Medical Disorders in Pregnancy:
A Manual for Midwives
Author details – in alphabetical
order
an MA in teaching health care ethics at the
University of London. With 14 years experience as
a midwifery lecturer she teaches midwifery,
haematological disorders, ethics, and contemporary
midwifery practice with a keen interest in global
midwifery and health issues.
Editors
S. Elizabeth Robson RGN RM ADM Cert(A)Ed
MTD MSc FHEA
Principal Lecturer in Midwifery; N&M Recruitment
and Public Engagement Lead at De Montfort
University
After staff nurse experience on medical and
gynaecological wards in Cambridge, Liz qualified
as a midwife and had 5 years of hospital experience
prior to winning the Jack Kerr Memorial Award for
Trent Regional Health Authority. Her ADM was
attained in Bristol, educational qualifications from
Nottingham University and an MSc in research
methods from Loughborough University. With 25
years experience as a midwifery lecturer, she leads a
module on medical disorders for student midwives
with a particular interest in immunology. Her
clinical liaison areas comprise a community team
and a high-risk maternity ward. Liz has presented
nationally, and has a number of publications.
Jason Waugh MB BS BSc(Hons) MRCOG DA
Consultant in Obstetrics and Maternal Medicine at
the Royal Victoria Infirmary, Newcastle upon Tyne
and Honorary Senior Lecturer at the University of
Newcastle upon Tyne and the University of
Leicester
Jason trained in maternal medicine in Sheffield,
New Zealand and Leicester before working as a
consultant in Leicester for 5 years. He is now lead
consultant for maternal medicine in Newcastle upon
Tyne and has established maternal medicine training
programmes for obstetricians in both cities. His
current research interests are hypertension in
pregnancy and renal and cardiovascular disease in
pregnancy and he has published extensively in these
fields as well as producing national guidelines for
the management of pre-eclampsia and renal disease.
He is president of the UK Macdonald Obstetric
Medicine Society.
Midwifery and Nursing Authors
Abena Addo MA PDGE BSc RGN RM
Senior Lecturer in Midwifery at De Montfort
University
After staff nurse experience in general surgery at the
Royal Masonic Hospital in London, Abena trained
as a midwife in Surrey, followed by midwifery
practice at The Royal Free Hospital, London where
she developed an interest in the care of women with
sickle cell anaemia in pregnancy and their coping
strategies. Abena then undertook a BSc followed by
Eleanor Burns-Kent RM BSc (Hons)
Midwife at the University Hospitals of Leicester
NHS Trust
Eleanor has worked full time in all aspects of
midwifery within the hospital setting since
qualification in 2000. For the past 8 years she has
worked in a high-risk delivery suite setting with a
passion for trying to normalise childbirth for the
high-risk pregnant woman.
Rhoda Cowell BSc(Hons) RGN DipEd
Community Dermatology Specialist Nurse and
Non-Medical Prescriber at County Durham and
Darlington Foundation Trust
After 20 years of community nursing Rhoda
specialised in dermatology and was involved in the
development of community dermatology and minor
surgery services throughout Sunderland. She
currently runs nurse-led clinics for dermatology,
cryosurgery and soon minor surgery.
Claire Dodd RGN BA(Hons) RM BSc(Hons)
Specialist Midwife in Hypertension at the
University Hospitals of Leicester NHS Trust.
Claire worked as a staff nurse in haematology
before undertaking her midwifery training in 1997.
She has had a keen interest in the hypertensive
disorders of pregnancy since 1999 and has been
involved in a number of research projects including
the Magpie Trial and GOPEC. Claire has been
working as a specialist midwife since 2006.
Rowena Doughty MSc PGDE BA(Hons) RGN RM
ADM FHEA
Senior Lecturer in Midwifery, Supervisor of
Midwives and Deputy Lead Midwife for Education
at De Montfort University
After staff nurse experience in general medicine and
gerontology, Rowena qualified as a midwife and
accrued 12 years full-time midwifery experience in
Lincolnshire, before her lectureship with De
Montfort University in 1997. She is also able to
maintain effective links with practice through
working within a local birth centre. Rowena is a
Nurse Medic providing initial treatment to victims
of emergencies in her local and very rural
community prior to the arrival of the Ambulance
Services. Her interests include promoting normality
in normal midwifery, breast-feeding, resuscitation
and metabolic disorders. Rowena is undertaking
PhD research exploring women’s lived experiences
of being obese while childbearing.
Daksha Elliott RGN RSCN
Lead Nurse/ Manager, Leicestershire Sickle Cell &
Thalassaemia Service at the University Hospitals of
Leicester NHS Trust
Daksha currently works with a multidisciplinary
team to provide education, support and coordination of care for patients with
haemoglobinopathies.
