1 00:00:01,980 --> 00:00:05,100 Okay. Can you start by saying your name and your position? 2 00:00:05,490 --> 00:00:11,850 So I'm Maria Knight and I'm professor of maternal and child population health in the Nuffield Department of Population Health. 3 00:00:12,000 --> 00:00:20,430 Lovely. Thank you. And without telling me your entire life story, can you just take me through the key steps in your career to date? 4 00:00:20,430 --> 00:00:24,960 And I mean, starting with how you got interested in science and medicine at all. 5 00:00:25,500 --> 00:00:31,710 So I'm medically trained and I started with an interest in pregnancy. 6 00:00:31,740 --> 00:00:36,810 So initially I moved into training as an obstetrician. 7 00:00:37,140 --> 00:00:44,090 I did a PhD at that point, a dphil in the university and realised that actually research for me. 8 00:00:44,100 --> 00:00:50,610 So I did land based research then, but that wasn't close enough to making a difference to patients for me. 9 00:00:51,150 --> 00:00:57,550 So I. So working in the lab wasn't close enough. 10 00:00:58,040 --> 00:01:08,660 The research didn't lead to a change for patients quick enough for me, whereas I got some exposure to to epidemiological research and clinical trials. 11 00:01:09,110 --> 00:01:16,700 So I realised that actually I wanted to get the epidemiology training and the route to do that was through training in public health. 12 00:01:17,150 --> 00:01:22,420 So what are the epidemiological questions in terms of maternal and neonatal health? 13 00:01:22,430 --> 00:01:28,010 What was I mean, I think what I'm. What was the big question that really drove you to say so? 14 00:01:28,040 --> 00:01:35,420 My my research in the lab was around understanding the causes, the basic causes of pre-eclampsia. 15 00:01:36,590 --> 00:01:43,669 But actually, you know, that's something that happens quite a long time before the poor outcomes. 16 00:01:43,670 --> 00:01:51,020 You know, we still lose mums, we still lose babies from pre-eclampsia because of the treatment they need around the time, 17 00:01:51,220 --> 00:01:56,420 you know, around the end of pregnancy, around the time of giving birth. So just to fill in quickly, what is pre-eclampsia? 18 00:01:56,420 --> 00:01:59,600 It's a pre-eclampsia is high blood pressure in pregnancy. 19 00:01:59,600 --> 00:02:10,370 So actually, when you're talking on a global basis, still one of the leading causes that we we lose mums and babies and yet you know, 20 00:02:10,370 --> 00:02:17,929 what we need to know is well what do we need to treat them with at the time we've made the diagnosis as opposed to my lab work, 21 00:02:17,930 --> 00:02:24,499 which was almost the how do we prevent this stage and to to, to find out how to treat them. 22 00:02:24,500 --> 00:02:35,090 We need an observational studies where we just look at what women are being treated with and who seems to do better, but also clinical trials. 23 00:02:35,570 --> 00:02:42,560 And through a very big clinical trial that was done around about the time that I was doing my PhD, not by me. 24 00:02:43,850 --> 00:02:51,620 We found that aspirin, simple aspirin was good at preventing baby deaths in women with pre-eclampsia. 25 00:02:52,040 --> 00:02:58,790 So seeing the power of that was what really drove me into public health. 26 00:02:59,150 --> 00:03:09,080 The added appeal of public health for me is that I can see that actually many things are driven by inequalities, 27 00:03:09,080 --> 00:03:16,069 by much more wider determinants of health and people will be familiar with, 28 00:03:16,070 --> 00:03:23,209 you know, things are much worse if you live in a deprived area, if you you're less educated, 29 00:03:23,210 --> 00:03:30,560 if you are unemployed, all of which relates to wider determinants of health. 30 00:03:31,520 --> 00:03:40,750 And the advantage of of working through public health is that I'm able to think about those wider prevention elements as well. 31 00:03:40,760 --> 00:03:48,680 So it's for me, a big a big motivated to to be able to link the two together and make a more immediate 32 00:03:48,680 --> 00:03:55,490 difference to preventing severe illness and death in pregnant women and their babies. 33 00:03:56,570 --> 00:04:00,110 So has that that I interrupted you as you would go through your career steps. 34 00:04:01,160 --> 00:04:09,410 Have you stayed in Oxford ever since? Not intentionally, but yes, I'm I stayed in Oxford ever since. 35 00:04:10,460 --> 00:04:20,330 Well, I as I say, I was I was doing my dphil here and then went back into training in obstetrics but realised I wanted to move into public health. 36 00:04:20,330 --> 00:04:29,000 And the huge advantage in Oxford is that we have the unit where I am now, which is the National Perinatal Epidemiology Unit, 37 00:04:29,000 --> 00:04:33,620 which does exactly the kind of research that I knew I was interested in. 38 00:04:34,160 --> 00:04:42,860 And an added benefit was that while training as a registrar in public health, I was able to come here to do some of my training. 39 00:04:42,860 --> 00:04:49,939 So because that was in Oxford and there's no other place like it, it was the reason to stay in Oxford. 40 00:04:49,940 --> 00:04:53,000 So and I've never left. 41 00:04:54,340 --> 00:04:57,500 So you've talked about pre-eclampsia and you've talked about some of the social factors. 42 00:04:58,040 --> 00:05:07,669 What is it possible to put a figure on how risky pregnancy and birth are today for a woman in the UK? 43 00:05:07,670 --> 00:05:11,360 Sorry, that's a terribly broad question and depends on those different things. 44 00:05:11,360 --> 00:05:16,280 But how is a problem? So so I can give you exact answers to that said. 45 00:05:16,280 --> 00:05:22,460 Part one of my current roles that I've been doing for about ten years now is that I lead the national 46 00:05:22,970 --> 00:05:29,390 investigations into all maternal deaths during pregnancy or up to a year after the end of pregnancy. 47 00:05:29,540 --> 00:05:38,450 This is the UK obstetric surveillance. No, this is this is the what is called the confidential inquiries into maternal deaths. 48 00:05:38,480 --> 00:05:45,290 All right. I like to, but not the same as the UK obstetric surveillance system. 49 00:05:45,830 --> 00:05:53,570 So the, the, the confidential inquiries is a program that's been going for 70 years in in the UK investigate. 50 00:05:53,710 --> 00:05:59,590 Maternal deaths. So every time a mother dies in pregnancy or shortly after, every time a mother dies in pregnancy, 51 00:05:59,590 --> 00:06:11,470 or shortly after we find out about it and then investigate her care to identify ways of improving care to prevent women from dying in the future. 52 00:06:12,730 --> 00:06:20,799 So on the basis of that, I can give you exact numbers around about one in every 10,000 women giving birth 53 00:06:20,800 --> 00:06:25,540 will die either during pregnancy or six weeks after the end of pregnancy. 54 00:06:26,050 --> 00:06:31,590 So it's not common. And sadly for babies, that's that's much more common. 55 00:06:31,600 --> 00:06:42,309 So about five in every thousand babies who are born either die or are either 56 00:06:42,310 --> 00:06:45,850 stillborn or die in the neonatal periods or die in the first month of life. 57 00:06:46,940 --> 00:06:56,810 And so, I mean, in summary, pregnancy is very safe in the UK, but then there are a lot of women who have severe complications. 58 00:06:56,830 --> 00:07:04,930 What we often talk about is near misses or well, I really like the South African system. 59 00:07:04,930 --> 00:07:11,290 We call them the Great Saves. So with my other hats on which she started to introduce, 60 00:07:11,680 --> 00:07:17,650 I set up the UK obstetric surveillance system to look at those severe complications in pregnancy. 