I was reminded recently that teen pregnancy is not always unintended. Last week, I saw a 16-year-old female for amenorrhea. R.K. stated that her menses were a week late and that she wanted to have a pregnancy test.
She reported using oral contraceptives for about a year, but said she often misses pills and does not use condoms for backup. R.K. has had one steady partner during this time period.
Both urine pregnancy test and serum human chorionic gonadotropin (hCG) levels were negative. Thyroid stimulating hormones (TSH) and prolactin levels were normal.
I reassured R.K. that amenorrhea can be a common side effect of oral contraceptives, and suggested other methods of birth control that do not require daily pill taking, including the Depo-Provera shot, NuvaRing, Implanon and the transdermal Ortho Evra system.
R.K. opted to stay with her current method. I encouraged her to set an alarm on her cell phone as a reminder to take her pill at the same time every day, and to use condoms as back up contraception method and for STD prevention.
Before she left the office, R.K. asked me if there was a blood test that she could use to find out if she could get pregnant. Upon further questioning, R.K. admitted she “wouldn’t mind getting pregnant.” She confessed that she often skipped taking her pills for two and three days in a row to see if she would “accidentally” conceive.
Despite a brief increase between 2005 and 2007, teenage birth rates in the United States have been steadily declining since 1991, according to the CDC Vital Statistics reports. This is good news, but I’m not sure I’m seeing this same decline in my practice.
I am concerned about the role that reality television shows may play in glamorizing adolescent pregnancy, as some of my patients have reported watching “16 and Pregnant” and “Teen Mom.” Many of them tell me that they think a baby would make their lives better, or improve their relationship with their boyfriend. These patients have a very unrealistic image of parenting and are ill equipped to handle the responsibilities that go along with raising a child.
R.K. is not the first teenager who has told me that she desired pregnancy, or didn’t really care if she had an unplanned pregnancy. Many teens ask me to test them to see if they can get pregnant after using no contraception or using it inconsistently without conceiving for months or even years. I usually tell them that they have been lucky thus far.
In this case, I explained to R.K. that there is no definitive test to confirm fertility, but rather a panel of labs and more invasive testing that are done after a period of actively trying to conceive without success. We then discussed the advantages of completing high school prior to starting a family. I also told her about some of my patients who have had babies in their teens, and the daily struggles they face.
I gave R.K. literature on alternate methods of contraception and reinforced the importance of consistency in taking oral contraceptives. I also encouraged her to talk with her boyfriend seriously about whether he was ready to have a baby.
Despite my advice, I am not sure if anything got through to this young woman. Adolescents often cannot be swayed in their thinking and counseling can be ineffective. Have you developed any successful strategies for communicating with teen patients?
Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.