The choices we make

Originally published in The Medical Post, VOLUME 37, NO. 19, May 15, 2001

At just 16, Mary was faced with her second pregnancy and a decision that would affect more than just herself

Life is about options, the choices we make and the paths we follow. For some it can be a bittersweet experience. Yet, these decisions can alter the lives of many. Some are aware of these changes and some, regretfully, are not.

We tell this story to the students during our classroom visits:

Mary (not her real name) was 16. Her mother, an alcoholic, paid little attention to her. Her father disappeared from her life when she was five years old. Her boyfriend abused drugs.

She came to the high school clinic 20 weeks pregnant, complaining of bleeding and cramping. She expressed hope the baby was dead. A fetal Doppler exam did not pick up a heart beat. An ultrasound performed the next day showed overlapping cranial bones and a deformed thoracic cavity. She was induced and the fetus delivered. She grieved after the abortion.

Three months later, in March, she was five weeks pregnant. She said she could not afford the cost of the Pill. She requested an abortion. She said she felt guilty and foolish about the pregnancy. She returned to the clinic in late April, stating she had slashed her wrists because she was overwhelmed by her problems and “lost it.” There was little support from her mother regarding her despondency. Her mother was unaware of the pregnancy. Mary admitted she was burying her feelings and was depressed since the abortion. Her depression was treated. Within a month, she felt better and had no further urge to hurt herself.

In early June, she returned to say she did not go for the abortion because she thought the baby had died. She said a Doppler done two months earlier did not pick up the heart beat. She admitted she had not come back to the office sooner because she felt ashamed. She feared if she did go for the abortion the staff at the hospital would judge her. An ultrasound showed a healthy 20-week fetus. She returned to her family doctor for prenatal care.

Come September, she returned because her family doctor threatened to tell her mother about the pregnancy. She did not follow up with her family doctor because of this threat. She was at 31 weeks of gestation for her first prenatal visit. Mary was initially not compliant with the required prenatal visits and tests. Our office had to call her often to remind her of her appointments. Her ambivalent behaviour stemmed from several areas. She bore the guilt over the loss of her first baby and faced difficult truths. Her boyfriend was unaware of her pregnancy. She feared telling him because he was not the father. She did not want her mother to know she was pregnant. She had plans for her life. These included continuing her education and attending university. She did not have the financial or emotional capacity to raise the child in the manner she wished.

At this later stage of adolescence, the future comes more into focus. One’s career, education, life goals and relationships assume greater importance. It is a remarkable transformation from the gregarious peer group behaviours seen in middle adolescence (14 to 16 years old) to the individualism of late adolescence.

After much thought, she decided to give the child up for adoption. There was no pressure on Mary to choose one course of action over another. Once her decision was made I informed her a couple in my practice wanted to adopt a child and that they should direct their attention to the appropriate child services to pursue this option. Mary spent time with the couple and accepted them. They were a great support to her. In many ways, they fulfilled Mary’s need for a stable family. They arranged to bring her to the hospital once labour started. They attended the birth and participated in the delivery. When she was in labour, she called her mother from the birthing room to tell her she was staying at a friend’s house for two days.

Her pregnancy was uneventful, except in one respect. No one acknowledged it! She began her pregnancy weighing about 72 kg. She gained about 11 kg. What was astonishing was that her friends did not comment or ask one question about the pregnancy. She hid her pregnancy well by wearing loose clothes, and no one seemed to suspect a thing. Her mother remarked she thought Mary was losing weight and looked good.

Two days after her delivery she was back in school with no one the wiser. In fact, people continued to comment about how good she looked.

This story increases student awareness that many people in school have problems; some minor, some more serious. The fact no one approached her about her pregnancy demonstrates fear or discomfort of not knowing what to say or do. It is a common denominator in many of the students’ “What do I do?” questions. Many of the students acknowledge there are people they know who are in trouble. We point out to them there is a distinction between thinking they must solve their friend’s problem and expressing concern. This matters most when a friend is depressed and potentially suicidal. They learn there are people who can help but they must become involved and ask questions.

During her pregnancy, Mary was depressed and ambivalent about her pregnancy. She lacked family support and was mistrustful of those who tried to help her. She needed continuous reinforcement to attend her prenatal visits. In short, she wanted someone to care for her. She wanted a family. With all these obstacles, it is a reminder how different the outcome could have been.

Now, almost seven years later, I continue to see Mary, her son Devon and his adoptive parents. They occasionally meet to maintain contact. Mary is attending university and pursuing her career. She does not regret her decision. Her son lives in a warm and caring environment. To this day, Mary’s mother does not know she has a grandson.

It is remarkable to witness how one person’s decision can change the lives of so many people.

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