Caroline Farrar RGN RM BSc(Hons) PGDipEd
MSC
Senior Lecturer in Midwifery at De Montfort
University
After working as a staff nurse in burns and plastic
surgery Caroline qualified as a midwife and
experienced all areas of midwifery including
integration of midwifery practice. It was noticeable
that her enthusiasm was within the delivery suite
environment and thus studied an MSc in midwifery
which in turn focused her energy into becoming a
midwifery lecturer.
Madeleine Findlay RGN RM BSc (Hons) PG Cert
Education and Training
Currently Parent Education Co-ordinator at the
Royal Victoria Infirmary, Newcastle upon Tyne
Madeleine has worked as a Midwife since 1994 in
community and hospital settings and for 10 years
has focused on the needs of vulnerable clients. From
2007 to 2010 she worked as a senior midwife for
drugs and alcohol in Newcastle and prior to this was
a Sure Start midwife in an inner city area. She has
organised and presented on drugs and alcohol in
pregnancy and associated issues at a number of
regional events and has taught on the midwifery
education programme at Northumbria University on
the topic of vulnerability for some years.
Deborah Frost RGN RM BSc (Hons) AHEA
Academic Co-ordinator at the University of
Leicester
Debbie qualified as a nurse in 1986 and as a
midwife in 1988, specialising in high-risk
pregnancy and care. She was the lead midwife for
the Maternal Medicine Clinic at Leicester for 3
years. A scholarship enabled her to study epilepsy
care at diploma level at Leeds Metropolitan
University. She teaches at the University of
Leicester where she is co-module lead for an Interprofessional learning community programme for
graduate and undergraduate medical students.
Debbie is also an experienced senior NLS instructor
for the UK Resuscitation Council and continues to
champion the role of the midwife.
Michelle Goldie
Formerly Specialist Midwife at the University
Hospitals of Leicester NHS Trust, Leicester
Michelle Goldie trained as a midwife in Leicester
and has published research presented at the
American Thoracic Society.
Andrea Goodlife RM Dip.Renal nursing
Specialist midwife in hypertension and renal disease
at the University Hospitals of Leicester NHS Trust
After 2 years as a nephrology unit staff nurse,
Andrea undertook midwifery training, and has
practised since 1988. The combined renal/obstetric
clinic was set up in 1998, and by furthering her
education by completing the Diploma in Renal
Nursing, Andrea has been involved in this clinic
since its outset.
Kathryn Gutteridge RGN, RM, SoM, MSc,
PG.Dip Counselling & Psychotherapy
Consultant Midwife at the Sandwell and West
Birmingham Hospitals NHS Trust
Kathryn founded a postnatal illness support group in
Tamworth. This project was highly commended in
the RCM Centenary Awards. She began her
postgraduate training in integrative psychotherapy
culminating in research into psychodynamic
transition to motherhood. In Leicester Kathryn
worked in developing midwifery led care and
latterly in supporting women’s mental health and
wellbeing. Kathryn is regarded as an expert advisor
in women survivors of sexual abuse and the impact
this has during childbirth; she regularly presents on
this subject. Kathryn is a member of the Expert
Advisory Committee for the East Midlands
Perinatal Psychiatry Clinical Network.
Juliet Houghton MSc Dip RGN RSCN ENB:934
Recently the Child and Family HIV/Hepatitis
Specialist Nurse at the University of Leicester
Hospitals NHS Trust, and now Programme Director
of CHIVA/KZN Support and Mentoring Initiative
based in Durban, South Africa
Juliet worked on neonatal units and a paediatric
oncology ward before qualifying in HIV nursing.
She then attained a diploma in Tropical Nursing at
the London School of Hygiene and Tropical
Medicine. More recently, she has graduated from
Brunel University with an MSc in the Social
Anthropology of Children and Child Development.
Juliet won the medical category of the ‘Barnardo’s
Children’s Champion’ award for 2005.
Veronica Johnson-Roffey BA(Hons) RGN RM
RHV FETC Dip.Infection control
Infection Control Lead Nurse at Northamptonshire
NHS Trust
Veronica worked in the NHS for 35 years. After
general nurse training she trained and practised as a
midwife and later health visitor and consequently
has worked both in hospital and community. During
her career she has also worked at Great Ormond
Street Children’s Hospital and also specialised in
cancer genetics, public health and infection control.
