Woman's Hour - Failures in maternity care, Spain's Princess Leonor turns 18, Women's Ballon d'Or

Episode Date: October 31, 2023

A group of families affected by failures in NHS maternity care are calling for a full statutory public inquiry into maternity safety in England. Emily Barley from the Maternity Safety Alliance group told Jessica Creighton why she thinks fundamental reform is needed. And presenter Krupa Padhy draws on her own personal story of baby loss in her BBC Radio 4 investigation, How safe is maternity care?The Covid inquiry is already under way and has heard about an internal report into the culture at the top of Government in the early months of the pandemic. This found that female staff were talked over and ignored. So what is the impact on the workplace when women can't speak out? And how can women get their voices heard in the workplace? Barbara Nixon is a success and leadership coach and she joined Jessica to discuss.There is a new superstar in women's football. Spain and Barcelona midfielder Aitana Bonmatí has won one of the sport's most presitgious awards... the Ballon d'Or. She is also one of five women nominated for the BBC Women’s Footballer of the Year award. Jo Currie, the BBC's Women's Football Correspondent, outlines the nominees.Princess Leonor of Spain turns 18 today and has been swearing allegiance to the country. So who is the young princess, and what role might she play in Spanish public life? Rafa de Miguel is the UK and Ireland correspondent for the Spanish newspaper El Pais and he joined Jessica to discuss.Producer: Hannah Sander Presenter: Jessica Creighton

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, I'm Jessica Crichton. Welcome to the Woman's Hour podcast. Now, there is an overarching theme this morning, and that is being heard, or rather not being heard, particularly in the workplace. This comes after former government aide Martin Reynolds gave evidence at the COVID inquiry yesterday. His report from 2020, written along with the former Deputy Cabinet Secretary, Helen McNamara, noted that junior women were being talked over and ignored in the early months of the pandemic. Now, some of you listening may have been in a similar workplace culture. You too may have been ignored or dismissed or maybe undermined. How did you deal

with it? How did you make sure that your voice was heard? Did you have anyone to help you, anyone to advocate for you? Get in touch, I'd like to know. Text me on 84844. Text will be charged at your standard message rate. You can WhatsApp me as well or send me a voice note on 03700 100 444. On social media, we're as always at BBC Women's Hour and you can email through our website as well. That text number again is 84844 and the WhatsApp number 03700 100 444. Now we'll be speaking to an expert who can tell us how we might be able to deal with this situation. So stand by for lots of useful tips and hopefully some guidance on making your voice heard. And that is exactly what Spanish footballer Aitana Bonmati did last night on one

of sport's biggest stages. She won the prestigious Ballon d'Or Award, which is given to the world's best footballer each year. Now, she's had an absolutely incredible 12 months winning the Champions League with her club Barcelona and the World Cup back in August with Spain. And I think she might need a bit more room in her trophy cabinet because she's also been nominated for the BBC's Woman's Footballer of the Year. Now, Bonmati is alongside four other women in that award, including the England goalkeeper Mary Earps. It is a public vote, so you can get involved, but it does close on Friday, so you haven't got too long left. But don't worry, we'll be giving you the lowdown on all five of the nominated players.

And also this morning, Princess Leonor, a name you'll be hearing much more about in the coming years. That's because today is her 18th birthday and she's heir to the throne of the Spanish royal family. Now, she's already making her voice heard in a recent public speech. She said, I'm aware of what my duty is and what my responsibilities entail. Now we'll be speaking to a journalist for an insight into how Princess Leonor's life might be about to change now that she's come of age. But first this morning. Today, a group of families who have been affected by failures in NHS maternity care, including bereaved parents and grandparents, are calling for a full statutory public inquiry into maternity safety in England. The Maternity Safety Alliance group argues that despite a number of reviews into maternity

services in Morecambe Bay, in Shrewsbury and Telford, too much avoidable harm continues to devastate lives. They say fundamental reform is needed. Now, just over a week ago on this very programme, we discussed the latest report from the CQC, the Quality Care Commission. They said that almost two thirds of maternity units in England provide dangerously substandard care that puts women and babies at risk. It has rated 65% of maternity services as either inadequate or requiring improvement, and that's an increase from 54% last year. Tonight, a documentary on Radio 4 investigates this very issue. Presenter Krupa Paddy, who many of our listeners will know as she regularly

presents this programme, she brings her own personal story to the investigation. How safe is maternity care? Krupa's baby died 10 years ago in April 2013 after mistakes were made during her childbirth. Krupa explores what happened to her and why the option of a c-section in her case wasn't considered much sooner. She joins me now, Krupa, also alongside Emily Barley, who is one of the parents from Maternity Safety Alliance, whose baby Beatrice died during labour last year in May 2020. A very good morning to you both. Good morning. Emily, first of all, very sorry for your loss, and I appreciate you coming on to share your experiences with us. And we will definitely be hearing about your birth story if you don't mind sharing it. But firstly, why are you calling for this judge-led full statutory inquiry now?

This is about stopping what happened to us and our babies from happening to other families. We've got this dire situation now in NHS maternity where more mums and babies are dying. We've got babies suffering life-changing brain injuries, loads of other kinds of harms to mums, birth injuries, psychological injuries that aren't even counted. And then the cost of all of this is just eye-watering.

