“If-then”-scenarios in the care of pregnant women with diabetes in socially vulnerable positions

Abstract

Abstract Background Pregnant women with diabetes in socially vulnerable positions face a multiplicity of medical, social, and psychological risks during pregnancy and birth and are susceptible to health inequities. This presentation explores the tentative nature of care provided to these women. Methods We base our findings on ethnographic fieldwork among health professionals at an obstetric outpatient clinic in Denmark. Results The unpredictability of diabetes during pregnancy calls for a flexible approach to treatment, placing significant demands on health professionals, pregnant women, and their partners and their ability to adjust to new scenarios. Our initial findings underscore that care is not static; it is dynamically adjusted to meet the medical, social, and psychological needs of the women. The adjustments in care encompass the negotiation and monitoring of insulin dosages, fetal weight, appointment frequencies, and additional consultations and impromptu phone consultations to follow up. An example of the tentativeness in care could be that if there is a sudden decrease in insulin requirements close to the due date then the birth might be induced. Beyond medical monitoring and treatment, the care extends to social initiatives that the health professionals must coordinate with various municipalities, depending on where the pregnant women live. This could include a joint meeting after the delivery between the woman, her partner, a health professional from the obstetric ward, and a social worker from the municipality. Often, this meeting is mentioned during consultations and intersectional meetings before the birth but is not formally arranged. Instead, it is tentative - if the pregnant woman would like a meeting upon discharge, then the health professional will set up a meeting. Conclusions Medical, social, and psychological care practices for women with diabetes in socially vulnerable positions are replete with “if-then” scenarios. Key messages • Care for pregnant women with diabetes in socially vulnerable positions is characterized by its fluidity and flexibility adjusting to the interplay of medical, social, and psychological needs. • The “if-then” scenarios that characterize the care for pregnant women with diabetes in socially vulnerable positions put high demands on the ability to adapt and adjust continuously.