Juggling type 1 diabetes and pregnancy in rural Australia.
OBJECTIVE
to explore the experiences of women with type 1 diabetes, living in rural Australia, while preparing for pregnancy and childbirth. Additionally, we aimed to describe the women's engagement with, and expectations of, health-care providers during this period, and subsequently highlight potential service and informational gaps.


METHODS
qualitative research using a collective case-study design; seven women with type 1 diabetes who had given birth within the previous 12 months participated in in-depth interviews about their experiences of pregnancy and birth. Data were analysed thematically.


METHODS
The experience of type 1 diabetes, preconception preparation and pregnancy among rural Australian women was explored, including interactions with health professionals.


METHODS
seven women aged between 26 and 35 years agreed to be interviewed. The woman had one or two children and had given birth within the past 12 months.


RESULTS
rigid narrow control of blood glucose levels before conception and during pregnancy created unfamiliar body responses for women, with hypoglycaemic symptoms disappearing or changing. For example, some women mentioned developing tunnel vision or numbness and tingling around their lips and tongue as different symptoms of hypoglycaemia. Women needed information and support to differentiate between what might be normal or abnormal bodily processes associated with pregnancy, diabetes, or both. The women's preparation for conception and pregnancy was reliant on the level of available expertise and advice. Participants' experiences were coloured by their limited access and interactions with expert health professionals.


CONCLUSIONS
women with type 1 diabetes experienced significant hardship during their pregnancy, including a higher incidence of hypoglycaemic episodes, a loss of hypoglycaemic symptom recognition and weight gain. These difficulties were compounded by a scarcity of available information to support the management of their pregnancy and a lack of availability of experienced health professionals.


CONCLUSIONS
national and international consensus guidelines emphasise the importance of preconception and pregnancy care for women with type 1 diabetes. Close clinical supervision and the development of closer co-operation and partnership between the women and health-care providers before conception and during pregnancy may improve outcomes for these women and their babies. Building confidence in professional care requires increased access to specialist services, increased levels of demonstrated knowledge and expertise and better general community access to information about preparation for pregnancy and birth among women who have type 1 diabetes.
King
Rosemary
R
School of Nursing, University of Ballarat, PO Box 663, Ballarat, 3353, Victoria, Australia. r.king@ballarat.edu.au
Wellard
Sally
S
D000739:Anecdotes as Topic; D001294:Attitude to Health; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000451:nursing / Q000523:psychology*; D005260:Female; D006801:Humans; D009035:Mothers / Q000193:education / Q000523:psychology*; D009723:Nurse-Patient Relations; D010353:Patient Education as Topic / Q000379:methods*; D016742:Preconception Care / Q000379:methods*; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000451:nursing / Q000523:psychology*; D018566:Pregnancy, High-Risk / Q000523:psychology; D012944:Social Support; D011795:Surveys and Questionnaires; D014739:Victoria; D055815:Young Adult