61 00:07:19,120 --> 00:07:21,850 Because they're severe, they're relatively uncommon. 62 00:07:22,450 --> 00:07:28,659 So it's not something as a as a clinician working in a hospital, you would see on a day to day basis, 63 00:07:28,660 --> 00:07:35,710 probably it's the kind of thing you might see once a year for the rarer complications, maybe once in your lifetime. 64 00:07:36,130 --> 00:07:45,070 So it's very difficult to build up the knowledge to know how we treat women as an individual, as obstetricians yet. 65 00:07:45,730 --> 00:07:50,920 But because we collect information on a national basis from all the hospitals with maternity units, 66 00:07:51,310 --> 00:08:01,330 we can bring all that together to then provide information on how women can and how we should be managing these women with these complications. 67 00:08:01,750 --> 00:08:05,310 But can you give a couple of examples of the kinds of complications? Yeah. 68 00:08:05,740 --> 00:08:18,250 So one of the complications, for example, is and is so sometimes that the placenta can grow deeper into the womb than normal. 69 00:08:18,460 --> 00:08:24,400 It's a condition called placenta accreta or abnormally invasive placenta placenta 70 00:08:24,400 --> 00:08:30,670 accreta spectrum often associated with having had a previous caesarian birth. 71 00:08:30,670 --> 00:08:34,750 So as you can imagine, we've got higher caesarean birth rates now. 72 00:08:35,140 --> 00:08:40,390 So the rates of placenta accreta are increasing. 73 00:08:41,200 --> 00:08:51,819 But a simple question is, well, I thought if I know that this woman I'm caring for has got this condition, how do I how do I deliver her baby? 74 00:08:51,820 --> 00:08:54,920 And then what do I do about the placenta? 75 00:08:54,940 --> 00:08:58,570 Because the risk to her is a very, very severe bleeding. 76 00:08:59,110 --> 00:09:07,839 And so by collecting that information nationally, we can show we did show that the best thing to do is is leave the placenta alone. 77 00:09:07,840 --> 00:09:15,710 Don't touch the placenta. Don't try and remove the placenta and then go straight to actually do a hysterectomy for 78 00:09:15,850 --> 00:09:19,690 for something which obviously certainly means that woman will no longer be fertile, 79 00:09:19,720 --> 00:09:23,049 but she will be alive and so will her baby. And say what? 80 00:09:23,050 --> 00:09:25,240 Her baby. Exactly. Yeah. 81 00:09:26,380 --> 00:09:36,850 So yeah, but but obviously we can't if we're if we're only managing to three women like that every year as an individual clinician, 82 00:09:36,850 --> 00:09:41,410 we wouldn't have all of the information to be able to to look at the difference. 83 00:09:41,510 --> 00:09:45,610 Hmm. And we're going to get to COVID. But what about infectious disease? 84 00:09:45,610 --> 00:09:51,370 What about things like flu and what what data was there available on how that affected pregnancy? 85 00:09:51,850 --> 00:09:55,479 So a very pertinent question and we'll come on to COVID. 86 00:09:55,480 --> 00:10:04,650 So because we have this national system, when the the swine flu pandemic came along, which I think is a distant memory for most people. 87 00:10:04,750 --> 00:10:08,140 2009 was a 2009. Yeah, that's right. 88 00:10:09,550 --> 00:10:14,350 One one of the questions was, well, was this going to. 89 00:10:14,500 --> 00:10:19,360 Did this affect pregnant women more than it affected affected non-pregnant women? 90 00:10:20,080 --> 00:10:25,600 So we were able to collect information very rapidly through the obstetric surveillance system, 91 00:10:26,170 --> 00:10:34,560 although it's not as rapidly as we would have would have wanted because the pandemic hit in. 92 00:10:34,630 --> 00:10:43,690 So I think it was about April 2009. So there was a small wave of flu infection sort of over the summer in the UK, but relatively small. 93 00:10:44,440 --> 00:10:52,560 We we because we hadn't planned the study at that point, we didn't collect data during that wave but it. 94 00:10:53,500 --> 00:10:59,290 Whereas we we were able to collect it in the winter wave, which was much bigger in the UK. 95 00:11:01,000 --> 00:11:07,360 And we were able to show that women who got treated with antivirals within two days 96 00:11:07,360 --> 00:11:14,320 of the symptoms starting had about a 90% lower risk of needing intensive care. 97 00:11:14,930 --> 00:11:22,749 So and at that time, the the guidance, again, I don't know if you remember, 98 00:11:22,750 --> 00:11:28,570 but there was a phone line that you could phone up to get antivirals at Tamiflu, I think it was. 99 00:11:29,380 --> 00:11:35,640 Now, I won't go into the the subsequent research around Tamiflu, 100 00:11:35,650 --> 00:11:41,890 but if you were not pregnant, you could phone up that line and you could just go collect it. 101 00:11:42,310 --> 00:11:48,160 And you didn't have to go to your doctor. But if you were pregnant, you had to go to your doctor. 102 00:11:48,250 --> 00:11:53,230 So there was there were more barriers to actually getting treated when you were pregnant. 103 00:11:53,620 --> 00:11:56,949 So obviously, by having that information to say, well, actually, 104 00:11:56,950 --> 00:12:03,129 it's even more important that pregnant women get treated quickly, it means you then thinking thinking a system level. 105 00:12:03,130 --> 00:12:09,700 Right. We've got to remove these barriers. So actually that the barriers were believed so that when pregnant women were able to 106 00:12:09,700 --> 00:12:15,819 get antivirals through the thing helpline and were they more vulnerable in pregnancy, 107 00:12:15,820 --> 00:12:21,430 does that increase your vulnerability to severe? It does so increases your vulnerability to severe flu. 108 00:12:21,970 --> 00:12:31,510 So so they were they were pregnant women who were having to go on heart bypass machines because of the severity of their flu. 109 00:12:33,100 --> 00:12:38,350 So, yes, it is undoubtedly makes your flu more severe. 110 00:12:38,350 --> 00:12:44,589 And, you know, that's an interesting question that we never quite know, 111 00:12:44,590 --> 00:12:51,249 so that there are some infections which whether you're pregnant or not, it's no difference in the severity. 112 00:12:51,250 --> 00:12:56,260 And there are others where we know that pregnant women are more severely affected. 113 00:12:56,830 --> 00:13:02,260 And that's a question that we will always need to answer if a new infection comes along. 114 00:13:04,570 --> 00:13:11,320 And yet, surprisingly not recognised that we will always need to answer that question. 115 00:13:11,950 --> 00:13:15,870 And so so yeah, very pertinent when it comes to COVID. 116 00:13:16,360 --> 00:13:21,580 Well, I think we have come to cope with I think that it was a very good background introduction. 117 00:13:22,000 --> 00:13:29,140 So I'm asking everybody this. Can you remember when you first became aware that something was going on in China 118 00:13:29,440 --> 00:13:33,280 and that actually it looked as if it was going to become a global pandemic? 119 00:13:34,730 --> 00:13:47,080 So I can't remember whether it was the end of December or beginning of January, but I became aware because there's a within the within the department, 120 00:13:47,080 --> 00:13:52,479 there's quite a lot of work goes on with with China and they actually have a large birth cohort. 121 00:13:52,480 --> 00:13:58,660 And in fact the year before, in fact actually it might even have been December, it was December 2019. 