Woman's Hour - Birth trauma, Sleepwalking, Lolita Chakrabarti

Episode Date: May 14, 2024

How many women have decided not to have more children after a traumatic birth? The UK’s first inquiry into traumatic childbirth has found that too often poor care is normalised, with devastating effects on women’s mental and physical health. Nuala McGovern talks to one Woman’s Hour listener who decided she couldn’t face having another child after a traumatic birth, and to the author of the report, Dr Kim Thomas, about its recommendations. Journalist Decca Aitkenhead regularly sleepwalks. She talks to Nuala about her night-time escapades which include finding herself locked out in the middle of the night, eating food she’d find disgusting when awake and incredible strength that has seen her smash furniture to pieces. She’s joined by neurologist and sleep expert Prof Guy Leschziner who explains what’s going on in our brains when we sleepwalk, and how women are affected. New analysis from the TUC, the Trades Union Congress, says that more than 1.5 million women have dropped out of the workforce because of long-term sickness. The figure marks a 48% increase compared with five years ago. Nicola Smith, Head of Economics at the TUC, tells Nuala McGovern what may be stopping women from returning to work. Award-winning playwright and actor Lolita Chakrabarti discusses her new Radio 3 play, Calmer. All about motherhood and chaos, it follows three generations of ultra-successful women in one family - but their lives are not as ‘good’ as they appear on paper.Presenter: Nuala McGovern Producer: Olivia Skinner

This BBC podcast is supported by ads outside the UK. I'm Natalia Melman-Petrozzella, and from the BBC, this is Extreme Peak Danger. The most beautiful mountain in the world. If you die on the mountain, you stay on the mountain. This is the story of what happened when 11 climbers died on one of the world's deadliest mountains, K2. And of the risks we'll take to feel truly alive. If I tell all the details, you won't believe it anymore. Extreme. Peak danger. Listen wherever you get your podcasts.

BBC Sounds. Music, radio, podcasts. Hello, this is Nuala McGovern and you're listening to the Woman's Hour podcast. Hello and welcome to Woman's Hour. Well, did you have a good night's sleep? Did you stay in your bed all night? That is something that my guest, Deca Aitkenhead, doesn't always do. She has woken up in other people's beds. She has been stark naked in public.

She's also destroyed furniture, all while sleepwalking, where we're going to hear her story this hour and why it happens. Also, we are following up on the birth trauma inquiry that was released yesterday. Today on Woman's Hour, we want to hear from women whose birth experiences influenced their decision not to have another child, even though they wanted one. Here's a little of Jen's story. I guess it wasn't an instant decision after giving birth and receiving that lack of care. It just was not an option for me

to have any more. The Conservative MP, Thea Clarke, who was involved in the inquiry, cites a figure of 53% of women who experienced birth trauma are less likely to have children in the future. Is that you?

If so, I want to hear from you. You can text the programme. The number is 84844. On social media, we're at BBC Woman's Hour, or you can email us through our website. And for a WhatsApp message or a voice note, that number 03700 100 444. Also, what was it that specifically determined your decision? The birth, the pain, how you were treated. Also, I've been listening to Calmer. No, not a meditation app, but Lalita Chakrabarty's new radio drama about the sometimes chaotic relationships between mothers and daughters,

grandmothers and daughters. Lalita will join me in the Woman's Hour studio. I'm looking forward to speaking to her. But let us begin with the birth trauma inquiry. It was the first of this kind in the UK. It's calling for huge changes to maternity care and you probably heard some of those truly harrowing stories from women that it spoke to. It is estimated that 30,000 women a year in the UK suffer negative experiences during the delivery of their babies. The report said that too often poor care is normalised

and women are often traumatised by the lack of basic care and compassion. One in 20 develops PTSD, post-traumatic stress disorder. And as I was mentioning, many decide never to have a child again. And what we want to talk about is particularly that. So 84844 is the way to get in touch i'm going to be speaking to the report's author dr kim thomas about her recommendations in just a moment but first let's hear from one woman's hour a woman's hour listener about her experience you heard a little offer there jen stevens she was so traumatized by her labour and her lack of care that she ended up with PTSD and made that decision not to have any more children.

Let's hear her story. My labour was fairly rapid and I don't think the midwives were aware of how quick I was progressing and due to this I was bundled off into a side room and not given much attention at all the pain was getting so severe and I didn't feel listened to at all I remember my husband going to find somebody to say that my waters had broken and the midwife came to look at me and she just looked at my trousers and just went, oh, I think you've just wet yourself and left. At about half past nine that evening, they said to me, you can probably come through to the delivery suite now.

By this point, no one had checked anything I don't quite know why they were moving me through there when they didn't really know what was happening with me but as soon as I got to the delivery suite I started pushing and my baby was born by 10 o'clock and it was all very very quick and very rapid. I then had a major haemorrhage which just really took its toll on my body. After the labour we were then moved to a side room and I was just still in sort of a real state of, I don't know it's so hard to describe, where the pethidine listed in my body. So basically I'd been birthing whilst on the pethidine, which wasn't what was meant to have happened at all. My son had a lot of problems with breathing and because of this,

he couldn't latch. And I didn't know at the time, but bethadine is given too late in the labour process it will cause congestion and breathing problems for the child but it also affected my ability to feel that I was bonding with him yeah it just I didn't feel looked after I didn't feel a priority, aside from the actual midwife that I birthed with. The rest of the team, unfortunately for me, just, I felt like an inconvenience to them. And I think because my emotions were just so high after the birth, and was just very very tearful and I had there was one midwife in particular on her shift um who just said to me you know why are you crying all the time you need to pull yourself together which and and this was from a very young midwife as well which I just I was absolutely horrified at and I had to stay in hospital for

three days because I'd lost so much blood although they never actually gave me a transfusion and that also hindered my ability to produce any milk and I guess it wasn't an instant decision after giving birth. But there was just never a point and still hasn't, that point has never come, even though my son is now eight and I'm probably not at an age to have any more children. But just the thought of giving birth and receiving that lack of care just wasn't an option for me I just you know I wouldn't put myself in that position in any other part of my life so it just was not an option for me to, yeah, to have any more.

