Sharing my pregnancy experiences to improve NHS care – Melissa Flanagan

Melissa-150x150.jpg Sadly I’m not a brilliant example of a diabetic. I’ve had Type one diabetes for the last 28 years, since I was 15. Over the years, it’s fair to say that my control has been widely variable, ranging from “almost perfect” (during my second pregnancy) to “quite frankly, pretty appalling” (two young children, demanding job, busy life and nowhere near enough sleep). Taking the DAFNE course in 2007 was a real eye-opener and, probably for the first time, showed me that good control was possible and achievable. I took the course in preparation for my first pregnancy and found it invaluable.

I have had two very different pregnancies at two very different hospitals and it was really my experiences with each that made me interested in finding out more about diabetes care, particularly with reference to pregnancy, and trying to do something to contribute.

For the last two years I’ve been a patient representative on the National Pregnancy in Diabetes Audit. As part of the wider National Diabetes Audit, it gives a picture of NHS care for people living with diabetes across England and Wales during pregnancy and how it can be improved. I found out about applying after signing up to Diabetes Voices.

Each audit has its own advisory group consisting of Health Care Professionals specialising in the field, health care information experts and four patient representatives. We meet four times a year, usually via teleconference, but sometimes in person. Many members are experts in their field and extremely well known and well respected.

A different patient view

Initially I must confess that I wondered whether we patients were present as a box-ticking exercise and whether anything we said would be at all relevant to anyone. However, I was really pleased to find that, not only are we treated with respect, but our opinions appear to be listened to and taken on board. It’s really encouraging to see this as I have always thought that effective diabetes care must work as a partnership between medical professionals and patients.

A lot of the other patient reps I’ve met are clearly exemplary patients with enviable control and it’s very easy to feel inadequate in their presence. However I like to think that I represent a different section of people with diabetes – those of us whose intentions are good but who ultimately struggle with the day to day management of everything.

The audit has real benefits for everyone living with diabetes, so it is important we all make sure as many GP practices are taking part as possible. I’d encourage anyone to mention the National Diabetes Audit to their GP practice as they have to opt in by 19 August 2016 so their data is included. Most practices will be keen to take part, but may not be sure how to actually get involved. If that’s a problem just point them to series of guides developed by the NDA team and Diabetes UK.

All the data obtained from the audits is collated and analysed and published annually in detailed reports. There is an awful lot of information processed but the reports make for very interesting reading. Details of everything published can be found on the NDA section of the Diabetes UK website

How can care for pregnant women be improved?

The general message from the National Pregnancy in Diabetes Audit is to increase awareness of the importance of pre-conception planning amongst all women with diabetes pre or of childbearing age. These are three of the main findings linked to this:

– Blood sugar control outside the suggested ranges – both before and during pregnancy.
– Women failing to take folic acid prior to conception and within the first three months of pregnancy to help prevent possible birth defects.
– Women continuing to take medications that could be harmful in pregnancy.

From my own experiences, I’m keen to emphasise just how stressful a time pregnancy can be, for anyone really, but particularly for women with diabetes.

In my case, practical and continuing advice and support led to a much smoother-running pregnancy and a far easier birth second time around.

I totally appreciate that the NHS is stretched but I believe that additional help after birth could also help to prevent additional problems further down the line.


  • Patient representatives are recruited occasionally through Diabetes Voices, which delivers the National Diabetes Audit in partnership with the Health and Social Care Information Centre.

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