122 00:13:58,660 --> 00:14:05,860 I had been over to visit the one here in China where they have this large birth cohort, 123 00:14:07,270 --> 00:14:13,750 which they recruit pregnant women, they have some blood tests, and then they follow them and their babies. 124 00:14:15,040 --> 00:14:23,440 And when the the the the COVID concern came up, as it were, as it was actually, we thought, well, 125 00:14:24,040 --> 00:14:31,110 this this cohort is it would be a great way of finding out whether it's adversely affecting pregnant women or not. 126 00:14:31,120 --> 00:14:41,409 So we actually applied for a grant to do that study that wasn't successful, but in actual fact was rapidly overtaken by events. 127 00:14:41,410 --> 00:14:48,390 And sadly, because that we had many, many more infections here, 128 00:14:48,970 --> 00:14:56,770 difference in public health control measures and actually collecting data in the UK became very much more pertinent. 129 00:14:58,330 --> 00:15:01,420 And so, yes, so my second part of that question is usually when, 130 00:15:01,420 --> 00:15:04,969 when did you realise that this was something that you were going to have to get involved with? 131 00:15:04,970 --> 00:15:08,140 But it sounded like, well, I'm going to take you I'm going to take you back to flu. 132 00:15:08,140 --> 00:15:17,890 Yes. Because what what was brilliant, I think about the UK I knew would have to be we have to be positive about the bits that were positive. 133 00:15:18,250 --> 00:15:24,280 So after the experience of the swine flu pandemic where we recognised that there were quite there 134 00:15:24,280 --> 00:15:31,090 were a number of research studies that would need to be done in the event of another pandemic. 135 00:15:31,570 --> 00:15:35,500 Actually, the National Institute for Health Research, as it was then, 136 00:15:35,500 --> 00:15:46,120 and I actually put out a call for studies to be set up and then what it called hibernated ready for a future pandemic. 137 00:15:46,570 --> 00:15:52,870 So in in 2011, I applied for one of those which we we were successful. 138 00:15:53,730 --> 00:16:04,050 Funded in 2012. So I had a hibernated what was we thought would be for another pandemic, flu pandemic. 139 00:16:04,470 --> 00:16:11,410 I had a hibernated study set up ready to run through the UK obstetrics the first time I've heard about hibernated studies. 140 00:16:11,850 --> 00:16:20,580 Okay. So I think there's no there were nine hibernated studies on the portfolio of of which I think eight were activated. 141 00:16:22,470 --> 00:16:27,950 And why it's important is because because I had everything ready to go. 142 00:16:27,960 --> 00:16:31,620 We tested it twice alone along the way. 143 00:16:31,620 --> 00:16:35,009 So effectively we knew things were still still. 144 00:16:35,010 --> 00:16:42,710 Right. It meant that I was very quickly able to adapt it to, to cave it in February, 145 00:16:42,750 --> 00:16:49,980 get the get the ethics permissions so that it meant that on March the 18th, 146 00:16:50,220 --> 00:16:56,670 when I was asked to activate it and I was able to get things going on March the 22nd. 147 00:16:57,510 --> 00:17:07,079 So you'll hear all about the nine days of the nine days of recovery from from start to activating. 148 00:17:07,080 --> 00:17:12,360 But we were even quicker. To be fair, we had been funded nine years beforehand. 149 00:17:12,960 --> 00:17:18,270 So, uh, and, and for me that's, 150 00:17:18,600 --> 00:17:23,219 I guess one of my concerns is that I think those portfolio studies were really 151 00:17:23,220 --> 00:17:28,980 successful and why are we not getting ready now for when we need those again? 152 00:17:29,530 --> 00:17:33,060 And what and what did the study actually do? 153 00:17:33,270 --> 00:17:38,820 I'd say and talk to you about the UK obstetric surveillance systems. 154 00:17:39,000 --> 00:17:48,510 We have hospitals in every maternity unit in the country participates and so we used across the UK obstetric 155 00:17:48,510 --> 00:17:55,780 surveillance system to collect information about all pregnant women with COVID who were hospitalised. 156 00:17:57,360 --> 00:18:11,370 We anticipated we'd have a study, a 500 week, up to 20,000 by the time we stopped at and obviously was a huge, 157 00:18:11,490 --> 00:18:17,340 hugely down to the efforts of clinicians in all of the hospitals, 158 00:18:17,850 --> 00:18:27,570 but particularly the network of research midwives who were also pivoted to help with that and and they were absolutely amazing. 159 00:18:28,620 --> 00:18:33,659 But so I was doing that. So I have to staff and myself. 160 00:18:33,660 --> 00:18:41,639 And so I would I was analysing those data on a weekly basis for the for the Royal Colleges to inform their guidance, 161 00:18:41,640 --> 00:18:49,170 but also for the Departments of health. So that so that A, we could see what was happening to numbers. 162 00:18:49,170 --> 00:18:54,810 But importantly, those questions about, well, if I get it, what happens to my baby? 163 00:18:55,560 --> 00:18:59,880 Is it worse for pregnant women? Which pregnant women is it worse for? 164 00:19:00,300 --> 00:19:01,710 And, you know, again, 165 00:19:01,740 --> 00:19:13,860 looking back to me and my public health background and in that the so we did the first analysis that we released at the end of May slightly earlier, 166 00:19:13,860 --> 00:19:27,390 obviously to NHS England and Department of Health, which showed that 56% of women admitted with COVID in pregnancy were from ethnic minority groups. 167 00:19:28,140 --> 00:19:35,400 That's on a background of normally about about 18% of the population of pregnant women as a whole are from ethnic minority groups. 168 00:19:35,460 --> 00:19:43,590 So clearly that group were particularly at very high risk of severe outcomes and 169 00:19:44,700 --> 00:19:50,400 the there was an instant response from NHS England and a number of hospitals. 170 00:19:51,330 --> 00:20:02,640 He put in place different actions to to ensure a lower threshold of, of, of concern of women from black and ethnic minority groups. 171 00:20:03,420 --> 00:20:08,579 Some did some some brilliant daily telephone calls to that because obviously we would 172 00:20:08,580 --> 00:20:14,970 we were being told to stay at home and and isolate if if we'd got an infection. 173 00:20:15,330 --> 00:20:21,000 But they were. So then there's a concern that you stay at home too long when you're too sick before you come in. 174 00:20:21,330 --> 00:20:29,910 So some hospitals were then instituting daily phone calls to to check in with women so that they knew that they could advise them to come in early. 175 00:20:30,340 --> 00:20:37,469 So so some really, really good responses by having the direct communication through and with, 176 00:20:37,470 --> 00:20:44,760 as I say, with the colleges, but also with the NHS and Department of Health. 177 00:20:46,560 --> 00:20:53,070 So, you know, as a researcher, incredibly satisfying is the wrong. 178 00:20:53,740 --> 00:20:58,420 But you know, you feel that actually your skills, 179 00:20:58,420 --> 00:21:04,410 what you're doing is really making a difference and going back to the beginning of this conversation. 180 00:21:04,420 --> 00:21:08,469 But you know that that is why I didn't carry on with love research. 181 00:21:08,470 --> 00:21:11,140 It was it was to enable this kind of research. 182 00:21:12,910 --> 00:21:20,560 And then we we carried on obviously collecting information as because then the next question, oh, well, we've now got a new variant. 183 00:21:20,800 --> 00:21:24,850 Have things changed? What is the impact of vaccination? 184 00:21:25,650 --> 00:21:33,130 And we we showed that the the Delta variant was very, very much worse for for pregnant women. 