Breaking News
August 18, 2018 - UTHealth-led survey shows much work remains to increase safety of e-health records
August 18, 2018 - Researchers use super-resolution microscope to unravel secrets of deadly Nipah virus
August 18, 2018 - Scientists identify pathways that reveal insights into mechanism of lung cancer etiology
August 18, 2018 - FDA approves marketing of brainsway deep transcranial magnetic stimulation system for OCD
August 17, 2018 - OUHSC gets $20 million grant to advance research and patient care for Oklahomans
August 17, 2018 - Sperm morphology differs depending on qualities of male bird
August 17, 2018 - Texas A&M researchers develop clay-based platform to grow blood vessels
August 17, 2018 - FDA Approves Expanded Indication for Orkambi (lumacaftor/ivacaftor) in Children Ages 2-5 Years
August 17, 2018 - Caring for Concussions | NIH News in Health
August 17, 2018 - Team explores diabetes drug’s ability to treat RSV infection
August 17, 2018 - New imaging technique can spot tuberculosis infection in an hour | News Center
August 17, 2018 - PolyU researchers design new self-fitting scaffold to induce bone regeneration
August 17, 2018 - CartiHeal and LSU Health successfully enroll first two patients in Agili-C IDE pivotal study
August 17, 2018 - Less-invasive options are slowing disease progression in glaucoma patients
August 17, 2018 - Researchers discover new promising target point for cancer and diabetes therapies
August 17, 2018 - Podcast: KHN’s ‘What the Health?’ See you in court!
August 17, 2018 - New mobile phone application enables early detection of cerebral ictus
August 17, 2018 - UK’s leading sight loss charity invites applications from brightest minds in ophthalmic research
August 17, 2018 - Researchers produce artificial placenta model that closely resembles natural organ
August 17, 2018 - FDA Alert: Temporary Total Artificial Heart Companion 2 Driver System by SynCardia Systems: Letter to Health Care Providers
August 17, 2018 - Researchers discover why sepsis from a staph infection causes organ failure
August 17, 2018 - Revealed: The molecular mechanism underlying hypertrophic cardiomyopathy | News Center
August 17, 2018 - Research explores relationship between personal history of infectious fever and cancer risk
August 17, 2018 - Study finds rise in cases of progressive massive fibrosis among U.S. coal miners
August 17, 2018 - NEDBELS project examines impact of neurodiversity concept on legal systems
August 17, 2018 - Seeking solutions to treat scleroderma
August 17, 2018 - Statins may improve conditions of people with rare lung disease
August 17, 2018 - Study finds why some people with brain markers of Alzheimer’s never develop dementia
August 17, 2018 - Life Biosciences contributes $100,000 to fund its biomedical innovation course on aging
August 17, 2018 - Researchers develop a set of health outcome measures for children with complex medical situations
August 17, 2018 - Many Americans Not Being Assessed for Depression
August 17, 2018 - Scientists report setbacks in quest for AIDS cure
August 17, 2018 - Christopher Gardner busts myths about milk | News Center
August 17, 2018 - Bacterial activity in child’s mouth may serve as biomarkers for autism spectrum disorder
August 17, 2018 - Scripps Research scientists uncover new approach for treating thrombocytopenia
August 17, 2018 - Mathematical model shows the influence of human behavior on spread of infectious diseases
August 17, 2018 - Valley Hospital achieves Magnet recognition for fourth consecutive time
August 17, 2018 - Researchers describe link between poor oocyte development and oxidative stress in obese mice
August 17, 2018 - Hospitals battle for control over fast-growing heart-valve procedure
August 17, 2018 - AHA: Home-Delivered Meals Keep Heart Failure Patients Out of Hospital
August 17, 2018 - In Southern Mozambique, only half of people diagnosed with HIV enroll in medical care
August 17, 2018 - Researchers discuss techniques to help combat growing epidemic of obesity
August 17, 2018 - Researchers develop novel statistical method to evaluate gene-to-gene interactions linked with cancer
August 17, 2018 - Island Fertility joins Stony Brook Community Medical to provide comprehensive fertility care
August 17, 2018 - Study shows link between thinning of the retina and early sign of Parkinson’s disease
August 17, 2018 - Digital birth control app gets FDA nod
August 17, 2018 - FDA grants approval for first generic version of epinephrine auto-injector
August 17, 2018 - Federal advisory group publishes recommendations on prevention of acute, chronic pain
August 17, 2018 - 3D-printed human body parts to be used as teaching aids for surgical training
August 17, 2018 - U.S. murder, suicide rates climbing again
August 17, 2018 - This is your brain on… roller coasters?
August 17, 2018 - Report discusses whether all newborns should undergo genetic sequencing
August 17, 2018 - UCR receives 2018 Inspiring Programs in STEM Award from INSIGHT Into Diversity magazine
August 17, 2018 - Researchers publish new paper on developing vaccine candidates for Helminthic parasites
August 17, 2018 - Researchers develop new method to diagnose broad range of cancers using malaria protein
August 17, 2018 - Female mosquitoes quickly evolve selective mating behavior when faced with threats
August 17, 2018 - FDA Grants Breakthrough Therapy Designation to Daiichi Sankyo’s FLT3 Inhibitor Quizartinib for Relapsed/Refractory FLT3-ITD AML
August 17, 2018 - Resistance training and exercise motivation go hand-in-hand
August 17, 2018 - A lesson for future doctors: Listen to and learn from your patients
August 17, 2018 - NUS study discovers a bidirectional regulator and shines light on A-to-I RNA editing in cancer cells
August 17, 2018 - Research shows link between high blood levels of omega-3s and better brain function in children
August 17, 2018 - Researchers propose new theory for how rare gene mutations cause Alzheimer’s disease
August 17, 2018 - New project to combat DMD-related fibrosis receives major funding boost
August 17, 2018 - Digital psychiatric therapy can ‘rewire’ the brain in children with ADHD, study shows
August 17, 2018 - Psychologist to assess how the brain maintains precise short-term and long-term memories
August 17, 2018 - Eating white button mushrooms could improve regulation of glucose in the liver
August 17, 2018 - Scientists identify mutational signatures in ovarian cancer
August 17, 2018 - Sun Pharma receives U.S. FDA approval for CEQUA to treat patients with dry eye disease
August 17, 2018 - Teva Announces Updated Indication and Vial Presentation for Granix (tbo-filgrastim) Injection in United States
August 17, 2018 - Study shows DNA methylation related to liver disease among obese patients
August 17, 2018 - Life on the border: Back at Stanford, ready to pitch in
August 17, 2018 - New device for accurately placing hemodialysis catheters on kidney patients
August 17, 2018 - New strategy accelerates, automates process of prototype molecule optimization
August 17, 2018 - Study finds role of autoimmunity in development of COPD
August 17, 2018 - Researchers transform research tool to study neuronal function
August 17, 2018 - Cognitive impairment does not equate to unhappiness in older adults
August 17, 2018 - Peer Comparisons Can Decrease Risky Prescribing Patterns
August 17, 2018 - Susceptible genes identified for childhood chronic kidney disease
August 17, 2018 - Research uncovers miscarriage cause, identifies potential targets for treatment
August 17, 2018 - Bacterial armor could be new target for antibiotics | News Center
Tackling teen pregnancy with a midwife at school

