A 'Bond Of Trust' Midwife For Teens A Comforting 'constant'

Posted: April 03, 1986

``I don't think I like her. She thinks she's cute."

Midwife Melita Jordan overheard that remark the first time she presented a class on health and pre-natal care to a roomful of feisty and frightened pregnant teenagers. The course is part of her duties as an instructor for the School Age Parents Program - the Institute for Adolescent Pregnancy and Family Services at Temple University.

Jordan had worn a three-piece suit that day - a mistake, she later realized. It had offended the young expectant mothers, who weren't feeling too good about their expanding waistlines.

Next time, Melita Jordan wore jeans, and adjusted her teaching plan to make room for the young women in the program to talk about what they need and, more important, what they feel about themselves and their futures.

She learned a lot - and will put her new knowledge to use as midwife-in- charge of a new comprehensive medical services program for pregnant teens on the Temple University campus.

Jordan says the program is unique for two reasons. First, it is for teens only - pregnant girls 13 to 19; adults' prenatal and general health needs are very different. Secondly, Jordan will be a comforting "constant" in the girls' lives during the emotionally and physically trying changes that come with pregnancy and childbirth: she will be their primary health care provider, instructor in childbirth, infant care and development classes, and barring complications, she will deliver their babies and provide follow-up care for weeks or months after the child is born.

The new program will enable her to build a "bond of trust" with the young mothers-to-be, says Jordan, instead of adding to their stress by sending them to different providers in different places throughout our fragmented health care delivery system.

With Melita Jordan, "bond of trust" is more than just a high-sounding phrase.

She's done more than change her outfit to win the confidence of the teens she's taught. She has listened closely, and with time and effort, discovered what the girls really care about. Even when they say they have nothing on their minds, Jordan has found they usually have very strong feelings they want to express.

"They are disturbed when people come in and ask others about them," Jordan explained, "but don't talk to them directly." So Jordan has listened, and discovered that the girls resent being portrayed as "loose" - as if all they've ever done and ever will do is have babies.

One student stated her feelings emphatically: she intends to finish school and go on to college, and her family is supportive of her, and she has no intention of living on welfare for the rest of her life.

What's often missing - and what Jordan hopes she'll be able to help give, along with medical counseling - is a sense of life beyond their immediate needs and perspectives: an element that, not surprisingly, is often lacking

from a 14-year-old's world view.

"They need to understand that there's another whole world out there - beyond the very small world where they live - a world they eventually have to enter," says Jordan. So she wants to introduce her patients to long-term thinking about how education and money and jobs are connected to the possibility of fulfilling immediate needs and long-term goals. And about the meaning of intimacy, relationships and sex - in that order.

If it's successful, the new teen clinic has the potential to reduce Philadelphia's infant mortality rate, which stands at 15.2 deaths per 1,000 live births - high, compared to national standards.

What's more disturbing is the racial picture on infant mortality in the city. While the death rate for white babies actually dropped in 1984 from 11 deaths per 1,000 live births to 8.5, the infant mortality rate for blacks increased - from 21.6 to 21.9.

A report and recommendations prepared last fall by a mayoral panel on infant mortality found that the major contributing factors to neonatal deaths include ". . . lack of education, substance abuse, single parenthood, low family income and age (under 17 and over 34) . . ."

The report concludes that to reduce the number of preventable infant deaths in Philadelphia, "comprehensive, high quality, culturally sensitive maternity and infant health services should be obtainable to every Philadelphian without financial constraints . . ."

The panel's charge sounds like a prescription for the new teen clinic program at Temple, incorporating the personalized care of a midwife with medical support from the university's obstetrics and gynecology department.

Any low-income pregnant teenager in the city is invited to call for an evaluation under the new program, housed at Temple Hospital pending approval of another permanent site on campus.

The number to call for an appointment is (215) 221-3050. After an initial medical interview, applicants will be channeled through the city's Maternity and Infant Care Program to determine their eligibility for financial assistance.

There are an estimated 3,000 to 4,000 pregnant teenagers in Philadelphia, and many of you could probably use some help.

Melita Jordan is expecting to hear from them. She's ready to help and willing to listen. Giving her a call could be a first step toward having a healthier baby and a happier more productive future too.

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