185 00:21:33,800 --> 00:21:40,900 And Omicron looks much similar to to the first variant as it was the wild type. 186 00:21:43,330 --> 00:21:51,250 What was that? And this is where I, I still get cross frustrated. 187 00:21:51,250 --> 00:22:00,500 Cross cross is a mild word for it. Pregnant women were excluded from all the initial via vaccine trials. 188 00:22:01,030 --> 00:22:05,409 Now, I had a question about that. Let's let's just explore that in a bit more detail. 189 00:22:05,410 --> 00:22:11,280 So. Yeah. 190 00:22:11,580 --> 00:22:14,640 I've got a question about, say, how they fit together. 191 00:22:15,000 --> 00:22:20,840 Oh, do you? But. But, yes. So let's just go back a bit of background. 192 00:22:21,120 --> 00:22:28,110 When people do trials of new kinds of treatments, how common is it for pregnant women to be included? 193 00:22:29,700 --> 00:22:39,839 Very rare. Yeah. And the reason for that is so the default is always exclusion because of fear of damaging the baby. 194 00:22:39,840 --> 00:22:43,010 As a fear of damaging the baby. Yes. So safe. 195 00:22:46,470 --> 00:22:58,350 It is. It is. So if you're if you're a pharmaceutical company, why would you include pregnant women in your research? 196 00:22:58,380 --> 00:23:05,850 It's it's risky. It means you are putting yourself theoretically, you might be putting yourself at risk. 197 00:23:05,850 --> 00:23:11,160 It'll be a much more bigger insurance. And it's a small market. 198 00:23:11,700 --> 00:23:18,960 You know, there is no motivation to include pregnant women in your in your trial, 199 00:23:20,040 --> 00:23:27,570 even if it is clearly a disease that affects pregnant women as well as others. 200 00:23:28,290 --> 00:23:35,340 The potential for benefit for pregnant women is as great, if not greater than than for others. 201 00:23:35,850 --> 00:23:47,490 And in many cases, there are similar drugs or that drugs have been used in pregnancy in in previous times. 202 00:23:47,520 --> 00:23:53,070 So you've got you've got evidence to suggest that there's not going to be a problem in pregnancy. 203 00:23:53,370 --> 00:24:00,420 But that benefit I, I always now talk about benefits before risks. 204 00:24:00,600 --> 00:24:03,900 So that benefit risk analysis is never done. 205 00:24:05,250 --> 00:24:11,190 And there is not there's no there's no incentive from regulators. 206 00:24:11,200 --> 00:24:19,649 So there's no you know, it's not it's not linked to your licensing approvals that you need to make sure that 207 00:24:19,650 --> 00:24:24,630 you're including pregnant women or at least justify why you're excluding them. 208 00:24:26,490 --> 00:24:31,770 But even more basic is that there's no real requirement to do to collect that 209 00:24:31,770 --> 00:24:37,979 information afterwards when we are using the medications in pregnant women. 210 00:24:37,980 --> 00:24:43,680 Because what happens is that the obstetricians and the doctors, 211 00:24:44,610 --> 00:24:54,630 physicians end up having to use medications in pregnancy because their assessment is this is the new woman I need. 212 00:24:55,500 --> 00:25:02,399 This is this is going to be of benefit. You know, I'm doing the the estimation in my head. 213 00:25:02,400 --> 00:25:07,650 And I think there is much greater potential for benefit than there is for any potential for harm. 214 00:25:08,130 --> 00:25:14,610 So they're having to do that on a daily basis. And I'd recommend to women that they take drugs. 215 00:25:15,600 --> 00:25:24,479 But even then, we've got no robust system for collecting the information about when those drugs are used and what happens to pregnant women, 216 00:25:24,480 --> 00:25:30,390 which, you know, a bit akin to what we do in the UK obstetric surveillance system could give us 217 00:25:30,720 --> 00:25:36,090 at least information for women to be able to base decisions on in the future. 218 00:25:36,570 --> 00:25:40,080 So going back to the COVID vaccine, I mean, as we all know, 219 00:25:40,080 --> 00:25:45,570 one of those vaccines was developed right here in Oxford in a building not too far away from where the one where you sit. 220 00:25:46,530 --> 00:25:50,910 Were you at all involved in conversations about how those trials were set up initially? 221 00:25:51,870 --> 00:26:01,800 No, I did I did send a message to the to the trial team at one point. 222 00:26:02,010 --> 00:26:08,010 But but I was told that somebody else was was talking to the company. 223 00:26:08,010 --> 00:26:15,210 And I don't think that the company wanted to take the risk and put, you know, pretty quotes around taking the risk. 224 00:26:18,000 --> 00:26:27,720 But obviously, nobody had the data that I was seeing about that to be able to make that benefit risk assessment. 225 00:26:27,750 --> 00:26:36,030 We've got very clear ethical guidance that pre-dates the pandemic plan for exactly the situation. 226 00:26:36,630 --> 00:26:42,570 And that quite clearly states that, you know, ethically, 227 00:26:43,050 --> 00:26:50,250 we should not be denying pregnant women the potential to benefit when when we're enabling it for other people. 228 00:26:51,330 --> 00:27:00,660 And I don't want it to come across that I am in any way going to be forcing pregnant women to take part in clinical trials. 229 00:27:01,500 --> 00:27:09,780 The position that I want to get to, the position where we are at least offering pregnant women the choice to participate in a. 230 00:27:09,980 --> 00:27:13,070 While that may be to their benefit. 231 00:27:14,950 --> 00:27:23,810 And and we do know that when we do enable pregnant women to take part, the pregnant women will choose to take part. 232 00:27:25,760 --> 00:27:29,870 And we did for recovery. So for recovery, we saw recovery. 233 00:27:29,870 --> 00:27:34,420 This was a trial of treatments in hospice. So this was a trial for treatment? 234 00:27:34,430 --> 00:27:39,440 Yes. So so obviously, we knew pregnant women were getting very sick. 235 00:27:40,290 --> 00:27:46,729 And but so so we enabled pregnant women to to participate. 236 00:27:46,730 --> 00:27:53,870 And because we enable pregnant women to participate, when the results of that trial came out, 237 00:27:53,960 --> 00:27:57,140 you could see pregnant women were included in this trial. 238 00:27:57,440 --> 00:28:05,059 Therefore, we can include them in the guidance. But you need to treat them with dexamethasone or in this case, steroids. 239 00:28:05,060 --> 00:28:08,450 But yeah, so so again, 240 00:28:08,480 --> 00:28:16,730 it was a direct you could see very quickly how the results of the trial were adopted into guidance for treatment 241 00:28:16,730 --> 00:28:22,970 for pregnant women and what was the consequence of their not having been included in the trials for vaccination. 242 00:28:24,170 --> 00:28:37,220 So I mentioned to you back at the beginning that one of one of my roles is to, um, count and investigate the care of all women who die in pregnancy. 243 00:28:37,730 --> 00:28:41,540 So obviously some women died during that. 244 00:28:41,820 --> 00:28:57,620 The 2020 when we didn't have vaccine, more women, three times as many women died in 2021, in 2021 winter, when everybody was eligible for vaccination, 245 00:28:58,130 --> 00:29:04,040 and then the end of 20 at the end of 2021 and almost exclusively they were unvaccinated 246 00:29:04,670 --> 00:29:21,620 because the the lack of evidence and the the a lot of a lot of the misinformation about risk. 247 00:29:21,920 --> 00:29:36,920 Misinformation. Absolutely, misinformation. Talking about risk not not ever thinking about benefit and not even not even no real conceptualisation 248 00:29:36,920 --> 00:29:43,760 of what that potential risk that they were talking about might be meant that that yeah. 249 00:29:43,760 --> 00:29:50,959 The very high levels of hesitancy in pregnancy and you know the system barriers in place at the beginning which 250 00:29:50,960 --> 00:29:59,240 didn't help either in that again you know we could all go to a mass vaccination centre to get our vaccine, 251 00:29:59,810 --> 00:30:05,629 but if you were pregnant, you had to get extra signatures or they refused to give you a vaccine, 252 00:30:05,630 --> 00:30:10,610 even though they were able to give you, you know, so they were there were challenges. 