Last year alone, there was £2.6 billion, that's billion, paid out in compensation to families because of this harm and because of the effect that it's had on their lives. Well, definitely come to those figures because that is an eye wateringly high number, isn't it? I wonder how this inquiry that you're calling for will be different to the others. As I mentioned, just a couple of weeks ago on this programme, on Women's Hour, we discussed the Care Quality Commission's report into maternity units. And of course, there was that massive review, the Ockenden review back in 2020. They all made recommendations of what should happen. Why will this inquiry be different, do you think? So they were local investigations into what happened in particular in HS Trusts. And while they were really useful and came up with findings that were so important, they were quite limited in scope.

They only looked at part of the problem. And at the same time, they haven't had the impact that we would all have hoped for. And instead, what they found is the same failings over and over again. So these investigations have taken place years apart and found the same things. And I think part of the reason for that is that it's not just what's happening in hospitals that's the problem. There's a much wider systemic problem.

We've got regulators that are failing so badly that families who are living through hell are having to raise the alarm. We've got regulators that are failing so badly that families who are living through hell are having to raise the alarm. We've got failing governance. The way adverse events are learned from, it's not real learning. It's not making any change. And then I think there's also this attitude at all levels through the NHS that kind of treats this kind of avoidable harm, including deaths, as though it's inevitable. But it's not inevitable. And we should have a system that treats every baby as precious. And every baby that can and

should live does live. And that's why we're calling for this national public inquiry. We think that it's all just so broken that we need a whole system analysis. Yeah, of course. And I'm sure the NHS would push back on some of what you said there because they aren't here right now. But I do appreciate what you're saying in that we need, you feel that we need a broader scope in looking at this issue. But I do remember the Ockenden Review, although local, did widen its findings to make sure that it was nationwide recommendations. Absolutely. But again, we're a year on now, and this is still happening.

And the Ockenden review, it wasn't the only one. We had the Morecambe Bay investigation before that. That was published in 2015 and found very similar things. National recommendations were made from there as well, and they didn't have an impact. And I think that's because there are these much wider failings and barriers to that change that we really need to see. Now, Emily, you mentioned the figures. I want to just focus on that for the moment, because as you've said in many of the interviews that you've done, poor maternity care is a problem

that affects everyone. It's not just the mothers, the babies and even the families that are involved, because so much is being spent by the NHS on payouts to families whose babies have died or been injured. So talk me through the numbers that you found and where you've got those figures from. So they come from NHS Resolution, which is an organisation that is set up specifically to deal with clinical injury that's through negligence,

which, I mean, that on its own just seems insane to me that we have to have a whole separate branch of the NHS just to deal with litigation because of all the harm that's been caused. The figures are huge. I think the bulk of them are made up of babies who suffer a brain injury at birth and then have lifelong care needs. But then it also does cover the psychological injury and other losses that families suffer when their baby dies.

And as well, other kinds of avoidable harm, mums who suffer physical injuries. There's just so much. And it makes up the entire NHS bill for negligence and compensation. Almost two in your own experience of maternity failures. It must have been very difficult going back to such a traumatic time in your life. It was. And well, first of all, Emily, it's great to hear from you. I commend what you're doing and I'm so sorry for what you and your family are about to go through. I wish 10 years on we weren't hearing stories like this.

And that's in part one of the reasons why I wanted to make this. I knew it was going to be challenging from the outset. Together with producer Caitlin Smith, we've been discussing whether or not it's the right time. But I realised there's never a right time to do a documentary like this, because something like this doesn't leave you. It changes, how you feel about it changes. And I also knew one thing, as a journalist, I'm in a privileged position, I always ask people to be vulnerable with me, I ask people to be authentic, to share the most fragile parts of their experiences. And sometimes, even though we don't want to be the story,

we as journalists become the story. And I just hope that someone listening to the documentary which goes out this evening might feel a bit more empowered as a result of what they've heard. Because there is so much that I wish I had known about my rights, about questions I can ask that I didn't know about and that I wish I had known about my rights, about questions I can ask that I didn't know about and that I wish I had known about. What were those things? My rights, my rights to a c-section, my rights to

access to my records. I mean it fundamentally comes down to being heard as you were saying in your introduction. I mean, it goes back to the multiple flaws that were made in my, during my labour, and there were countless errors made in my labour. And all of those, in all of those, I felt disempowered, I didn't have the knowledge. I mean, I'll go right back to the beginning, I was induced at 41 weeks because my amniotic fluid was low. And I was by default told I was going to have an induction. I was 29 when I fell pregnant with Elora. I was healthy, she was healthy. And I naively just accepted what I was told. And I was told by the doctor, you're going to have an induction, not knowing that actually, I could have asked whether I could have had a C-section. And I think that was a fundamental flaw. I mean, I didn't realize, you know, I'm a petite lady, Elora was a big baby,

all these factors didn't come into it. I blindly just said, okay, doctor knows best, I'm going to have an induction. Thereafter, it just went downhill, really. I was induced, I hypercontracted, which is when you have too many contractions during a short period of time. I wasn't listened to on multiple occasions. I was told I was being dramatic. And then multiple failings, the CTG, the heart rate readings were incorrectly read at multiple times I developed a fever which subsequently turned into sepsis again that wasn't recognized and this went on for 36 hours until I delivered her there was a full sex delivery which went wrong which left a bleed to Laura's brain and then a very delayed C-section.