And as much as there's a sadness there for me, there's also anger there for me, which I have processed a lot through counselling. But it's still very much a part of my life and I can still see the faces of those people telling me you know to pull myself together and stop crying and just you know what what part of anybody says that to somebody in any situation where they've just been through something really full-on. That was Woman's Hour listener Jen Stevens. Thanks very

much to her for sharing her story. Lots of you getting in touch already 84844. Carla says when you and your baby come so close to death the idea of more babies is terrifying. Well joining me now is the author of the report Dr Kim Thomas the CEO of the Birth Trauma Association. She's also published two books on the issues of birth trauma. Welcome to Women's Hour. First of all, your reaction to what you just heard. How representative is Jen? Very representative of the stories we hear.

I mean, it is absolutely heartbreaking to hear a story like that, but it is very, very typical. From that bit at the beginning where she says the midwife said, you've probably wet yourself which is such a ludicrous thing to say but actually something we hear quite a lot you know woman's waters are broken she's told that she's wet herself which is nonsense that's immediately going to make you less less trusting and feel quite frightened then being told um to stop crying uh you know what way to respond to somebody who's in distress. But it's very,

very characteristic of the stories we hear. And again, that decision not to have any more children, which women often tell us because they felt so frightened during labour that they couldn't face going through it again. So unfortunately, everything Jen said resonates with the stories we hear all the time. You know, I even heard from a woman who's 42. This is Libby in Kingston. She says, I'm the first of two. And so my mother's traumatic birth experience didn't deter her from having a second. But her retelling of her experience discouraged me from being a mother.

I'm 42. I'm married and child free. My whole life I've been surprised by women excited to be pregnant. I think there is at times a secrecy about what happens at birth. And then we also hear this other aspect of a woman speaking about what she went through, but actually frightening another woman. Yes, it is quite hard because I think a lot of women keep quiet about their stories because they don't want to frighten pregnant women which is which is very understandable but of course if as a pregnant woman you don't know what might happen during labor then it becomes even more shocking when when you you find the reality so i think it's quite a difficult line to tread but i do think women should be

informed of the risks. I mean, they should know, for example, it's possible to tear during childbirth or it's possible to have a postpartum haemorrhage. And I think with any other kind of medical procedure, you wouldn't go in ill-informed. You'd want to know what might happen to you, what side effects of medication might be, for example. So how do you understand that? Why isn't that information getting across? Because they're coming in in just a couple of moments of asking for stories, people are sharing them. But how come women are going into that situation that can be precarious at times without the full raft of knowledge? Well, I think quite often women don't attend anti-native classes. So a lot of NHS trusts don't offer anti-native classes now.

Or if they do, they're kind of quite limited in the information they offer because there is this idea that you shouldn't frighten women. So I think also there's an idea as well on social media, you're supposed to have a very lovely birth and you can have a water birth and you can breathe your baby out and it's all going to be lovely. And when that isn't the reality, that can be quite frightening. on the website of MP Theo Clark that women basically decide not to have another child because of a traumatic birth experience. How often do you hear about it and how often do you think

it's first-time mothers? I think it's usually first-time mothers, not always, but most of the women who come to us with traumatic birth experiences are first-time mothers and I would say a sizable minority of the women who come to us with traumatic birth experiences are first-time mothers. And I would say, yeah, a sizable minority of the women who come to us

say they won't have another baby. And some eventually do decide. They give it four or five years, and they feel ready to try again. What do they tell you? Yeah. We have a quite big Facebook group, and I asked women about this yesterday. I'd like to quote a couple, if I could. So one said, I was advised that I could have an elective C-section should I decide to have more children. My issue is that I can never trust them again,

and definitely not have another child. To be honest, I've been unable to be intimate since giving birth over four years ago. The experience has totally changed me as a person um and another one said as one of three myself i couldn't picture one child but when even in your debrief the consultant says well you didn't die did you you know that you wouldn't be supported even if you did decide to have another how are you meant to willingly choose to put yourself in that vulnerable position again so there's there's a lot of fear there about having another child particularly if the care was was really poor and the trust and is it as i was asking our listeners 84844 is it the actual birth is it the pain or how they were treated i think i'm hearing more treated at the moment it's often how they were treated and that kind of lack of care and that

callousness. But there's also an element of if the birth was really frightening. For example, if there was a postpartum hemorrhage or if the woman feels she nearly died in labour, the prospect of having to go through that again and not feeling reassured that you'll be looked after is very, very daunting. And sometimes we find as well, it's the men who say, I can't watch my wife go through that again because I was so frightened. So that's an interesting perspective. Doctor, let me read one. This is from Julia. I didn't make a definite decision not to have a second child. I just never felt I could face it. In my case, it was a combination of birth trauma and my husband's cold and unsympathetic attitude. He witnessed the whole thing and I think it was worse for him.

I believe now that he had PTSD at the time and it just seemed like he'd withdrawn from both me and the baby. I got through it because I had to, but I didn't feel I could go through it again. Yeah, that's really sad, isn't it? But that's, again, that's not untypical of the stories we hear what would you say to women who are wondering if they can cope with having to go through another labor because you say some wait four or five years some people don't have that time no no that's true i think it's very difficult what i would advise that i mean i think there are a few things well i mean one is you can get to some therapy and kind of talk through what happened to you.