253 00:30:10,610 --> 00:30:19,460 So it wasn't just the the women who were hesitant that the clinical system itself had hesitancy within it about treating the exact. 254 00:30:19,490 --> 00:30:26,270 Yes, yes. Yeah. And so it was left to individual clinicians, nurses who had to say whether it was safe or not. 255 00:30:26,420 --> 00:30:28,520 Exactly. Yeah, yeah, it was. 256 00:30:28,520 --> 00:30:41,510 It was, um, and if you want to, you know, if you want to enable pregnant women to get vaccinated, you do it when they're going for a routine check. 257 00:30:42,350 --> 00:30:49,729 But because I mean, because of some of the issues around storage and things of the of the Pfizer vaccine in particular, 258 00:30:49,730 --> 00:30:51,770 they were only available in certain places. 259 00:30:51,770 --> 00:31:01,280 They didn't have them in hospital clinics in a short, short shelf life out of the extreme deep freeze and that that kind of thing. 260 00:31:01,490 --> 00:31:07,760 So there were lots of barriers that made it harder, coupled with a lot of misinformation. 261 00:31:08,750 --> 00:31:14,030 Um, and again, you know, there could be other solutions. 262 00:31:14,030 --> 00:31:20,660 So we started talking about flu. You know, pregnant women have been having flu vaccine so that there are, 263 00:31:21,080 --> 00:31:31,460 there are old vaccine technologies that pregnant women are being been being vaccinated with with with vaccines for a long time. 264 00:31:31,520 --> 00:31:39,200 And, you know, we could have made sure that we were we were enabling one of the old vaccine technologies. 265 00:31:39,200 --> 00:31:46,580 So, you know, killed virus, for example, which we would have new concerns over safety and pregnancy. 266 00:31:47,000 --> 00:31:55,550 So at least that was a vaccine that pregnant women could have had without any theoretical concerns over them or any vaccines, 267 00:31:56,930 --> 00:32:01,010 which that there are no real concerns about it or any vaccine. 268 00:32:03,020 --> 00:32:09,650 We obviously now have information about millions of women who have been vaccinated. 269 00:32:09,910 --> 00:32:13,060 Pregnancy with no concerns at all. 270 00:32:15,940 --> 00:32:25,179 But even when we started vaccinating in the UK and pregnant women were being vaccinated, that information was not being collected. 271 00:32:25,180 --> 00:32:28,670 So again, we had to delay it. 272 00:32:28,720 --> 00:32:37,750 Even when we were recommending the vaccine to pregnant women, we had to delay in enabling them to have information to make an informed choice. 273 00:32:38,500 --> 00:32:46,180 So all of these things, I really just want to make sure that they're not going to happen again. 274 00:32:47,500 --> 00:32:52,060 There's still some big delays to actually getting information out. 275 00:32:52,140 --> 00:32:55,330 Mm hmm. And that I mean, what can you say? 276 00:32:55,330 --> 00:33:03,940 Is that a system failure? Or can you point the finger at who was the what was the of bill putting up the barriers? 277 00:33:03,940 --> 00:33:13,899 It was so, so clearly I female I spend my life working on my own pregnancy research. 278 00:33:13,900 --> 00:33:20,500 I have three daughters. So everything, everything in my world, life revolves around women, pregnancy. 279 00:33:20,500 --> 00:33:26,080 It's it's just a no brainer for me. You have to be thinking about pregnant women. 280 00:33:28,060 --> 00:33:39,010 I'm just not sure, you know, in those groups that were advising it the first time is was there anybody who even have that thinking? 281 00:33:39,010 --> 00:33:44,920 I suspect not. They kind of thought I mean, if I thought they were having, as you suggested earlier, 282 00:33:45,220 --> 00:33:50,110 with all around the threat of compensation if babies died and that kind of thing. 283 00:33:50,110 --> 00:33:56,050 Yeah, yeah, yeah. Um, some of the lessons to be learned. 284 00:33:57,940 --> 00:34:06,460 Well, so we're about to go into a, well, pregnant women because I was counting so many dying last winter, 285 00:34:07,000 --> 00:34:14,710 the JCB changed their guidance and put pregnant women into a higher risk group so they are now eligible for the booster doses. 286 00:34:16,890 --> 00:34:23,850 But I still am not clear that anybody will be collecting systematically and 287 00:34:23,850 --> 00:34:29,280 publishing in a timely manner information about women who've had the booster dose 288 00:34:29,280 --> 00:34:35,939 in pregnancy to be be reassured that the booster dose is effective and to give 289 00:34:35,940 --> 00:34:41,010 that reassuring information about women for women who are getting immunised. 290 00:34:41,970 --> 00:34:53,610 And to counter all of the misinformation that's on social media, I'm not convinced that that's going to happen in a timely manner yet. 291 00:34:54,000 --> 00:34:58,280 I'm still hopeful, but I'm not convinced. Mm hmm. 292 00:34:58,830 --> 00:35:02,730 I meant to do this in a different order, but never mind. It is sort of slightly back to front. 293 00:35:03,000 --> 00:35:06,220 But what? What? 294 00:35:06,600 --> 00:35:11,040 Why are pregnant women at heightened risk from the infection itself? 295 00:35:12,870 --> 00:35:20,609 So good question. To which I'm not sure I can give you a straight answer because I do kind of work at the lab level. 296 00:35:20,610 --> 00:35:30,060 But we do know that your immune system changes when you're pregnant because effectively you are the baby is genetically different from you. 297 00:35:30,390 --> 00:35:40,140 So you have to become more immune tolerant, a bit like, you know, if you if you have a transplant, you have to you have to become b immunosuppressed. 298 00:35:40,140 --> 00:35:44,970 So you do reject the transplant. So we have there are immune changes in pregnancy. 299 00:35:45,690 --> 00:35:51,540 And obviously, depending on which bits of your immune system are tackling, 300 00:35:51,540 --> 00:35:59,369 which infection that that whether that the changes of pregnancy mean that you're effectively a little bit more immunosuppressed, 301 00:35:59,370 --> 00:36:02,790 therefore you might get a worse infection. 302 00:36:03,850 --> 00:36:09,120 And there are probably you know, there's likely to be other genetic things involved. 303 00:36:09,210 --> 00:36:14,820 The mean particular groups of pregnant women might be more at risk, but we don't know any of those. 304 00:36:15,390 --> 00:36:18,420 And is that just a physiological thing about having a very large abdomen? 305 00:36:19,050 --> 00:36:22,080 Well, so so, yes. 306 00:36:22,080 --> 00:36:30,930 I mean, there is there's no doubt that that severe COVID is much worse in the in the third trimester of pregnancy. 307 00:36:31,380 --> 00:36:46,170 So so obviously, the physical and lung capacity is part of an issue, partly an issue that but yes, but but yeah, that's not the sole explanation. 308 00:36:46,170 --> 00:36:51,030 But yeah, yeah. And, and then there's the that kind of social side of it. 309 00:36:51,040 --> 00:36:58,110 So how did the pandemic impact the experience of being a pregnant woman in society? 