Type 1 diabetes is an autoimmune condition which occurs when a person’s immune system destroys the insulin producing cells of the pancreas (beta-cells) and so requires daily insulin therapy. The main signs and symptoms are thirst (excessive drinking, unable to quench thirst), toilet needs (frequent urination, particularly at night), tiredness (lack of energy, sleeping more than usual) and weight loss (rapid weight loss over a short period of time). Other, less common symptoms include lack of concentration, vomiting, abdominal pain, constipation, bedwetting, mood swings, frequent infections and itchy skin infections. (Diabetes Ireland, 2018). In this essay I will discuss the general role of a midwife, the risks associated with pregnancy for women with Type 1 Diabetes, extra cautions taken before and during pregnancy for women with Type 1 Diabetes and the role of the midwife in the preconceptual and antenatal care of a woman with Type 1 Diabetes using insulin.
The word midwife means ‘with woman’ and with that comes many important roles and responsibilities. These include providing antenatal care (teaching parenting classes, offering clinical examinations and screenings), identifying high risk pregnancies, monitoring, informing and supporting women during labour and birth and educating new mothers on how to care for their babies. (NHS Health Education England, 2018) MORE OF GENEREAL ROLE
What is diabetes type 1
Role of a midwife
It is extremely important for women who have type 1 diabetes to avoid unplanned pregnancies. High blood sugars associated with diabetes can cause harm to the embryo in the early days of pregnancy, at a crucial time for organ formation. Women who are planning to become pregnant should wait to do so until their glycaemic control is within the recommended target levels. They should also first be assessed for any complications that may need to be addressed before becoming pregnant. (Diabetes Ireland, 2018) The Joslin-Beth Israel Deaconess Pregnancy Program recommends the following blood glucose goals and medical assessments before pregnancy: fasting and pre-meal blood glucose: 80-110 mg/dl, blood glucose one hour after meal: 100-155 mg/dl, A1C: less than 7% (the A1C test measures the amount of haemoglobin that has glucose attached and reflects average blood glucose levels over the past three months. The higher the percentage, the higher the blood glucose levels), review of diabetes and obstetric history, eye checks to screen for diabetic retinopathy, renal, thyroid, gynaecological and cardiac evaluations. (Brown ; Takoudes, 2006). Babies of women with higher blood glucose levels have a higher chance of being born with congenital deformities (for example heart defects, neural tube defects) or even stillbirth or neonatal death than babies of women without diabetes, therefore it is extremely important for women to stabilise their A1C before becoming pregnant. It is the responsibilty of the midwife to educate women with Type 1 Diabetes of the risks and recommendations before she tries to conceive. The midwife could recommend that a woman starts or continues to use contraception until her blood glucose levels have met the target, her medical assessments are completed and she has discussed all of the above with a medical professional who now agrees that it would be safe for her to become pregnant and have a successful pregnancy. Currently, no contraceptive methods are contraindicated specifically for diabetic women. The choice of method should be made by the woman with the help of a medical professional who has experience with prescribing contraception, the same as for non-diabetic women. Failure of contraception can result in serious complications for the baby of a woman with diabetes, so methods that are proven to be highly effective should be recommended. (American Diabetes Association, 2002)