Teenage and Unwed Pregnancies

It's hard to go to work every day and see the things that I do and not be affected. I'm sure other people find themselves in this situation. There are a lot of careers that can wear emotionally on a person after some time, like, I don't know, prison jobs, counseling/therapy, or working with any underserved population. Sometimes I feel like I'm working against unbeatable odds. Can I really make a difference in the lives of the people I care for and counsel on a daily basis? Is there anything powerful enough to break the horrendous cycle in which some of my (young) patients are so deeply entrenched?

Kevin gets to hear a lot of my crazy stories. We commonly talk about how grateful we are to have been raised in the gospel, and how that single fact makes our lives so dramatically different from those I come across at work. We also appreciate that it's not only the gospel that has given us such an advantage over these women, but being raised by a mother AND father who taught us to value and respect the power of education, sobriety, sexual abstinence until marriage, civil obedience, and service to our fellow men. Those priniciples can be taught without any reference to religion or a higher power.

Maybe we midwives see a disproportionate number of disadvantaged women in our practice because we don't turn anybody away. We also have a lot of disadvantaged or teenage pregnant patients who come to us because their friends/family members referred them to us. We have a reputation for spending more time with our patients, listening to and acknowledging their problems and concerns, treating them with respect regardless of their situation or status, and offering support. Our prenatal visits range from 30 mins to 1 hour long because we believe in the value of spending more time educating our patients to prevent complications, rather than ushering them quickly through office visits to end up fixing problems later. Most busy OB practices allot 10-15 minutes for a routine prenatal visit. It's a smarter business move, but not necessarily better for the patient. I would estimate that over 75% of our pregnant patients are on Medicaid. I think it's important that the government provides a means for pregnant women to receive healthcare, but I think there is a staggering influx of pregnancies that end up being funded by tax dollars which could and should have been prevented.

Here's a snapshot of a few typical pregnant patients in our practice:

--A 15 year old girl who is an average teenager, states she has never drunk alcohol in the past, but last weekend her cousin (also a teenager, but already a mother) invited her to go to a party out of town with her. This girl makes a bad choice to try alcohol for the first time, gets drunk, and consents to have unprotected sex with a boy she had never met before. Now she is in my office crying because she's pregnant. She doesn't even remember the father's name and has no way to contact him. She's not ready to be a mother, but she's not going to get an abortion. One stupid decision on one night has changed her life forever.

--A 23 year old single mother of two gives birth to twins. Her two daughters are 4 and 2 and now she has two infant boys. She has myriad mental health issues including bipolar disorder and schizophrenia, but somehow manages to care for these four children, reporting only sleeping about 2 hours per 24 hour period. She was employed through a state assistance program with a desk job during her early pregnancy, but would continually not show up to work because it was "too hard on her body" to be sitting in a chair all day. She has complaints of chronic pain in her back, neck, and hips for which we referred her to a physical therapist. She is totally dependent on government and state assistance. She never finished high school. Her two girls and the twin boys were all conceived with different men, none of whom stayed around long enough to find out she was pregnant.

--A 19 year old woman comes in with her third pregnancy. Her first child was given up for adoption because the Department of Family Services deemed her unsafe to have custody of the child. She has a history of IV drug use and alcoholism. She has Hepatitis C. Her second pregnancy was an elective abortion because she was still using drugs and knew she would not be allowed to keep her baby. She is trying to turn her life around and has been sober for 6 months now. She is about 6 weeks pregnant at her first visit. Four weeks later, she states she would like an abortion. She broke her longest streak of sobriety and decided to stop going to her chemical dependency program. Two weeks later, after a domestic dispute with her ex-husband which was reported to police by her neighbors, she states she is moving to Illinois to live with her ex-husband's mother and is going to try to keep the baby. When asking us to fax her records to her new provider in Illinois, she states, "Don't send any paperwork or notes about my decision for abortion." What else does she plan to try to keep secret from these people in Illinois?

Now here are some statistics that I found in a little research I did yesterday. These numbers are from the Center for Disease Control's National Center for Health Statistics.

--After a 14 year downward trend in teenage (age 15-19) births from 1991 to 2005, there was a significant (3%) increase in the number of U.S. teen births from 2005 to 2006. Data from 2007 are still being compiled and analyzed and were not included in this report.

--Unmarried childbearing has risen 20% since 2000, and reached a record high in 2006.