But a lot of women try and take control of it. But if they do decide to have a second baby, they might go to a different trust from the one they gave birth at, which is, you know, which can make a difference if they had really poor care. Some NHS trusts offer trauma-informed care. So they will talk you through what happened in your previous birth and they'll inform the obstetric team of what happened to you and they might offer you psychological help and they'll make sure they do everything they can

to make sure you have a better experience. And some women also try and take control by asking for a planned caesarean or in some cases asking for a home birth, but just to make sure that they have more control over the situation than they did the first time round. Yes, and of course I realise there'll be a lot of women that are pregnant listening to this show. And also it's interesting, you said that phrase at the beginning,

that people don't want to frighten pregnant women. And we don't. It's more about empowering, I suppose, to take control and know what to be aware of or to have an advocate perhaps oh yes having an advocate is a really good idea you know making sure that your partner your birth partner is really well informed and knows what questions to ask and some someone will have doulas as well which can be really helpful you know i'm hearing some that are more historic doctor and others that that are recent here a, I had a traumatic birth 34 years ago.

It still affects my life today. I had PTSD and struggled with the physical effects for years. My husband took his own life when my daughter was four. She now suffers with her mental health as a consequence. I truly believe all these things would not have happened if I hadn't had such a traumatic and uncaring experience. That was Catherine. Another from Jennifer. I have such a feeling of

sympathy and recognition listening to Jen. That was our Woman's Hour listener who began this item, speaking about her birth trauma. I was told, you need to pull yourself together. You're a mum now, by a midwife when I was crying. I'd been in hospital for eight days by this point. I came home with a uterine infection and a feeling of

absolute hopelessness and fear. I adore my son, but I won't be having any more children. In fact, I had a termination in 2021. Wow. That's so hard to listen to, isn't it? But yes, really kind of moving. Do you think,

and I should say there are sources of support on the Women's Hour website, but do you think this inquiry I should say there are sources of support on the Women's Hour website, but do you think this inquiry might be a game changer, that in fact we might begin to have a recognition? Because when I looked around the world, like the US and Australia, those stats came up and they're pretty similar to the UK. This is not just a UK problem.

You're absolutely right there, yeah. This is worldwide. So it's not just the NHS. People often think it's an NHS problem but I think it's a maternity problem and the way the kind of attitudes that prevalent in maternity and that's a kind of paternalistic attitude and I you know I really really hope that the inquiry makes a difference there have been a number of inquiries and reports over the years but we've had such a good response to our inquiry and people seem to have been genuinely shocked by the findings. And the health secretary has said she's going to take some of the recommendations on board.

So I really hope that it will make a difference. Thank you for speaking to us, Dr. Kim Thomas, the CEO of the Birth Trauma Association. And it's also written a couple of books on this. Also, thank you for those of you who got in touch sharing your stories. 84844 at BBC Women's Hour is the way to get in touch. Now, the journalist, Deca Aitkenhead,

recently wrote an article about her experiences of sleepwalking. It was surprising, to say the least. There are a lot of adventures that Deca has had locking herself out in the middle of the night, eating food that she wouldn't usually eat during the day. But let us hear it from Deca, who is with us to talk about her sleepwalking. Also joined by a professor of neurology and the sleep medicine guy is Guy Leschner, who has written a book about sleepwalking that is called The Nocturnal Brain. Also some

great documentaries as well about the mysteries of sleep. Guy is in studio with me. Welcome, Guy. Hello. So, Decker, tell us some of the things you have experienced while sleepwalking. Oh, God, Nuala, where do I even begin? I suppose the first incident when I was an adult that got me slightly into hot water was I was sent off in the 90s to interview Paddy Ashdown in Somerset. I stayed in a lovely grand old country house hotel, went to bed very early, thinking I need a good night's sleep. And I woke up at 3am in the hotel basement in the kitchen, peering into the fridge, stark naked. And I wasn't particularly bothered. I thought,

oh God, here we go again. You know, this is not entirely out of the ordinary. But when I got back to my room, I realised, of course, the door was locked and I had no way of getting back in. And there was no one on reception and ended up phoning my boyfriend in London, who ended up having to call the Taunton police to come and get me. So that was sort of somewhat mortifying. And then the next time I stayed in a hotel, I made a very clear mental note to wear pyjamas and put the key card in my pocket. This was on a busy main road in Bristol. And I don't know why, but at some point in the night, I clearly took off my pyjamas and went walking because when I woke up, I was in the street. And that was, I have to tell you, this was the first of many, many such incidents. I mean,

they've sort of, they've punctuated my life. Since you were a child, right? Yeah, my first memory was waking up peeing into a small cup. And my mum said, oh, don't worry, you know, you'll grow out of this. But I never have. But you're so relaxed about it from my immediate interaction with you laughing. And it is funny. But the thought of being naked on a street in Bristol, and I will also say as a woman, because when I was speaking to people about this story, they're like, she's a woman and she was naked on the street. Does that not fill you with any fear?

No, no, it's a really funny thing. When you put the question to me, I think, well, of course, one manifestly should. I can't really account for why it doesn't. I think I've always just found it it's inherently comical and sort of bizarre. And there's also, I'm faintly charmed by the idea of this other self, this other version of mine who does completely bananas things. And it is true, you know, I could have got into hot water on lots of different occasions.

