Finding a balance for the pregnant woman with diabetes | |
Diabetes and pregnancy. Women's experiences and medical guidelines. Alison Nankervis, Josephine Costa (editors). Melbourne: Miranova, 2000 (xii + 242 pp). ISBN 0 958 71423 1. |
This book aims to "give courage to and reassure the woman with type I diabetes who wishes to have children". Nineteen women were prepared to record their experiences, problems and concerns in pregnancy. Each story is accompanied by comments from a physician, an obstetrician and others, and is followed by summary advice, which is generally pithy and valuable. Unfortunately, there is no index, so specific information is difficult to locate. It is difficult to follow any individual woman through the book, as her contribution must be found separately in each chapter. The book seeks to reassure women with diabetes, yet portrays a succession of 35 pregnancies which are mostly complicated and far from normal. More than half the babies were born by caesarean, 42% weve preterm. There were no cases of spontaneous labour, all being delivered either by caesarean, after preterm labour, or after induction of labour. Many of the babies were macrosomic. Some of the practices described are unconventional but there is nothing in the text to indicate this. For example, heparin and dipyridamole were used for diabetic nephropathy; epidural for women using low dose aspirin was disallowed; it is stated that adequate care for pregnant women with type I diabetes is only available from a public hospital; and most babies were taken to the special nursery from the delivery room. There is a lack of balance in the book — breastfeeding is given 33 pages, while contraception is dismissed in half a page. The breastfeeding section is not a gentle introduction for the novice and its approach may result in feelings of guilt for those who "fail". A patient with diabetes may read this book hoping for confirmation that something resembling normal pregnancy is possible for her. While there is much interest and emotion in the personal accounts, and the medical advice is useful and clear, this book will not reassure these women. To quote one, "I was tired of it all &38212; seeing different doctors…blood tests…ultrasounds…bruises and lumps from injections and staying in hospital. I had never thought that in my lifetime having a baby would cause this much pain and suffering". As health care professionals we must learn from such cries of angst. We must try to empower our pregnant patients, particularly, but not only, those with diabetes. For them, pregnancy does require special care, but it can also lead to renewed self-confidence and some semblance of autonomy. The difficulty lies in finding the balance between well-meaning but obsessional surveillance and nonchalant management. We should be able to do it.
Barry N J Walters
|