I have an ethical question regarding a patient whom I just saw for routine prenatal teaching:
This patient is pregnant and due in May. In reviewing her records, she has an extensive inpatient behavioral health history (i.e. suicidal ideation, among other things), as well as an evident learning disability. She has one living child to which custody was given to a family member at birth. Her significant other was present with her during our teaching session, and I just have an overall bad feeling about their ability to care for newborn. His presence seemed as if he was supervising her interaction with me; it didn't seem as if he was there for the education. When I inquired about her living child, she made a comment along the lines of "I used to be sick in the head, but I'm better now." I feel as though some of her answers were rehearsed, so to speak.
A much more experienced nurse than myself told me to phone our county's social service department. I also addressed my concerns with the L&D department head, who gave me a vague answer about how social services would "probably" follow up being that they were involved in her first pregnancy. I feel like this isn't a definite answer. I don't want to be meddlesome, but I also want to make sure that I am being an advocate for this unborn child. I want to make sure that I handle this in the most ethical way possible, and I want to address it before the birth of this infant (which is quickly approaching) so that we can avoid a "now what do we do?" situation after delivery.
In conclusion, what is the most ethical, discreet, and appropriate way to handle this situation?
Thank you in advance.