Neither Tennessee, nor 10-year-olds, are equipped for childhood pregnancies

A case that made headlines across the U.S. recently has stuck with me. 

By now, most people in America have heard about the 10-year-old Ohio rape victim who had to travel across state lines to receive necessary healthcare in Indiana, the closest state where a legal abortion was available. 

This case has affected me deeply. I remember what it was like to be a 10-year-old girl. At that age, I was running around, skinning my knees on playgrounds with my best friend. I went to see “Kindergarten Cop” with my first “boyfriend,”  his mother sitting behind us supervising. My dad took me golfing for the first time. My parents took my sisters and me to ski school. 

These are the kinds of memories someone should be able to look back on when remembering childhood. But for too many children, their memories of childhood include horrible physical, emotional and sexual abuse. 

As an emergency physician, I am involved in child abuse cases occasionally when children are brought to my emergency department after injuries that we suspect are not accidental. I’ve also been there when children were brought to the ER after a suspected sexual assault. We take those cases seriously and are quick to consult child protective services and our pediatric colleagues for advice, treatment and follow up care.

One of the things I have never been faced with is what to do with a pregnant pediatric rape victim. But this case has made me think long and hard. Unfortunately in Tennessee, options for pediatric rape victims to access necessary care are limited.

Tennessee law currently specifies no one can have an abortion past the 6-week mark of pregnancy.  Most adult women don’t know they are pregnant at 6 weeks past gestation. How would a 10-year-old child know this? Most 10-year-olds haven’t even menstruated yet. I remember sitting in class in 5th grade when teachers separated the girls from the boys and taught us about the changes that would soon be happening to our bodies. 

The complete abortion ban that will go into effect in Tennessee in August  has no exceptions save this: an “affirmative defense” for doctors in order to save the life of the mother. This places doctors in a role where we must defend necessary healthcare we provide in order to save the lives of our patients. 

I would argue that any pediatric rape victim’s life is in danger during pregnancy and as physicians, we must do everything we can to prevent the forced pregnancies of children. 

Children should not be forced to carry a pregnancy for many reasons. Someone that young is likely not developed enough physically to handle carrying a pregnancy to term, thus putting their life and future fertility at risk. Also, think about the mental development of a 10-year-old. There is absolutely no way someone that young would fully understand what is happening to their body and what having a baby really means.

In the world of pediatrics, we are taught about something called Adverse Childhood Events (ACEs). These are events that happen during childhood that cause severe emotional distress, such as the loss of a parent, divorce, illness, abuse, and witnessing violence. Being sexually abused is an ACE. Being forced to carry a pregnancy to term and then either deliver vaginally or go through the trauma of a major surgery, as in a cesarean section, is another. 

I discussed the Ohio case with some of my OB colleagues because I wasn’t sure how we would handle labor and delivery of a 10-year-old patient. My hospital, like many hospitals, has OB services but we do not admit pediatric patients. Pediatric hospitals don’t have OB services, something available only at adult hospitals. 

A pregnant 10-year- old would likely need to be admitted to an adult hospital to deliver a baby and would need an anesthesiologist comfortable with both OB and pediatrics in order to go to the operating room for a C-section. In Nashville, I know of only two facilities that could accommodate such a case. 

With so many rural hospital closures in Tennessee and so few pediatric centers, who will be caring for the inevitable forced pregnancies in children? Someone please ask the members of the General Assembly who passed the trigger bill with no exceptions, and ask Gov. Bill Lee, who signed it into law.

 I would really like to know before a 10-year-old comes to my emergency room in labor and I have to figure out where I can send them to receive care.