Professor of Maternal and Child Population Health
Nuffield Department of Population Health
Tell us a bit about your role
I lead programmes of research into preventing and treating complications of pregnancy and early life. I have always known, since my early days at medical school, that I wanted to pursue a research career. However, I hadn’t realised until after I did my DPhil, which was lab-based, that a really important motivator for me was to conduct research that was going to make a more immediate impact on women’s and children’s health. I therefore moved from training in obstetrics and gynaecology to population health. Population health research, including observational studies and clinical trials, allows me to identify immediate changes to policy and practice to improve outcomes for large numbers of women and children, both in the UK and internationally.
Within the Medical Sciences this means my research bridges the gap between direct clinical care and national and international health policy. I work directly with obstetricians, midwives, anaesthetists, paediatric surgeons to improve clinical care, but I also work with policy organisations such as the UK Departments of Health and World Health Organisation to make changes to health service provision to make an even wider impact.
What is the most meaningful aspect of your work?
The UK was the first country in the world to investigate all maternal deaths – deaths of women during or after pregnancy – and this programme, which is regarded as the global gold standard, has been ongoing for more than 60 years. I took over leading this programme in 2012, overseeing expansion into investigation of severe complications in pregnancy as well as maternal deaths. The research has a huge impact both in the UK and internationally in improving women’s health. While it is a challenging programme to lead, ensuring that we learn from the deaths of any women as a consequence of pregnancy to prevent others from dying in the future has to be the most important thing that I do.
Can you tell us about something you've done, contributed to that you're most proud of?
I led the ANODE trial of antibiotic prophylaxis after forceps or ventouse birth, which was awarded ‘Research paper of the year 2020’ in the BMJ awards. It was one of those research questions which I couldn’t quite understand why no-one had answered before. The trial showed that a single dose of antibiotic after women gave birth almost halved the number of women who had an infection, as well as improving other outcomes such as pain levels. Importantly, as antibiotic stewardship is so crucial, it also reduced the number of doses of antibiotic used overall, because of the infections prevented.
What changes would you most like to see in the Medical Sciences in the next 100 years?
Globally maternal and perinatal deaths remain one of the leading causes of preventable mortality. Many of the solutions, however, move beyond immediate healthcare to wider determinants of health. As a public health physician, I would like to see a shift from a focus on treatment in Medical Sciences to much more emphasis on prevention and wider determinants of health. It won’t be straightforward, because preventive actions need to be put in place years or even decades before they have an impact, and wider determinants of health need action from individuals outside the health sector. For me this shift is essential to address the widening health inequalities in different sectors of our population.