Abstract
BACKGROUND : This thesis examines the issue of unplanned pregnancy in women with diabetes mellitus (DM) in order to understand what factors promote or discourage effective preconception care. DM is a common disorder complicating pregnancy and unplanned pregnancy can present major health risks to both a woman with diabetes and her fetus (CEMACH 2005a). In spite of the risks, less than half of women with diabetes are reported to plan their pregnancies (CEMACH 2007). METHOD: Extended case method (Burawoy 1998) was applied to a case study: ‘the prevention of unplanned pregnancy in women with type 1 or type 2 DM’. An ethnographic approach and feminist focus explored the macro and micro perspectives of the case. The study used mixed methods with three sequential phases; a database study reviewed the general practice records of 1683 women with diabetes and a comparison group. Questionnaires from 107 women followed by 32 semi structured interviews were then used to examine the experiences, attitudes and knowledge of women with diabetes and the health care professionals who provide their diabetes care. The first two phases were analysed using SPSS and the qualitative data by NVIVO 7. FINDINGS: Incongruence in views between the health professionals and women with DM were found. This included the meaning of a ‘planned ‘pregnancy, knowledge of preconception issues, and in use of contraception where differences in prescribing and less use of hormonal methods were seen. Women were found to experience a medicalised approach to care. CONCLUSIONS: I argue that the approach to preconception care for women with DM requires reconceptualisation with a shift away from a medicalised model of care and a dynamic holistic bio-psychosocial model is proposed. My findings suggest that important factors appear to include the strength of relationships with health professionals, congruence of views between women with DM and their health carers, the belief systems of the women with diabetes in relation to planning for pregnancy, receptiveness to preconception information and care and the use of contraception.