310 00:36:58,340 --> 00:37:05,820 Yeah. So again, when you look back and you think, well, why did nobody realise? 311 00:37:05,830 --> 00:37:14,670 So obviously the pandemic hit lockdown, dramatic change in NHS services, you know, clinics stopped, everything went online. 312 00:37:15,690 --> 00:37:26,070 But lots of, you know, surgeons who've been doing routine operations with pivoted to COVID care and in whatever shape it took. 313 00:37:26,820 --> 00:37:36,510 But hang on, you know, pregnant women who are still pregnant and will carry on giving birth, they'll carry on having the same complications. 314 00:37:36,930 --> 00:37:42,600 They will need the same level of care. And yet it was highly variable in some places. 315 00:37:43,080 --> 00:37:50,250 They they took the took away the the consultant obstetricians to COVID care. 316 00:37:51,180 --> 00:37:57,940 In other places, it was the other way round that kept the consultant obstetricians and took away the juniors too, 317 00:37:58,500 --> 00:38:02,100 which at least meant that you were left with your experts. 318 00:38:02,100 --> 00:38:09,899 But, you know, the the Royal College of Obstetricians and Gynaecologists had to intervene and say, look, don't take away the senior stuff, 319 00:38:09,900 --> 00:38:15,890 which you'd have thought was just common sense, but all of those, you know, 320 00:38:16,020 --> 00:38:22,110 so the other aspects to pregnant women you know that the do we don't we shield. 321 00:38:22,260 --> 00:38:29,070 So they were recommended to shield because we had no idea about whether it was going to be more severe in pregnancy. 322 00:38:29,580 --> 00:38:32,879 They couldn't take their partners with them to appointments. 323 00:38:32,880 --> 00:38:42,870 They some of the obviously more appointments had to be online, but mental health wise, big impacts. 324 00:38:43,170 --> 00:38:50,190 I mean, mental health is of concern during and after pregnancy as it is, but hugely more potentially impacts. 325 00:38:50,190 --> 00:38:52,750 And if you can't even have the support of about that, 326 00:38:52,770 --> 00:39:01,090 when you when you're going through various appointments, it's obviously going to make it even worse. 327 00:39:02,520 --> 00:39:06,090 And then even when we began, can't come out of it. 328 00:39:07,110 --> 00:39:10,740 You know, pregnant women didn't know, well, should I still be shielding? 329 00:39:11,610 --> 00:39:15,030 What should I do now? And then when? 330 00:39:16,540 --> 00:39:20,949 Vaccination began to come in. It's like, well, do I get vaccinated? 331 00:39:20,950 --> 00:39:24,610 Don't I get vaccinated? And if I don't, do I then shield. 332 00:39:24,640 --> 00:39:34,240 And so very difficult messaging for for pregnant women and a huge change in their care. 333 00:39:34,240 --> 00:39:39,370 And there's no doubt we saw some impacts of of more remote care, 334 00:39:41,230 --> 00:39:47,410 particularly for for more vulnerable women or where language was was more of a problem. 335 00:39:47,890 --> 00:39:58,240 Because you can imagine having having a remote consultation where your English understanding is is okay. 336 00:39:58,240 --> 00:40:03,850 But but but not, you know, not not not native speaking. 337 00:40:03,940 --> 00:40:10,780 It can be can be very easy to to nod through things and actually not be able to express your concerns. 338 00:40:10,780 --> 00:40:17,680 And some of those things which which would come out in a face to face consultation or with an interpreter. 339 00:40:17,920 --> 00:40:25,900 And so there were there were undoubtedly changes that that impacted on maternity care. 340 00:40:26,170 --> 00:40:30,990 And what about birth itself? Were partners forbidden to attend to? 341 00:40:31,300 --> 00:40:37,450 So partners were allowed to in most places. It was only when the woman was in established labour. 342 00:40:37,450 --> 00:40:44,859 So there were there were quite a lot of people reporting their experiences of, 343 00:40:44,860 --> 00:40:53,349 of a sick waiting in the car park in the car for when they were told that they could go in and partners missing the event because 344 00:40:53,350 --> 00:41:05,920 they were still out in the car park in the car and labour starting you know is that it's it's a bit uncertain as to you know, 345 00:41:06,160 --> 00:41:14,229 when labour when you're in established labour or not so and that I mean, 346 00:41:14,230 --> 00:41:19,930 particularly for your first birth is an incredibly uncertain time for you as a woman. 347 00:41:19,930 --> 00:41:26,170 And to be completely unsupported at that time makes it really so hard. 348 00:41:26,720 --> 00:41:30,730 So hard. And is that something you've been able to follow up? 349 00:41:31,840 --> 00:41:42,820 So it's a there are there's quite a number of studies that have picked up on women's experiences, not know that that I've done. 350 00:41:43,740 --> 00:41:52,000 And there are obviously and were looking at whether there were changes in outcomes over the pandemic. 351 00:41:53,410 --> 00:41:59,590 I the mental health in particular is a big concern to me. 352 00:41:59,590 --> 00:42:08,890 So I know that, that, that there definitely been changes in mental health that that were very negative. 353 00:42:09,070 --> 00:42:18,250 But yeah and, and what I noticed you've got a study just a but there was a paper about the protocol for the study. 354 00:42:18,250 --> 00:42:24,880 So I don't know how far you've got with it yet, but looking out to two years, babies when they get to two years old. 355 00:42:25,000 --> 00:42:29,590 Yeah. Whether or not there's any effect of the mother having been infected. 356 00:42:30,370 --> 00:42:46,149 Yes. So if you've basically described it so, you know, we where we are looking at babies and mums who've been infected, 357 00:42:46,150 --> 00:42:52,990 but also babies of mums who haven't been infected to see whether there's any changes in their developmental outcomes. 358 00:42:53,040 --> 00:42:56,440 A Two years because we, we simply don't know. 359 00:42:56,680 --> 00:43:06,759 So it's a completely open question. Exactly. Yes, it's an interesting you one of the one of the challenges that's always thrown back 360 00:43:06,760 --> 00:43:14,640 by the the the the the misinformation brigade when you're talking about vaccine, 361 00:43:14,650 --> 00:43:18,130 well, what's the long term outcomes of the baby? 362 00:43:18,700 --> 00:43:23,200 Well, you know, we can't answer that because we're only two years from the beginning of the 363 00:43:23,200 --> 00:43:29,290 pandemic and only a year and a half from when we first started giving vaccines. 364 00:43:29,290 --> 00:43:37,500 So so it's an immediate way of being able to just put them on the back foot, because you can't answer that. 365 00:43:37,510 --> 00:43:42,339 But though I suppose what you can always say is that you do know that the outcomes of 366 00:43:42,340 --> 00:43:46,419 babies whose mothers were not vaccinated and who got severely ill with COVID exactly. 367 00:43:46,420 --> 00:43:49,810 Are pretty bad. Yeah. Yeah. 368 00:43:52,600 --> 00:43:59,229 So did did you I mean, how supported did you feel by your research community? 369 00:43:59,230 --> 00:44:08,500 I mean, you clearly the big differences between people within the field in which you work and other areas of medicine. 370 00:44:09,070 --> 00:44:14,260 But was there a sense of a community pulling together in the subject that you're of? 371 00:44:14,680 --> 00:44:25,690 Very definitely. I mean, you mentioned. Earlier the than the network of of research midwives and the the reporting conditions for you costs 372 00:44:25,720 --> 00:44:33,650 none of whom were paid to to to collect the information that they did was was was incredible. 