One time in a hotel in San Francisco, I went wandering off down the corridor looking for the loo. And my husband woke up to hear him knocking on the door and slightly cross looking man in his boxer shorts saying, could you come and get your wife out of my bed, please? And he's waking her but she just kicks me. So of course, you know, there are many times when things could have gone wrong. But most of the time, it's sort of faintly comical I often wake up in the morning and I look at my hands I oh god because the fingernails are clogged with food I'm downstairs to the kitchen thinking oh god what have I eaten this time and sometimes the fridge door is wide open and the kitchen looks like a bombsite and I will have eaten almost the entire contents of the fridge I mean there are 24-hour periods when I eat far more

asleep than I do when awake. And quite often food I absolutely hate as well. There's no rhyme nor reason to it. My kids have learned to take precautions. They hide their chocolate now because they know that that may vanish in the night. But it's, as I say, I can't account for why it's never worried me. But you also talk about food under your fingernails what about glass shards in your feet yeah that was less funny I mean again I can't account for why it never occurred to me that I might actually hurt myself until I did and that was August last year I was in Jamaica and I woke up in the morning and thought oh my god you know there's scenes in crying and tv films tv and films the crime scene and you have these sort

of pools of blood and bloody footprints i thought what's going on here and i got out of bed to investigate and just plunged my knees sort of screaming my feet had been absolutely slashed to ribbons and um and i could kind of piece together what had happened sure enough there was a kind of incriminating empty plate on the sideboard. So I'd obviously gone looking for food in the night. And then I'd knocked over a glass and I'd walked all over the broken glass in my sleep. Then I'd gone off to the loo and got back into bed without even waking me up. I mean, awake, I couldn't walk for days.

And because we were in rural Jamaica and a long way from a hospital, a friend of mine just kind of cleaned my feet up and we hoped for the best. And after a few days, I could walk again. But a few months later, I thought, yeah, something doesn't feel right. And sure enough, there were bits of glass embedded in my feet and I had to have a general anaesthetic and surgery and I couldn't walk for two weeks. And that was obviously quite a bore. That was not ideal at all. Let's park that one for a moment. I have to bring in Guy here. What is going on? Well, Decker's stories are really rather familiar, actually, amongst many of the people that I see. We tend to think of the brain as working as a single unit in sleep. But actually, over the last 20 or 30 years, we've realised that that's not the case

at all. And that actually, different parts of the brain can exist in different stages of wake or sleep at the same time. Now why people like Decker might sleepwalk remains a bit of a mystery. We think that there's a strong genetic component and that certain triggers can disrupt deep sleep and result in parts of the brain being awake. So what sort of trigger? Well things like for example extrinsic noise or snoring, sleep disordered breathing, restless leg syndrome and issues related to that but in some individuals they don't need any of that in order to precipitate these kind of sleepwalking events. Okay Deca does your family do it? Do you have restless legs? No and no, I'm afraid.

It's a bit of an enigma. I think there might be an element of stress involved. I think it happens more during stressful periods than not. Okay, let's throw that back to Guy. So a lot of people wonder whether or not there's a psychological cause for sleepwalking, but actually it's very much a neurological issue. It's the same as, for example, having a seizure or a head injury

where part of your brain is not working properly. But actually this is related to how the brain functions in sleep. Undoubtedly, psychological factors may influence your events. So we know that, for example, sleep eating can be associated with particular psychological triggers, and actually it's not unusual for stress to disrupt your sleep anyway. If you've got a predisposition to sleepwalking and you're stressed, that makes it more likely to occur. We all know stress can affect sleep.

How does sleepwalking affect women in comparison to men? Guy? Well, I think that there are a number of different issues. So we know that, for example, in women, restless leg syndrome is much more common than in men. Some of that is hormonal. Some of that is related to having lower iron levels. And restless leg syndrome and associated conditions can act as a trigger. Insomnia is much more common in women than it is in men. And one of the cohorts of individuals I see are women who have been started on sleeping tablets, for example. And some sleeping tablets are well known to precipitate rather dramatic sleepwalking events in people who may have never had sleepwalking before they started on those medications. Why do women have more insomnia? Is that too big a question?

Well, I think that's very... How long have you got? Because that maybe having another programme. I think some of that is hormonal. Some of that is related to societal stresses and strains. But, you know, it's a very consistent finding. Ah, so many aspects of this are so interesting. Right, also on women and men. Let's talk about physical strength

and what happens with sleepwalking. You have shredded things, Deca. Yeah, this is fascinating to me. I mean, it's also deeply inconvenient. I sometimes break things in my sleep that if awake, I would not possibly have the physical strength to do so. I went through a long phase of ripping toilet seats off their hinges and smashing them to bits over my knee and there was a lovely chest that I really rather treasured that I woke up one morning and found in splinters in the living room and there's no way in the world I could have done

that so so I'm wondering I don't know guy I mean do we know like why you might break furniture when you say Deca that's not something you do when you're awake, usually. No, no, no, I'm not. Okay, good to know. So I think that there's quite good evidence that in sleep, certain parts of the brain that are responsible for measuring exertion to limiting your physical strength are switched off. And we see that, for example, in people with Parkinson's disease, who may be unable to walk or move very slowly or talk in a very soft voice during waking hours. But then when they exhibit

acting out their dreams, they will talk normally or they will move normally. And we also know that these parts of the brain are affected by emotional state. So there are all these examples of what's termed hysterical strength, you know, women defending their kids from raging bears, for example. And so it's likely that in these sleepwalking events some of those areas are turned off and that allows you to exert more strength than you would in day-to-day life. How common is it? Sleepwalking?

Yeah. So it's very common in children. A lot of people with children will have seen that their kids will occasionally sleepwalk or will have night terrors. We think that it persists into adulthood in about 1% to 2% of people. So it's not that rare. A person has got in touch, Mo, a woman, I believe, from Scotland. I've been a sleepwalker since I was 12. Many a laugh was had, but now as a woman of 60, I have suffered from night terrors for the last five years.

