Pregnant 15 y/o in School

[MisRN]

So I can't say that I'm exactly new to school nursing because this is my 3rd school year, but I've been doing it with very little guidance. I am the only nurse at an independent school with student from 3 years old to HS seniors. Typically I try to emulate what the public schools are doing, utilize best practices, stay within scope of practice etc....

Here's my question.... I have a 15 year old student who advised me the other day she just found out she is pregnant. Before confiding in me, she asked if I have to grant her confidentiality, which I told her yes (with some exceptions, but in this case, yes). In talking to her, I found out she also told her 4 or 5 "best friends" and 2 of her teachers, and a former teacher here from elementary grades. (So much for confidentiality!). She has since spoke to our school counselors at my advice. Now the Head of Upper School has requested a meeting with myself, the counselors and the Dean of Students in regards to how to handle the situation (future and current). I'm sure they're concerned how this will affect the other students as well. What do I need to be aware of and careful of during this meeting? I feel like I don't need to tell them any information that pertains to her specifically, but they already know. It's my understanding that the teachers and administrators would probably have called her parents & told them, but I'm not sure if that's happened.

When I worked in the Emergency Department previously, a pregnant minor can consent to care and treatment pertaining to her pregnancy without adult guardian, but not for things not related to her pregnancy.

Thanks for any input, information, advice, warnings, etc....

[ruby_jane, BSN, RN]

Oy. Well, has she gone for a pregnancy test yet? The kind where there's a paper trail? Because I have had at least a dozen "pregnancy scares" that were not actually pregnancies.

So, if you're getting this directive then someone told the upper administration. At this time, I would probably choose not to say anything to them (citing confidentiality) unless the young lady is in the meeting. I assume that what they're worried about and what you're worried about are very different. While she can go get a pregnancy test (and perhaps treatment, depending on your state) without parental consent, the odds of her carrying though 9 months at age 15 without parental units knowing are slim to none.

Good luck!

[caliotter3]

I would not want to be the one who is singled out for passing information, authorized or not. Why is a meeting necessary anyway? The school has never dealt with pregnant students before? Say as close to nothing as possible while taking in what the meeting is truly about.

[OldDude]

This is the right place to come for sound advise, but not from me. I love ELEMENTARY school nursing. Good luck.

[NutmeggeRN, BSN]

I would first try to ensure that she is in fact pregnant. If I had a dollar for evey "pregnancy scare"...Hopefully she is safe and not a victim of abuse.

Howver, if it is true, sounds like she will be due in late spring early summer? I would not want to be at a meeting to discuss her situation per say, but to address the fact that a student will need to have accomodations in order to support her education. What might those be? Depending on how well she is:

Maybe exra time/flexible deadlines for for work if she misses school due to illness (we do that anyway)

No exposure to chemicals in certain classes (we would do that for an allergy)

Waive PE for this year (we would do that for an extended illness or injury)

Use of elevator (we would do that for a fx leg)

A more comfortable chair and table, we use trap tables in some rooms. (we would do that for an injury)

When she is closer to delivery, plan on a tutor and or access to on line learning ( we would do that for at kid home)

As you can see, many of the accomodations we can provide for a pregnancy, we do for so many other things. There does not need to be a big deal made of this situation. She should be treated with dignity and respect. And whatever decision she makes regarding the baby, it should be respected.

Her days will be hard enough. We have no idea what may be going on at home and school needs to be a safe environment. I would also work to ensure she gets appropriate prenatal care if that support is not at home.

What you don't want to happen is that she feels unsupported and drops out. She does herself, her child (if she is keeping it) and in the long run, society no good if she cannot get her HS education.

Good luck and keep us posted.

[ruby_jane, BSN, RN]

What you don't want to happen is that she feels unsupported and drops out. She does herself, her child (if she is keeping it) and in the long run, society no good if she cannot get her HS education.

Good luck and keep us posted.

You have such a beautiful, good heart!!!

[NutmeggeRN, BSN]

Thank you! I was the pregnant college junior in a small Catholic college. They stood by me and made darn sure I finished (one year later, but never the less, I completed my degree).

[ohiobobcat]

I would not want to be the one who is singled out for passing information, authorized or not. Why is a meeting necessary anyway? The school has never dealt with pregnant students before? Say as close to nothing as possible while taking in what the meeting is truly about.

I, too, am wondering what the meeting is about. In my experience, most students and teachers are supportive of the pregnant student and the pregnancy gets treated like any other "medical" condition as far as the school goes. What needs to be "handled"?

I have had pregnant students before and while I was always available if they needed me, the pregnancies were healthy and I rarely saw them. I let guidance know (with the student's permission) as another source of support, and to assist in handling the academic side of things once it becomes necessary. Who the student chose to tell beyond that is up to her and wouldn't be considered a breach of confidentiality if the student is the one doing the telling.

[Flare, ASN, BSN]

So had a student in a similar situation, except that the parents were aware so getting prenatal care was not a big deal and beyond me checking in with the student from time to time, making sure that once her PE restictions were in place and finally once she was set up for homebound instruction that the medical piece was in place we were good to go. I was even able to provide a place for her to pump once she returned.

If your student is not willing to disclose to their parent at this time, perhaps you can help them find a place to go to start getting care. My county has a resource guide of clinics that provide low cost and no cost. States vary on what age a child is considered emancipated based on the pregnancy. However, (and don't take my word as law) i believe most are at 14.

[WineRN]

As you can see, many of the accomodations we can provide for a pregnancy, we do for so many other things. There does not need to be a big deal made of this situation. She should be treated with dignity and respect. And whatever decision she makes regarding the baby, it should be respected.

Her days will be hard enough. We have no idea what may be going on at home and school needs to be a safe environment. I would also work to ensure she gets appropriate prenatal care if that support is not at home.

What you don't want to happen is that she feels unsupported and drops out. She does herself, her child (if she is keeping it) and in the long run, society no good if she cannot get her HS education.

Good luck and keep us posted.

This is perfectly said.

There is most likely going to be backlash from other students, other student's parents and all sorts of people who really have no business with having an opinion in the first place. School needs to be a safe place and it sounds like from the OP there is a small handful of trusted adults and friends which should help the student through this challenging time.

[DeeAngel]

I dont see where this requires a meeting but guard your answers carefully and do not trust anyone to have your back in this matter. If you are uncomfortable at the meeting or feel accused, I would end the meeting right then and there and would not speak another word without an attorney. I have little faith in any form of administration anymore.

[JenTheSchoolRN, BSN, RN]

Nutmegge said it all very well up thread. In my state, I cannot reveal a student's pregnancy to anyone without that student's permission. Teachers will speculate if this is a confirmed pregnancy that the student will be carrying to term. But even then, I cannot confirm or deny. I say nothing.

Last pregnant student I treated luckily had a good support system at home, and principal was aware of the pregnancy, but so respectful. I am not allowed to document any treatment for this student in my computer, as it is protected information that does not become part of her educational record (as the rest of her health file did). After she gave birth, she was out for 8 weeks, during which we arranged for tutoring to happen at home. She graduated on time with the rest of her class.