Fundamentally, it all came down to not being listened to, not knowing that it is my right to ask for a C-section at any stage. I was granted a C-section about 24 hours in by the consultant who was on call. But the doctor who I was seeing never came back to tell me that why not she didn't hand over that information she clocked off she clocked off her shift and she did not hand over that information to the night team um there was I was seen by so many members of staff that evening I've lost count I can remember a few faces but the rest is just a blur. 36 hours of labour, a countless number of team members trying to help me, but no communication, not listening to me and not listening to one another. So it sounds like a series of failures. It wasn't

just one thing that led to this. It was one thing after another, after another that happened and put you in that vulnerable position yeah it was a multiple of factors as you as you as you said um fundamentally a delayed c-section played a huge part um and they were and that was one of the key factors that was recognized and that then fed into a wider concern about a lack of communication between staff and between staff and the mother and in addition to that there were concerns about training that staff didn't have sufficient training in reading and recognizing concerns when it comes to heart traces and again didn't have the ability to communicate that and another error was not recognizing sepsis because Elora became very poorly she also was just as well as I was inside

me and then finally you know the the use of forceps that led to a bleed to her brain so there were multiple factors but ultimately if she'd been brought out earlier, she would be with us. Now, I just want to read this statement, Krupa, from Imperial College Healthcare NHS Trust. We asked them for a statement and they've said this. Words cannot express the sadness we feel about the loss of Krupa's baby, Elora, in 2013. We are so sorry we did not provide the care that Krupa and her family should have received. We recognise how difficult it must be for her to share her story and feel privileged to have the opportunity

to discuss improvements in maternity care with her. Over the past 10 years, we have transformed our team working and culture, one of the key issues that Krupa identified. We've also put much better training and safety processes in place, increased staffing levels and increased our focus on continuity of care, enabling more women to have the same small team throughout their pregnancy, delivery and postnatal care. The views and voices of our family have been key to these developments and continue to drive improvement.

Emily, I'd like to come to you now to just talk us through a bit about what the Maternity Safety Alliance group is all about and how you actually found each other. Just to say first, I'm so sorry Krupa for your loss and it's striking how much of Krupa and Laura's story is familiar and is there's there's so much in common with mine and Beatrice's story um and the same things that we hear from the families that we're working with so the Maternity Safety Alliance is a group primarily of bereaved families um parents and grandparents, and also other maternity campaigners, people who take an interest in maternity safety. We came together largely through social media, each individually sharing our stories there,

finding each other and agreeing that this has to stop. We need to do something. And we spent quite a lot of time. We started connecting in January of this year. We spent a lot of time thinking about what it is that we need to happen. What is the right thing to do? What will actually make a change? Our experiences span two separate decades.

And yeah, it is always so very striking how much in common all of these stories have, all of these deaths. And that's what worries us the most, that it's still happening. Not enough has changed. Still so many similarities between you and Krupa and it was 10 years apart. And now, Emily, if you would like to share, could you tell us about Beatrice and your experience from May 2022? Yeah so Beatrice was a healthy full-term baby she's absolutely perfect when she was born she was just beautiful. Beatrice died during labour because of another series of very very very basic failings. And I think what people need to understand is that for a baby to die, a lot has to happen, a lot has to go wrong,

a lot of really basic things. So in our case, I also hyper contracted. That's one of the similarities with Krupa's story. I raised concerns and then I begged for help um and I was just met with kind of shrugs and literal eye rolls um I wasn't listened to I felt as though um I was judged for being a bit of a drama queen you know I was a first time mum who didn't know what was going on and and yeah I was ignored when we finally did have monitoring of Beatrice's heart it showed that she was struggling and then that she was dying and at the point where we should have been rushed into theatre for an emergency caesarean it just didn't happen and there was a lot of delay and faffing around and kind of it's's hard to understand I had in our case I had sort

of three midwives and two doctors in the room just standing around not really doing anything not recognizing the emergency and and then she was dead and she was born a couple of hours later and I gave birth to her in the pool in the birthing pool and it's so difficult to describe because it was the best moment of my life meeting my baby and she was incredible but it was the worst moment as well because she was dead. I'm so sorry that happened to you Emily thank you for sharing. Thank you. We do have a statement as well from Barnsley Hospital in regards to your case, Emily. And they said, we are deeply sorry for the loss of Beatrice and we have met with Emily to apologise.

We immediately recognised that this tragic event should not have happened and we reported it to healthcare safety investigation branch. We have fully cooperated with their independent investigation and we entirely accept the findings and the recommendations which we are now implementing. Like other maternity units we are constantly striving to make our services better and safer. All NHS trusts are required to report certain cases to the HSIB, who provide an independent review and recommendations which we implement. Each case is unique and provides specific and distinct learning points that allow the service to make progressive improvements. Cooper, if I could just come back to you now on making this documentary I think you explored this idea of the natural birth movement and almost an opposition to having c-sections which could have changed the outcome of what happened to you

