases, but it is only necessary to consume an additional 300 calories per day to support the growing fetus. Most pregnant people gain approximately 0.45 kg (1 lb) per week.
| Component | Weight (kg) | Weight (lb) |
|---|---|---|
| Fetus | 3.2–3.6 | 7–8 |
| Placenta and fetal membranes | 0.9–1.8 | 2–4 |
| Amniotic fluid | 0.9–1.4 | 2–3 |
| Breast tissue | 0.9–1.4 | 2–3 |
| Blood | 1.4 | 4 |
| Fat | 0.9–4.1 | 3–9 |
| Uterus | 0.9–2.3 | 2–5 |
| Total | 10–16.3 | 22–36 |
Changes in Organ Systems During Pregnancy
As the body adapts to pregnancy, characteristic physiologic changes occur. These changes can sometimes prompt symptoms often referred to collectively as the common discomforts of pregnancy.
Digestive and Urinary System Changes
Nausea and vomiting, sometimes triggered by an increased sensitivity to odors, are common during the first few weeks to months of pregnancy. This phenomenon is often referred to as “morning sickness,” although the nausea may persist all day. The source of pregnancy nausea is thought to be the increased circulation of pregnancy-related hormones, specifically circulating estrogen, progesterone, and hCG. Decreased intestinal peristalsis may also contribute to nausea. By about week 12 of pregnancy, nausea typically subsides.
A common gastrointestinal complaint during the later stages of pregnancy is gastric reflux, or heartburn, which results from the upward, constrictive pressure of the growing uterus on the stomach. The same decreased peristalsis that may contribute to nausea in early pregnancy is also thought to be responsible for pregnancy-related constipation as pregnancy progresses.
The downward pressure of the uterus also compresses the urinary bladder, leading to frequent urination. The problem is exacerbated by increased urine production. In addition, the maternal urinary system processes both maternal and fetal wastes, further increasing the total volume of urine.
Circulatory System Changes
Blood volume increases substantially during pregnancy, so that by childbirth, it exceeds its preconception volume by 30 percent, or approximately 1–2 liters. The greater blood volume helps to manage the demands of fetal nourishment and fetal waste removal. In conjunction with increased blood volume, the pulse and blood pressure also rise moderately during pregnancy. As the fetus grows, the uterus compresses underlying pelvic blood vessels, hampering venous return from the legs and pelvic region. As a result, many pregnant people develop varicose veins or hemorrhoids.
Respiratory System Changes
During the second half of pregnancy, the respiratory minute volume (volume of gas inhaled or exhaled by the lungs per minute) increases by 50 percent to compensate for the oxygen demands of the fetus and the increased maternal metabolic rate. The growing uterus exerts upward pressure on the diaphragm, decreasing the volume of each inspiration and potentially causing shortness of breath, or dyspnea. During the last several weeks of pregnancy, the pelvis becomes more elastic, and the fetus descends lower in a process called lightening . This typically ameliorates dyspnea.
The respiratory mucosa swell in response to increased blood flow during pregnancy, leading to nasal congestion and nose bleeds, particularly when the weather is cold and dry. Humidifier use and increased fluid intake are often recommended to counteract congestion.
Integumentary System Changes
The dermis stretches extensively to accommodate the growing uterus, breast tissue, and fat deposits on the thighs and hips. Torn connective tissue beneath the dermis can cause striae (stretch marks) on the abdomen, which appear as red or purple marks during pregnancy that fade to a silvery white color in the months after childbirth.
An increase in melanocyte-stimulating hormone, in conjunction with estrogens, darkens the areolae and creates a line of pigment from the umbilicus to the pubis called the linea nigra (Figure \(\PageIndex{2}\)). Melanin production during pregnancy may also darken or discolor skin on the face to create a chloasma, or “mask of pregnancy.”
Physiology of Labor
Childbirth, or parturition , typically occurs within a week of the due date, unless the pregnancy involves more than one fetus, which usually causes labor to begin early. As a pregnancy progresses into its final weeks, several physiological changes occur in response to hormones that trigger labor.
