Cases/Maternity and Reproductive Health

Pregnant 17-year-old Who Wants to Keep Her Baby — Free SCA Practice Case

Pregnant 17-year-old who wants to keep her baby

Station Timer

12:00

Golden Minute

Initial Introduction

•Introduce yourself

•Ask an open question — "How can I help you today?"

•Listen — don't interrupt

•Catch early cues

Data Gathering

History, ICE & Diagnosis

Clinical Management

Diagnosis, Plan & Decisions

Safety Net

Follow-up & Close

12:00

Golden Minute

Materials for Candidate

Please review before starting the consultation

Patient Profile

Full Name

Jade Mitchell

Age

17 years

Consultation Type

Video

Age

Situation

Video Consultation.

Reason for Encounter

"I've found out I'm pregnant — about three months. I want to keep the baby. I don't want a social worker involved though."

Medical Records

●PMH: Previous pregnancy aged 13 (placed for adoption). Looked-after child in the past; now a care leaver.
●Medications: Nil. (Contraceptive implant previously fitted, since removed/discontinued.)
●Allergies: NKDA.
●Social: Previously in foster care; currently living in supported hostel accommodation.

Patient Script

For the friend playing the patient role

Character Overview: You are Jade, 17, about three months pregnant. You are guarded at first — you have had a lot of professionals in your life and are wary of being judged or "having things done to you." You are clear that you want to keep this baby and you are frightened of a social worker taking it away, as happened when you were 13. If the doctor is warm, non-judgemental, and on your side, you will open up. You are not hostile — you are a young person who has had a hard time and wants to be treated as capable and supported.

Opening Sentence: "So, I found out I'm pregnant — about three months gone. I want to keep it, and I've made up my mind about that. The main thing is, I don't want a social worker involved. Last time they took my baby away, and I can't go through that again."

History if Asked (Data Gathering Phase)

●This pregnancy: "I'm about three months. I did a test a couple of weeks ago. I haven't seen a midwife yet. I definitely want to keep it."
●The previous pregnancy (only if asked, sensitively): "I had a baby when I was 13. I was in foster care, and it was the foster family's son. The baby was taken for adoption. It was the worst thing that's ever happened to me."
●Contraception: "I had the implant for a while, but I stopped it — I didn't get on with it."
●Current partner: "My boyfriend's 17, same as me. He knows about the baby and he's happy. He wants me to move in with him."
●Living situation: "I'm in a hostel — supported housing. I left care not that long ago."

ICE — Ideas, Concerns, Expectations

The patient does not volunteer this information unprompted. These responses surface only when the candidate directly explores her perspective.

●Ideas: Jade sees professionals mainly as people who take control away from her, and equates "social worker" with "having the baby taken." She is not fully aware of the antenatal care and support available to her. "In my head, professionals turning up means losing control — and a social worker means losing the baby."
●Concerns: Her overwhelming concern is that the baby will be taken from her as before. Beneath that are worries about coping, housing, money, and whether people will judge her. "The thing that terrifies me is them taking this baby too. And underneath that — can I even do this? Where will we live? Will everyone judge me?"
●Expectations: She wants to keep her baby, to be supported without being "taken over," and reassurance that she will not automatically lose the baby. "I want to keep my baby, get whatever help there is, and not be treated like I can't be trusted."

If Asked — Safeguarding, Relationship, and Support (approached sensitively)

The patient answers these only when directly and sensitively asked.

●If asked whether she feels safe in her current relationship: "Yeah, my boyfriend's good to me, he's the same age, we're happy. He's never hurt me or forced me into anything."
●If asked about the pressure to move in with him: "He wants me to move in. I think I want to too, but it's a big step — I haven't decided."
●If asked about coercion or feeling pressured (generally): "No, no one's pressuring me. This is my choice."
●If asked, sensitively, about the circumstances of the pregnancy at 13: "It was the foster family's son. I was 13. I don't really want to go over it all — it was dealt with at the time." (Handled as a sensitive historical safeguarding fact; the candidate should not press for distressing detail.)
●If asked about her support network: "My boyfriend, and there's a key worker at the hostel who's alright. I don't really have family."
●If asked about smoking, alcohol, drugs: "I don't drink or take anything. I smoke a few cigarettes but I want to stop for the baby."
●If asked about her mental health/mood: "I'm okay, actually — I feel more positive having something to focus on. I'm not depressed."
●If asked about folic acid / vitamins: "No, I'm not taking anything like that. Should I be?"
●If asked about her general health/periods: "I'm well. Everything's been normal apart from being pregnant."

