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DAU - lack of knowledge frightening.

courtenayjane

courtenayjane

Active Member
Had a scan yesterday and because of previous low sugar issues, my diabetic obstetrician told me that I should go straight to the DAU afterwards so that the scans could be reviewed/discussed. When I got there, they were appalling!

I waited 2.5hours to be seen and then was dismissed in the waiting room, I was told that I shouldn't be there and to go home. I explained my situation and that, as per my notes, I had been directed to come here for review. I argued with them until they let me see the obstetrician but his lack of diabetes knowledge was frightening. He talked to me like I was an idiot or a child that had just been diagnosed with diabetes. His questions showed that he did not understand a T1 pregnancy at all.

I am now concerned that in an emergency situation this is where I am going to be sent for assessment. No reassurance to be found there! How did other people manage this?
 
When I was pregnant, I had my scans and consultations in the same place. So, I'd have a scan then have an appointment afterwards where the results of the scan were discussed plus any other pregnancy/diabetes things, including any questions I had.

I always saw a team. This consisted of a number of different people - Consultant Obstetrician, Consultant Diabetes Specialist, DSN, midwife. So at that appointment I had both my pregnancy AND diabetes covered. I thought this was common all over the UK?

If you're not happy with your care, you should speak to someone. If you were told to go there by a consultant, then couldn't the person there have checked that? Did they read your notes? There should be good communication between the people involved in your care. I'm not sure who you could speak to, but my suggestion would be the Director of Midwifery services at the hospital. I believe it's them you need to contact if you're unhappy with your care, as that's what I was told (I'm in the UK).
 
Day Assessment Unit.

They sent me there to have a scan reviewed as it was not a day when the diabetic pregnancy clinic was running. So basically you see a generic obstetrician and midwife and hope that they know something about T1. Which in this case they did not.

It just made me worry about what will happen in an emergency as apparently this is where you go...
 
I had to go in to triage suddenly and saw the normal midwife and OB there, but they they contacted the diabetes department and someone came down to see me.

My team had also left really good notes as to what should happen so that made me happier too. You could maybe ask your diabetes consultant or DSN what support they'd have if you had to go into the DAU.
 
@courtenayjane I'm a little confused as to what you mean by a diabetic obstetrician. In my hospital (which is a big London teaching one with quite a lot of expertise on diabetes) you get see jointly by an endocrinologist and an obstetrician as @azure describes. One specialises in diabetes and the other in pregnancy. When you're on the labour ward in my experience you only see an obstetrician and it's luck of the draw how much they know about diabetes. Saying which when you have an obstetric issue although diabetes may cause specific challenges at the end of the day an obstetrician will view you from an obstetric point of view with the addition of you'll need a sliding scale and are more likely to have a larger baby which poses obstetric issues. A paediatrician will get alerted to the increased likelihood that on delivery the baby will have low blood sugar or other issues. The endocrinologist will be more concerned with you but are unlikely to be anywhere near you when you are in labour.

My experience has been that how well you're treated depends a lot on the staff on duty and the day of the week. I have never had to go to a DAU but I had an issue in antenatal clinic in one pregnancy where the consultant obstetrician decided I needed an extra scan and the receptionist and scanner decided the protocol didn't permit this. The consultant went majorly out of her way to try and sort out this problem including trying to arrange it in another hospital in the trust and in the end asked me to wait until the end of clinic and did it for me herself. I was somewhat appalled at the lack of respect shown by the other staff to her although she took great care of me. The issue was she was asking for something they didn't believe was permitted by the system (as she thought it clinicly necessary) and even when she managed to override the scanner's manager they claimed there were no slots available (entirely possible). The scan she gave me was the nicest I ever had.

My experience has been that:
1. You tend to be the person who knows most about diabetes in the room
2. You need an advocate to support you through these conversations (husband, partner, doula).
3. Get anything you care about written in the notes but you or your advocate may need to draw the doctor's attention to it
4. A lot depends on the person who sees you. Some are very knowledgable, some are more willing to listen and some will go completely out of their way to provide you with amazing care and reassurance, but it's luck of the draw which is why it's important not to go into any vulnerable situation alone and frankly being pregnant is a vulnerable time.

It sounds to me like there was poor communication going on between your doctor and the DAU. It is also possible that the obstetrician was perfectly happy from an obstetric point of view and you got the brunt of a bad day and underresourced unit. I know that sounds horrible but it can happen. My experience has generally been good in that when something is going seriously wrong you are noticed.

I hope that reassures you a little but I would recommend that if you find yourself in this situation again you do your best to make sure you have someone with you, that you can trust to advocate for you.
 
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