While a public health nurse she undertook her
honours degree in Health and Social Policy at
Warwick University. Recently she retired from the
NHS and now works in the private healthcare sector
Rosemary Lydall RGN RM BA (Hons)
Infant Feeding Coordinator - Women's, Perinatal
and Sexual Health Clinical Business Unit at the
University Hospitals of Leicester NHS Trust
After working as a staff nurse in orthopaedics,
Rosemary trained as a midwife in 1985. Rosemary
is experienced in all areas of midwifery within the
hospital setting, and has an interest in
gastrointestinal disorders. In 2000, Rosemary
became a Supervisor of Midwives, which enhances
all aspects of the care that Rosemary gives to
women and the support she can offer to her
colleagues.
Moira McLean RGN RM ENB:402 ADM PGCEA
MTD PGDip SoM
Senior Lecturer in Midwifery at De Montfort
University
Moira has been teaching student midwives for over
20 years and has specialist interest in normal
midwifery, fetal heart monitoring, neonatal
resuscitation and maternal resuscitation. She is an
ALSO course trainer, and external examiner to three
centres in the UK. Moira maintains a caseload of
mothers in clinical practice and is a voluntary
breast-feeding advisor.
Jane Scullion BA(Hons) RGN MSc
Respiratory Nurse Consultant at University
Hospitals of Leicester NHS Trust; Honorary Senior
Lecturer at De Montfort University; Clinical
Research Fellow at Aberdeen University
Jane Scullion is a Respiratory Nurse Consultant
working across the interface of primary and
secondary care with patients with chronic
respiratory diseases and developing respiratory
services within Leicestershire. She has published
widely and presented both nationally and
internationally
Diane Todd BSc(Hons) DipHE RM RGN
Specialist Midwife - Diabetes at the University
Hospitals of Leicester NHS Trust
Diane trained as a staff nurse in 1984 and gained
several years experience in Surgical Speciality and
Intensive Care Nursing, after which she chose a
career in midwifery. Qualifying in 1992 much of
her practice has focused on high-risk pregnancies, in
particular those women who have diabetes. As part
of a multidisciplinary team she has further
developed the care and service offered to these
women, winning a Trent Travel Award in 1995, for
a Leicester Team to visit Edinburgh Royal
Infirmary to learn more about pre-conception clinics
and actively participating in the recent CEMACH
Diabetes in Pregnancy Study. She has also
undertaken specific courses to enhance her
knowledge and skills and has presented at national
and international level.
Medical Authors
Professor Fionnuala McAuliffe MD, FRCOG,
FRCPI, DCH
Associate Professor in Obstetrics and Gynaecology,
University College Dublin, Ireland and
Consultant Obstetrician and Gynaecologist and
Maternal and Fetal Medicine Specialist, National
Maternity Hospital, Dublin, Ireland
Fionnuala trained in maternal and fetal medicine in
London and Toronto prior to her current
appointment in Dublin. She is lead clinician for
maternal medicine and diabetic pregnancy and
Director of the maternal and fetal medicine subspecialty programme at National Maternity
Hospital, Dublin. Current research interests are
diabetic pregnancy, maternal nutrition in pregnancy,
fetal ultrasound and fetal growth. She is extensively
published with over 75 publications in maternal and
fetal medicine.
Christopher Brightling BSc(Hons) MBBS MRCP
PhD FCCP
MRC Clinician Scientist and Honorary Consultant
Respiratory Physician at the University Hospitals of
Leicester NHS Trust, Leicester
Chris Brightling trained in London and Leicester
and in 2002 was appointed Senior Lecturer and
Honorary Consultant in Respiratory Medicine at
Glenfield Hospital. His major research interests are
the utilisation of inflammatory markers in the
management of airway diseases and mast cell-airway smooth muscle interactions in the
pathophysiology of asthma. He has authored over
50 peer-reviewed papers.
Professor Nigel J. Brunskill MB ChB, PhD, FRCP
Nephrologist at Leicester General Hospital and
Senior Lecturer at the University of Leicester
After training as a nephrologist in Sheffield, St
Louis, Missouri, USA and Leicester, Nigel became
a Consultant Nephrologist in 1997. As a clinical
academic, in addition to clinical responsibilities, he
supervises a laboratory team investigating cellular
mechanisms of kidney disease. His particular
clinical interests include proteinuria, progressive
renal disease and management of renal disease in
pregnancy. He has published widely in the field of
kidney disease.
Frances A. Bu’Lock MD FRCP
Consultant Paediatric Cardiologist at Glenfield
Hospital, Leicester
Frances graduated from Cambridge and Oxford, and
trained in congenital heart disease in Bristol,
Birmingham and Liverpool before coming to
Leicester in 1999. Her main clinical interests are in
fetal and adult congenital heart disease, which fit
remarkably well together. She is the Cardiology
Associate Editor for Archives of Diseases in
Childhood and has written extensively in the field of
congenital and fetal heart disease. She is currently
co-investigator for a large study into the genetics of
congenital heart disease funded by the British Heart
Foundation.
