Dr. Rohan D’Souza is a maternal fetal medicine physician and associate professor in the departments of Obstetrics & Gynecology and Health Research Methods, Evidence and Impact at McMaster University. He was recently awarded the Canada Research Chair in Maternal Health. In the interview below, Dr. D’Souza discusses the importance of centering individuals with lived experience of pregnancy in pregnancy-related research. He also shares what he aims to accomplish during his term as Chair.
Tell us about your research.
The overarching goal of my research is to improve the physical, mental and social well-being of pregnant and postpartum individuals. In high-income countries, up to one in four people enter pregnancy with a medical disorder, which could put their pregnancies at risk for complications. Individuals who do not have any pre-existing medical conditions may also experience unexpected, serious complications during pregnancy. My research centres around preventing pregnancy complications and optimizing outcomes for pregnant individuals and their families.
What kind of pregnancy-related complications does your research focus on?
My research is focused on reducing the most severe and unexpected complications in pregnancy. Maternal mortality in Canada is very rare, but for every person that dies during pregnancy, about 75 to 100 nearly die from pregnancy-related complications. These near-miss situations often lead to severe illness and disability, which has negative long-term physical, mental and social impacts on patients and their families. In many cases, near-miss situations are preventable.
I’m currently co-leading a feasibility study that will lay the foundation for a Canadian Obstetric Survey System (CanOSS). The system will help Canadian pregnancy care providers share and learn from near-miss situations and develop targeted measures to reduce them.
Why is it important to centre patient experiences in maternal health research?
We need to involve patients in pregnancy-related health research so that we can better understand their perspectives and priorities. Clinical practice guidelines tend to promote pregnancy outcomes that are important to clinicians and healthcare systems – but these guidelines often fail to consider which outcomes are most important to pregnant individuals.
I aim to bring more perspectives into clinical decision-making by engaging pregnant individuals and families in the entire research process – from establishing priorities, planning and collaborating on research studies as partners and participants, interpreting study results and disseminating research findings. In doing so, we can tailor research to meet the needs of pregnant persons.
What motivates you about your research?
I practiced as a clinician in India and the United Kingdom before moving to Canada, and I became interested in research relatively late in my career. Having worked in different healthcare settings and with patients and care providers of different cultural and socio-economic backgrounds, I’ve found that a lot of published pregnancy-related research is not relevant to every population. Much of the research that comes out of high-income settings may not be relevant to people from low-income settings or even among certain high-income sub-populations, for example, and some recommendations may not be culturally appropriate for certain groups.
I have always felt that there is a need to apply research more considerately to the context of each individual patient. I’m motived by the challenging and rewarding practice of marrying evidence-based medicine with individualized care.
What are some of the biggest challenges you face in your area of research?
I think we can do more as a research community to prioritize pregnancy-related research and improve access to funding for family-centered research. Pregnancy-related research is so valuable, not only to the health of pregnant individuals, but also to children and families. Yet, it can be challenging to engage relevant stakeholders in this research.
For example, Canada does not have a nationwide system for conducting confidential enquiries into pregnancy-related deaths or a system for reviewing and learning from near-miss situations. Many high-income countries already have these systems in place, but the fear of ethical, legal and resource considerations, among others, influences Canadian practitioners’ willingness to share data and learn from past mistakes. As part of my research, I am working to minimize these barriers so that we can engage relevant stakeholders in research that will help reduce serious pregnancy complications.
Tell us about your Canada Research Chair – what do you hope to accomplish during your five-year term?
The goal of my Chair is to improve the health of pregnant and childbearing individuals in Canada – and this goal involves several initiatives. First, I would like to engage more Canadians with lived experience of pregnancy in our research. To this end, we are currently training the first cohort of individuals in the Patient and Community Engagement Research (PaCER) program at the University of Calgary, to conduct patient-led peer-to-peer research on pregnancy-related complications. Following their training, we hope to find avenues for these PaCER graduates to support our research endeavours.
Second, we hope to establish a Canada-wide system for reviewing severe pregnancy-related complications. We also hope to determine if causes of complications vary according to different factors, including an individuals’ geographic location, race, ethnicity, socio-economic status and level of access to care and identify strategies for reducing these complications.
It isn’t possible to accomplish everything within my five-year term, but I’m excited to make progress on developing a system that can help us better understand and reduce severe pregnancy complications and improve the health of pregnant and postpartum Canadians.