Many young women could become pregnant at the age of 10, although I have never seen a pregnancy in a girl this young. Text books report pregnant patients as young as five or six years. These children would have what is called premature menarchy (onset of ovulation and periods). I have delivered a few 12-year-old girls and they actually have done very well with pregnancy and even delivery. The problem arises with postpartum care when you have a child taking care of a child. Although a young girl’s body might be ready, the emotions and psyche of the child are not.
While both pregnancy in a 12-year-old and 19-year-old are considered teenage pregnancies, obviously the outcome depends largely upon how old the teenager is. For example, if she is 12 years old and pregnant, the outcome is considerably different than being 19 years old and pregnant. Years ago women matured later. They often had their first period around age 18, got married at age 19 and got pregnant at age 20. That was reality for hundreds of years.
In my experience, there are two reasons for teenage pregnancy. The reason for pregnancies in many 12-year olds can be related to family members, whether a stepfather, brother, uncle, or even fathers. Another reason for teenage pregnancies can be found in their lack of education about pregnancy and their options.
When I was a resident we had clinics in some high schools, but today parents are much more vociferous about sex education in school than they were then. When we went to school clinics, we managed all kinds of care: flu, sore throat, earaches, bronchitis, STDs, but the primary reason for being in the schools was to offer birth control options. Whether parents liked it or not, these programs were effective in reducing teenage pregnancy.
We also offered prenatal and postpartum care to teenage moms and their children. The idea was to keep the moms in school, add child care, and add valuable healthcare services. Yes, the kids got contraception. Our program did exactly what we wanted it to do. It lowered the teenage pregnancy rate and provided good postpartum care to teenage mothers. And there were no maternal deaths.
In most states, the teenage pregnant patient is her own agent for matters of pregnancy. She, not her parents or guardian, must give consent for any birth procedure, including vaginal birth or a c-section. Only she can consent. But on the other hand, she cannot consent for any other procedure such as a tonsillectomy, appendectomy, or even setting a broken bone.
For women under 20 years of age, much like women over 40 years of age, pregnancy carries increased risk. Although most women do well with pregnancy at these ages, there are nevertheless risk factors that need to be recognized and managed. One of the biggest problems for either age group is preeclampsia, which can be followed by the threat of eclampsia or a stroke and even death. Women at these age extremes are also at an increased risk of cesarean section, infection, bleeding, transfusion, and death. Additionally, there may be some problem with weight gain for mom or baby. The baby might be a little on the small side or the baby could also be quite large if the mother has pre-existing diabetes or develops gestational diabetes during the pregnancy.
Although every pregnancy is different, teen pregnancies are likely to be even more variable. Both the new mother and the new baby need care after birth and much support from family and healthcare providers. If the father of the baby is able to be involved, he should be. Then there is the issue of supporting the mother’s finishing high school and going to college. Often the baby’s primary caregiver will be the maternal grandmother. The person who will be the primary parent needs to be clear from the very beginning.
Pregnancy at any age involves a tremendous amount of decision-making. With teenage pregnancies, the number of decisions to be made can become overwhelming but are manageable with proper support.
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Dr. Lindemann’s book Pregnancy Your Way will be published and available on Amazon August 3rd!
