Professor Fergal Malone - Growing research for mother and baby health in Ireland

Consultant obstetrician and Master of the Rotunda Professor Fergal Malone combines a busy clinical practice with medical research and family life. He talks to Claire O'Connell...

Professor Fergal Malone. Image courtesy of Irish Examiner

The birth of a baby is a momentous event in any family. For Fergal Malone, current Master of the Rotunda Hospital, it’s an event he witnesses around 10 times each week. Each week he also monitors about 50-60 more who are on the journey, gestating in pregnancy.

The majority of them are thankfully healthy. ‘By and large obstetrics is a feelgood specialty, you are there for the happy events', says Professor Malone who is Chairman of the Department of Obstetrics and Gynaecology at the RCSI School of Medicine. ‘But some pregnancies and births need more help, and this is where research and clinical interventions can improve health and save lives’.

Wide-ranging interests

He was initially drawn to obstetrics because it would allow him to engage in so many aspects of science, surgery and medicine. ‘When I was going through medical school I loved medicine – the diseases, the complexity - and I also loved surgery, the technical dexterity of doing things by hand. Genetics and radiology also appealed to me,’ recalls Professor Malone, who studied medicine at University College Dublin. ‘And it struck me when I did obstetrics, that this was a specialty where you get to do all of those things’.

All in together

Professor Malone moved to the US for much of his training, and was a principal investigator in a National Institutes of Health-funded network of 16 major academic centres that researched pregnancy and birth.

‘When I came back to Ireland in 2007, I thought wouldn't it be great if we had something similar in Ireland, rather than individual clinicians doing their own thing', he says. ‘So we got funding from the HRB to set up Perinatal Ireland, which brought together hospitals, clinicians and scientists and recruited large numbers of pregnant women into scientific studies’.

That network was the foundation for the HRB Mother and Baby Clinical Trial Network Ireland, which Professor Malone now co-ordinates together with colleagues in Cork, Professor Gene Dempsey and Professor Louise Kenny.

‘We are working on how to predict pre-eclampsia in pregnancy, how to help babies who are growing too slowly in the womb using medicines to improve blood flow and looking at medicines we could give premature newborns to reduce complications', he explains. ‘The network brings together obstetricians, midwives and neonataologists as well as support disciplines to collaborate together on large scale research projects. It also means we don’t stop collecting data when a baby is born, we have paediatricians who can follow up with them as they grow’.

Delivering benefit

Some of Professor Malone’s most rewarding (and stressful) moments have been enabled by advances in real-time ultrasound imaging of the growing foetus, so that precision surgery can be carried out while still in the womb.

‘You could have a woman come in at 20 weeks [of pregnancy] and the foetus could be in heart failure with severe anaemia', he says. ‘You can put a needle in through her abdominal wall and give the foetus a rescue blood transfusion and within minutes the baby improves in front of your eyes. The instant gratification and professional satisfaction it gives you is like nothing else’.

Professor Malone has also pioneered surgery in Ireland to help twin pregnancies where one foetus is getting too much blood and the other too little. ‘You can put a camera into the womb, find those abnormal blood vessels that are causing that imbalance and seal them up', he says. ‘It is stressful surgery, but when in front of your eyes you see the sickness go away, that is extremely satisfying’.

Work-life balance

Professor Malone’s twin-track approach of clinical practice (it’s worth remembering that babies are born at all hours of day and night) and medical research has obvious benefits - but how does it leave room for family and personal pursuits?

‘It’s hard', he admits. ‘But I have a very happy family life. My wife is a huge support, I rely on her so much, and we have four daughters. We always try to ensure the evening meal is inviolable, and at the weekends I try and carve out a number of hours each day for kid time. As the parents of teenagers will recognise, a lot of the time they don’t want to hang out with you, but it is important to be there if they want your company!’

There’s a new generation of researchers, too, that Professor Malone is looking to support.

‘If we have a paper coming out, I don’t need to be first author, I want to see the trainees, fellows, registrars and early-stage career scientists get that, and to see them giving the presentations at conferences', he says. ‘When you retire from your career in medicine and science, would you prefer to be remembered for some hotshot paper from 30 years ago, or for giving others a start after you established your own career? I think it’s better to be remembered for the people you trained, and who went on to be leading lights. That is where you can keep having an impact on medicine’.