Emotional trauma the worry when a child gives birth


It appears there is little medical difference between a 13-year-old or a 23-year-old giving birth to a baby. However, medical experts agree, it is the psychological consequences that are of grave concern.

"It is difficult to imagine the circumstances where a 13-year-old would have an `acceptable' pregnancy," said Dr Peter McKenna, Master of the Rotunda Hospital in Dublin. "It would be very tempting for doctors to rush in and try to make a huge medical issue of this. But, medically, all other things being equal, the problems would be very small and pale into insignificance compared to the social and psychological problems.

"It is not a medical matter at all really, because a pregnancy in a 13-year-old is not different from any other pregnancy. Actually it is a cultural thing that we think it is so terrible."

A girl of that age has not yet stopped growing. It is very slightly more likely, he said, that their may be some unusual problems such as a tumour of the afterbirth. "But this is extremely rare. We have occasionally had young girls, 14-year-olds, giving birth here. The main focus of their problems are social and psychological."

But Dr Siobhan Barry, a psychiatrist at the Coombe Hospital who specialises in psychiatric problems arising from childbirth, said she would have concerns about an early adolescent giving birth.

"The body and the pelvis would not be that of a grown woman. Speaking generally, for a 13-year-old to be sexually active, particularly if it was such a violent experience, and to become a mother, gives rise to all sorts of problems in the future, in relation to interpersonal problems." Also, the dilemma over abortion "escalates the trauma", said Dr Barry. "We do not have exams for people to become parents, but undoubtedly a girl of that age would not have much experience of life and there would be adverse consequences."

All the relevant information should be known before a decision on termination is made. "To answer a question like that you would have to take maturity into question, and actually, as accurately as possible, know what the circumstances are. But she does need lots of support. Responsibility for what happened needs to be placed firmly with the person responsible. A crime has been committed and it is important not to lose sight of that. It is not good that she be "tug-of-warred" between polar opposites. Usually, the answer is somewhere in between," said Dr Barry.

Dr Patricia Casey, consultant psychiatrist at the Mater Hospital, and a well-known anti-abortion campaigner, said that the young girl needed a lot of support, regardless of what decision is made. "I would have a view about it morally: the bottom line is that while the baby was conceived in rape it is still a baby. You cannot unrape the girl. You only solve one problem with abortion."

Studies in the US and the UK showed a 10 per cent incidence of severe depression in women who had abortions in a five-year follow-up study. This girl was already traumatised, Dr Casey said, and it was impossible to separate the trauma of the rape from the effects of continuing the pregnancy. Overall, she said, women who have abortions and who are ambivalent about it or lack adequate support fare badly psychologically. "The decision is for her and her family." According to her mother, the 13-year-old was given the morning-after pill but was ill afterwards, which is not unusual. Dr McKenna said there is evidence that a failed morning-after pill can slightly increase the risk of foetal abnormality, including heart damage. "It is not that unusual that a women would be ill after taking the morning-after pill. If a doctor is giving it they usually tell the patient to come back if they are ill," said Dr McKenna.

Abortions are usually carried out in Britain up to 24 weeks, but the earlier the procedure is carried out the better, he said. A late termination was "physically and psychologically more traumatic, and that would apply irrespective of age".

At 14 weeks, it is possible, on an ultrasound scan, to see a foetal heartbeat, to see the baby moving, to make out the head and the body. It is not until a few weeks later than you can make out further details. By 18 weeks, it is possible to see hands, feet and legs but it is not until further in the pregnancy that it is possible to make out the sex of the child.

Psychiatrist, Dr Emer Philbin Bowman, said the fact the case was in the public domain could not be of benefit to the girl and her family. In her clinic at the Well Woman Centre, Dr Philbin Bowman sees women who have had problems following an abortion. "No matter how extreme the circumstances, it is important not to have a preconceived view on how an individual will be affected in this situation or what the outcome should be. In order for the individual young girl to be able to live with her decision it is important that the fullest exploration of all the options are explored with her so that she can feel she has made the best decision in the light of her understanding, her maturity and the help available to her." Dr Mary Henry, Independent senator and medical doctor, said it was "most unfortunate" the case had become so public. "The Minister for Health, Mr Cowen, said that he was surprised at such a case but I am surprised he is, considering the number of girls at this age that are becoming pregnant. Last year, 46 girls under 15 years of age got pregnant. It was 57 the year before and at least one a month at that age go for an abortion.

"I assume as Minister for Health his shock was at the violence involved and not at the pregnancy. I would like to see the health board guidelines mentioned by the Minister for use in such a case. Do these include giving the morning-after pill? Did anyone check after she was given that to see if it had worked or not? Was a pregnancy test done as soon as possible? How was it decided what was the right sort of care for a girl so violently raped?"

Dr Henry said she felt great sympathy for the professionals involved in the case as they had been failed by the legislators. She said that we now needed "to settle down" and decide in what circumstances we would allow pregnancy terminations. She said that RU486, known as the abortion pill, which acts like an early miscarriage, was available in a number of other countries, and would "certainly be a possibility for a child in these circumstances".

"We should not look on this as an isolated case because it is not. I know of children in ankle socks who have got pregnant. I once knew sisters aged 14 and 16 who were both pregnant by the same man and gave birth within a short time of each other," said Dr Henry.