Creating a teenage pregnancy pathway

When a 15-year-old pregnant girl walked into A&E asking for help, the paediatric trainee doctor was surprised to be at such a loss. There was no clear referral system or outline of available resources for these girls. We decided that the area needed a teenage pregnancy pathway to include resources for pregnant girls no matter what they decide – to continue with the pregnancy, to terminate, and especially if they are undecided. These services must exist, so why don’t we know about them?

To try to get a hold of the services, I started with the sexual health clinics. There was one across the street – they knew the midwives, and they knew the termination clinics. I thought I was all set. Was it this simple?

A week later, I tagged along to the children’s trust board meeting for the tri-borough area. To my great advantage, the topic was sexual health. I was stunned that I was only one of two doctors present. School nurses, teachers, members of charities, people helping children involved with gangs, police officers, social council members and health commissioners took up the majority of the room – all of whom had so much to say about the sexual health of children and adolescents. I was the least knowledgeable person in the room regarding sexual health in the area.

My head was spinning as I tried to grasp how much there was to think about in the making of this pathway. What safeguarding issues would arise? What do pregnant teenagers actually want in sexual health services? What would aid the school nurses and GPs? And how can we make these girls aware of the myriad of charities and community services available to them?

The beauty of Connecting Care for Children is that it allows medical professionals like myself to come into contact with the plethora of people and organisations committed to child health. While medicine may be the first aspect that comes to mind regarding child health, it is the people who see the child more often and on another level who actually have the biggest impact. School nurses, teachers, community services and charities interact with these girls for a longer time than the 15 minutes we spend with them. We have to be attuned to what the girls require, or else who really benefits from the pathway, if not them?

When I first took on the task to create this pathway, I thought it would be simple and quick. It has ended up taking me more than three months to gather all the relevant information and organise it so that health professionals and the general public can easily find a point of reference regarding teenage pregnancy – whether that is a sexual health clinic, termination service, midwife support, or community service/charity.

This all makes me wonder: if I had so much trouble finding all the relevant services, how can we expect a worried pregnant teenage girl to know about them?