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In what way can high-risk pregnant women be helped by a utility centre?
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A letter from a diabetic women to the doctor of the gynecological hospital Barmbek-Finkenau, Hamburg after the birth of her son Rafael
08.10.2005
Dear Mr. Prof. Dr. Schmidt-Rohde!
I thank you very much for the aid in the birth of my son Rafael on the 28. May 2005. My special thank you goes to the very kind and very competent anaesthetists. I chose your hospital, because it is recommended for the delivery of children from women who suffer from diabetes type 1. The birth of my son went without complications concerning my diabetes. Moreover, no prenatal diabetes could have been diagnosed which is not only accidently, but rather a consequence of the efforts my husband and I took for nine months. I did 8 to 14 blood sugar measurements each day; visited my diabetologist very often; and additionally went to private consultations of diabetic experts. However, due to concerns about the development of my son, I had to take care to my confirmation of insulin. Although everything went alright, I want to mention some diabetic-related aspects that are capable of improvement. Your hospital is said to be a utitility centre for high-risk pregnant women. However, not much attention is payed to diabetes type 1. But I think that the quality and the instruments in your clinic could make an indivual adequat medical care possible. I had the impression that diabetes mellitus there is generalised in many ways. Actual research has shown that ideal confirmations can result in usual pregnancies comparable to non-diabetics. This means that an intensive, interdisciplinary cooperation is neccessary on the one hand, but that every intervention into the natural birth circulation has to be indicated on the other hand. Diabetes mellitus as a risk factor alone cannot justify an intervention.
My personal documents do not contain any evidence about my diabetes; about my confirmation during the pregnancy; about my last blood sugar values; or about my diabetologist. An appropriate treatment in consideration to my diabetological situation would have been impossible in emergency. I think the treatment would have been done in a very general diabetic-referential way. My opinion results from the following observations: I was again told that deliveries in the hospital of Barmbek are done on exact dates. It was the same with me, but I am the opinion that there is no reason for this treatment, because the sonograms showed normal values. There was no evidence for a risk birth. Instead of an interdisciplinary medical care, I got some incompetent commentaries about my blood sugar value confirmation which made me feel unsure of myself. Although I demanded for a conversation with the doctor, he did not have any interest in my diabetic confirmation during the pregnancy. An evaluation about my situation from a diabetologist was also not considered to be important. Plus, no post natal confirmations have been done. Although I had to stay in the pueperal station because of increased bilirubin values. However, no information was given to the neighboring diabetes station. When I became aware of the fact that I had to confirm my insulin dose newly, I had to arrange a date with an expert in diabetes on my own. I must conclude that a treatment in the hospital of Barmbek is not recommendable and I therefore plead for:
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an appropriate diabetological education for all employees;
- the establishment of an interdisciplinary concept of treatment in cooperation with the neighboring diabetes centre,
- the establishment of individual situational descriptions and of documents about the most important diabetoligical diagnoses of the pregnant women
Yours sincerely, Bettina Berger
[1] see: Howorka K et al: Modulare Schulung bei Diabetes und Schwangerschaft: Ergebnis-Analyse in 58 Schwangerschaften von Diabetikerinnen unter funktioneller Insulinbehandlung, Geburtsh. U. Frauenheilk. 56, 1996, 41-49
[2] According to my research, there is no scientific material about induction of labor that justifies this treatment.
The only review on this topic is:
Boulvain M, Stan C, Irion O. Elective delivery in diabetic pregnant women. The Cochrane Database Database of Systematic Reviews 2001, Issue 2.
Bettina Berger
Hallerstr. 4
20146 Hamburg
Phone: 040 3903066
Bettina.berger@email.de
Translated by Kristin Henke
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in Version 00.08.49