yeah there's a long history to this and it all kind of begins in the 60s and 70s where there was this emphasis on having a natural or vaginal birth and how empowering that could be and then come the 1980s there was this concern that childbirth had become too medicalized um add to that you then had the world health organizations saying that the c-section rate shouldn't go above 10 to 15 percent and we then had NHS c-section targets being brought in alongside this oath almost to to commit to a normal or vaginal birth and this began to change a year after Elora's death in 2014 the policy came about that a woman can have a c-section if that is what she chooses even if there is no medical reason for

this and I don't think enough women know this as long as you've made an informed decision this is something that a woman is entitled to have well this would be useful advice to women that are are listening now because they might not know this at all and it could it could have a major impact on their birth story absolutely I mean it's the emphasis now is on what has been called better birth choosing the right outcome for mother and baby whether that be a vaginal birth whether that be a you know a c-section or otherwise um but what we've seen for example the shrewsbury and telford report clearly found that staff were deliberately seeking to keep c-section rates low and so it's one thing to change policies it's a different thing to change mindset you know in 2022 after rockenden we have the c-section targets rates entirely scrapped

but i was speaking to one obstetrician who works on the wall day in day out who says you know it's one thing to change these guidelines on paper. It's a very different thing to change the mindsets of individuals. These ideas are deep rooted. It's almost a badge of honour amongst some people to have that natural vaginal birth. And amongst some parents, too. How many times have we heard amongst parents saying, oh, did you have any pain relief? And, you know, it's natural to hear those conversations. It's normalised in some ways. But fundamentally, changing those mindsets is taking a lot longer, no matter how many guidelines and policies change. What about the mindsets of the staff themselves, of the midwives, of the doctors and all those involved with giving birth? The

culture, I know you spend a lot of time looking at the culture between staff members during your experience. What did you find? Yeah, again, going back to, you know, we looked back through those various reports that Emily highlighted. More conveying 2015, Shrewsbury and Talbot, the East Kent reports in 2022. And they all say similar things about this word culture and the way these teams work. They talk about a culture of competition between some team members, this insistence that I'm going to get the baby out naturally. And this is not all stuff. It's important to say that the system is huge. There are lots of different personalities, different energies working, a lot of hardworking

individuals. But there's also this sense of denial and in some case incompetence um when it when it comes to dealing with the maternity wards um there was this insistence that we found by some midwives to pursue a natural birth at any cost um but that's the culture amongst the team members but what about the culture that then translates and and is communicated to the actual mother you know what was also found was the way in which some parents were spoken to with a lack of compassion and a lack of um respect almost and that their concerns weren't being addressed appropriately um which then spirals right because then you then get women not feeling comfortable enough to ask those key questions and not feeling empowered enough to ask key questions,

to get the information they need to make an informed choice. And another thing, I mean, I spoke to Dr. Bill Kirkup, who led two of those reports, and he said, it's one thing to put these measures in place to change the culture. It's one thing to go back and in place to change the culture it's one thing to go back and review them but are they sustained it's what you know so that's the key thing how long are these measures in place before they default back to the ways that weren't working and all this is happening with the backdrop of falling midwife numbers and a number of pressures on the maternity services emily there'll be many women listening to this that might be horrified at what they're hearing and the terrible experiences that some women have had. What

advice would you give to women to empower them, to make them feel confident in giving birth? It's really difficult because the system isn't safe. in an unsafe system there isn't anything sadly if I'm honest with you isn't anything that an individual woman can do you're in such a vulnerable position it is not in your power to do that I know that if I have another baby I will have an elective cesarean for me that seems like the only way to avoid the lottery of going into spontaneous birth. But the only other advice I could give really is to trust your instincts and question everything. I regret and will regret to the end of my days

ever trusting the people who were there to look after me because they didn't. Yeah, I think that's something that we would all do in that vulnerable state is trust the expert. What would you like to see happen next, Emily? So obviously, we want this full statutory national public inquiry so that we can have a whole system analysis and figure out what's broken, how to fix it, and why it hasn't, why all of the other attempts to fix it haven't worked before but

fundamentally what that needs to translate into is listening to women and implementing the clinical best practice that we already understand we know how to deliver babies safely and for some reason it's not happening that's what we need to find out. That is a very pertinent issue. Thank you, Emily. We do have a statement that's just come in from the Department of Health and Social Care. They say that every parent deserves to feel confident in the care that they and their baby receive. And we welcome the CQC's commitment to monitoring those trusts that are not providing an adequate standard to ensure improvements are made. Nationally, we have invested £165 million a year since 2021 to grow the maternity workforce

and improve neonatal services. And we are promoting careers in midwifery by increasing training places by up to 3,650 over the past four years. That statement coming in just in the last few moments. A big thank you to Krupa Patti for joining me this morning and also Emily Barley. And this is something that you have also spoken about. Sorry, Krupa. Sorry.

One thing I really want to stress before we move on is that there will be many pregnant women listening who may be concerned by what they've heard. I want to reassure them that there is a very high chance that your baby is going to be just perfect. If you look at the various data, just in 2021, we had almost 700,000 healthy babies born in the UK. If you are pregnant or expecting or hoping to get pregnant, trust that your baby will be perfect, but be empowered with the information you need to ask the right questions. Thank you, Krupa. Yeah, an important note to end on. And as you give us that last piece of information, a lot of people have actually been getting involved about this very subject. I've got some messages here. Sue says she experienced exactly what your guests are talking

about. My baby died from distress during labour in 2008. The hospital took full responsibility. She was perfectly healthy. Someone else says, as a recently retired midwife, please consider that in maternity care intervention often leads to further intervention. early induction, for example. We've lost sight of how capable women's bodies are, and I often see how women have lost confidence in their bodies from birthing to breastfeeding. Please do continue to get in touch with all your messages. You can text me on 84844. And the WhatsApp number, once again, 03700 100 444.

