PROFESSIONAL CLINICAL SETTING

Professional Clinical Setting

Professional Clinical Setting

ST is a 20 year Black female who came in Cayon Health center in St. Kitts for her initial pre-natal check-up. Her background disclosed that her pregnancy was accidental and she was gravida 1, para 0, at fourteen weeks of gestation. Social history indicated she was currently unemployed and was living in a mobile home with her 27-year-old boyfriend whom she had met 9 months ago. Both the patient and her partner were considering giving the baby up for adoption due to financial strain and other reasons.

During the physical exam, the physician notices several bruises at different stages of healing. When he questions ST about the bruises, she brushes it off with a nervous laugh and says that she has become increasingly clumsy during her pregnancy. We've begun asking our patients about abuse at our facility: Within the past year, or since you have been pregnant, have you been hit, slapped, kicked or otherwise physically hurt by your current partner or someone else?

ST becomes visibly upset and teary-eyed and states that her boyfriend has slapped her around on several occasions and that once she was accidentally dragged by his truck during an especially intense argument. He had slammed the driver's door, started the engine and put the truck in gear, reportedly without realizing that her dress was caught in the car door. On further questioning, the patient indicates that she is not happy in this relationship and, in fact, does not feel safe. However, she says that she has no place else to go and expresses some optimism about the future because her partner has begun attending church and said that he wanted to be a good father.

The patient tells the doctor that she is concerned about her situation, but she feels helpless and without recourse. The obstetrician tells her that there is help available and that he will provide her with information regarding her options. First, however, he tells her that he must assess her safety to determine the next step. He asks her if the violence has escalated and if her boyfriend has access to firearms or other weapons. The patient replies that the last time her boyfriend hit her was a couple of weeks ago when he smacked her across the face. She also told the obstetrician that her boyfriend had a gun, but that he had never threatened ...