15. 16. 17. 18. 19. Years old. The ages of patients I have currently that are with child. Prior to a year ago the youngest pregnant woman I cared for was 18~pure luck, I know. But, starting 6 weeks ago this all changed. My nurse teases that there is a bright yellow sign outside advertising that I am running a teen clinic. The harsh reality is that I am really, really struggling with it all. And I think this is for multiple reasons. I know it is, in fact. It is not merely because these are children having babies….there is more to it than that. But. I’d be lying if the whole teen pregnancy thing doesn’t hit close to home. Our niece Heather (read about Heather here) is 16 and has a 7 month old and the truth is that although I will never (NEVER) look at a baby as a mistake, Heather made a bad decision~which brought to our family Alexia. The thing is this: Alexia is a beautiful, bright baby girl that has effected Adam’s family tremendously. While no one can imagine life without her now, she literally upended my in-laws life. She completely changed my sister-in-laws life. You see, Heather was not the only one changed by Alexia….they all were. Life as my in-laws knew it changed. They aren’t just grandparents, they are practically parents all over again and believe you me~that wasn’t their intention. This gorgeous baby resulted in such a trickle down effect onto so many people. This is what terrifies me the most about teen pregnancy.
I worry if these girls will finish school. Will they even get their GED? I worry about their self-esteem because I know (I KNOW) that there are peers that tease and make fun of their pregnant selves. To me there is very little more beautiful than a pregnant belly but to a teenager it is horrific much of the time. I worry that he won’t stick around because lets just face it, the statistics show he often does not. I worry that they will not know what is a warning sign and let me know in time-both during their pregnancy and after. I worry they will get pregnant again because I know research shows that girls that have a baby as a teenager are most likely to have a second child by their first baby’s second birthday. I worry about their little sisters because research has shown that they will be more likely to also become a teen mom. I worry that for some reason they will require a cesarean birth~MAJOR abdominal surgery for such a young person. I think to myself when they go into labor, man oh man we have to have a successful vaginal delivery so she can get back to school soon as a cesarean birth will delay that and what if she doesn’t go back then. What if? All of these darn what ifs haunt me.
And there is so much more. Like breastfeeding. I can hardly really push breastfeeding on an adolescent that needs to be in school. When will she pump and how can I even expect that of a child. Think of the ridicule. And who will take care of that baby when it is sick-its Mama will have to miss school.
And then there is my patience. I need more of it. I have and always have had soooo much passion for obstetrics and the labor and delivery process that I want my patients to feel that I am there for them their entire pregnancy adventure. In order for this to occur I give them my cell phone number, Adam’s too in case I don’t hear my phone. I have always done this and have always told them there is no such thing as a stupid question. Call me anytime 24/7, text me, whatever works for you is what I tell them. I have always figured it better for my patients to call me and ask questions then to call the hospital and talk to a nurse that does not know them, know where they are at in their pregnancy, know any personal dynamics they may have, etc. But with teen pregnancy I am finding this is much more demanding on myself. They have more questions and praise God that they ask and thank God they feel they can ask me. That is what I tell them, right? But there are so many more calls, more texts, etc. I have had to stop and remind myself in my text replies that I am texting to an adolescent and avoid as Adam says “texting with an attitude”.
And how do I teach them? I recently held a “revised” Births R Us class. After all I cannot (should not) talk to them about the natural prostaglandin effect sperm will have on their cervix helping it to soften for delivery. I should not talk to them about when it is safe to resume sex after delivery and the $600 DVD I use in class has NO teenagers in it. This bothers me. They are all grown women with fantastic support persons (Husbands, significant others) by their side. Can a teenager even relate to this DVD? Do I need to change my teaching style completely? And if so, how? Make it more serious? More fun? Of course, my classes already have a mix of both I think but is it the right mix for a teenager? Because if not, she will not get out of the class what she needs….what she deserves to have her best birth experience. And being Lamaze International Certified, I had hoped they would have more resources for me but they don’t. The college (American College of Obstetricians and Gynecology) doesn’t even have much available.
My labor and delivery hospital privileges here are different than in my previous practice. I am way more restricted here. Staying upright and moving while laboring is difficult when hooked up to continuous monitoring which is often required at this facility. Squatting (which has been proven to open a woman’s pelvis by up to 25%, creating 1-2cm more space) to help open these young adolescent, non-adult pelvises is difficult when their delivering physician prefers them to be in stirrups for their delivery. Don’t get me wrong~I am NOT a certified nurse midwife and therefore my physician counterparts most DEFINITELY have more say, more authority and all but two have more years of experience in labor and delivery. They ARE good at what they are do. These are fabulous physicians, people. They ARE. It is just that we all practice differently. Which is the same in EVERY type of medicine, every ailment, etc may be managed differently by each and every one of us. That is, after all, what makes a good medical practice good. Having a variety of providers with different personalities for patients to choose from is paramount.
A year ago I was at a crossroads in my career. I was in between deciding upon sticking with family medicine vs. getting my nurse midwifery certificate. That is how much obstetrics meant to me. It feels different now, though. Now I almost dread my obstetric patients and I am not for sure why. I do not know what to do. When the 19 year old first came to me and I told my Husband I had another pregnant teen he said to me, “I don’t know what it is but I think God has something planned for you. He is obviously sending these teens to you for a reason”. My initial response (literally), “I’m not interested”. My nurse told me that if I was going to argue with God she was shutting my office door to leave me alone-Ha!
I think Adam is right. He does have a plan for me but Adam and I have been talking more and more about it and are wondering if it maybe might be that I don’t do obstetrics anymore???? Or am I just being a weenie? When the going gets tough (tough patients, more needy patients), I decide to run? But do I want this in my life? And if you do obstetrics you don’t get to choose your patients. Your patients choose you. Do I maybe just set more boundaries? Ie: no longer give out my numbers???? No longer promise to labor with them by their side, often lasting all night. I honestly-very truly–CANNOT imagine practicing medicine without obstetrics so I know I will NEVER just give it up. I somehow just need to “restructure” my self to better adapt to my patients.
With school starting we have been doing sports physicals like crazy. In the past couple of weeks I have had both a 13 year old girl and boy readily admit to me that they are sexually active. A 14 year old girl came in to actually get birth control-thank God. It is frightening to me. And the trouble is that not all of these teen pregnancies are local. They are from 4 different towns so it isn’t like I can go to the school nurse and talk to her about starting a “safe sex” campaign here in our local school system because it is more wide-spread than that.
What to do? Grrrrrr. One thing is for sure, if you are reading this and have a preadolescent or adolescent child please (PRETTY PLEASE) talk to them about sex. Do not be ignorant to the fact that they will most likely be sexually active during their adolescence as I believe the most recent study I read (I’m pretty sure anyways) says 78% of them WILL have sex before the age of 18. Scary stuff. While I, too, wish they would abstain and wait until marriage like I chose the reality is that they most likely will not and we need to arm them with the knowledge/means, etc to prevent pregnancy (and std’s for that matter).
Well, now that I have rambled on and on I will leave you with this one final thought. At the Women of Faith conference they talked about how research shows that kids that regularly attend youth group are just as likely to be sexually active as those that do not. Wow.