Women's experiences of becoming pregnant varied by pregnancy, with differences for individual women as well as between women. Appendices 1–6 illustrate this diversity with summaries of the experiences of five women including what they said about taking positive steps towards becoming pregnant, or not, and what they told us about action they took in relation to their diabetes, if any.
The journey to becoming pregnant
Table 1 summarises the number of pregnancies and live births for each of the women interviewed and for which pregnancies the women described taking positive steps towards becoming pregnant. The positive steps described by women varied and included discussing becoming pregnant with their partner, coming off the oral contraceptive pill, deciding not to restart contraception, undergoing fertility treatment, and careful attention to their diabetes. These are illustrated in the case studies (Appendices 1–5) and below:
‘When we decided that it would be a good idea to have baby number two it became very difficult to get pregnant. They changed my insulin about three times in about 3 months and I went for tests and they said I wasn't ovulating. Once all the insulin issues had been sorted out then my periods started again and I got pregnant.’ (Amy)
‘We had to wait for a while, while we got the diabetes under control before we could start trying again, so the sort of months leading up to becoming pregnant were sort of trying to get well and get everything under control and then once the staff here gave me the go ahead, then we could start trying again and it took about 3 or 4 months to get pregnant.’ (Helen)
‘We decided … before we got married that once we were married then we would just carry on and then if it happened, it happened sort of thing, because I thought it was going to take a long time so we weren't going to get hung up on it if you like … I come off the pill [first pregnancy] … [after pregnancy] I had the hormone implant for a while … I did start bleeding throughout after a while, so I had that removed and a coil fitted but never again … I went for my 6-week check and it wasn't in. So after that we just said that … you know … we were planning on looking into having another baby anyway, so if it happened again, it happened sort of thing and here we are now.’ (Isabelle)
Interviewer: ‘And what about when you started the fertility treatment? I mean did you do anything with your diet?’
Participant: ‘No … well I was taking folic acid and that was one thing I was doing before trying to become pregnant. I didn't really change my diet.’ (Abigail)
Table 1 Women's pregnancies and live births and the pregnancies for which they describe taking positive steps towards becoming pregnant.
The interviews with women took place some time after they became pregnant which is likely to have affected their recall of this time period. Some women seemed clear they took positive steps (for example Madeline, second pregnancy) or did not take any positive steps (for example Madeline, first pregnancy) but with other women, their journey to becoming pregnant was less clear. While in many instances there was evidence of positive steps towards pregnancy, it is difficult to determine how many of these were being retrospectively interpreted as positive, or where the women were telescoping together the time prior to becoming pregnant and the very early stages of pregnancy. For example, Stephanie initially described being shocked to find herself pregnant while still taking the oral contraceptive pill, but later in the interview described taking folic acid in preparation for this same pregnancy. There is evidence that currently in the UK women perceive becoming pregnant as something they should make positive decisions about,11 so the women in this study are likely to give accounts overemphasising positive steps to becoming pregnant. Women also struggled to reconcile conflicting feelings about a pregnancy. For example one woman, when asked how she felt when she first found out about her current pregnancy, said:
‘I can't remember. It was all sort of … to be perfectly honest with you I would not have had another child if it wasn't for [son]. If it was down to me personally I wouldn't have another one.’ (Joy)
But later in the interview said:
‘I think I should stress … because it sounded really bad, but this pregnancy … I do want as much as we wanted the first time but just for different reasons. It's really hard to explain that without sounding like “I'm not really that bothered.” You know, we really are.’ (Joy)
Any indications that the women gave of considering pregnancy beforehand were included as positive steps towards becoming pregnant in this analysis. However, of the 40 pregnancies described by the 15 participants, 23 pregnancies of 11 different women were identified, where they described taking at least one positive step towards becoming pregnant.
There were various patterns of consistency as to whether women took positive steps towards becoming pregnant. Of the women who had been pregnant more than once, five women consistently took positive steps towards becoming pregnant for each pregnancy, three women consistently did not take positive steps towards becoming pregnant for each pregnancy, and four women took positive steps in some pregnancies and not in others.
For the 17 pregnancies where no positive steps were taken towards becoming pregnant, the eight women varied in how they described this including not using contraception, taking contraception on and off, or becoming pregnant while taking the contraceptive pill:
‘I was hoping to get pregnant later in life because we were still young, but I don't regret it now … I was using contraception but I'd gone onto a new pill and I was on it for about 2 months and it obviously failed and I became pregnant.’ (Jane)
‘We were trying to save up some money [for a holiday] … which I was looking forward to until I found out I was pregnant with my first child … I wasn't quite sure if I was ready to be a mother, but now I'm a mum I'm pleased …’
Interviewer: ‘So before you became pregnant with [daughter] were you using contraception?’
Participant: ‘Yes and no. Well, it was just where I'd get to the stage where I would keep forgetting to take my tablets or knew where the condoms were … We kept both, which … It's easily done.’ (Rachel)
‘Well baby number three was a bit of a surprise. I said that I would very much like to have three children because I am one of three, my husband is one of two and once we had a boy and a girl he was quite happy that we'd finished our family. We'd just moved house and he'd said ‘well maybe we could think about number three’ the week that I was going “I think it's too late to …” … It just sort of happened … I just wasn't using any contraception, which is how I got caught again …” (Amy)
Advice from health professionals on living with diabetes and pregnancy
In the early stages of pregnancy, before attending formal antenatal care, some women felt they needed no additional advice from health professionals, considering themselves experienced at managing their own diabetes. This was particularly the case if they had a previous successful pregnancy. Women that did seek advice early in pregnancy tended to go to their usual health professional, their GP, the nurse in the GP practice with expertise in diabetes, or a diabetes nurse specialist. Those that could recall being given advice described being reassured to continue with what they were already doing to keep their blood glucose under control.
Some women described being given advice about diabetes and pregnancy before becoming pregnant. Isabelle recalled her doctor saying ‘When you're planning on getting pregnant we need to know’. She went on to say:
‘I didn't exactly go and tell him I was trying sort of thing. I just made sure that my bloods were well controlled beforehand and then I went from there.’ (Isabelle)
Juliet recalled being told she could not have children and the effect this had on her:
‘I wanted children and I was told to face the fact that I would probably never have them. And that was a crushing blow because at the time I really, really wanted children, so then I resigned myself to the fact that I was never going to have children and developed a lifestyle around that and that was fine. Then when I got pregnant with [son] … your life changes overnight … I said,’ “I never expected to be pregnant so no matter what happens I'm going to enjoy the pregnancy while I'm pregnant and enjoy the attention of being pregnant”.’ (Juliet)
Nadine was advised to have children early and found her life choices fitted well with this advice:
‘I was always advised if I wanted children to have them earlier rather than later and it just happened that I happened to meet the guy that I wanted to marry and have children with early, so I'm quite fortunate really.’ (Nadine)
Three women described attending preconception counselling prior to their first pregnancy at two different hospital-based clinics. All three women talked about the fear they experienced after the preconception counselling and that after the counselling they found it difficult to make the decision to become pregnant (see Nadine and Joy in Appendices 2 and 5 respectively).
‘We'd gone to the hospital and we'd had pre-pregnancy counselling … which wasn't very positive … it was a very, very negative experience. We came away from there and I was very upset and [husband] was quite upset too and then we started talking about adoption and fostering. We were filled with dread really about the consequences of getting pregnant — for me and for the baby. That was November-time and then in the January I sort of thought I'm never going to rest if I don't … you know … if I'm not getting pregnant myself, so let's just … I'm going to look after myself and let's just go for it.’ (Natalie)