--In the 25-29 year age group, unmarried births increased by 10% from 2005 to 2006.

What impact is this having on society? A classmate of mine at Georgetown did a lecture on teen pregnancy during our Master's program. In a 20-year retrospective study of children of teenage mothers:

--Children of teenage moms had increased rates of school dropout, depression, incarceration, and public assistance compared with children of moms aged 20 or older.

Are you starting to get a glimpse of the sad state of childbirth in our country? And teenage and unwed pregnancies are just one facet of the GINORMOUS problem. I'll probably post on a few of the other contributors in days to come.

This is such a difficult cycle to break. Most of my pregnant patients that come in with their first pregnancy at age 14, 15, or 16 are themselves daughters of teenage moms. A lot of their mothers were still children when they were born, so these girls were raised by their grandmothers. One great thing about grandmothers is that they have a tendency to spoil and/or not discipline their grandchildren. But when a grandmother is in the role of mother, the child seems to grow up under less supervision, less scrutiny, and is not taught about choice and consequences. The nurse that works in my office was raised by her grandmother and she said that is a very representative picture of her growing-up experience.

I don't know how much of a correlation there is, but the daughters of teenage moms also seem to engage in sexual activity at a very young age. Maybe it has nothing to do with the age of their mothers. It could just be a gradual cultural change. Most of my non-pregnant patients that come in for health screening or general health/gyn problems, when asked their age at onset of sexual activity, give an answer somewhere between 12 years old and 18 years old. Very VERY seldomly do I have a woman who tells me she initiated sexual activity after the age of 20. TWELVE YEARS OLD, people! Some sixth graders are twelve years old. By the time most girls here are getting to middle school, they are starting to have sex. By the time they're in high school, they and their friends are all getting pregnant.

Whenever my colleagues or I see a patient that comes to us for prenatal care who is married, planned pregnancy, and has at least one college degree, we take special care to mention it to the other providers in our office because it is such a rare thing. Of the 50 or 60 pregnant women I've met since starting work here, fewer than ten have been married. I can count the college graduates on one hand.

How are these girls going to learn to have respect for the power of procreation? I wish I could help them change their immature way of thinking, but that is a change that needs to take place in the home. I just don't see that happening here, now or anytime soon. These young girls are so flippant about sex. One of the most mind-blowingly immature conversations I have with teenage moms at their first pregnancy visit goes a little like this:

Me:"So was this a planned pregnancy?"

Girl and/or boyfriend: "No, it took me completely off guard."

Me: "So were you using birth control at the time?"

Girl: "No."

Me: "Condoms?"

Girl: "No."

Me: "So, this pregnancy was unplanned, but not prevented."

Girl and/or boyfriend get puzzled look on face at first, think for a second, then smile and say: "Yes! I never thought of it that way. That's exactly what it was."

HELLO??!?!? If you're having unprotected sex, you are asking to get pregnant. If you're having sex at all, you are opening yourself to the possibility that you will become pregnant. Even if you're using birth control, if you are engaging in sexual activity, you MUST understand that there is a possibility you can become pregnant. Where is the logic? Where is the OBVIOUS cause and effect chain of thinking? It's not there. Nobody is teaching these girls. The boys have also learned from society that it is okay to sleep around with multiple girls, dispensing sperm like candy, with no thought for repercussions and no sense of responsibility to their offspring.

I want to be involved in some sort of education program for these kids, but even that seems like it would be futile. They need their parents to teach them, but most of them only have one parent who is not even any more mature than the child is. It is so sad. We need to teach girls about the serious and life-long consequences of deciding to become sexually active at such a young age. When I hear the arguments for abortion and a woman's CHOICE, it screams to me that our society has it all wrong. The choice that a woman should be making is the choice of whether she is financially/emotionally/developmentally ready to bear and raise a child. If the answer is no, she should abstain from sex as this is the only 100% effective method of birth control. Sex is not a hobby, it is not an after school activity, it is a sacred power given to us from God through which we can create human life. Even if a woman doesn't believe in God, she should still revere the fact that her reproductive system has the power to nourish a human body and use it appropriately. A girl or woman who chooses to have sex needs to be taught the seriousness of the possible consequences. We need to reverse the rapid degeneration of the sanctity and/or gravity of the powers of reproduction.

Off soapbox.