“We are more than diabetes”: a qualitative study of maternity and postnatal care experiences of mothers in England with type 1, type 2 and gestational diabetes

Background Diabetes is a significant health issue during and after pregnancy, with increased risks of adverse outcomes for mothers and babies if maternal blood glucose is not controlled. National guidelines in England cover maternity care for women with pre-existing (type 1 or type 2) and newly-diagnosed (gestational) diabetes, but as the incidence of pregnancies affected by diabetes increases, it is unclear to what extent this guidance is being followed. Methods 32 mothers in England with type 1, type 2 or gestational diabetes were interviewed about their experiences of antenatal, intrapartum and postnatal care. Interviews were analysed using thematic analysis. Results Four themes were developed: ‘The antenatal information gap’, ‘Monitoring and management’, ‘Communicating risk and choice’, and ‘The postnatal cliff edge’. There were examples of good and poor practice across all themes, and themes were similar across all types of diabetes. Mothers felt safe when care met their needs for pre-conception counselling; high quality and timely information about diet and exercise; access to personalised advice; real time communication of blood glucose results through the use of technology; non-judgemental support that recognised their expertise on their own bodies; meaningful informed choice about mode and timing of birth with risks explained clearly and without drama; well-planned intrapartum care that included management of their blood glucose; and information to prepare for the postnatal period. Inconsistent, poorly-informed and judgemental interactions made mothers feel coerced and unsafe. Most reported intensive antenatal support but a lack of postnatal support. Conclusions Maternity services should offer mothers with diabetes person-centred, non-judgmental care that respects the autonomy of the mother as a decision-maker based on sufficient information about personal risk. Mothers need high quality, consistent, evidenced-based, culturally relevant and timely information about managing diabetes, with practical tips and recipes and access to support from other mothers, and this might be achieved by services working in partnership with third sector organisations. Primary and secondary healthcare needs to be joined up, particularly to increase postnatal support. All health professionals who are involved in maternity and postnatal care need the knowledge, skills and confidence to support mothers with all types of diabetes.