First, recall that progesterone inhibits uterine contractions throughout the first several months of pregnancy. As the pregnancy enters its seventh month, progesterone levels plateau and then drop. Estrogen levels, however, continue to rise in the maternal circulation (Figure \(\PageIndex{3}\)). The increasing ratio of estrogen to progesterone makes the myometrium (the uterine smooth muscle) more sensitive to stimuli that promote contractions (because progesterone no longer inhibits them). Moreover, in the eighth month of pregnancy, fetal cortisol rises, which boosts estrogen secretion by the placenta and further overpowers the uterine-calming effects of progesterone. Some people may feel the result of the decreasing levels of progesterone in late pregnancy as weak and irregular peristaltic Braxton Hicks contractions , also called false labor. These contractions can often be relieved with rest or hydration.
A common sign that labor will be short is the so-called “bloody show.” During pregnancy, a plug of mucus accumulates in the cervical canal, blocking the entrance to the uterus. Approximately 1–2 days prior to the onset of true labor, this plug loosens and is expelled, along with a small amount of blood.
Meanwhile, the posterior pituitary has been boosting its secretion of oxytocin, a hormone that stimulates the contractions of labor. At the same time, the myometrium increases its sensitivity to oxytocin by expressing more receptors for this hormone. As labor nears, oxytocin begins to stimulate stronger, more painful uterine contractions, which—in a positive feedback loop—stimulate the secretion of prostaglandins from fetal membranes. Like oxytocin, prostaglandins also enhance uterine contractile strength. The fetal pituitary also secretes oxytocin, which increases prostaglandins even further. Given the importance of oxytocin and prostaglandins to the initiation and maintenance of labor, it is not surprising that, when a pregnancy is not progressing to labor and needs to be induced, a pharmaceutical version of these compounds (called pitocin) is administered by intravenous drip.
Finally, stretching of the myometrium and cervix by a full-term fetus in the vertex (head-down) position is regarded as a stimulant to uterine contractions. The sum of these changes initiates the regular contractions known as true labor , which become more powerful and more frequent with time. The pain of labor is attributed to myometrial hypoxia during uterine contractions.
Stages of Childbirth
The process of childbirth can be divided into three stages: cervical dilation, expulsion of the newborn, and afterbirth (Figure \(\PageIndex{4}\)).
Cervical Dilation
For vaginal birth to occur, the cervix must dilate fully to 10 cm in diameter—wide enough to deliver the newborn’s head. The dilation stage is the longest stage of labor and typically takes 6–12 hours. However, it varies widely and may take minutes, hours, or days, depending in part on whether the person has given birth before; in each subsequent labor, this stage tends to be shorter.
True labor progresses in a positive feedback loop in which uterine contractions stretch the cervix, causing it to dilate and efface, or become thinner. Cervical stretching induces reflexive uterine contractions that dilate and efface the cervix further. In addition, cervical dilation boosts oxytocin secretion from the pituitary, which in turn triggers more powerful uterine contractions. When labor begins, uterine contractions may occur only every 3–30 minutes and last only 20–40 seconds; however, by the end of this stage, contractions may occur as frequently as every 1.5–2 minutes and last for a full minute.
Each contraction sharply reduces oxygenated blood flow to the fetus. For this reason, it is critical that a period of relaxation occur after each contraction. Fetal distress, measured as a sustained decrease or increase in the fetal heart rate, can result from severe contractions that are too powerful or lengthy for oxygenated blood to be restored to the fetus. Such a situation can be cause for an emergency birth with vacuum, forceps, or surgically by Caesarian section.
The amniotic membranes rupture before the onset of labor in about 12 percent of people; they typically rupture at the end of the dilation stage in response to excessive pressure from the fetal head entering the birth canal.