These are terrifying. I get wonderful support from my husband and now with hypnosis, I get a few months of relief. But what frustrates me is that people find it both fascinating and amusing. And I tend not to speak about it now for these reasons. Guy, the women who come to your clinic, what about sleepwalking? What are they most concerned about? Well, I think it's a range of things. Guy, the women who come to your clinic, about sleepwalking, what are they most concerned about? Well, I think it's a range of things.

A lot of people find them very distressing, particularly if there's a very strong emotional component to them. So one of the areas of the brain that seems to have a tendency to wake up during these events is an area of the brain called the limbic system, which is the emotional centre of the brain. So there can be the distress. Then there's also the risk of harm. So you talked a little bit earlier about finding yourself as a woman naked in the streets. But there's also physical injury. You know, I've had patients who have broken limbs, for example, one patient that I can remember who actually stabbed themselves with a knife in the leg, which has, you know, it's slightly reminiscent of Decker's event. So there's a range of issues that cause significant distress in this situation.

I just want to ask you also, Guy, when I was looking into this, it didn't take too long before sexsomnia came up or sleep sex, a sleep disorder characterised by sexual behaviours committed while asleep. There was a report in The Observer about a rise in the use of sexsomnia in recent years as part of defence cases in criminal trials. How do you understand it? Well, I think sexsomnia very much exists. I think one has to be very suspicious when it's used as a legal defence

and there is a burden of proof to try and demonstrate that there is beyond a reasonable doubt that, you know, sex omnia was involved in this setting. So I think that certainly there are a number of individuals who use this as a as a defence, whether or not it has a basis. In fact, in that individual is somewhat difficult to ascertain. Deca, have you ever tried to cure your sleepwalking? Several people have asked me that, actually. And I find myself asking myself, I wonder why not? I suppose in the kind of list of issues to attend to,

it's always ranked fairly low to me. So, no, I've not sought any kind of help. I did at one point consider putting a lock on the kitchen fridge. But then I thought, God, what would that look like to my children's friends when they came round? So no, no, I've taken no precautions other than always taking pyjamas to hotels, although I can't always be sure to wake up in them. Do you think the sleepwalking you has a different personality? Oh, that is an interesting question

isn't it i mean she's certainly awfully violent and incredibly messy and hungry yeah well yeah no that that applies when awake as well lula i i quite i leave a hell of a mess and i'm puzzled by the ripping things up and smashing things about. I would, obviously, Guy is describing very serious circumstances in which people have done themselves terrible injuries or committed crimes. And I count myself very lucky that I don't feel that I belong in that camp. For me, it's just a kind of comedic aspect to my life, really. Fascinating stuff. Deca Ickenhead, you can also read her article in The Times.

And Professor Guy Lechthinner, author of The Nocturnal Brain, you can also find. Mysteries of Sleep, that is the documentary. That's the radio series. Yeah, exactly, radio series, which is online, which is also fascinating. Thanks to both of you. 84844, some of you getting in touch with those stories

as well as we're taking your stories of whether a traumatic birth experience influenced your decision not to have another child. That's 84844. Now, you may have missed our Women's Hour exclusive yesterday. We heard the testimony of a female officer in the military who says she was raped

by a more senior officer in the Royal Navy. a man who is responsible for behaviours and values, including sexual consent. She says while he has been permitted to continue his career, hers has been ruined. You can hear the full interview with a woman we are calling Joanna and also with the MP Sarah Atherton on BBC Sounds. Here's a reminder of the impact the incident had on her. It ended my career. I've been medically discharged because of the mental health consequences of this. You know, it led me getting very close to attempting to take my life. The only reason I didn't is because I'm a mother. I strongly believe that if I wasn't, I wouldn't be here today. The physical effects of the assault itself didn't last very long.

The mental side remains, and that manifests itself physically when you've been through an extreme trauma. You feel it in your body in many, many ways. I went through periods where I couldn't eat, I couldn't sleep, I lost a dramatic amount of weight. I was a different person. I was a shell. And I've partially recovered some of that, but not fully. And I never will be the same person again.

I think it's generally the worst crime you can survive. Rape's up there with murder as a really serious crime. And you can't survive murder by definition. I'd have rather broken every bone in my body and gone through physical rehab than this. Essentially, he's been given a slap on the wrist. He hasn't been demoted in rank. It might have cost him a promotion. It might have affected his career a little bit but he is still in a job in the Royal Navy. He's still in the same rank. Whatever he's doing he will have power and influence over people and their careers. My career

has ended and his carries on. And he's still earning a good salary and he's adding to his pension. It is wrong. And the first sea lord, the head of the navy, has gone public and said this behaviour is not tolerated. He didn't say if you've committed a crime. He said anyone who has been found to be acting inappropriately in this way, which this person has admitted to doing, you will be discharged. There's no place for you in the Navy. Yet this man still serves. Let me ask you, Joanna, you know, you talked about trying to move forward.

Do you feel you can? I've lost the career that I loved. But that's, you know, that's not as important as being as well as I can be. I will carry on, but it will never have not happened. I also spoke to the Conservative MP Sarah Atherton, a former member of the Armed Forces who sits on the Defence Select Committee. In 2021, she led a landmark review into women's experiences in the Armed Forces and she gave us her reaction to Joanna's story.

It's saddening to hear yet another account of mistreatment in the military of a servicewoman. I'm sad, but I'm not surprised. What I repeatedly hear is abuse of power in the military, a breach of trust, a duty of care that's neglected. And actually, I get into my office at least one case a week from servicewomen and veterans around this issue. So it is a topic that is not going away. And servicewomen

now feel more empowered and veterans feel more empowered to speak about it. This person, the senior officer, has a responsibility and it's incumbent on him to have protected her, not exploit her. I know it's very difficult to have a conviction when it's one word against another. But, you know, these are not the standards we expect from a professional military. Do you think this person should still be in this post? No, he's let the military down. He's let himself down. He's certainly let Joanna down.

