Path to preterm birth research

Interview with Professor Mark Johnson on preterm birth research

Professor Mark Johnson co-founded Borne, a medical research charity looking for answers to preterm labour. When he is not busy fundraising for his cause, Professor Johnson is in the Labour Ward delivering babies, researching in Borne’s labs with his PhD students or spending time with his family.

What inspired you to get into medicine?

I was looking for some way to work with people. I managed to get into medical school, and once there I really enjoyed it, I found something inspiring.

I originally wanted to be a GP, to be a part of the community and to look after the community. I worked for many years in General Medicine, until I did a PhD in a hormone called relaxin, a hormone with great potential to help human labour. This meant that I spent a lot of time on the labour ward and there I was drawn to the challenge of obstetrics and I have never looked back!

You’ve studied a lot of different aspects in your medical career – how did you arrive at obstetrics?

I always liked obstetrics when I was in medical school. It’s fascinating because you look after every aspect, general medical to surgical, as well as all of the obstetric problems.

You are completely responsible for a woman for nine months, with the added complication that anything treatment that you give will impact not only her, but also her baby. It is really challenging and occasionally very difficult, but all the more rewarding for that! I think to be a good obstetrician you need to be someone who is always thinking, asking questions, trying to understand things.

The problem in obstetrics is that we genuinely know so little, the amount of research that has been carried out in obstetrics is negligible in comparison to the research in cardiology, neurology or virtually any other medical speciality.

Is it difficult to juggle all the demands of your career and home, and remain positive and passionate?

All the demands make you more positive and passionate, for me it’s about finding the best way to help pregnant women who have problems and at the same time always considering the baby. If you are passionate about something, you will use that passion to find a better way to do things.

What do your wife and kids think about it? 

They understand the importance of my work, but it takes me away from them, so they would probably prefer to have more of my time. I have five children (you have got to practice what you preach) they are all marvellous, each an inspiration in their own way.

How did you become so committed to the study of premature birth? 

Premature birth is the most important complication of obstetrics, one that almost without exception we can do little about.

If a woman comes in with preterm labour, there is nothing that we can do to change the outcome. It’s a huge unsolved problem and the leading cause of child mortality worldwide.

As a doctor, I want pregnancy to be much safer and the outcome for both mothers and babies to be better, for this reason, I am committed to finding a cure for preterm labour, to make pregnancy safer and to give each baby a chance of a full life.

One of the problems is that we don’t understand who to give drugs to, some women need to be delivered immediately others need to have their labour stopped, at the moment we can’t tell the difference. This is one of the key problems that Borne is trying to overcome. We need to really understand the problem, so we can find a drug or several drugs that might actually make a difference.

Once we understand what is causing preterm labour and find markers for this problem before conception, then we will really be able to make real progress to actually stop preterm labour, that is the future that I am working for.

While we can’t talk patient specifics, have there been any stand out moments in your career which drove your passion to study preterm birth? 

Over the years I have taken care of many women who have lost their babies, either as a late miscarriage or early preterm birth.

I will always remember a little girl, who was the only survivor of a set of twins, both born at 23 weeks. An absolutely wonderful child, completely normal, you wouldn’t have thought she was a premature baby.

Very sadly that is not true for every baby born at 23 weeks. Most die and the majority of those who survive have life-long disabilities: having to use a wheelchair or being completely dependent on oxygen.

That little girl was very lucky, achieving what she did was amazing.

How did you begin Borne?

For many years I worked in a private practice and funded my research that way. But many of my patients said to me you should reduce the amount of time you spend doing the private practice and spend more time doing research and we will support you.

So Borne started through the generosity of the people I’ve looked after. Sometimes they’ve had preterm birth, but often not. Either way, once you’ve had a baby you really understand the importance of having a happy, healthy baby.

Some are very lucky, like me, all my children have been fine, but a lot of people are not that lucky and that is why people support Borne.

What would you say your five, or ten, year goals are for the charity?

Work on preterm birth is very fragmented. There are a lot of small groups not really working together. I think the solution is to form a centre, based at Chelsea and Westminster and involving Imperial College, where we will bring international experts to work together to really get to grips with this problem.

My next big ambition is to open a centre in Africa or possibly in other areas where preterm birth is a big problem.

Why a centre in Africa?

The majority of preterm birth occurs in sub-Saharan Africa and if you are born preterm in Africa, your prognosis is far worse.

In the UK if you’re born at 24 weeks you have a 50% chance of survival. You don’t achieve a 50% chance of survival if you are born in Africa until 34 weeks.

We must understand the nature of the problem in Africa if we are going to make any real impact worldwide. And it’s very likely that the causes in Africa are very different than the ones in Europe. We may think that our treatments here will work there, but we have no idea.

You decided to work with PhD students in Borne’s labs, why? 

That’s another key part of what we do at Borne; really growing the next generation of people who will continue the research. We’ve got to think about who is coming next.

I try to infect my students with the same enthusiasm and understanding of the importance of the problem. Obstetricians like delivering babies of course; but they don’t like doing research.

Research in obstetrics is really very difficult. It’s not that women who are pregnant have a problem. They’re fine. They’re normal, healthy people and you have to persuade these people that research is important. And they don’t necessarily see that there is a problem.

If you could look back at Borne 20 years from now, having achieved your dream goals, what would that look like?

In 20 years, I hope that we will see all women before they get pregnant. We will be able to identify those who are at risk and have effective interventions to reduce that risk.

For years, I have felt that if we are going to achieve a significant improvement in health, it must start with childhood. You need to be in the schools, educating people, changing people’s perspectives of life.

Only by intervening in childhood will you change the next set of parents, so that they will actually be able to give their children a better upbringing, a better healthy future.

There’s so many medical charities out there that do great research for important causes. How would you respond to someone who asked you why Borne is important?

Borne is all about giving babies a chance of a normal life, who would otherwise not have one.

Our work helps babies who would otherwise be born at 23, 24, 25 weeks and who, if they survive, will be left with lifelong disability. We will change the landscape for these people. They will have a chance at a normal life and achieving their full potential.

By correcting the beginning, Borne will change the end. And that’s what I’d like us to achieve for everybody. That’s the secret.