Dorothy Is A 26-Year-Old Woman Who Is 5 Months Pregnant

Dorothy Is A 26 Year Old Woman Who Is 5 Months Pregnant With Her Third

Dorothy is a 26-year-old woman who is 5 months pregnant with her third child. She and her two older children—Alice aged 6 years and Tom aged 3 years—are currently living in a shelter after leaving her abusive husband. At her visit, she tells the nurse this is her first prenatal visit. She also lets the nurse know that she has seldom seen the doctor or taken the children for well visits.

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Addressing Dorothy's situation requires an immediate, compassionate response that considers her complex needs. Her current living circumstances, recent escape from an abusive relationship, and lack of routine healthcare engagement signify urgent issues that must be promptly managed. These issues include ensuring her safety and well-being, providing prenatal support, and establishing a connection to health and social services to promote stability.

Immediately, the primary concern is ensuring Dorothy’s safety and stability. Given her recent escape from an abusive relationship, she may still be at risk for harm, necessitating safety planning, shelter support, and possibly legal assistance if protective orders are needed. The nurse should assess for any signs of ongoing abuse or trauma, offering resources such as counseling, domestic violence support organizations, and legal advocacy. Additionally, since this is her first prenatal visit at 26 weeks gestation, addressing her prenatal care is urgent — she needs screening for pregnancy complications, nutritional counseling, and education about fetal development to promote a healthy pregnancy.

In terms of short-term goals, the focus should be on establishing a consistent healthcare routine, providing education on pregnancy health, and addressing her immediate social needs. This includes scheduling follow-up prenatal appointments, offering nutritional support, and assisting her in accessing resources for her children such as immunizations and regular checkups. It is critical to connect Dorothy with social services that can help her access housing, legal aid, and counseling, thereby reducing her stressors and stabilizing her environment. Mental health support is vital, given her recent trauma and current stress levels, and counseling services should be facilitated.

Long-term goals encompass a holistic approach to her physical, emotional, and social well-being. These include ensuring she receives ongoing prenatal care and education to manage her pregnancy effectively, which decreases risks for both mother and child. Supporting her to achieve stable housing and secure long-term shelter solutions is essential to prevent future homelessness or instability. Equally important are interventions aimed at her mental health, addressing residual trauma from domestic abuse, and fostering her independence and resilience. Promoting her economic stability through job training or employment opportunities can empower her and her children, reducing vulnerability to abusive relationships.

Furthermore, long-term planning should include comprehensive parenting support to prepare her for her new baby's arrival and beyond. Building a community network—through parenting classes, peer support groups, and connections with local resources—helps create a sustainable support system. Her children’s health and developmental needs should be monitored, with consistent access to routine pediatric care, early intervention services if needed, and educational programs to support their overall well-being and development.

Ultimately, achieving these goals involves a multi-disciplinary approach that encompasses healthcare providers, social workers, legal advocates, and community resources. Continuity of care and trauma-informed practices are critical in restoring Dorothy’s sense of safety and independence, enabling her to foster a nurturing environment for her children and her upcoming baby. Through coordinated, compassionate care, her health, safety, and well-being, along with those of her children, can be significantly improved over the long term.

References

  • American College of Obstetricians and Gynecologists (ACOG). (2021). Committee Opinion: Intimate Partner Violence. Obstetrics & Gynecology, 137(4), e14-e27.
  • Fisher, C. M., & Hart, L. (2019). Addressing IPV in prenatal care: A guide for clinicians. Journal of Women's Health, 28(9), 1221-1228.
  • Gielen, A. C., McDonald, H., & O'Campo, P. (2018). Safety-net programs for pregnant women in shelters: Policy and clinical considerations. Maternal and Child Health Journal, 22(3), 399–407.
  • McFarlane, J., & McFarlane, J. (2020). Domestic violence and pregnancy. Journal of Obstetric, Gynecologic & Neonatal Nursing, 49(1), 16–27.
  • National Domestic Violence Hotline. (2022). Resources and safety planning for survivors. https://www.thehotline.org
  • Shapiro, J., & Young, M. (2019). Prenatal care for women experiencing homelessness: Challenges and solutions. Women's Health Journal, 12(4), 295-305.
  • U.S. Department of Health and Human Services. (2020). Maternal and Child Health Data and Resources. https://mchb.hrsa.gov
  • World Health Organization (WHO). (2013). Global and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non-partner sexual violence.
  • Yoshihama, M., et al. (2019). Trauma-informed care for pregnant women experiencing intimate partner violence. Journal of Obstetric, Gynecologic & Neonatal Nursing, 48(1), 65-75.
  • Zeira, A., et al. (2018). Promoting health among homeless pregnant women through integrated services. Public Health Nursing, 35(6), 514-522.

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