And of course, you can get in touch via the social media as well. We are at BBC Woman's Hour on social media. 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. 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. Now, an inquiry that's already in the headlines is the ongoing COVID-19 public inquiry.

Now, that focus has been on the apparent chaos at the heart of number 10 during the pandemic, with the former top aide, Martin Reynolds, admitting that government failings and apologising unreservedly for parties in Downing Street during lockdown. But one of the stories that's gone quite under the radar is the release of an internal report into the culture at the top of the government in the early months of the pandemic. It said that female staff were talked over and ignored. The report was by Martin Reynolds and the then Deputy Cabinet Secretary Helen McNamara. It was written in May 2020. So what is the impact on the workplace when women can't speak out? And how can women get their voices heard in the workplace? I'm joined by Success and Leadership Coach Barbara Nixon. Good morning to you, Barbara. Morning. I think many people listening will have experienced just this, I know I have, not in this particular workplace I might add, not here at

Women's Hour but you coach many women in different industries so what are the main concerns they have about confidence, speaking out and making sure that their voice is heard. I think you're absolutely right. I think as women, we've all been there, haven't we, where we feel unable to speak up, where we don't feel as though we're valued or that we just don't feel safe to speak up. And I think a lot of the times it comes down to organisations. As organisations have a real responsibility to create safe environments for for everybody to be able to to express themselves freely and i think sometimes this uh the the ability to create that psychological safety often goes on untouched and unnoticed um where people do need to have that that ability to speak up be heard and be valued especially in in day-to-day situations like meetings, one-to-ones

or even just around the office. And I think as managers and organisations, that's something that has to be of paramount importance. So things like just inviting people to speak in meetings, especially those people that haven't actually spoken up. So if you're noticing a person that's not spoken up, how can you actually get them involved? And I think as organisations, we really need to be developing leaders to empower and encourage and invite and listen to women to enable them to speak up confidently. Yeah, I suppose that's the thing though isn't it because you can I've been there I've been worried about going into a work meeting so the morning before I've looked in the mirror and I've told myself I am empowered I'm ready to do this but doing it and going and enacting that in a practical sense is difficult so how do you make

that step how do you go from perhaps nervous shy and reserved to being more outspoken and feeling more empowered yeah I'm a huge fan of taking baby steps so it really acclimatized into that situation so growing your confidence on a on a day-to-day basis and one thing that I invite people to do is focus more on bravery than confidence and being brave in that situation. So encouraging yourself to just speak up in a meeting, whether that's something that you've not been able to do before. Even if it's just to summarise what somebody said, often that's just powerful. Hearing your own voice in a meeting, getting used to actually being seen, having people look at you, having your voice and your opinion actually heard,

you can actually build that up over time. And you can even do that around the office. You can start to speak to people that you haven't normally spoken to. You can start to just start asking for what you want and just taking those steps to stretch your comfort zone on a day-to-day basis even if it feels like the smallest step it's actually just growing your confidence and acclimatizing yourself to actually work at that next level. I'm wary though of how we frame this because I mean even in my introduction there I said how can women make sure that their voices are heard but what if they're in a toxic culture what if they're in an environment where that isn't necessarily nurtured in the workplace? I almost feel like we shouldn't be framing it so women have to change. Sometimes it's the culture, sometimes it's the environment

that we're in. Oh, absolutely. I'm all for organisations looking at creating that psychological safety. If you do find yourself in that environment where you just can't be heard, start building your own network. You might want to look at who you're surrounding yourself with and create a powerful network of other strong women or other women who are feeling exactly the same so you can maybe meet on a regular basis support each other empower each other because you can feel stronger together but in in answer to your question I think definitely definitely the answer should be looking at leaders in organizations and helping them to actually empower, develop our leaders to support women to speak up and to grow that confidence and resilience. I like the idea of trying to find your network. It sounds like some serious girl power. I mean but how much of this is pre-emptive as well because is there a way of almost building

yourself up so that when you actually get to crisis point you know what to do in that moment yeah and just like I said building yourself up and having confidence and again resilience they go hand in hand confidence and resilience is part of your development plan and just focusing on that day-to-day so looking at how you can stretch yourself looking at opportunities and what I would say is start familiarizing familiarizing yourself with the feeling of fear so it doesn't feel like something that will block you it feels like something that will empower you so when you're feeling nervous when you're feeling like um you're you're scared or fearful to actually speak up you're using that as a nudge that you're actually heading in the right direction and it's not something that will

block you some very useful tips there thank you very much uh barbara nixon that's very helpful and a lot of you at home have been getting in touch as well i'm just going to read out a couple of messages kate says amplification that's the tip i learned a woman presents a solution very quickly another echoes it and a third woman concurs it's sad isn't it that you have to stratify stratifies but i've tried it and it works that's a great one kate thank you for that jemma says i find the best way to make myself heard on important matters is through written correspondence. It is unfortunate that paper trails need to be created to avoid gaslighting and being ignored, but it seems to be the only effective way. Some really useful practical tips there. Thank you for all for getting involved and many thanks again to Barbara Nixon for joining me on Woman's Hour.

