Helping women help themselves
Lesley Regan is director of the Recurrent Miscarriage Service at St Mary’s Hospital, London
Lesley Regan graduated from the Royal Free Hospital, London in 1980 before becoming a registrar in obstetrics and gynaecology at Addenbrooke’s Hospital, Cambridge. She was awarded an MD thesis after a secondment to the Medical Research Council’s Embryo and Gamete Research Group before moving to London to be consultant and senior lecturer in obstetrics and gynaecology at St Mary’s Hospital, where she is now chair and head of the department. Regan is director of the Recurrent Miscarriage Service at St Mary’s—a multidisciplinary team that helps couples with a history of recurrent miscarriages—and co-director of the Baby Bio Bank, which is a research project that collects tissue samples for the four major complications of pregnancy—recurrent miscarriage, preterm birth, fetal growth restriction, and pre-eclampsia. She has twin daughters who are 20.
What made you decide to specialise in obstetrics and gynaecology?
I was inspired by one of my mentors at medical school. She was almost like a surrogate mother to me as well as being a fantastic teacher. She would talk about what a wonderful specialty it is because it mixes surgery and medicine with psychology and pathology—a little bit of everything. Also, in obstetrics and gynaecology we tend to look after women who are relatively well but are at a part of their life where they need help and advice, and I enjoy participating in that as opposed to just treating people. Pregnant women are more altruistic and more receptive to advice than most other patients. They tend to be altruistic not just about their baby, but they are also caring about other women. For me, the pleasure of the specialty is being a partner in their treatment, and in trying to provide them with good advice and healthcare for the future.
Can you tell us what the Recurrent Miscarriage Service does?
The women who use the service have had three or more early losses, or a late loss or stillbirth. We see about 1000 couples a year. The service is the biggest in the world. It’s powerful because we can run studies, train people, and share our knowledge, samples, experience, and information. Because of that people want to come and work with us and we hope that they take away that same ethos—sharing to move things forward.
When I was training I was frustrated when dealing with distraught couples who’d just lost a baby because I never had much to tell them about it, so I went to work for the Medical Research Council on a project about miscarriage. One of the areas we researched was about women who miscarry repeatedly, and that has underwritten much of my work in obstetrics and gynaecology and women’s health. We now know that miscarriage is at one end of a spectrum of adverse outcomes. Often a woman whom we’ve successfully treated for recurrent miscarriage has complications such as pre-eclampsia or premature delivery later in pregnancy, so much of the research we’ve done has helped us understand these problems too. What the miscarriage work and research have emphasised to me is that most of the problems in pregnancy have their root cause in the depth and quality of implantation at the beginning of pregnancy. That may seem simplistic, but I think it’s been a major step in our understanding.
Pregnancy is just one part of the spectrum in a woman’s life course, and there is transgenerational transmission of problems.
We also know that women who repeatedly miscarry are more likely to have a heart attack or a stroke at an earlier age than their next door neighbour who has never had a miscarriage or repeated miscarriages. Wouldn’t it be fantastic if, instead of waiting for you to have your stroke at 60, somebody said to you when you were 35 and in the antenatal or postnatal clinic, “Listen, if you have these miscarriages we know that this increases your risk. I don’t mean you’re going to have a heart attack or a stroke, but you need to be more careful. You must tackle your weight. You need to understand that smoking is out, and we’ve got to think of checking your lipids at an earlier date than your next door neighbour’s because you could be at risk.”
Can you explain what the Baby Bio Bank is?
I run the Baby Bio Bank with my co-director, Gudrun Moore. She’s fantastic because she’s not threatened by bossy doctors, and I’m not threatened by the fact she’s really talented—“Brain of Britain” when it comes to molecules and genetics. The collaboration between clinician and scientist in clinical medicine and research is very important. We are trying to collect a tissue bank of samples for the four major complications of pregnancy as a legacy for the future for others to work on. Researchers can apply to our bank to get samples to underpin their work. We hope it will speed up finding the answers.
When do you find your job the most rewarding?
When you realise that you’ve empowered a woman with an understanding of what she’s got to do to solve her problem. If you came to visit me, you’d see that the walls are covered with photographs of babies. That’s the easy bit to understand. The more subtle reward is realising that you’ve not just helped the woman deliver a baby, but you’ve set them up to be independent. You give them the tools to get on with their lives. That’s what I find most rewarding.
What has been the highlight of your career?
Getting to the point where I was able to persuade colleagues to think about pregnancy as part of a life course approach. It didn’t just come to me in the bath one night. It was something that was a culmination of working and getting a lot of things wrong and thinking that we needed to look at things differently. Pregnancy is the healthcare opportunity of two lives. That’s the important thing. I heard somebody talking about this the other day and owning the idea as if it were accepted and commonplace. I thought that that was quite an achievement and I feel I’ve made a big contribution to that change.
What ambitions do you still have?
I want get to the point where we’re designing healthcare policies that prevent women going to clinics and hospital—the opposite of what we do now. I want to keep them out of hospital and medical environments by providing preventive means to keep them healthy.
Do you have any advice for students who might be thinking about a career in obstetrics and gynaecology?
Do it. It’s incredibly rewarding. Lots of women are in it, which is great, but I think men have got important contributions to make to obstetrics and gynaecology too. I go out of my way to be welcoming and helpful to men.
You need to be prepared to work hard and have stamina because those training years are tiring, and you need a sense of humour. Obstetrics and gynaecology can be emotionally taxing. You need to find ways of dealing with that. My secret is to have a sense of humour that is pointed at myself—that helps.
Do you manage to achieve a good work-life balance, and has it always been this way?
I think my children would refer to me as a workaholic. I have got the most gorgeous daughters who are at university. They are now lovely friends of mine so I can’t have got it all wrong, but I’ve always worked full time. They tell me that they’re pleased that I brought them up to be independent.
A fantastic friend and mentor—a man—told me that the two things that were really important for children were to give them secure roots and a good set of wings to fly. I think that is a good message for parents with small children. You worry about being late for sports day or not making the perfect cake for them to take in, but that doesn’t matter and they don’t really care about it either. They just want to feel secure and that you love them and that you’re going to be there when there’s a problem.Sally Carter, technical editor, BMJ
Competing interests: None declared.
Provenance and peer review: Commissioned; not externally peer reviewed.
Cite this as: Student BMJ 2013;21:f4551