He should not be in the post. Why do you think it's not working? The zero tolerance policy is not working for a number of reasons. One, we have, or the military has a problem with personnel recruitment and retention. These people that usually are perpetrators of these acts are senior male officers with 10, 15, 20 years of experience and the military are saying actually we cannot afford to lose that level of expertise. I have no doubt that service chiefs, ministers and civil

servants at the MOD think they are doing the right thing. But there's a disconnect between what they think is happening and what is actually happening on the ground. The Conservative MP Sarah Atherton there and a response from the Royal Navy who said sexual

assault and other sexual offences are not tolerated in the Royal Navy and anything which falls short of the highest of standards is totally unacceptable. Thank you for all your messages also coming in on birth trauma. One here that says, I'm listening to the interview about birth trauma, I'm a midwife, it's so sad hearing what is happening to women, but it feels like midwives are being attacked when it's the system

letting women and the midwives down. Lack of funding, increased cost to train as a midwife, lack of managerial support and increased medicalisation have all put too much pressure on midwives and midwives are now afraid of women. Thanks for that message, 84844. I want to turn to a new analysis from the TUC, the Trades Union Congress,

and that says that more than 1.5 million women have dropped out of the workforce because of long-term sickness. So this figure marks a 48% increase compared to five years ago. Back and neck pain were the biggest drivers of women leaving the workforce. Nicola Smith, Head of Economics at the TUC is here to speak to me about it. So give me some more details on what you found and welcome. Thanks, thanks so much. I mean these are really concerning data because what they show us is that being out of work because of long-term sickness is now the top reason that women are outside of the jobs market. Now we've seen some new figures today, you'll have heard it reported across the news, unemployment has been rising again and it's going up for women but actually

more than double the number of women than are unemployed are out of work because they are too sick so that's a really concerning trend and and it's it's a new trend because you know latterly over the sort of last 10 20 years women are much more likely than men to be out of the work because of caring responsibilities and over the last four to five years that trend has turned around and the number of women who are out of work because they're caring for others has been declining quite sharply and the number of women who are reporting all sorts of health conditions that are leaving them unable to work has risen quite dramatically. What about that aspect of muscles and joints causing such issues to the female workforce and it being part of this long

term sickness trend? Well I mean there's a whole range of different health conditions that are seeing increases and that is a particularly concerning part of the data so this 47% increase in women who say they're economically inactive because of musculoskeletal issues a 15% increase in women who say that they're out of work because of conditions like cancer. And, you know, there is inevitably lots of different trends going on here. So, you know, you can see quite a strong link between the start of the pandemic and a small rise in the number of women that are out of work because of ill health. In recent years, that's increased quite substantially. And that leads us to see there must be a very clear link between current

NHS waiting lists currently standing at about seven and a half million huge waiting lists for community health services including for musculoskeletal care and for physiotherapy and women not being able to move back into work and to get the care they need. So I think we're seeing both declines in people's overall health, but also a sharp deterioration in people's ability to access the services that will help them improve their health and move back into work. And I guess you've got to see that all alongside as well, you know, a real deterioration in living standards and a rise in the sorts of insecure jobs where we know women are more likely to be concentrated and that can themselves,

you know, lead to deteriorations in people's health and well-being. And of course, the government has talked about trying to get people back into the workforce. We did ask the government for a statement and through a spokesperson we heard them say our £2.5 billion back to work plan will help over a million people, including women, with long term health conditions, break down barriers to work. They say they're reforming

the benefit system so that it's fairer on the taxpayer and make sure that those who can work do work. This includes enhancing support for people with health conditions and disabilities

through programmes like WorkWell and reforming the FitNote process so people can return to and stay in employment. Your reaction? I mean, I think it's great to hear the government want to move people back to work, but the statistics we've seen today have seen a really sharp rise in the number of people who are out of work. We've seen one of the largest rises in unemployment for years from today's data. The answer to getting more people back into work is running the economy in such a way that growth is strong after we've had years of stagnation, and also making sure that when we do get growth, the rewards are fairly shared and deliver the

sorts of jobs that mean people can improve their health, develop their skills, progress in the labour market, and not particularly for women find themselves stuck in very insecure zero-hours jobs, which can put real extra pressures on people's wealth and well-being. I mean, alongside that, the big unspoken part of the government's response has to be funding for the health service. But is that what you're talking about, Nicola, so that strong economic growth to then bolster the NHS? It's clear that the two are in lockstep. The reality is that we need to see more people able to move into work.

We need a healthy, productive workforce who are able to grow our economy and we also need to see the sorts of jobs being created that give people the opportunity to use their skills and to engage productively in the labour market. Those two go together you know you can't run a productive economy without excellent public services so it's a real concern to see so many women now out of work when they want to be in jobs because either their illnesses aren't being treated or the sorts of jobs that they're able to access are leading to their health deteriorating. You know, a proper plan for moving people back into work would sort out those waiting lists, make sure people can get the care they need and focus on the sorts of growth that is shared fairly

between everybody. The government's new occupational health czar Dame Carol Black said last week that the GP sick note system was no longer fit for purpose, given the pressures on the NHS. And she also thought that the current process of being signed off meant people were able to lose contact really with that idea of going back to work. Briefly, what do you say to that? tweaks and improvements you can make to systems but when you look at this trend it hasn't been caused by a particular policy around fit notes or by specific changes in the benefit system and all the evidence from past increases of the sorts we've seen in economic inactivity in ill health in unemployment suggests that it's not twiddling around with the benefit system that's going to make a difference it's the growth rate in the economy, it's the funding for our public services, it's the quality of health care that people are able to access. Those are

the real drivers of the trend that we're seeing at the moment and it's action in those areas that we're going to need to see if these trends are going to be turned around. Thank you very much for speaking to us and I would like to hear from women. That's Nicola Smith, Head of Economics at the TUC. For women, particularly neck and back pain, you know, how that came about or what you're seeing or what you're hearing, your experience, 84844. Lots of you getting in touch.