Tackling teen pregnancy with a midwife at school

image_pdfDownload PDFimage_print

The student comes in for a pregnancy test — the second time she has asked for one in a matter of weeks.

She’s 15. She lives with her boyfriend. He wants kids — he won’t use protection. She loves him, she says. But she doesn’t want to get pregnant. She knows how much harder it would be for her to finish high school.

At many schools, she would have gotten little more than some advice from a school nurse. But here at Anacostia High School in Washington, D.C., she gets a dose of midwife Loral Patchen.

Patchen asks her bluntly what she’s going to do about it. Because one of these days, the test is going to show a positive.

Patchen talks her through a range of birth control methods. There’s a shot you take every few months, an IUD, or a small implant that goes into your arm, which can prevent pregnancy for years. And, of course there are birth control pills. The student opts for pills, and leaves Patchen’s office with a one-month supply with a standing order for refills through the school clinic.

The hope is that this interaction will mean one fewer teen pregnancy in the city. In the Washington, D.C., neighborhood where this student lives, her chance of getting pregnant is nearly three times the national average.

While U.S. teen pregnancy rates overall have trended steadily downward in the past decade, they remain high in some communities. The rates for black and Latina teens is around twice that of whites, and kids from low-income families tend to have higher rates.

Anacostia High School’s midwife program is a novel approach that’s showing promise in tackling the problem.

Patchen had been trying to combat the city’s teen pregnancy rates for 20 years as the founder of the Teen Alliance for Prepared Parenting, or TAPP, at MedStar Washington Hospital Center. She was happy with what they accomplished, but she wanted more access to the young people who needed her. Her organization received a 2015 grant from the CareFirst BlueCross BlueShield health insurer to start working in two schools. Now she’s one of a handful of school midwives in the country, she said.

“It’s much better to go where the need is rather than to sit back and wait for the need to come to you,” she said.

And her role goes beyond providing prenatal care for the five to eight pregnant students who get care in the school clinic each year. Being at the school gives her a chance to help prevent pregnancies in the first place. “I wouldn’t have seen these youth in any other setting — not easily, anyway,” she said.