373 00:44:33,670 --> 00:44:42,370 So absolutely within the pregnancy care community huge huge support for because they 374 00:44:42,370 --> 00:44:48,430 recognised the need for and the importance of the information for for them and for women. 375 00:44:49,510 --> 00:44:52,620 So, so really. Absolutely amazing. 376 00:44:52,690 --> 00:44:57,309 Mm hmm. And what about internationally? I mean, you you do have international links. 377 00:44:57,310 --> 00:45:07,750 Yes. So so we have an international collaboration of of countries who have systems similar to to to and the UK obstetrics surveillance system. 378 00:45:07,750 --> 00:45:19,030 And actually they adopted similar protocol and and data were collected across several of the European countries as well. 379 00:45:20,650 --> 00:45:31,240 And, and in fact, now the the the w the W.H.O. are trying to also put in place something that means we're not going to be here, 380 00:45:34,720 --> 00:45:42,940 that the data collection will be enabled across a range of low and middle income country settings in the event of another pandemic, 381 00:45:42,940 --> 00:45:52,690 and have been using the UK centric surveillance system as a model to to think about what we should set in place now for the future. 382 00:45:52,690 --> 00:45:58,989 So, you know, again, satisfaction is the wrong word. 383 00:45:58,990 --> 00:46:06,670 But but I, I certainly feel that by, by at least doing a small bit, 384 00:46:06,820 --> 00:46:12,760 but showing what might work and that the fact that it could then be adopted globally is, is. 385 00:46:12,760 --> 00:46:16,809 Yeah. And the pandemic, I mean, it's a sort of silver lining story, isn't it? 386 00:46:16,810 --> 00:46:18,340 And obviously the pandemic was awful, 387 00:46:18,640 --> 00:46:26,320 but if it puts in place something that could be beneficial with other diseases and other conditions, then that's at least something to. 388 00:46:26,680 --> 00:46:32,169 And I will absolutely continue to advocate for for pregnant women. 389 00:46:32,170 --> 00:46:41,379 So if nothing, you know, if if we can actually change the conversation and let's let's think about benefits as well as risks 390 00:46:41,380 --> 00:46:46,660 when we're talking about any research question or let's just make sure we're collecting the data. 391 00:46:46,660 --> 00:47:01,090 So so like you say that there are there are definite silver linings that the that we can hopefully ensure are put in place for next time. 392 00:47:01,270 --> 00:47:10,120 So so that the last part of this, I just want to ask you about how the pandemic and what went on in the pandemic impacted on you personally. 393 00:47:15,700 --> 00:47:23,260 Yes. So how did they. I mean, first of all, there was lockdown. How did that impact on what you were able to do or what what what was your sense so. 394 00:47:23,470 --> 00:47:26,950 Well, it was it was fascinating. Fascinating. 395 00:47:26,950 --> 00:47:32,980 On how I was frantically busy, the busiest I've ever been in my life. 396 00:47:33,610 --> 00:47:37,809 Within the four walls of study. This is the thing I said to you. 397 00:47:37,810 --> 00:47:44,880 I've got three daughters, two of whom were at university, but obviously with the university shop. 398 00:47:44,920 --> 00:47:48,130 So they. So we we were all locked in at home. 399 00:47:48,910 --> 00:47:52,149 And the youngest one was still at school, but she was still at school. Yes. 400 00:47:52,150 --> 00:47:56,770 Yes. So the youngest was doing A-level, doing well in the sixth form. 401 00:47:58,570 --> 00:48:01,510 So, yes, we we we were all locked in. 402 00:48:01,510 --> 00:48:12,280 And, you know, all of those from from the the kids about, you know, missing the these university experiences they would never have again. 403 00:48:12,290 --> 00:48:23,620 And so so obviously having to be a mum as well and and try and support them in what was a particularly challenging time for them. 404 00:48:26,200 --> 00:48:39,140 You may have seen in an opinion piece. So I think I said to you, I'll have the the study is activated on the Friday the 18th or the Friday the 19th. 405 00:48:39,620 --> 00:48:46,270 But anyway, Friday, Saturday, Sunday, the Sunday, my dad was admitted to hospital with COVID. 406 00:48:47,680 --> 00:48:53,770 We opened the study on the Monday he died two weeks later in hospital couldn't go and. 407 00:48:54,640 --> 00:49:03,290 So very personal and and yet I almost fell for him I had to keep going to get the information. 408 00:49:05,200 --> 00:49:08,380 So sorry. I'm I'm not surprised. 409 00:49:08,890 --> 00:49:17,290 That sounds extraordinarily tough. And did you yourself feel personally threatened by the possibility of catching the virus? 410 00:49:18,070 --> 00:49:27,400 I was never really particularly worried about, you know, I'm youngish, relatively fit, female. 411 00:49:28,180 --> 00:49:33,460 And I kind of assumed if I got over, it would be okay. 412 00:49:33,550 --> 00:49:38,590 I volunteered for one of the trials, so I was a participant in one of the trials. 413 00:49:39,520 --> 00:49:53,250 Um, do you know whether you would, you would receive, but you were in a group that, and, and, but, but no, I was not particularly worried. 414 00:49:53,260 --> 00:49:58,300 I, I stick to the rules of the, you know, so we, we stuck to the rule. 415 00:49:58,750 --> 00:50:03,190 You know, there was again, there was some, you know, nice family experiences that you would never. 416 00:50:03,610 --> 00:50:11,680 So we would all but every morning, all five of us would do some exercises in the back garden, you know. 417 00:50:12,010 --> 00:50:15,790 So there was some family experiences we wouldn't otherwise have had. 418 00:50:15,790 --> 00:50:19,599 So you've got to you've got to positively on know on those kind of things. 419 00:50:19,600 --> 00:50:34,350 But, and yeah, so it was, it was the, the challenge of, of having to do so much oneself in in yeah it, 420 00:50:34,590 --> 00:50:39,790 it just was bizarre being frantically busy, sat in a chair in a very small room. 421 00:50:40,810 --> 00:50:51,490 We had to do a bit of rearranging so that the conservatory became my husband's office and the children with, uh, with me arranged to meet me. 422 00:50:51,490 --> 00:50:55,899 So there were places where they could work, but. Yeah. And do you think. 423 00:50:55,900 --> 00:51:00,580 I think you've already answered this really. But do you think that the fact that you were working on something that was so 424 00:51:00,580 --> 00:51:05,350 important helped to support your own wellbeing through those difficult times? 425 00:51:07,000 --> 00:51:16,629 Yeah, I think you're right. And, and actually I, I so I did feel valued because there's no doubt. 426 00:51:16,630 --> 00:51:27,610 And in interacting directly with, with people like Eddie Morris, who was the president of the Royal College of Obstetricians and Gynaecologists. 427 00:51:27,610 --> 00:51:35,680 And so knowing that the information that I was collating, analysing was going directly to make a difference. 428 00:51:36,370 --> 00:51:39,940 It does, as you say, it motivates you to keep going. 429 00:51:40,150 --> 00:51:44,040 And and. Yeah, don't. 430 00:51:44,080 --> 00:51:48,580 Don't have time to think or worry. Mm hmm. And what about your wider team? 431 00:51:48,580 --> 00:51:55,030 Did they have pressures that you needed to take time to pay attention to, to help them keep going? 