Francis J.E. Gardner BSc MB ChB MRCOG
DFFP BSCCP accredited
Consultant in Gynaecology and Gynaecological
Oncology and Clinical Director for Gynaecology at
the Queen Alexandra Hospital, Portsmouth
Hospitals NHS Trust
Francis’ main area of expertise is in gynaecological
oncology but he has a specialist interest in minimal
access surgery for patients with gynaecological
cancer. As a result of this he has led a number of
service developments related to minimal access
surgery such that the standard treatment for a
number of common cancers such as endometrial
cancer is now being performed using these
techniques in the Queen Alexander Hospital Cancer
Centre. This has led to a very significant
improvement in service delivery for women with
these cancers coming for treatment at this Cancer
Centre. In addition to this Francis is leading on the
development of a robotic surgery programme for
patients with gynaecological cancer which in time
should also provide a further very significant
improvement in service delivery.
Catherine Gittins BM MRCGP DCH DRCOG
DFFP DPD.
GP partner in Whitley Bay and Dermatology
Specialty Doctor at the Royal Victoria Infirmary,
Newcastle upon Tyne
Catherine passed the Diploma in Practical
Dermatology (DPD) with distinction in 1999 and is
a member of the primary care dermatology society.
Julie Goddard MBBS DFFP MRCOG
Consultant Obstetrician at the Calderdale Royal
Hospital, Halifax
Julie graduated from the University of Newcastle
upon Tyne in 1998. Having completed her specialist
registrar training in the North Eastern Deanery, she
moved to Yorkshire in September 2008 to take up a
consultant post. Julie has special interests in
maternal medicine, high-risk obstetrics and
intrapartum care. She is currently Clinical Lead for
Obstetric Risk Management.
Robert Gregory BA MB BS DM FRCP
Consultant Physician and Head of Service,
Metabolic Medicine at the University Hospitals of
Leicester NHS Trust
Rob undertook research in the immunology of
diabetes at University Hospital, where he developed
an interest in the medical problems of pregnancy
and in the management of pregnancy in diabetes in
particular. In 1992 he published a controversial
article questioning the value of pre-pregnancy
counselling clinics for women with diabetes. He
researched metabolic aspects of gestational diabetes
in Cambridge. Since moving to Leicester he works
in multiprofessional diabetic antenatal clinics. The
team visited San Antonio in 1996 thanks to a Trent
Regional Quality Travel Award to study the
management of gestational diabetes in Hispanic
women.
The late Edmund S. Howarth MB ChB MRCOG
Formerly Consultant in Maternal and Fetal
Medicine at the University Hospitals of
Leicester NHS Trust
General training in obstetrics and gynaecology
followed by sub-specialty training in maternal and
fetal medicine. He led a team providing tertiary
level service for maternal medical problems and
fetal problems, and established a service for
managing neurological problems in pregnancy.
The late Javed Iqbal BSc MSc(Hons) FRCPath
FRCP
Consultant in Biochemical Medicine
Javed Iqbal qualified with commendation from the
University of Dundee Medical School. Whilst a
Senior Registrar at the Royal Liverpool University
Hospital he developed an in interest in metabolic
bone disease which continued to be the main area of
his clinical and laboratory practise. He had a special
interest in clinical aspects of disorders of Vitamin D
metabolism.
Manjiri Khare MRCOG MD FCPS DNB, Diploma
in Obstetric Ultrasound
Consultant in Maternal-Fetal Medicine at the
University Hospitals of Leicester NHS Trust
Manjiri has completed subspecialty training in
maternal-fetal medicine in Leicester after training in
obstetrics and gynaecology as a South East Thames
trainee. She is the lead clinician for maternal-fetal
medicine and Training Programme Director for the
maternal-fetal medicine subspecialty programme in
Leicester. She has special interests in managing
multiple pregnancies, high-risk mothers with
medical problems, infection in pregnancy and
prenatal diagnosis. She is passionate about teaching
and is a faculty member on the MRCOG course in
Leicester. She is a co-convenor for the basic
practical skills course in obstetrics and gynaecology
in Leicester. She is a regional ultrasound training
co-ordinator and runs the theory and hands on
ultrasound course. She teaches midwifery students
at the De Montfort University. She has contributed
to substantive textbooks in her field. She has several
publications in peer-reviewed journals and has been
invited as international faculty for fetal medicine
workshops, panel discussions and lectures.