My birth trauma. Here's Michael. He says, I'm a therapist working in the NHS. I see traumatised mothers. I also see nurses and midwives traumatised by their work. So echoing my previous person who was commenting.

The moral injury inflicted on midwives and nurses is huge with lack of staff and management teams that tell them to suck it up. I believe this thing gets passed on to the mothers. There needs to be more care for the carers. Here's another one. Emma in Hull. My tear was so serious

I had to have surgery. It took me two years to recover. It was so hard I couldn't face doing it all again. I have one wonderful daughter. I feel blessed but feel the choice for more was taken away by my pain and trauma. 84844. Please get in touch if you'd like to share your story.

Now to the award winning playwright and actor Lalita Chakrabarty. She's here in studio with me again. Welcome back. You'll know her for many things, including her adaptations, theatre adaptations of Hamnet and The Life of Pi. We spoke about Hamnet last time.

But she has written and stars in a new radio drama for Radio 3 called Calmer. You might have heard it on Sunday. If you didn't, don't worry. It's still there on BBC Sounds. And it follows the lives of three generations

of ultra successful women in one family. Grandmother Maya, self-help guru with an avid following, also has an American TV deal in the offing that is played by Meera Sayal. Nina, her daughter, sitting opposite me, is a psychiatrist who is expanding her thriving practice, played by Lolita. And Amber, Nina's daughter, who is an offer from Cambridge

and played by Pyle Mystery. But fault lines do appear in the relationships, showing their lives perhaps are not as good as they appear on paper. Where did the idea for this come about, to write this? And welcome back, Lolita. Thank you. Nice to be here. I guess the seeds of it started when I was at school. Isn't that funny?

Like years and years ago, I think for A-level drama, I studied Ghosts by Ibsen and one of the sort of parts of that story were the sins of the father father being visited on the son and that stayed with me for decades and I thought what about the sins of the mother being visited on the daughter and then just looking at I am a mother of children who are now in their 20s but I wrote this play 10 years ago so when they were teenagers and looking at I am a mother of children who are now in their 20s but I wrote this play 10 years ago so when they were teenagers and looking at the world then and just all these things came together I wanted to write about motherhood chaos family and legacy and called it calmer yeah or calmer depends how you say it yeah well it's c-a-l-m-e-r is what it's written because I

I was also really struck by I spent I've stopped doing it now. I used to say to everyone, I'm so busy, I'm so busy. And I noticed all my friends doing the same. We're all so busy trying to keep up with everything. And we are busy, but it just and then we're also doing all this sort of yoga and meditation and the opposition of life. And and so that's why it's called karma karma because these are people who are the family within this story are living a life where they think they're achieving everything they need to and they're doing it in exactly the right way but it's not calm at all yes and karma i was also the

k-a-r-m-a karma um which you know people thinking about that word karma, actually, karma with a K. People who have children, you often hear, say, if they have a difficult child, let's say, and the granny will say, ha ha, it's karma. You know what I mean? That it's kind of coming back to bite you. If you were perhaps a tricky kid yourself. You mentioned a little bit of your experience of motherhood there. Did you find it chaotic?

Yes. I don't know any mum who manages it and goes, oh, that's all great. That's as I expected. It's just never, I mean, life is difficult anyway, isn't it? But you chuck other people into it where you're meant to be in charge and knowing the right decisions. I mean, who knows the right decisions about anything? And you're looking after people that rely on you to make the right decisions for them. I think it's difficult. It's difficult in terms of getting the packed lunches and the right PE kit and answering the letters and the emails. But it's also emotionally difficult and internally difficult.

But there are the small things, the lunches and whatnot that make up a life, of course. But listening to Kam come or particularly at the beginning it was like you know it's the parents that will determine how that child turns out and I was like whoa that's a bit of responsibility on somebody's shoulders well you got to remember it's a play so I am trying to consolidate all ideas of motherhood and chaos because that's my remit into a two hour drama. So, no, I don't think this is everybody. We've got a clip. Let us take a listen. This is when Nina played by.

Actually, I think it's Amber who played by Pyle tries to tell her mum, Nina, played by you, that she wants to go on a gap year. I got this brochure. A holiday, darling. We can look at it later. No, I was thinking of taking a year out. Oh, Amber. Everyone else is doing it. I could work abroad, learn a language. But you're doing medicine. It would be a break. There's no need. I know, but... You've always been driven, known what you want. I envy that. All your hard work's paid off, just like I said it would. Yes, but... That work experience in the X-ray department, you were a natural.

I was only filing. Bola mentioned your mock interview was brilliant. She's on the college board, so she'd know. Mum! It just came up over drinks. She was so impressed with you being captain of the British Biology Olympiad. You took a year out. That's totally different. I had to.

But if you did it, then... I didn't have a choice. I could teach English, build toilets, help with farming, all sorts of things. You're studying medicine at Cambridge. Why wait? I tell you what, after your first term, I'll take you any place you want. But don't delay. Life waits for no one. Recycle this brochure, darling. You don't need it. Oh, that's the kicker. But it is a great example of how there can be a conversation, but there's actually no communication?