As the school midwife, Patchen can be an informal — and reliable — resource for students’ questions about sex and contraception and relationships.

“I love it when I’m walking in or in the hall during lunch because I see people and they recognize me,” Patchen said. “And they come in to ask me a question and they’ve got their two girlfriends with them. And we’ll talk about condom use or a side effect of a particular method or they’ll say ‘I heard …’”

If she were in a hospital, seeing young people only after they’re pregnant, she would never get this kind of interaction, Patchen said. Plus, the information she gives them spreads through their circle of friends.

At the school, Patchen keeps her schedule flexible to leave room for informal interactions and walk-in appointments, alongside her regular appointments with students.

When a student comes in, Patchen can offer counseling and immediate options. If a student decides she wants an IUD, Patchen can insert it on the spot. She can prescribe birth control pills and then hand the student a packet.

The CareFirst grant pays for the services and any contraception the students request, so students don’t have to rely on insurance to cover them.

“I feel really good about the fact that we offer the full range of options and we have very, very low removal rates,” Patchen said. She said that she talks students through the different methods and their adverse effects, and leaves the decision about which — if any — method they want to use. “And if the decision is ‘yes,’ it’s a very informed and well-grounded decision,” she said.

In the three years that she’s been working out of Anacostia High School, Patchen said, no students participating in the program have had a subsequent pregnancy. And after choosing a long-term birth control method like an IUD, 85 percent of Anacostia students are still using it one year later.

Patchen can also test for sexually transmitted diseases, or STDs, including doing rapid HIV tests in the school clinic’s lab.

Just as critical, she said, is the ability to spend time talking with students about their lives — from deciding not to have sex, to navigating relationships.

For instance, she asks: “‘Who makes a good girlfriend or a boyfriend? What is that kind of person? How do you make decisions together? What do you do when you have conflict?’”

The other part of Patchen’s job is on-site prenatal care for students who do get pregnant.

Last year, one of those students was Kiera — we’re using students’ first names only, to protect their privacy. When Kiera got pregnant, she was 15 — and scared.

“When I met Loral and she started taking care of me in my pregnancy, she made me feel happier about being a parent,” Kiera said. “She helped me out a lot.”

Patchen said being in the school made it easy for Kiera to come in many times throughout her pregnancy, and talk about things like getting a required blood glucose test, or the benefits of breastfeeding — and also about her relationship with the baby’s father, D’Monte.

Since D’Monte is also a student at the school, Patchen could talk to them about parenting together. And even since Kiera and D’Monte broke up, Patchen still helps them figure out how to maintain a relationship so their daughter will have two parents.

Patchen was there, along with D’Monte and Kiera’s mother, when Kiera gave birth to her daughter last January.

“All I saw was excitement on [Patchen’s] face,” D’Monte recalled. “She was just so excited and she was so proud. So I couldn’t let her down.”

The baby is now a toddling 1-year-old who goes to the day care on-site at the high school. Kiera can bring her by the school clinic whenever she needs a visit with the pediatrician, or just to say hi.

“I love it when they come to the office because her daughter is laughing and she’s responsive to things and they’re responsive to her. And it’s a beautiful thing,” Patchen said.

The fact that this is a happy, communicative family is not an accident, Patchen said. There were times of frustration, times of disagreement — it could have gone badly. But everyone — the TAPP team, the school clinic staff and the student parents — put in a lot of hard work to do the best they could by this child.

Midwife Loral Patchen wants to be clear: She is by no means saying that teen pregnancy is a great thing. But Patchen feels strongly that once pregnant, a student needs real, steady support.

“Youth that are pregnant, they are very aware of all the judgment, the assumption they will fail: ‘You won’t be able to. Now you can’t.’” Patchen said. “It’s our mandate to make sure they still see themselves as having a future and an opportunity. And that means not buying in to the fact that they will fail with the next 60 years of their lives.”

She said a lot of people tell her her job sounds “dire” — working with young people facing the challenge of dealing with parenthood and high school at the same time. She said that’s not her experience.

Patchen works in two D.C.-area schools. She says she believes she’s one of a very few school midwives in the nation. (Meredith Rizzo/NPR)

“My day at the school health center is the highlight of my week,” Patchen said. “I see young people be brave every single day that I show up there. And I see people willing to figure out how to do really hard things. What’s better than that?”

She wants more — more days in the school clinic, more schools in the program, more staff — to meet the need she sees every day she’s there. She thinks this is one of the few interventions that could have a direct impact on bringing down the high rate of teen pregnancy for these young women in the district.

This story is part of NPR’s reporting partnership with Kaiser Health News.

Kaiser Health NewsThis article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Tagged with:

About author

Related Articles