Now, there is a new superstar in women's football. Spain and Barcelona midfielder Aitana Bonmati has won one of sport's most prestigious awards, the Ballon d'Or. She's had a spectacular 12 months, winning the UEFA Play of the Year, the Domestic League and the Champions League with her club Barcelona and the World Cup with Spain. Here's what she had to say using her voice after winning the Ballon d'Or for the first time. Finally, congratulations to all the nominees. All of them are great and inspiring footballers. As role model, we have a responsibility on and off the pitch.

We should be more than athletes. Keep leading by example and keep fighting together for a better, peaceful and equal world. Merci. And if all that wasn't enough, she's also nominated for the BBC's Women's Footballer of the Year. And it's an award that you can actually vote for as well. There are five of the world's best players on the shortlist. Here to tell us more about those players and more on how Antoinette Bonmati reacted to her big win

is Jo Currie, the BBC's women's football correspondent. Good morning, Jo. Morning, Jess. Thanks for having me on. Pleasure as always. Firstly, we have to talk about the Ballon d'Or because Spain have a record in this competition in the women's Ballon d'Or. They just they've won it three years in a row now.

First time for Bon Mati. And tell us why. What is it about her? Why has she won this? What's so good about her? Well, for a 25 year old, she has had an incredible 12 months. So last night she obviously won the Ballon d'Or. She's already been named UEFA Player of the Year as well. Her domestic club Barcelona, she helped them to win the Spanish League title and the Champions League. And of course, she had that starring role with three goals for Spain at the World Cup as they beat England along the way in the final to lift the trophy for the first time at a tournament where she was named player of the World Cup. It's been quite the year.

She's a player that plays in midfield. She's known for dictating play and her slick passing. And in the past, she's been compared to the men's Spanish great, Andreas Iniesta, as well. Wow. I mean, as comparisons go, I've had the pleasure of watching her live, Bonmati, and she just glides across the pitch.

It's incredible. OK, so how about the English Lionesses? Because there were a few in the long list, weren't there, nominated for that Ballon d'Or award? Absolutely. I mean, considering that in the last 18 months or so, England won the Euros and then got to the World Cup final, just pipped by Spain in that 1-0 defeat in the final. You'd expect some Lionesses to be in the short list or long list. And in the end,

Mary Oates, the goalkeeper, she came in fifth which for goalkeepers don't tend to do particularly well in these big award ceremonies particularly after World Cups. They're normally dictated by the big goal scorers. You had Rachel Daly who can play at left-back, right-back up front. She finished 10th. And then Millie Bright who captured the Lionesses this summer, finished 11th.

Not bad at all for a centre defender, I'd say. Yeah, that's pretty impressive, isn't it? OK, so let's get more then on the BBC's Women's Football Awards. And that's, of course, where our listeners at Women's Hour can have their say and they can vote. Just tell us about the shortlist and how was it actually decided? OK, so the bbc women's footballer of the year award or were footy as we like to call it it was created by the bbc world service it's a global it's a global award that is voted for by everyone at home it started out in

2015 so it's still relatively new previous winners have included the likes of lionesses beth mead and lucy bronze other winners uh the norwegian forward arda hegerberg has won it twice this year there new. Previous winners have included the likes of Lionesses Beth Mead and Lucy Bronze. Other winners, the Norwegian forward Arda Hegerberg has won it twice. This year, there are five contenders. It's chosen by a panel of experts, which is made up of coaches, players, administrators and journalists. Now, if you want to vote, you can vote online. You go to the BBC Sport website, you go to football and the women's football section of the website, you'll find the article there. And voting closes at 9am on Friday friday now i always wonder with these types of things what are we voting for are we voting for who we like are we voting for who we think is the

most skillful or who has the most goals or like how does it work what's the criteria well this is the beauty slash danger of the public vote really because people can vote for whoever they want for whatever reason. The idea is that the player you think is the best in the world is who you vote for. But how you quantify best may come down to, as you said, you think someone is the most skillful, who's been the most successful. Perhaps it might bring into account off field achievements, maybe even personality. We've had across women's awards globally, and not just BBC Women's Football of the Year award, but other awards, some slightly rogue selections in the past, simply because the knowledge in the women's game

hasn't always been there to back it up with the voting. But I think now off the back of such a wonderful World Cup and the fact that so much women's football is now televised, that we hope the right winner, whoever that is, picked the right winner that is subjective isn't it okay just just give us a quick rundown then of the full list the full five names of these great women's players so we've talked about Aitana Bonmati next up on the list would be Mary Earps the England goalkeeper she's had a real career turnaround. Just a few years ago, she thought her international career was over

and she said, fallen out of love with football. Fast forward 18 months, she helped England win the Euros last summer, got them to a World Cup final this summer for Manchester United, helped them to second in the league and got them to an FA Cup final. And she is a real fan's favourite with the Lionesses as well. Then you've got Sam Kerr, who is a name that's well known with fans of the Women's Super League in England. She's a prolific scorer for Chelsea, but also for Australia as well. For Chelsea last season, 29 goals in 38 games helped them to not just the league,