Yeah, absolutely. I mean, I thought when my kids were young, I thought, oh, I'm listening to them. I'm hearing what they need and I'm responding. And then slowly I realised, God, they live in a very different world that I don't really understand. And so listening has to be much more acute and different

and responding to what they're actually going through. And I think also, I mean, that clip, the levels of achievement we're demanding from our children now. You know, I was really struck when they went through their exams, this A star. A star is the minimum of what we require. Oh my God, what happened to a good C? You know, what happened to just trying and doing your best? And that in society has really struck me, actually, how we're just aiming for the top

and there's no grey or in-between or achievement underneath that. You are obviously very successful yourself. You're an award-winning writer, a great actor. You have an OBE. I mean, what have you learned about success that you have tried to pass on to your daughters particularly in that context of an A star you might not be pushing for it I don't know maybe you were um but I would imagine your

daughters were surrounded by people that were I suppose so but I mean I'm in my 50s and my success I mean I've been a jobbing actor for a really long time. I've been working for 34 years. But the success in the writing and the acting has come later in the last 10, 12 years. So I have worked really hard. And I think that they have seen that. And there's been a lot of disappointments along the way. A lot of rejection, which is just part of the business. So I don't think it's taken for granted.

So, yes, you can look at the shiny box of the business. So I don't think it's taken for granted. So yes, you can look at the shiny box at the end, but how the box was made is a very different deal. Are there any choices you made as a mother that you regret? Oh, gosh, yes. We could probably have an hour on that from our listeners. Oh my gosh, yes. But you live and learn, right? You're doing it for the first or the second time with your second kid. You live and learn. You know, I was struck by so much of the language, which is just wonderful. But I think sometimes mothers and daughters or that kind of female relationships through families, they know each other in a way that sometimes the men don't. And it was even the grandmother talking about Nina,

her daughter saying, oh, you know, she has a hard tone today. These subtleties in the way somebody speaks that only I think a mother or daughter can pick up on. Yes, absolutely. Where did you get that from? I mean, where did you mine it from? I'm listening to everyone all the time. So some of it is that's actually from a real situation. You know, I'm just picking things up from all around me and then inventing some of it. I think that it's a subtle thing, isn't it? Of absolutely knowing that person and saying it's a hard tone, but also putting them down a little.

Because actually it's going, oh, no, she's not. It was all about those subtleties within the relationships and how although we know each other, we can also really affect each other by our judgments, which aren't always good. And also that there can be a brittleness in the relationship that is also so full of love. Yeah, absolutely.

I mean, it's really tricky, isn't it? You love your family, but you don't always tell the truth because it's too much. So then the truth builds up, up, up, up, up until it explodes, which is because this is a drama and a play is what happens. And so actually, it's really interesting watching people compress what they feel as much as it exploding. Do you think that's what's behind it those family dynamics that the truth has been suppressed uh at times yes i mean definitely but i guess it depends on what the truth is and how extreme yeah in small and big ways small and big ways absolutely because

you have to gauge is it good for me to say this or actually is it just upsetting for no reason and i have a relationship hopefully with this person for the rest of my life. We had you, as I mentioned, the wonderful Maggie Farrell's novel Hamlet for the stage that was performed at the Royal Shakespeare Company, then transferred to the Garrick Theatre in London. But how does the experience of adapting a play compare with writing your own and starring in it? You know, it's very different and very similar. So adapting a play, I'm taking on somebody else's vision

and mining it to see what they were trying to say and then putting my own thread of drama into it. And your own vision, you start with a totally blank page. So it's quite scary, but also you invent everybody. So all of them are from me. And I'm having to make the story myself and solve the problems myself. And playing a part, I tell you what's really great, is when you're an actor, you're going into the script

to see all the clues the writer has given, take what the director said and putting it together. When you've written it, you know what the root of it is. So the work has been sort of done. Obviously, you still need the director to guide you, but you know what the root of every thought is. And what does it feel like in your ears when you hear the finished product? It's a funny thing.

I think second time will be better. I've listened to it once and it's wonderful. But you can just go, oh go of myself, not of everybody else it's of myself, I'm like, ooh I know that feeling. There you go, it's a bit weird isn't it, you can't kind of hear yourself as someone else but hopefully in a few days time I'll listen to it again and I'll think

oh there it is, there's the play. Well, thank you very much for coming back to us, Lita Chakrabarty, so talented. You can catch Up With Calmer on Radio 3 and also on BBC Sounds. It's a great lesson. Thank you so much. I also want to let people know that tomorrow on Women's Hour I will be

joined by the composer Cecilia McDowell and the singer Carys Jones. They'll be telling me about women's increasing prominence in choral music. Also the Pulitzer Prize winning Mexican author Cristina Rivera Garza will be talking about her sister who was murdered into the narrative of their country of Mexico and I just have a couple of moments for a couple more

of your comments thanks so much for sharing today Anya on birth trauma I also had a traumatic birth experience it was the lack of care and a crowded maternity ward that was so traumatic two years later I had therapy and was diagnosed with PTSD. Following that, I had two more births, which were amazing. A good birth experience in the same hospital and an absolutely fantastic home birth after that. Let us leave on that uplifting note. I'll speak to you tomorrow at 10. That's all for today's Woman's Hour. Join us again next time. From BBC Radio 4, Scott Lidster, you've directed another terrible film, The 15th in as many years Woman's Hour. Join us again next time. No room. Michael Spicer, No Room. It's a sketch show with lots and lots and lots and lots of Michael Spicers.

Listen on BBC Sounds. I'm Sarah Treleaven, and for over a year, I've been working on one of the most complex stories I've ever covered. There was somebody out there who was faking pregnancies. I started, like, warning everybody. Every doula that I know. It was fake. No pregnancy.

And the deeper I dig, the more questions I unearth. How long has she been doing this? What does she have to gain from this? From CBC and the BBC World Service, The Con, Caitlin's Baby. It's a long story, settle in. Available now.