Caring for pregnant with pre-existing and gestational diabetes

By Lisa Grant, specialist diabetes midwife Cwm Taf Morganwg, Wales MSWs - Maternity Support Workers Safety Maternity Safety Diabetes Wellbeing Of Women Women

To coincide with the Caring for pregnant with pre-existing and gestational diabetes guidance launch, specialist diabetes midwife Lisa Grant shares her experience of supporting women in maternity care.

I always enjoyed acute medical nursing and realised that as a practising midwife I would be able to cross over and enjoy both my favourite health interests within this new role.

Although I had previous medical knowledge, and appreciating how beneficial that would be, I also felt the need to undergo further education in diabetes, so embarked on a diabetes post graduate diploma, online, which consisted of six modules over an academic year. Committing to academic learning was a challenge but I felt crucial to this role as I felt I would be able to establish myself professionally within the multidisciplinary team.

I realised how much I enjoyed learning again, and as course participants were worldwide it was so interesting learning how services and care were organised and provided elsewhere, the course would also give me an insight into disease prevention and have a better understanding of the disease process in general.

As this was a new role, I also placed myself with the DNS team at different sites within my health board to learn as much about their role as possible.

I had correlated the most recent evidenced based guidance and started to filter through to all sites what was out of date and no longer evidence based and with the agreement and support of endocrine and obstetric teams, unified processes and standards according to these standards were met to ensure the same approach across sites.

Importantly, I had no previous role example to follow and realised that I needed to travel to other local health boards to find out how other diabetes midwives were practising and how I could establish the role and practice within it.

I quickly realised that throughout different health boards different approaches and resources were available and I needed to be flexible working within this environment and establish my role within the resources available within my local health board.

I needed the support of my DNS colleagues who would support me as I now would need to work alongside a new team of endocrine/medical colleagues. I would describe my approach as very tentative and making new relationships that challenged me personally and professionally.

I started writing information booklets for women and work on the out of date guideline as well as placing myself within the clinics providing women with more midwifery advice and support, ensuring the care was as holistic as possible. I am particularly passionate about encouraging harvesting colostrum/breastfeeding and helping women to achieve the best outcomes for mothers and baby.

Ensuring women had the most up to date information around glycaemic control, birth options, timing and mode of delivery while maintaining optimum independence and choice to ensure best outcomes for mum and baby were crucial to me.

My main aim was to update and work collaboratively with obstetric, endocrine and pharmacy colleagues to update the Diabetes In Pregnancy guideline, this has been very timing consuming and challenging which has been more difficult in the midst of a pandemic.

I see the future of my role as advisory and encouraging the use of app based care such GDM Health and more choices such as CGM which encourages independence.

I have learnt that there is not always a one size fits all approach, as usually more complex conditions may also be present and as  a midwife I feel the value of face to face consultations cannot be underestimated, women should feel supported throughout their pregnancy journey, ensuring choice and understanding at every opportunity.

There is much more I need to achieve by completing audits to find further ways to improve women’s care and experiences within the service about diabetes care in pregnancy, measuring these outcomes can help to shape further improvement changes.

I look forward to this year because I would have achieved completion of work that I have worked tirelessly for, and can move on to other projects,

So if I have any advice, please keep aiming for the improvements you know are needed, don’t look back just keep moving forward!