Adolescent pregnancy and parenting OSCE — confirmation, options, safeguarding and postpartum care

Station objectives

1. Confirm and date a pregnancy while excluding an emergency, in a non-judgemental adolescent consultation. [1]
2. Deliver non-directive options counselling and a safeguarding review. [2]
3. At a postpartum visit, assess mood and contraception and plan to prevent rapid repeat pregnancy. [4] [6]

Candidate brief

You are the paediatric doctor in adolescent clinic. You have 10 minutes for Station A (newly pregnant, ambivalent) and 12 minutes for Station B (postpartum, low mood, no contraception). Examiners score process, safety, safeguarding and partnership language. [1] [2]

Station A — Ambivalent newly pregnant 16-year-old

Setup: A 16-year-old with a positive home test, eight weeks by LMP, no pain or bleeding; in a consensual relationship with a 17-year-old partner; frightened to tell her mother; unsure whether to continue. [2]

Expected actions:

• Greet the young person first; secure time alone; state conditional confidentiality with lawful limits. [2]
• Confirm pregnancy (urine ± serum β-hCG), date with ultrasound, and explicitly exclude ectopic (ask about pain/bleeding). [1]
• Offer non-directive options counselling: parenting, adoption, termination (where legal) within the time window; do not steer. [2]
• Complete a safeguarding review of the partner and consent context; assess capacity; agree who is involved. [2]
• Arrange a close follow-up regardless of the decision; give written safety-netting. [1]

Station B — Postpartum adolescent mother, low mood, no contraception

Setup: A 17-year-old at six weeks post uncomplicated vaginal birth, formula-feeding, reports low mood and broken sleep, no contraception, little support; the baby is growing well and is due immunisations. [6] [5]

Expected actions:

• Recognise the parent as the patient as well as the infant (two patients). [7]
• Screen mood with a validated instrument and take a focused history including self-harm and harm-to-baby thoughts. [6]
• Perform a same-visit suicide and safety assessment if the screen is positive; decide early review with safety plan versus crisis pathway; exclude postpartum psychosis. [6]
• Contraception counselling: offer the most effective acceptable method (LARC where available and chosen, offered not imposed) — emphasise this prevents rapid repeat pregnancy and should be agreed before she leaves. [4] [8]
• Offer breastfeeding support without judgement, plan school re-entry with education liaison, and arrange close multidisciplinary follow-up. [7]

Marking anchors

Clear pass: secures time alone; correct confidentiality limits; confirms and dates pregnancy and excludes ectopic; non-directive options; safeguarding review; postpartum mood screen with same-visit safety assessment; contraception plan offered before leaving; two-patients language throughout. [1] [2] [4] [6] Borderline: good rapport but incomplete risk assessment, vague follow-up, or contraception deferred to "next time." Fail: no private time; judgemental; steers a single option; ignores safeguarding cues; misses positive mood screen; discharges without contraception discussion; focuses only on the baby. [2] [6] [5]

Debrief pearls

• The postpartum visit is a contraception visit, a mood visit and a parenting-support visit at once. [4] [6]
• Non-directive counselling is a skill examiners probe deliberately — any sign of steering fails the station. [2]
• Adolescent-specific breastfeeding support improves outcomes; never shame a young mother. [7]