432 00:51:55,360 --> 00:52:06,069 I mean, it was challenging for the wider team. So, um, my programme manager was herself pregnant at the time, so, and, 433 00:52:06,070 --> 00:52:14,500 and the registrar I worked most closely with actually went through two pregnancies in the course of the. 434 00:52:15,100 --> 00:52:28,360 So so for them, you know, absolutely incredibly, you know, really close to the personal for them as well. 435 00:52:29,380 --> 00:52:37,750 And again, you know, they they worked so much over and above, you know, within within the unit here. 436 00:52:37,750 --> 00:52:46,260 We obviously had clinical trials and other studies ongoing and people were working off their ironing boards. 437 00:52:46,270 --> 00:52:57,160 And, you know, the I mean so the team in that that the rapidly pivoting to try and get laptops to as many people as possible 438 00:52:57,200 --> 00:53:04,990 and set up all the remote access that they did do an amazing job to to enable us all to keep going. 439 00:53:05,860 --> 00:53:12,909 And so. Yeah. And when did you feel satisfied with the way the university or the department or 440 00:53:12,910 --> 00:53:21,549 between them handled the and meeting the regulations for for not coming in to work, 441 00:53:21,550 --> 00:53:26,530 not mixing at work or and when things began to reopen and so on. 442 00:53:27,580 --> 00:53:34,299 So, so I guess, I mean, the, the, I was fortunate. 443 00:53:34,300 --> 00:53:38,950 I had the laptop, I already had remote access anyway. 444 00:53:38,950 --> 00:53:43,450 So I was relatively able to, to, to get on with things. 445 00:53:44,200 --> 00:53:51,370 But, you know, and obviously the department here was was leading the recovery trial as well. 446 00:53:51,370 --> 00:53:58,330 So so I think that the support they were very well aware of people who had kind of critical positions, 447 00:53:59,500 --> 00:54:09,010 but also kept it going for most of the most of the people as well and recognised where there was a need for you know, 448 00:54:09,010 --> 00:54:16,659 there were there were people who, whose home arrangements were really difficult to enable to, to work. 449 00:54:16,660 --> 00:54:23,110 So we were very good at putting in the protective and you know, 450 00:54:23,810 --> 00:54:34,060 been doing twice weekly testing and lots of protective aspects to for people who had come into the office or needed to come into the office. 451 00:54:34,690 --> 00:54:39,070 Um, I in fact ended up coming back to work into the, 452 00:54:39,190 --> 00:54:51,790 in the office earlier than many people for my mental health basically because it was you know that the that that frantically busy within 453 00:54:51,790 --> 00:54:58,980 the same four walls never getting out was really I suppose that was about it must have been what it must've been about a year in. 454 00:54:59,440 --> 00:55:10,050 Yeah. So after, after about a year I just, I needed to go back into the office and, but felt very safe when I was, it was just like Glen. 455 00:55:10,120 --> 00:55:13,120 So, you know, I wasn't having to sit on a bus or anything. 456 00:55:14,520 --> 00:55:19,150 And as a department they certainly recognised, you know, where that they were. 457 00:55:19,270 --> 00:55:33,429 Challenges. I think now we're at a more difficult stage where there are people who have enjoyed remote working and there are definitely benefits. 458 00:55:33,430 --> 00:55:40,630 You know, there were meetings that we used to do in person that were much better done remotely now. 459 00:55:41,030 --> 00:55:55,030 Um, and I think we're at a delicate balance between, between coming back or coming back as we were before or a more flexible stage. 460 00:55:55,030 --> 00:56:02,320 And I think I think the jury's out department to list with whether we've hit the right balance yet. 461 00:56:03,460 --> 00:56:07,330 But it's it's impossible to to gauge at the moment. 462 00:56:07,380 --> 00:56:13,510 We're still you know, what we know can be cases are going up a bit at the moment and we're only really getting 463 00:56:13,510 --> 00:56:19,690 back into the business as usual kind of research and NHS is still under strain. 464 00:56:20,560 --> 00:56:28,370 So I think it's, I think it's a bit of what this space and you do, 465 00:56:28,420 --> 00:56:34,060 I mean you still have some questions to answer to ask about COVID like this was study. 466 00:56:34,490 --> 00:56:40,270 Yes, exactly. And we will have an while to come to know that will. 467 00:56:40,850 --> 00:56:50,499 Exactly. There will still be boosters, you know, I mean, sorry, there will still be variants and you know, will we will we will will. 468 00:56:50,500 --> 00:56:59,650 It's, as most people seem to think, turn into a flu being you know, it being a winter a winter kind of disease, a bit like flu. 469 00:57:01,270 --> 00:57:10,060 Yeah. So has the experience changed your attitude or your approach to your work? 470 00:57:10,150 --> 00:57:13,480 And how would you like to see things change in the future? 471 00:57:14,960 --> 00:57:22,460 So it's definitely made me more outspoken. 472 00:57:26,190 --> 00:57:33,210 People laugh when they hear me say this. But I'm not I'm not a terribly outspoken person, usually. 473 00:57:33,930 --> 00:57:42,220 But some of what is still happening in terms of exclusion of pregnant women is just so wrong. 474 00:57:42,240 --> 00:57:48,000 I am getting more and more vocal. I think people probably think I'm now just that's all I ever talk about. 475 00:57:48,950 --> 00:57:53,130 Don't use social media. I didn't ask. So I will. 476 00:57:53,490 --> 00:58:02,129 Good question. So I'm very, very I tend to use social media for disseminating things. 477 00:58:02,130 --> 00:58:08,700 I don't I don't tend to express a lot of opinions on social media. 478 00:58:09,360 --> 00:58:22,590 And I, I've written 2 to 2 opinion articles for the BMJ where I expressed some of it, but I don't, I, I don't tend to mouth off on social media, but. 479 00:58:24,680 --> 00:58:37,760 But I, I, I am trying and trying to advocate in the forums where it's for where it's and where there might be an ear of relevant people in power. 480 00:58:37,940 --> 00:58:46,970 Mm hmm. Mm hmm. And how sanguine are you that some things might change as a result of the experience of the pandemic? 481 00:58:47,750 --> 00:58:54,890 I'm I'm worried that they they don't seem to be moving. 482 00:58:55,250 --> 00:58:57,230 We I mean, we learnt so many lessons. 483 00:58:57,270 --> 00:59:05,540 You know, I could and I think there are many of us that could write down a list now of what we need to have in place research wise, 484 00:59:05,540 --> 00:59:11,510 research platform wise, studies in hibernation for the next time. 485 00:59:12,530 --> 00:59:17,030 But that doesn't seem to be happening. I and I'm not entirely sure why. 486 00:59:17,840 --> 00:59:21,440 Possibly because everybody's still concentrating on getting back to normal. 487 00:59:22,730 --> 00:59:29,360 And and, you know, maybe we're not going to be rapidly going into that next pandemic. 488 00:59:29,390 --> 00:59:35,250 I mean, at one point, monkeypox looks like it might be, but that does seem to be settling down. 489 00:59:35,280 --> 00:59:43,130 Well, I mean, and fortunately, a vaccine that was an off the shelf, readily available to to help. 490 00:59:43,200 --> 00:59:48,620 And there's a new pandemic preparedness institute. 491 00:59:48,650 --> 00:59:51,770 I wondered whether that might have a maternity strand in it. 492 00:59:53,990 --> 00:59:56,630 Good question. To which I don't know the answer. 493 00:59:56,750 --> 01:00:06,440 I know nothing at all about what's happening in the Pandemic Preparedness Institute, but many things at Oxford are totally opaque. 494 01:00:07,650 --> 01:00:12,560 But is an 800 year old institution? Yeah. 495 01:00:13,250 --> 01:00:14,210 Thank you very much.