but also the FA Cup, where she scored the only goal in the final. Now, admittedly, her home World Cup in the summer in Australia and New Zealand didn't really go to plan. She was the face of the tournament, but because she picked up an injury before the start of the tournament, we didn't see her play to the quarterfinals. She came back with revenge in the semifinals, scored this outstanding goal against England,

but Australia just couldn't quite make it to the World Cup final itself. She's often picked to these big international awards, but has already been named the PFA Player of the Year in this country. Next up, we've got Alexandra Popp. She's a German forward and a real legend of the game, probably one of the most clinical finishers in the world as well. She's had a career that's been blighted by injuries. For example, last summer, she was cruelly ruled out at the last minute for the Euros final against England with Wolfsburg. She helped them to the Champions League final,

where they were eventually pipped. They were just pipped in the league title race against Bayern Munich as well, but she did help them win the German Cup. They had a terrible World Cup, Germany did. They were knocked out in the group stages, but in that three games, she still manages to score four goals. It gives you an idea of just how good she is. And then finally, we've got Fridolina

Rolfo she is a Swede who can play at fullback or as a forward she's just a starring on the biggest stages she scored the winner as Barcelona came from 2-0 down to eventually win the Champions League 3-2 they also won the Spanish League by 10 points and then at the World Cup she scored three goals in the process of helping Swedeneden to the bronze medal 29 years old probably one of the most universal players in the world right now i was hoping that you giving that rundown was going to help me decide who to vote for you've just made it a lot harder my goodness me that shortlist is absolutely stacked i don't know how honestly i don't know how our listeners are going to try and make up their mind. How do our listeners vote if they want to?

So it's an online vote. So if you head to the BBC Sport website, and then the easiest way to do it is to go to football and then women, and then you'll find a big section towards the bottom on the BBC Women's Footballer of the Year Award. There are individual articles on each player. So I've given you a snippet of what these players have achieved are individual articles on each player. So I've given you a snippet of what these players have achieved and why they're so fantastic.

There are articles there which will give you far more details which will hopefully make your selection a little easier. But you need to get your vote in before 9am on Friday. OK, not long to go. So get your thinking caps on, listeners, about who you might want to vote for. Jo Currie, the BBC's women's football correspondent. Thank you very much for joining us on Women's Hour.

Thanks, Jo. Now, while you might be gearing up for a Halloween party, it's Halloween as well. Congratulations, you've made it. In Madrid, the royal family is instead celebrating Princess Leonor's 18th birthday. And with the princess officially coming of age, she's stepping further into the spotlight as the heir to the throne, leaving some people asking, well, what

will her role be now as an adult royal? With me to discuss this is Rafa de Miguel in the UK and, oh, sorry, excuse me, he is the UK and Ireland correspondent for the Spanish newspaper El Pies. Good morning, Rafa. Can you hear me OK? Yes, I can hear you perfectly. Good morning. Yeah, thank you for coming on. I mean, first of all, we need some background because I feel like we are suddenly hearing loads and loads about Princess Leonor when we didn't necessarily have any background information on her. So tell us a bit more about her well she's a quite shy

hard-working uh conscious of her role a young lady as you just said she's turning 18 today and that's the reason why a few minutes ago she just gave before the parliament spanish parliament her sworn pledge to the constitution as his father did when he was 18 and now we're gonna uh be having more and more of her presence in the public debate because uh yeah no please carry on now till now uh one of the the things that i think uh queen leticia has done uh wonderfully is that she has uh protected her two daughters uh from from public opinion and from the public discourse. She has led both young ladies to enjoy quite normal, if we may say so, life with friends and family, with a strong sense of privacy.

But now, Leonor's time has come to start sharing the spotlight with his father. And in that sense, today is probably the beginning of a gradual exposition of Leonor to public opinion more and more. Well, that's quite a big step for an 18-year-old who has lived quite a private life, isn't it? So how will her life change now, just because she's turned 18 and is stepping more into the spotlight? Well, her father, Felipe, is still 55. I mean, we might think in a reasonable way that he still has a long way ahead as being king. Of course, but she will be doing more public duties, I imagine. But as you're saying, we will be doing much more publicly.

And I would say that in that sense, it may turn out, that's something that only time will prove, but it may turn out a very wonderful instrument for monarchy to establish or to consolidate its role in the Spanish political institution, because as you probably know, the former king has been in the middle of a huge controversy in the last years, and that has diminished quite strongly the monarchic sentiment in Spain. Even though the generation that is as old as the current king is,elf, for instance, I'm 55. We've been learning to appreciate all the qualities of the actual king, the king Felipe. I think that Leonor's generation in Spain, as in the United Kingdom, if you ask young people,

they're not very fond with all the idea of monarchy and it are not very fond with all the idea of monarchy and it's not very popular among young people. But I would say that if Leonor does her role well, and I think she's going to, probably her generation is going to appreciate more and more the institution of the monarchy as our generation did when we grew up on King's Day. Rafa, we're just having some issues hearing you.

