“God has something planned for you…”

I came across this and I am sure it is a spoof although Barbie DID sell a pregnant friend named Midge several years back-she was pulled from most retailers, thankfully.

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 trulyCANNOT 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.

Teen pregnancy: Close in our hearts

This post has been in my mind/heart for days, weeks and months. Typing it and putting it into words is a different thing. A difficult thing. Where to start-you see? Difficult already!!!

First let me say that we love all of our nieces and nephews as if they were our own children. While there are many, many other reasons we do not have a child of ours yet there IS one thing for sure and it is that we have always had these wonderful children around us that we love so very much and therefore have very rarely felt like we were lacking our own. Bad choices are made, yes. By all of us, including me. Including Adam. Including these children that we love. We and these children all learn by these choices and will hopefully be stronger, more productive because of them.

Now, our story.

MISSISSIPPI is ranked 3rd in the United States for teen pregnancy. In general the states that have the highest teen pregnancy rates are in the southern part of the US. One high school a mere 45 minute drive from where our family in Mississippi lives has a 26% teen pregnancy rate. This school has hired an additional 5 social workers to assist in “identifying pregnant teens and showing them resources”. Seems backwards to me. I am glad that they are going to try to identify these girls as early on as possible but shouldn’t they be focusing on preventing pregnancy instead?

What about Teen Mom on MTV? Just last week they announced that  the current teen mom on the show has three friends (all of whom who are teens) are pregnant, too.

Is it an epidemic? Is there more teen pregnancies in certain areas in the south because the education levels are lower? There is less for teens to do, activity-wise? Religion, perhaps? In general, do they think a pregnancy bump is “cute”? Do they want a little baby to dress up and don’t think about the actual hard-core care part of being a teen-parent (or any aged parent for that case!)? Lack of education of contraception use? Poor parenting? OR. Are teens just going to do what they are going to do? I have some of my own thoughts.

In Mississippi where our family is there are very few safe activities available for adolescents to do. There are very few sports. There is not a YMCA. You can play softball but that is pretty much it. There is a movie theater that is a 45 minute drive. That is if you have the money to go. I imagine teens must get bored.  Mississippi is a very poor state. The public schools are not safe. The private schools are very, very expensive. Religion is huge in Mississippi. My own Father-in-law is a preacher, in fact having two churches. Abstinence of course is preached. I imagine contraception is often not discussed between parents and children. As there are not as many sports I imagine there are not sports physicals required each summer like there are where I have always lived. When I do sports physicals on adolescents I take advantage of those few precious moments with that teen and zone in on sex, protection, pregnancy prevention, std’s, etc. In fact, now that I think about it…..I remember them doing that in Whitefish, Montana when I had to have my yearly sports physical in high school.

This is Heather. I remember the day Heather was born, I was outside the hospital room. Adam and I were dating and had just become engaged in fact. She and her little sister spent last July with Adam and I and we spoiled them rotten like you would not believe. We all had a wonderful time. We knew she wanted to be a veterinarian so we had arranged for her to spend a day with our vet in Lincoln before she came to stay with us. I took her shopping for scrubs and here she is before we went to Lincoln. She was so, so excited. This is one of a TON of shots as she twirled around on the deck! When I picked her up later that day she had somehow decided she wanted to be a large animal vet-hmmm….go figure. Before she came to visit with us she didn’t know she could do it but after we talked about how scholarships work and the schools that had vet programs, etc..she was very excited.

We now know that while with us in July she was already far enough along that she was having some morning sickness. In hindsight, Uncle Adam and I recall one specific morning at Worlds of Fun!!! And, it was always soooooo hard to get her to wake up. She was very, very tired....

Because of the cost of private school, Heather home schools.

Meet Alexia Hope. Alexia is Heather’s daughter. 16 days old now, born 5 weeks early. A very high-risk complicated pregnancy. Born via csection due to risk of stroke to Heather. Alexia came home when she was 10 days old and weighed 4lbs 6oz when she came home. We praise God that she is healthy and that Heather is now all better because she wasn’t. She was very sick for the last several months. Children are not meant to have children. Their underdeveloped bodies are simply not ready. Heather had pre-eclampsia, she had supraventricular tachycardia (SVT), intrauterine growth retardation-she was on catergory c cardiac medications just to get far enough in the pregnancy until it was safe enough to deliver Alexia. Heather landed in the ICU after delivery but has done remarkable since. Once again we are blessed.

But. Heather turned 16 a month ago and has a high-risk newborn daughter now. She has completed 9th grade. Adam’s sister and his Mom are helping. This IS how it will work (it takes a village after all). There will be no other way. She is now trying to figure out how to get her GED someday and is thinking about maybe going to a local community college to be an LPN to be able to buy things her baby needs. She already likes to take her baby to her friend’s house so they can see her but Heather doesn’t have a driver’s license so she has to rely on Adam’s sister. Again, a reminder that she is still a child.

Although a child, she is still a mama that is definitely in love with the baby that was in her for all of those months. She puts pictures on her facebook and says I am in love with her. I can tell it is legitimate and she has bonded very well. She did not handle leaving the hospital before Alexia well AT ALL. She only got to go back twice per day to feed her and she was tormented with missing her.

I am saddened in just a quick view of some of her facebook friends when I see a couple of other teens either pregnant or that already have a baby talking to one another about how they can’t wait to see each other’s pregnant tummy, etc.  I think that teen pregnancy is a multi-factorial issue. It starts at home most definitely but social exposure also plays a role. Adolescents need entertainment. We are happy to say that Heather’s little sister will be attending private school next year, thank you Nana and Pawpaw.

We are happy our Heather and Alexia is healthy. A bumpy road may be ahead, yes but ultimately though a beautiful child is here now and in our lives and we have our first great niece….Alexia Hope.