Q: Kidney Research UK is funding you to investigate whether it’s possible to improve the diagnosis of acute kidney injury in pregnancy – can you remind us why you chose to go down this research path? How much had your personal experiences as a midwife influenced your decision?

A: One of the benefits of working in a specialist clinical role (for me that was Specialist Midwife for Hypertension), is that you get experience quickly. Sadly, this included looking after too many women who had AKI in pregnancy. There was one case in particular where the mother and baby were in ICU following a severe AKI keeping them separated for the first weeks of life. It was clear that we really need to be faster at diagnosing and therefore treating AKI in pregnancy. I could really see the disparity when you compared the leaps forward in identification, treatment and prevention of AKI in the general population that pregnant people were just not benefitting from. I wanted to work to address this.

 

Q: Not many midwives choose to combine research into their careers, what has it been like for you? How have you found balancing research with clinical duties?

A: The biggest challenge for me was finding role models and supervisors and also getting support from the clinical leadership team. Once I had the correct support team everything fell into place. I think that this is changing so hopefully it will be easier and easier for midwives to move into a clinical academic career.

One ongoing challenge is the discussion around what research midwives should be carrying out and what should be done by doctors. My strong view is that, if a research question comes from a clinical question that we ask in our practice and the actions expected from the output of the research impact the practice of midwives, then that is research appropriate for a midwife. It shouldn’t matter who does what, as long as the work gets done by someone with the right skills and knowledge.

 

Q: How did you hear about the opportunity to be funded through a Kidney Research UK Allied Health Professional Fellowship?

A: I was lucky to be pointed towards Kidney Research UK by my supervisor, Dr Kate Bramham. I was very excited to apply for the AHP Fellowship, one of the few clinical academic funding calls targeted not at medical doctors.

 

Q: You were in the early stages of your fellowship when Covid hit. How has that affected the course of your research? We can only imagine how frustrating that’s been.

A: COVID has had a big impact on the progress of my project. This was in part because I had a responsibility to pause my research to return to support the clinical team. However, the main impact was that the appropriate prioritisation of Covid research had substantial impact on the time to getting ethics approval as well as the allocation of research resources.

There were a few benefits. Firstly, the benefits of good quality timely research was very evident in the national media which has enhanced the positive research culture within our clinical setting. Secondly, AKI is a known complication of Covid and previous AKI increases the risk of AKI in pregnancy, so this work becomes even more important.

 

Q: So tell us where you are at with your studies so far. We’d previously described that the project could be split into four components.

A: I am at a really exciting part of my studies. All the groundwork is in place and I have data for the first two components of my project. I am expecting to be able to share results for the normal ranges for creatinine in pregnancy in the next few months and the pregnancy specific definition for AKI in the next nine months or so. The APRICOTS study has now opened and we expect to recruit the first participant within the next week. Everything is coming together and I am excited to share the work and see some clinical benefit.

We have managed to make the work better than expected due to collaboration with Professor Kypros Nicolaides and his team. This is very exciting!

 

Q: What have been the biggest challenges through this fellowship?

A: Honestly, the biggest challenge has been balancing pushing forward this work against the demands of Covid. Also, being on the fellowship has allowed me time to broaden my networks and with this has come a lot of additional opportunities to do good work outside that within my fellowship. Time management and prioritisation of work that is important to do now or what can wait till later is a good challenge that I face!

 

Q: And what has been the most interesting or satisfying aspect of your research?

A: The best bit of my research is meeting good people who are interested in the work and can see the value. This has been both other researchers and clinicians as well as families who have experienced AKI.

 

Q: And what about on a personal level, what has this fellowship taught you about yourself?

A: I am so grateful for the confidence that the fellowship has brought me. The imposter syndrome remains, for sure, but I am feeling more confident that I have a contribution to make, that I have good ideas and that I couldn’t imagine not being involved in clinical research. This fellowship has finally brought together all the previous decisions and experiences I have had professionally, from my background in biomedical sciences, midwifery and research.

 

Q: You did a fantastic job running the virtual London Marathon to raise money for us in 2020 – any more physical challenges on the cards?

A: Well, I am running the marathon for Kidney Research UK again this year, for my sins! See you in April!

 

Q: Finally, what are your aspirations for when the project is complete?

A: I am really hopeful that we can move on to do a complex intervention trial to optimise detection and management of AKI in pregnancy. Once we know how to identify it and risk assess, then we need to look at how to prevent it and manage it. If we get this right then we will reduce the short and long term impact for families. I am also really interested in working on the postpartum care pathways for people who have AKI in pregnancy to reduce the impact on their lifelong health.