Wednesday, July 7, 2010

Babies Having Babies

She was 15 years old. She looked like any other youthful teeny bopper, with her silly band bracelets and hot pink nail polish. She should have been at home, in bed, dreaming about the Jonas Brothers, her high school crush, or what she was going to wear to school in the morning. Instead it was 3:00am and she was in our Triage, alone, and 30 weeks pregnant. She sat tearfully on the hospital gurney as the contractions came and went every 3 minutes. Like clockwork.

Concerned she may have broken her water, I did a speculum exam. Through a dilated cervix and amniotic membrane, I saw a head of hair. It was then that I knew my patient was going to deliver early. By the morning, this baby was going to be a mother.

Explaining the implications of delivering an infant 2 ½ months early to a 15 year old girl was not easy. I’m not sure if it was the fact that she was alone, in pain, or still a baby herself, but nothing I said seemed to sink in.

I explained, in the simplest way I could, that we were going to give her steroids in an effort to mature the baby’s lungs prior to delivery. I talked about the role of tocolytics and its purpose in slowing down the labor long enough to give steroids. I discussed the role of magnesium in protecting the baby from the perils of cerebral palsy. After all was said and done, she looked up at me blankly. Her only response was, “Can I take this off now?” referring to the fetal monitoring system attached to her belly. The next question that followed, “Can I just get a c-section now?”

Her lack of insight was profound. I pulled out my doctoring skills, asked her to tell me what she understood about what was happening. She recited back to me the facts of the situation at hand. Her explanation, brief and without detail, was notably void of any emotion or understanding about the gravity of delivering a 30 week infant.

“Do you have any family with you?”
I asked. “Can you call anyone to be with you right now?” Apparently her mother had dropped her off at the Emergency Room and left. Despite several phone calls by both the patient and the resident team, she failed to show up. Our young friend delivered a 2 ½ lb baby girl, alone, at 9:00am the next morning.

Anyone who argues against comprehensive sex education, condom distribution in schools, or unlimited access to family planning for minors needs to meet patients like these. These are young girls with little to no family support or financial resources. Their neurologic development will not be complete until their early 20s. Most of them lack the maturity or understanding it takes to raise a child. Their bodies, underdeveloped for childbearing, put them at risk for severe pregnancy complications like preeclampsia, obstructed labor, and having low birth weight babies. Having a child drastically decreases their likelihood of completing high school and increases their likelihood of relying on public assistance in the long term.

There is also a gender issue here – it takes both a man and a woman to achieve pregnancy. Yet time and time again, it is the young girls who suffer the consequences of pregnancy. It’s their lives that are forever changed, their dreams that are forever shattered. Unfortunately, it is just too easy for boys/men to walk away from their responsibility. When my patient delivered, it was her alone in that delivery room.

The most conservative of parents should know that none of the aforementioned interventions (sex ed, condom distribution, access to family planning) have been shown to promote earlier sexual activity in teens. These teens will start becoming sexually active at the same time as their peers. The difference? They are more likely to use birth control or condoms when they do it.

Of course, we all want our youth to postpone sexual onset. But the fact is, they make mistakes. Are we so dogmatic that we don’t want to give our children room for error? Are we really that strict that we will force our kids to suffer life-altering consequences of unprotected sex? I hope not. For every young girl like this one.

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  1. Man, that really sucks. Love your insight. Guys are stupid. And you're right, the right wing self righteous soap boxers of the world need to stop the denial of what people really are. Come visit me! (totally unrelated)

  2. I'm a big fan of your posts. They're funny, insightful, intelligent. Thanks for spending time in your busy schedule to write =)

  3. I really enjoy you're posts, it's so wonderful to get a little insight into this field. And how frustrating that must be! I also had no idea that parents could leave their minor in the hospital like that.

  4. thank you so much for the comments - they keep me writing :)

  5. I'm glad to have found your blog! As a RN who specializes in lactation, I have seen these young ones time and time again. It is such a problem. As a mom of four girls, I am very honest, open and candid with my girls (age appropriately of course). I pray my girls wait until they are adults to start having sex so they can handle the possible outcomes.

    Thanks for the post!

  6. A very insightful and well written post. My heart breaks for these young women with so little knowledge and so little support.

  7. Let's keep the conversation going. I have often marveled that our society demands driver education, has age requirements for voting and drinking, but has no requirements for parenthood. How can we educate young people about birth control, family planning, and most importantly, how to parent well? Our children deserve better.

  8. this is a fantastic post. so few people realize the true implications of not educating youth about sex. from personal experience at a catholic school, these adolescents miss out on the harsh realities that exist once they leave the "safe" haven of middle or high school and enter the real world.

  9. Great post. During my OB rotation, I saw a number of teenage girls giving birth. It always made me uncomfortable.