life after roe

An OB/GYN on What It’s Like Working With Pregnant Children

Photo: Peter Vadasz / EyeEm/Getty Images

When news broke that a 10-year-old survivor of rape had been forced to travel to Indiana from Ohio in order to terminate a six-week pregnancy (due to restrictive abortion laws imposed after Roe v. Wade was overturned in June), right-wing media outlets and personalities were quick to dismiss the story’s veracity. On Twitter, Washington Post columnist Megan McArdle commented that such pregnancies were rare, writing, “Only 52 girls under the age of 14 got abortions in Ohio last year — and 10 is a long way from 14.” Her comments, and the initial story, sparked days of debate over the prevalence of child pregnancy. The Cut spoke to Patricia Bailey-Sarnelli, an OB/GYN in Massachusetts, about her experience working with very young patients. Her story, below, has been edited and condensed for clarity.

I’ve been doing pediatric and adolescent gynecology for over 30 years. I have occasionally had patients who were significantly younger who had pregnancies. The numbers are quite small when you look at the number of kids between 10 to 14 — it’s not rare rare, but it’s fairly rare. I don’t think anybody has extensive experience, but everybody who does what I do has had their share of younger folks with pregnancies.

It’s obviously very distressing for the family. This is something that’s often found out in the office — the patient comes in because she’s missed a couple of periods, then you run the pregnancy test and it comes up positive. Then you’re sitting there with this 13- or 14-year-old, and you have to walk your way through it. First, you talk to her privately and find out what she wants to do: Does she want to discuss it with her family now? Does she want me to tell them? We have to get some idea how far along she is. You have to walk through it very, very carefully, and I’ve had it go many different ways. I’ve had kids say, “Will you tell my mom?” or “No, I’ll tell my mom, but can you sit there with me while I tell her?” She’s trying to process it. She’s maybe even afraid of it, but a lot of times she isn’t afraid, because she doesn’t really understand the symptoms of pregnancy.

I had a patient who was 14. I was palpating her abdomen, and I felt there was this mass. I said, “Have you ever, ever had sex?” She said, “Oh no, no, never, never.” Then I said, “Really never, never, never?” And she said, “Well, one time.” And I said, “Well, how long ago was that?” And she said, “Maybe four months ago.” And I was like, Oh, man. Then the whole world crumbles, and it’s just really tough. You have to do options counseling. I’ve had parents come completely unglued. I’ve had dads sit in the office and threaten to “go kill that boy.” It can get that intense. Once everybody’s aware, you walk through options counseling. There are only three options: You can continue the pregnancy and plan to become a parent, you can continue the pregnancy and place for adoption, or you can terminate the pregnancy. It’s ultimately her decision, even though the family will weigh in heavily. [Editor’s note: Massachusetts law requires that a minor under the age of 16 get parental consent for an abortion.] I’ve had it go both ways. I’ve had kids say, “I’m continuing this pregnancy,” and the parents are like, “No, you’re not” or “Yes, you are.” Then I’ve had it go the opposite way.

Especially for the younger folks — 10, 11, 12 years old — they haven’t fully matured yet. They may have ovulated; they may have started puberty early, but they still haven’t completely grown. So the pelvis isn’t necessarily mature enough to be able to pass a baby through. The rate of complications, obstructed labor, preeclampsia: They’re very high in developing countries. You end up with kids with obstructed labor for days, then they end up with a fistula, which is a hole between the bladder and vagina or between the rectum and vagina. They’re dreadful, dreadful complications. In this country, you don’t see that so much, because we have better health care, but still, the idea of a C-section in a 10-year-old is just … There are just a lot of complications.

I had a pregnant 12-year-old patient many years ago. Her mother was very heavily into drugs, so she was basically raising herself. She said, “I can’t do this. I know if I do this, I’ll end up like my mom.” It was strikingly mature. She had a termination when she was 12 and got on birth control. She’s now an adult and comfortable with her decision. She has created a good life for herself. She’s still my patient; she has to be 30 by now.

I had a 10-year-old in my practice many years ago who had been assaulted by her stepfather. The mom was obviously distraught, and she made the decision for the termination. I think that child kind of understood what was going on, but I don’t know how much. It was really tough. I got legal and a child psych involved, because I felt like, Okay, I think this is the right thing to do for this child, but I want to make sure that I have a little bit of backup here. It was really, really gut-wrenching.

Especially in cases of assault, you have to deal with the legal aspects of the fact that the child has been assaulted; and you have to deal with this, then with ongoing consequence. I have had moms hold onto me like I was a life raft and they were drowning, sobbing and holding me, because this terrible thing has happened to their kids. And now they don’t quite know what they’re going to do. They’re so bereft. It truly is one of the most heartbreaking things I’ve seen in my career — the poor mothers of these girls who are facing this terrible ordeal one way or the other. That’s really tough.

When you look at the literature on teen pregnancy, the numbers have plummeted in the last 30 years. And that’s due to good discussions about sexuality, good birth control — especially good long-acting birth control like IUDs and Nexplanon. I view it as this huge success story, ultimately. Then you have these terribly tragic things that happen, and it doesn’t seem to register. A lot of what I’ve read in the press is very cavalier about this whole discussion. I think that tragedy is something that seems to get missed.

An OB/GYN on What It’s Like Working With Pregnant Children