Renuka Lazarus MBBS MD MRCPsych
Consultant Liaison Psychiatrist and Clinical Lead
for Perinatal Psychiatry at the University Hospitals
of Leicester NHS Trust
After training in the Charing Cross rotation in
London, Dr Lazarus completed her higher training
in psychiatry in Leicester. She took up her
consultant post in liaison psychiatry in 2002. She is
the clinical lead for the Perinatal Psychiatry Service
in Leicestershire. She runs a weekly specialist
perinatal psychiatry clinic based in the Antenatal
Clinic at the Leicester Royal Infirmary; in-patient
care is provided in a specialist mother and baby
unit. She is involved in teaching medical and
midwifery students and is a clinical supervisor for
psychiatry trainees. She has organised training
sessions for midwives and obstetricians. She is
actively involved in research and audit. She is on
the Expert Advisory Committee for the East
Midlands Perinatal Psychiatry Clinical Network.
Christina Oppenheimer MA MB BS, FRCS,
FRCOG
Consultant in Obstetrics and Gynaecology, Head of
Service for Obstetrics at the University Hospitals of
Leicester and Honorary Senior Lecturer in Medical
Education
Christina qualified from Cambridge and London
and pursued a broad-based surgical background
prior to settling in obstetrics and gynaecology. Her
particular interests are in obstetric haematology,
hands-on high-risk intrapartum care with emphasis
on multiprofessional care and training, paediatric
gynaecology and pastoral aspects of medical
education. She has published in both obstetric
haematology and using qualitative research
techniques in obstetrics. Team-working and
multidisciplinary care is a particular passion.
Sue Pavord MB ChB, FRCP, FRCPath
Consultant Haematologist and Honorary Senior
Lecturer in Medical Education at the University
Hospitals of Leicester NHS Trust
Sue was appointed to this post in 1998. Her specialist
clinical interests are obstetric haematology and
haemostasis and thrombosis. In collaboration with
obstetricians and specialist nurses, she established and
has continued to develop a comprehensive obstetric
haematology service with a heavy throughput of
patients. She also runs a large Haemostasis
Thrombosis Unit and is Haemophilia Comprehensive
Care Centre Director. She is co-founder of the national
Obstetric Haematology Group and established a
postgraduate certificate course for health care
workers in the field of obstetric haematology.
Paul Moran BM BS BMedSci MRCOG MD
Consultant in Obstetrics and Fetal Medicine at the
Royal Victoria Infirmary, Newcastle upon Tyne
Paul graduated from Nottingham in 1989. He
trained in Nottingham and the Northern Deanery
and became a consultant in Newcastle in 2001. On
appointment he introduced clinics for vulnerable
women including those with substance misuse and
mental health problems. He is lead clinician for fetal
medicine with particular interest in fetal surgery,
echocardiography and 4D ultrasound. Keen to
promote more widespread understanding of
pregnancy and fetal development he has contributed
to books for a general readership and most recently
edited The Pregnant Body Book.
Marie C. Smith MBBS MRCOG MD
Consultant Obstetrician at the Royal Victoria
Infirmary, Newcastle upon Tyne and Senior
Lecturer, Newcastle University
Marie graduated from Newcastle and completed
obstetrics and gynaecology training in Nottingham,
London and the Northern Deanery. She joined the
Newcastle consultant maternal medicine team in
2008, and is the lead obstetrician in the Connective
Tissue Disease clinic. Her current research interest
is pre-term labour, in particular, the role of
inflammatory signalling pathways in cervical
remodelling.
Karen Watkins MB ChB(Hons) MRCOG
Lead Obstetrician for Intrapartum Care and
Maternal Medicine at The Royal Cornwall Hospital,
Truro
Karen graduated in 1993 with honours. She
completed her basic training in Obstetrics and
Gynaecology then in 1998 she became Clinical
Research Fellow for the Magpie Trial investigating
magnesium sulphate and its role in preventing
eclampsia. Karen then worked for a number of
years in Australia and during this time was awarded
‘Best of Free Communications’ at the RANZCOG
Annual Scientific Meeting, June 2000 for research
she had undertaken whilst in Australia. Karen
completed the RCOG Maternal Medicine Module in
May 2005 and spent a further year gaining
additional training in maternal and fetal medicine.
Sophia Webster BMedSci(Hons) BMBS DFFP
MRCOG
Obstetric Registrar at the Royal Victoria Infirmary,
Newcastle upon Tyne
After qualifying from the University of Nottingham
Medical School, Sophia began her obstetric training
in London where her interest in high-risk obstetrics
began to develop. This led her to spend 12 months
in Cape Town, South Africa, before returning to the
North East of England to complete her specialist
training.