Hopefully we can try and get those technical details ironed out. Let me just ask you a question. Hopefully you can still hear me okay. I wonder though, you used a very interesting term there. Leonora becoming of age could be used as an instrument for this royal family. And with all the negative press, as you rightly alluded to, how helpful is it that this young, very articulate, very pretty young girl was now 18 and can be put forward, thrust forward into the spotlight

for everyone to see in Spain? Could it be used as a way to change opinion of the royal family in that country? Yes, and I forgot to say something that I think is very, very special in that sense. She is a woman. She's a quite articulated, young and very amiable woman. Her mother, Queen Letizia, has strong feminist sentiments and she has spoken out in the last years about several feminist issues with a strong voice and she has educated her daughter to represent what a Spanish woman, a modern Spanish woman now represents and in that sense I think is going to be an enormous instrument to amplify the role of the monarchy right now. And just how much power, what is the profile as well of the royal family in Spain? It's very high profile as we sit here in England, but in Spain, is it different? Do they have much actual power?

No, they don't. I mean, in that sense, from a constitutional point of view, King Felipe would say, I would say that has the same neutral, out of politics role that King Charles has here in the United Kingdom. And in that sense, it's a quite delicate role because you have to keep a constant balance and be perceived by the population as the symbol of unity, as being representative of every single Spaniard, regardless of the political ideology. In that sense, I think King Felipe has been doing a quite good job, even though

he's had quite hard years with all the Catalonia independence movement and especially with all the problems derived from his own father behavior. Tell us about her education because she graduated from a boarding school in Wales not far from us is that normal for her to have gone to a boarding school in Wales I think there are some other royals that also attended there, but, I mean, how much of the norm is that? Well, her father went to

study to the States, the United States also, but I think in Leonor's case, that's been much more well thought, and the idea that she spent two years in Wales in a quite international school with a different ambience and being able to have relations with people from the most wide variety of backgrounds, that has helped her a lot. Now she's going through a much more formal education as her father went he just he's just uh now in the in the military academy in the army academy she's going to then spend one more year in the royal air force and then another year in the navy as her father did and she would probably go to some kind of law degree

and political international relations degree even though we know that she's much more fond uh she likes much more the the science likes much more the science than the humanity studies. But just for the reason that she's the royal heir, she was going to have to go through the same steps as her father did, and she will probably have to study law and international politics. But it then says that the idea of spending those two years in Wales has been fantastic in the sense that she has a wide variety of friends and relations that she would probably not get staying in Spain. the spotlight of the public glare. I wonder, we've seen it here with our royal family, how much intrusion there is to royal family members' public life, particularly the young women. Do you expect to see more scrutiny of her personal life or maybe even her love life now that she's in the spotlight, now that she's 18?

It's quite hard to forecast that. I mean, right now, or up till now, the media has been quite polite when it comes to her love relations. We basically don't know of any of those love relations. We know that last summer, for instance, she brought to Madrid one of her friends, a student from Wales, but we barely know anything about him. And right now, we don't have any formal relation with someone. But I think that at least up till now, and I would say that in the following years, the media is going to be trying to be careful. I mean, I don't think we're going to be as intrusive as you're used to here with the tabloids

in the United Kingdom. Okay, you've given us a pretty good picture of what she's like, and how the Spanish public have received her so far. I might be jumping the gun a little bit, but it is quite exciting. If she was to become Queen, what kind of Queen

do you think she would be for Spain? I think that she has the temperament and the character of her dad i mean as i was telling you she's a quite reflective she's hard working she's quite conscious of the world around her and i'm quite interested in on anything that's that that's going on i was talking to a colleague of mine in the newspaper last night, Mabel Galat, who has written a wonderful book about Queen Leticia, and knows a lot about the Spanish royal family. And we drew this comparison, and I know this is a high jump, there are a lot of differences also, but when you think of Leonor and her sister, Sophia,

you might think of Queen Elizabeth and her sister Margaret in the sense that Leonor is the thoughtful one, the quiet one, the more responsible one. And Sophia tends to be much more extrovertive and funny and nice to be with. Rafa de Miguel, thank you very much for giving us a more broader overview of

Princess Eleonora. Thank you very much. That was Rafa de Miguel, the UK and Ireland correspondent for the Spanish newspaper Pies. Now, I just wanted to come back to a couple of messages that we've had from you. Someone here has said, I resigned from the job I loved two years ago after 20 years. The privilege and joy of being a midwife is enormous. However,

it is an unsafe system broken with both the voices of women and midwives not listened to. And to finish with this, I am a recently retired midwife of over 40 years. It's heartbreaking that we are still having these conversations. Midwifery and obstetric culture is toxic in many institutions. What will it take to change? And that is, of course, something we will continue to ask here on Woman's Hour. Thank you very much for joining me. I'll be back tomorrow morning from 10. And that's all for today's Woman's Hour. Join us again next time. From BBC Radio 4, life can be unexpected. It was big. This was not a wind. This was not a storm. This was a tsunami. But when confronted with change, humans are remarkably resilient. I knew in that moment as I fell to the ground that I would recover more. I'm Dr Sian Williams, psychologist and presenter of Life Changing, the programme that speaks to people whose worlds have been flipped upside down and transformed in a moment.

If I had to live my life again, would I ever want to go through what I went through? There's a very simple answer to that. I would go through it again. Subscribe to Life Changing 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's faking pregnancies. I started like warning everybody. Every doula that I know. It was fake. No pregnancy. And the deeper I dig, the more Thank you.