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with Rod Moser, PA, PhD

Stories from behind the examining room door, as told by Rod Moser, PA, a primary care physician assistant with more than 35 years of clinical experience.

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Monday, December 28, 2009

Birth Rate Rising Among Teenagers

WebMD (12/21, Boyles) reported that, according to a paper in the Jan. issue of the journal Pediatrics, “for the second year in a row, the birth rate among teens increased in 2007.” Specifically, “teen births increased 5% between 2005 and 2007, following a 34% drop between 1991 and 2005,” researchers from the CDC’s National Center for Health Statistics found. In fact, “in 2007 – the last year for which figures are available – the birth rate among teens rose by about 1%, with 42.5 babies born for every 1,000 teens aged 15 to 19.”

Our practice has a high percentage of adolescents, and those adolescents have a relatively high incidence of sexually-transmitted conditions – pregnancy being one of them. In spite of aggressive sex education programs, the availability of confidential contraceptive services, and condoms available just about anywhere, you would think that an unplanned pregnancy would be rare. Sadly, it is not.

Preaching abstinence or providing knowledge of what to do to prevent pregnancy is not sufficient. A person has to apply that knowledge in a practical way and exercise that judgment. I asked a teenage boy if he agreed with the belief that the “average teenage boy thinks about sex a hundred times a day”. He thought about if for a few moments, doing some mental math, and said, “Yes, that’s about right.”

Condoms are 100% ineffective if left in the package, in a wallet, or on the shelf at the pharmacy. They are considerably more effective when consistently used on the penis. Perhaps the biggest excuse I have heard for not using condoms is that they did not have any. Apparently, the idea of not having sex apparently was not an option. A high school buddy, faced with the “no condom” situation, decided to use a plastic sandwich bag! Another excuse is that condoms decreases sensitivity for the man. My retort is that teenage boys, given a choice of no sex, or sex with a condom will always choose the sex. Personally, I think teen boys should wear TWO condoms all of the time. If sensitivity is an issue, they can remove one of them just before having sex. Obviously, the irony of this joking statement may not be truly appreciated when I counsel them.

The condom broke! This definitely does not happen as often as people claim. If they did break often, the companies would be out of business. As a demonstration, I once saw a person put a condom completely over this head. He then blew it up the size of a carnival balloon. It did not break. A claim of a broken condom usually means “no condom used”. By claiming it broke somehow exonerates the user of personal responsibility.

Teenage girls presenting with irregular or painful periods is often a smoke screen to start oral contraceptives with a parental blessing. Teens do have painful periods at times, don’t get me wrong, but the ones who claim they have never been sexually involved in front of the parents, often fess up the truth in private. Knowing that they have had unprotected coitus justifies testing for sexually-transmitted diseases (STDs). A relatively large number will already have Chlamydia; a few with Gonorrhea; and some with both.

When a teenagers consider themselves capable of making an adult decision to have sex, then why can’t they take it one step further and inform their parents? Most parents, faced with a sexually-active teen, would do what they can to see that unwanted pregnancies and/or STDs do not happen. Parents are never happy when they discover that their teenagers are having sex, but they are rarely surprised.

Several years ago, my PA wife was examining a teenager in her family practice clinic for a watery discharge. Mom was in the waiting room. The examination quickly revealed the reason for the watery discharge – she was in labor, and that was amniotic fluid. Her water broke. An ambulance was called, and the surprised mother who did not know her teen was even sexually involved, was informed that she was going to be grandmother. I would have loved to have overheard the phone call to her Dad (aka Grandpa).

Of course, not all teen pregnancies go to term. Some teenagers elect to terminate them early with a therapeutic abortion, which can open up a lot of psychological issues. Some teenagers have the maturity to put their baby up for adoption to a two parent family. Teens that continue their pregnancies will need to grow up very fast. One of my patients sincerely felt that it was her parent’s responsibility to care for her new baby so she can go to school and still “hang out” with her friends. It is relatively unusual for the baby’s father to step up to the plate, and physically and financially care for the child. Pregnant teens can go to Continuation Schools to finish their high school education, with classes in parenting thrown in. These classes are absolutely essential. It is relatively easy to get pregnant. The years of parenting to follow will not always be smooth (A pregnant teen’s own parents will attest to this).

Pregnant teenagers often elect to continue to the pregnancy and put the baby up for adoption. This may be the best option in many cases. Not only would this baby be placed with (usually) a two-person adoptive family who desires a baby, the teenager will be able to go back to their former life as a teenager, student, etc. This can be a win-win situation, but adoptions are not that simple. Teenagers often change their minds, much to the pain of the adoptive families. Biological fathers and even grandparents often complicate matters by challenging the details of an open adoption, requesting contact, visitation, etc. A friend of ours who adopted a baby from a teen mother was approached by her family asking for money – about twenty thousand dollars! This is illegal of course, so this demand for cash was disclosed to the judge. Mothers, whether they are teenagers or not, have a maternal bond that cannot be easily severed, so extensive counseling is required prior to these important decisions.

Some teen girls plan to get pregnant. They feel that having a baby will be fun (“They are soooo cute!”), just like babysitting. If they get pregnant, maybe their boyfriend will not go off to college and marry them instead. They will surely live happily ever after. Society does reward the irresponsible. Pregnant teens can petition to become emancipated minors and actually move out of their parent’s house. Welfare programs will provide them with basic necessities like free or subsidized housing, food, job-training, free medical care, and even transportation in some geographic areas. They way some teenagers view life; this is not such a bad deal. Recreational sex can develop into “procreational” sex.

Just like vaccinations, it is much easier to prevent a disease or condition, than to treat them. Millions and millions of dollars have been spent on sex education programs, from abstinence programs to contraception, yet teens continue to have unprotected sex and have unplanned pregnancies. Parents may continue to preach morality and abstinence, but may also provide condoms, or accompany their teens to clinics for other forms of contraception (just in case), and of course, pregnancy tests. Our kids’ babysitter (age 15), a bible-carrying child from a Fundamentalist Christian sect became pregnant by their minister’s son on a church retreat. After her abortion, she ran away from home, married a sailor she hardly knew, got married, and had three more children, one right after another. Twenty years later, she is divorced and still cries about having that abortion.

Mistakes do happen and for some, the sexual debut may be unplanned. Teenage love and sexual feeling are painfully powerful; parents need to remember this. Teens are famous for “taking chances” – sexual roulette can be the name of the game. Date rape situations where alcohol and/or drugs are involved are all too common. I spent several year
s doing evidentiary medical examinations during these situations. Disproportionate dating ages where the girl is 15 and her boy (man) friend is 18 or older is a significant factor in sexual activity, yet many parents permit their younger teens to date men.

Parents always hope their teens are not sexually active, but often accurately suspect when their kids are having sex, but fail to be confrontational or proactive about dealing with it. I have had teen after teen swear to the All Mighty, that they are not having sex, only to admit it freely when given a confidential opportunity. Teenagers will lie with conviction when it benefits them. As a clinician, I struggle with supporting this naïve child, insuring her legal privacy, while at the same time, sympathizing with the parents who have to step in and pick up the emotional pieces of a life interrupted by bad decisions.

Posted by: Rod Moser, PA, PhD at 2:28 pm

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