"Birthing at Narrogin"

Just wanted to provide some feedback on my recent experience antenatally and birthing at Narrogin Hospital. 

This is my second pregnancy/child- and the pregnancy was a little more complex than the first with Gestational Diabetes and other small things affecting my antenatal care. 

I had an exceptional experience birthing at Narrogin with our first- and we really wanted to birth at Narrogin for this baby. Not only because of the high care standard we received the first time, but because of the convenience of not having to travel metro if it could be avoided. 

I spoke to my care provider Dr Claire about what was involved with being able to stay birthing at Narrogin with Gestational Diabetes. We had discussed early on that it depended on a few factors that we'd keep an eye on as my pregnancy progressed (such as my sugar levels, baby's growth, placenta health etc) as to whether I'd be suitable to remain birthing at Narrogin, or would require tertiary care. 

I felt supported by Dr Claire every step of the way, I felt empowered and informed. I feel Dr Claire embodies what all doctors should strive to be- patient centred and collaborative with their care whilst still achieving a high standard of support. I'd really like to thank her for being a truly exceptional GP Obstetrician.

One negative of my journey was that Dr Claire had been supporting me to be able to deliver at Narrogin, and we had both been happy with growth and risk factors to safely deliver at Narrogin towards the end of my pregnancy, as this is what we'd been aiming for if possible. I understood that if my risk factors increased, or if my Gestational diabetes became unstable requiring insulin then of course tertiary care would be recommended but I had excellent control of my sugars- but did require x1 Metformin 500mg tablet at night to support my fasting sugar levels overnight for a few weeks during the "peak" period where hormonal control and demands peak. 

Dr Claire researched and worked in collaboration with Diabetes WA team that was supporting me, and looked at latest research  and deemed this was a suitable treatment method- and assuming I remained well controlled shouldn't affect my ability to deliver at Narrogin. If I had of gone onto insulin tertiary care would of been required. We felt happy that meformin was a good middle line. In the final weeks prior to reaching term there were concerns raised about where the current WACHS policies stood about whether I fit the criteria to deliver or not. It was unclear as to whether I counted as "medicated" because the policies referred to insulin or uncontrolled OR diet controlled. Metformin was and is a bit of a grey area. This made it hard to work out what risk category I fit into and as to whether I was eligible to deliver at Narrogin or not. The Narrogin MGP team had concerns based on their criteria  about suitability and risk. It looked like tertiary deliver may be required after all but it was a grey area as to what risk category I truly fit into. 

I spoke about my concerns and risks in depth with Dr Claire , and my midwife. We were able to collaborate about my desires, and escalate to higher powers and gained approval to continue with delivery at Narrogin assuming certain risks remained the same and supportive measures were met/understood. I truly appreciate the support from the Narrogin MGP team and Dr Claire in making sure my care was personalised. I appreciate feeling like patient centred care was truly achieved, whilst reducing risks and concerns. 

In the final week I also had the support of Dr Opeyemi in managing my care. He was also wonderful- reassuring, understanding and provided a high level of advocacy and support to me. 

Thank you to my team for supporting me with my wishes.

I'm proud and thankful to say my delivery went smoothly and was everything I had wished it could be. The after-care from Dr Opeyemi and the Narrogin MGP team had been amazing. 

My only advice and desire is that the powers above review and update the policy regarding metformin use and supporting gestational diabetes to ensure clarity going forward for all health professionals and consumers. First line treatments of insulin are changing and the grey area around metformin use in the policy are open to misinterpretation and confusion.