As part of International Women's Day (IWD) 2023, Te Whatu Ora is taking an in-depth look at two of IWD's key missions - to assist women to be in a position of power to make informed decisions about their health; and to forge inclusive work cultures where women's careers thrive and their achievements are celebrated.
Capital, Coast and Hutt Valley Clinical Nurse Specialist (Diabetes) Julie Bate, helps demystify a health condition experienced by approximately 4000 women each year in New Zealand.
What do you do?
I educate women about diabetes and its management while pregnant, working very closely with them throughout their pregnancy and up to 6-weeks post-delivery. This involves monitoring blood glucose levels, medication and insulin use, support and mentoring and developing management plans. We encourage a balanced diet, gentle physical activity (if safe), mental well-being, and breast-feeding.
What made you decide on this particular career path?
I first developed an interest in diabetes while working in primary health as a Practice Nurse. It can affect all ages of the life span, and can also have a huge impact on individuals and families. I wanted to increase my knowledge of diabetes and its management, and was fortunate to be offered a position as a Diabetes Nurse at Wellington Regional Hospital. I have always had an interest in women's health, and after becoming a Nurse Prescriber in Diabetes, I moved into the area of diabetes in pregnancy. I am very passionate about my role because we can make a huge difference to maternal and foetal outcomes.
What do you enjoy most about your role?
I love working in a multidisciplinary team (MDT) with my diabetes colleagues alongside the obstetric team, midwives, nurses, dietitians, and healthcare assistants. We are all passionate about maternal health and achieving excellent standards of healthcare. I enjoy building rapport with the women I work with, and helping them to feel safe and supported at a time when they can feel very worried and overwhelmed.
How do we, as the health sector, best support women going through gestational diabetes?
Diabetes in pregnancy is an extra stress for our women. It can be overwhelming, but our MDT approach promotes equity, access, engagement, communication, support, consistent advice and education, and expertise to our women and their families.
What makes you particularly passionate about women's health?
Pregnancy is an incredibly special time for the women and their families. I feel very privileged to be part of this time and this journey!
How do we make sure there is equity of care for all women diagnosed with gestational diabetes?
We embrace diversity and are inclusive. This is a journey of partnership and our aim is to empower women to achieve the best possible maternal health outcomes. Accessing resources and support through other key providers to ensure equity is important – for example, translators, the Sign Language Service, Whanau Support, Pacific Health Unit, Taeaomanino, Vaka Atafaga, social workers and mental wellbeing support.
The use of technology and recent innovations for people with diabetes, such as insulin pumps and Continuous Glucose Monitoring Systems (CGMS) also aids equity, however funding for these remains a significant equity issue.
Are there any misconceptions about, or stigma attached to, gestational diabetes?
Yes, women who develop gestational diabetes often feel guilty or that it is their fault. We reassure all of our women that this is not the case. There are a lot of misconceptions and stigma regarding insulin use in the community, but it is the gold standard treatment for diabetes in pregnancy. Insulin is safe in pregnancy because it doesn't cross the placenta to the baby. Having information like this is important, knowledge is empowering!
Is it a common condition, or has it become more common in recent years?
Gestational diabetes affects around 4-8 % of pregnancies in New Zealand. This seems to be fairly stable according to our hospital statistics. However, because diabetes outside of pregnancy is increasing, we are seeing more women in our clinic with existing diabetes. These pregnancies are more complex.
Have you seen improvements in the way gestational diabetes is diagnosed, treated and managed in your time in your role?
The biggest change from my perspective has been around the management of type 1 diabetes in pregnancy, delivery and postnatally. The use of technology has increased (insulin pumps and CGMS) and I have seen improved maternal outcomes and fewer neonatal unit admissions during my time in this role.
What does international women's day mean to you?
International Women's Day is a global day celebrating the achievements of women and gives us the opportunity to reflect on our progress to date and look to the future. The future for me is to embrace the movement promoting equity for women worldwide.
What would you like to see the future of women's healthcare look like?
Equity - through excellent health outcomes for all our women and their families.
Photo caption: Julie Bate (seated, second from left) with her team