Responses to Management (The Negotiation Phase)

●If the Doctor supports her decision and offers antenatal care: "So you're not going to try to talk me out of it? You'll actually help me have this baby?" (The tested point is respecting her autonomy and decision to continue, and offering supportive antenatal care.)
●If the Doctor sensitively explains that some safeguarding involvement may be needed: "But that means a social worker, doesn't it? They'll take the baby — I knew it." (The tested point is explaining, honestly and supportively, why safeguarding/support involvement may be needed — for her and the baby — while distinguishing support from removal and working to keep her engaged.)
●If the Doctor explains her rights and confidentiality: "So do I get a say? Or do you just do what you want because I'm 17?"
●If the Doctor offers practical support (housing, social prescribing, care-leaver support): "There's help with housing and money? No one's really explained that to me."
●If the Doctor arranges midwife/antenatal referral: "What happens at the midwife? Will they judge me for being young and having been in care?"

Mark Scheme

Domain 1: Data Gathering and Diagnosis

0 / 16 indicators checked+0−0

Positive (0/8)

Negative (0/8)

Domain 2: Clinical Management and Medical Complexity

0 / 20 indicators checked+0−0

Positive (0/10)

Negative (0/10)

Domain 3: Relating to Others

0 / 12 indicators checked+0−0

Positive (0/6)

Negative (0/6)

Clinical Learning Points

Teenage Pregnancy — Supportive, Non-Judgemental Care

●A pregnant teenager who has decided to continue needs prompt, supportive, non-judgemental antenatal care, ideally via a specialist teenage-pregnancy / young-parents' pathway. Early midwife booking, folic acid, vitamin D, smoking cessation, and a dating scan are the basics.
●Rapport and respect for her autonomy are essential to engagement — alienating a young person risks her disengaging from care.

Competence and Autonomy

●A young person under 18 who has sufficient understanding (Gillick competent) can make decisions about their own care, including continuing a pregnancy. Respect that autonomy while holding safeguarding in mind.

Proportionate Safeguarding Assessment

●A pregnant 17-year-old is a child. Assess: current relationship safety and consent (including the partner's age and any coercion), exploitation, vulnerability (here, a care leaver in hostel accommodation), mental health, substance use, and the historical safeguarding context.
●The historical pregnancy at 13 while in foster care is a serious historical safeguarding matter; approach it sensitively, making clear it was not her fault.

Confidentiality vs Safeguarding Duty

●Young people have a right to confidentiality, but this is not absolute where there are safeguarding concerns. Given her age and vulnerability, some information-sharing and safeguarding/support involvement may be necessary.
●Be honest and transparent about what will be shared and why, and distinguish support and safeguarding from automatic removal of the baby — over-promising secrecy or issuing threats both damage trust and safety.

Care-Leaver and Practical Support

●Care leavers have specific entitlements (a personal adviser / leaving-care team). Mobilise housing support, social prescribing, financial support, and young-parent support. Practical support both improves outcomes and strengthens engagement.

Maintaining Engagement

●The linchpin of this consultation is keeping the young person engaged so she attends antenatal care and accepts support. Balancing honesty about safeguarding with a supportive, respectful relationship is the core skill.

Multi-Agency, Documented Care

●Coordinate multi-agency care (midwifery, safeguarding, housing, care-leaver services), document the assessment and plan, and arrange follow-up.

Common Candidate Mistakes in This Case

●Being judgemental or paternalistic: questioning her decision or talking down to her, causing disengagement — the relational failure.
●Mishandling confidentiality: either promising secrecy that cannot be guaranteed, or invoking safeguarding heavy-handedly without explanation.
●Missing or over-reacting on safeguarding: failing to assess a vulnerable child, or over-reacting disproportionately without assessment.
●Neglecting practical support and care-leaver entitlements: overlooking housing, finances, and leaving-care support.
●Losing her engagement: handling the consultation so she will not attend antenatal care — the worst outcome for mother and baby.

Free MRCGP SCA practice case for GP registrars covering Pregnant 17-year-old Who Wants to Keep Her Baby — Maternity and Reproductive Health. Includes candidate brief, patient script, marking scheme mapped to the RCGP SCA marking domains, and learning points. Built directly from the RCGP curriculum topic stations listed under "How this might be tested in the MRCGP SCA," part of a free library of 79 SCA practice cases for simulated consultation assessment preparation.

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