“Realistic Medicine” has prompted and supported changes to the way NHS Orkney deliver maternity care for women with diabetes in a remote setting


The aim is to provide as much care locally as is safely possible, reducing unnecessary and costly travel and disruption for women and families and avoiding taking up unnecessary appointment times at the referral centre.

This has been achieved by providing additional midwifery training to a senior midwife who is now taking all women with pre-existing and newly diagnosed gestational diabetes as her caseload. She and her deputy provide a fortnightly clinic for women with diabetes, run jointly with the diabetes nurse specialist and an obstetrics and gynecology consultant as required. There are close links with the specialist service in Aberdeen and regular updates about individual patients.

Our designated midwife has spent time with the team in Aberdeen and has updated and amended all our local guidance to support the local team to deliver safe and appropriate care to this group of “high risk” mothers.

So far the team have been able to achieve more consistent care, fewer visits to Aberdeen, videoconferencing as an alternative to patient travel and better planned transfer for women who need delivery in Aberdeen, minimising their time off island and away from home and family.