Expulsion Stage
The expulsion stage begins when the fetal head enters the birth canal and ends with birth of the newborn. It typically takes up to 2 hours, but it can last longer or be completed in minutes, depending in part on the orientation of the fetus. The vertex presentation known as the occiput anterior vertex is the most common presentation and is associated with the greatest ease of vaginal birth. The fetus faces the maternal spinal cord and the smallest part of the head (the posterior aspect called the occiput) exits the birth canal first.
In fewer than 5 percent of births, the infant is oriented in the breech presentation, or buttocks down. In a complete breech, both legs are crossed and oriented downward. In a frank breech presentation, the legs are oriented upward. Before the 1960s, it was common for breech presentations to be delivered vaginally. Today, most breech births are accomplished by Caesarian section.
Vaginal birth is associated with significant stretching of the vaginal canal, the cervix, and the perineum. Until recent decades, it was routine procedure for an obstetrician to numb the perineum and perform an episiotomy , an incision in the posterior vaginal wall and perineum. The perineum is now more commonly allowed to tear on its own during birth. Both an episiotomy and a perineal tear need to be sutured shortly after birth to ensure optimal healing. Although suturing the jagged edges of a perineal tear may be more difficult than suturing an episiotomy, tears heal more quickly, are less painful, and are associated with less damage to the muscles around the vagina and rectum.
Upon birth of the newborn’s head, an obstetrician will aspirate mucus from the mouth and nose before the newborn’s first breath. Once the head is birthed, the rest of the body usually follows quickly. The umbilical cord is then double-clamped, and a cut is made between the clamps. This completes the second stage of childbirth.
Afterbirth
The delivery of the placenta and associated membranes, commonly referred to as the afterbirth , marks the final stage of childbirth. After expulsion of the newborn, the myometrium continues to contract. This movement shears the placenta from the back of the uterine wall. It is then easily delivered through the vagina. Continued uterine contractions then reduce blood loss from the site of the placenta. Delivery of the placenta marks the beginning of the postpartum period—the period of approximately 6 weeks immediately following childbirth during which the body gradually returns to a non-pregnant state. If the placenta does not birth spontaneously within approximately 30 minutes, it is considered retained, and the obstetrician may attempt manual removal. If this is not successful, surgery may be required.
It is important that the obstetrician examines the expelled placenta and fetal membranes to ensure that they are intact. If fragments of the placenta remain in the uterus, they can cause postpartum hemorrhage. Uterine contractions continue for several hours after birth to return the uterus to its pre-pregnancy size in a process called involution , which also allows the abdominal organs to return to their pre-pregnancy locations. Breastfeeding facilitates this process.
Although postpartum uterine contractions limit blood loss from the detachment of the placenta, the person who has recently given birth does experience a postpartum vaginal discharge called lochia . This is made up of uterine lining cells, erythrocytes, leukocytes, and other debris. Thick, dark, lochia rubra (red lochia) typically continues for 2–3 days, and is replaced by lochia serosa, a thinner, pinkish form that continues until about the tenth postpartum day. After this period, a scant, creamy, or watery discharge called lochia alba (white lochia) may continue for another 1–2 weeks.


16.4: Learning Activities
Learning Activities
(Answers to “Learning Activities” can be found in the “Answer Key” at the end of the book. Answers to interactive activity elements will be provided within the elements as immediate feedback.)
1. You are caring for an elderly patient who is complaining of pain, severe nausea, and who has difficulty swallowing. In addition to intravenous medication administration, what route of medication delivery might be beneficial for this patient? Please provide rationale for your selection.
2. Which of the following transdermal medication administration actions are correct? (Select all that apply).
- The nurse may apply heat to all medication patches to help aid absorption of the medication.
- When placing a patch, the nurse should press the patch firmly to the skin to ensure adequate adherence.
- Gloves are required for patch application and removal.
- Transdermal patches may be placed directly into the trash.
- Date and location of patch application should be promptly documented in the medication administration record (MAR).
Check your knowledge with this flashcard learning activity:
Query \(\PageIndex{1}\)
Check your knowledge with these quiz questions:
Query \(\PageIndex{2}\)