Woman's Hour - Maternity care, Friends 30th anniversary, Breast implant illness

Episode Date: September 19, 2024

Maternity failings at scandal-hit hospitals are becoming more widespread, according to the Care Quality Commission. In a review of 131 maternity units across the NHS in England, 48% have been rated as requiring improvement or inadequate. Anita Rani gets the latest from BBC health correspondent Nick Triggle, and speaks to NHS midwife and author Leah Hazard about whether women can keep themselves safe on maternity wards.On 22 September 1994, the American TV show Friends premiered on NBC. Monica, Rachel, Phoebe, Joey, Chandler and Ross became household names. To celebrate its 30th anniversary, Anita speaks to one of the show’s writers and producers, Betsy Borns. Plus, we hear from journalist Emma Loffhagen about why the show still resonates with Gen Z all these years later. Reporter Melanie Abbott joins Anita – she has been investigating breast implant illness. Thousands of women are having their implants removed because they think they are making them sick. We hear from Caroline George who had hers taken out four months ago, and from a doctor and researcher, Prabath Nanayakkara, in the Netherlands who has been running a specific clinic for this for 12 years. He thinks that the UK desperately needs a similar resource. Breast surgeon Steven Thrush will tell us what is happening here in the UK where it seems much harder to get a diagnosis.Stand-up comedian, writer, and actor Lucy Beaumont joins Anita to talk about the next leg of her tour – Lucy Beaumont Live. She’ll tell us about the stories and jokes we can expect on the tour, as well as why she thinks the world of comedy has gone backwards to being male-dominated. Presenter: Anita Rani Producer: Lottie Garton

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 Anita Rani and welcome to Woman's Hour from BBC Radio 4. Just to say that for rights reasons, the music in the original radio broadcast has been removed for this podcast. Good morning and welcome to Woman's Hour. Another news story this morning about maternity services failing. The Health Secretary, Wes Streeting, has described the crisis in maternity care as something that keeps him awake at night, worrying. Well, this morning, I simply want to ask all of you how you feel. You might know someone who's pregnant. You might be expecting yourself. Maybe you're thinking about having a baby. What does hearing that of the 131

maternity units inspected in England, only 4% were rated outstanding. 48% were rated as requires improvement or inadequate. How does that make you feel? So right now, I simply want you to tell me how you're feeling and to share your experiences. And I'm sure that lots of you will have had very good experiences too. Either way, get in touch. We would love to hear from you this morning. Get in touch in the usual way, the text number 84844. You can email by going to our website or WhatsApp us on 03700 100 444. And feel free to leave a voice note as well.

You can also get in touch with us on social media. It's at BBC Woman's Hour. Also on the programme today, comedian Lucy Beaumont will be telling us about her new tour. And our reporter Melanie Abbott will be in the studio. She's been investigating breast implant illness and hearing about women who are having their implants removed because of it. And the very first episode of the iconic US TV sitcom Friends was first broadcast this week in 1994. So this is the episode where Woman's Hour talk about Friends and why it's endured for 30 years. Yes, believe it or not, 30 years, that's dated us, hasn't it?

84844 is the number to text. First, maternity care in England needs urgent reform to prevent harm becoming normalised. The Care Quality Commission warns that there are widespread problems across the country and urgent action is needed. The conclusion is based on visits that took place between August 2022 and December 2023 with the CQC finding that almost two thirds of maternity units it inspected were not meeting safety standards. The health secretary says the findings are a cause for national shame. 84844, again, the number to text. Well, following the story is health correspondent Nick Triggle, who joins me now in the studio. Morning, Nick.

Good morning. Can you give us an overview, please, of all of this? What's been said? Well, this review was ordered amid mounting concern about maternity care. We've had in the past few years high profile inquiries into care at Telford and Shrewsbury Hospital and East Kent, where investigators said poor care may have contributed to babies dying and being left with life-changing injuries. So the Care Quality Commission launched an intensive investigation into 131 units over a 16-month period. This is about two-thirds of the total number of maternity units in the country. It's basically those that had not been inspected for the longest.

Now, they should be the best performing because the regulator leaves them because they have less concern about them. But the findings were damning. And the regulator said there was a risk that preventable harm was going to become normalised in the NHS because of just how poor maternity care was. How widespread is it? Well, the overall, just under 50% of maternity units were rated good

enough. Safety was a particular concern. There was issues with staffing, equipment, major emergencies for example being classed as causing no or low harm and that meant that the mistakes being made or the complications that developing couldn't be properly investigated. There was bad leadership and management creating low morale and blamed cultures. There was also poor pain management. One woman told the inspectors

she was given no pain relief at all and had an unbearably painful labour. There was examples of call bells not working, operating theatres not available when emergency caesareans needed to take place and women being left in blood-stained sheets, compromising of course their privacy and dignity. There were major problems across the board. What does the government have to say? Well, Wes Street in the health secretary has said it's a national shame the state of maternity care. He says the government will be working in particularly with those trusts that are struggling the most. The Care Quality Commission though has

said, and this is quite unusual for the regulator, they've said there's got to be more investment, particularly into buildings and equipment to address this. So we'll have to wait to see whether, when we do get the spending plans later this year and next year, whether there is extra money going to be put into maternity care. Wonderful. Thank you so much for coming in to talk to me about that, Nick Triggle there. Thank you, Nick. Also, we have Leah Hazard. She's an NHS midwife and an author. Leah, thank you for taking the time out to speak to us this

morning. So you've been a midwife for 10 years. Is it getting worse? Or is this report uncovering what you already knew? Good morning, Anita. It's a pleasure to be here. Yes, things are absolutely getting worse. But I think what's important to point out is that things have been bad for a very long time. You know, the CQC have said that substandard care is at risk of being normalised. But I think that's a bit tone deaf, because in my experience, substandard care has been normalised for quite a long time. And that's reflected in the feedback that I get from midwives up and down the country and have been getting for the last 11 years. Which I think a lot of our listeners will be sitting up and paying attention to because you're a midwife who's on the front line, who's having to deal with women giving birth and you're saying

that the care is substandard. They look to you to give them the care. Why is it substandard? What's been happening? What have you been witnessing? Well, you know, we're all trained in this country to deliver gold standard, excellent care. And we're really proud of that. And the vast majority of us have good intentions and want to go to work every day to help people. But the problem is putting the issue of culture and attitudes to one side, which is, of course, incredibly important. The problem is that we are a system which is running at a constant deficit. We are chronically under-resourced. We have been under-resourced for a very long time.

There just aren't the staff, there aren't the resources. The buildings are often, you know, in many cases, not fit for purpose. I recently heard just in the last few weeks about a large urban maternity unit, which was running at a third of the midwives it needed in its labour ward to be, you know, minimally safe. And that's just, you know, as you were saying, that is a shame, that is a national emergency, and it should not be happening. So what does that do to staff morale? Well, it's, I mean, it's absolutely destructive and soul destroying because, as I said, many of us go in with the right intentions. We work incredibly hard. We know the NHS runs on the goodwill of its staff and midwives are no exception. We work long hours, often extra unpaid hours.

We often take on many more patients at a time than we would like to or than we know is safe. But we see this reflected in figures of retention and recruitment. We know that applications to study midwifery in June 2024 were the lowest they've been for six years. And although this is really disappointing, I have to say, Anita, it doesn't come as a surprise to me. You know, younger prospective student midwives often ask me advice about going into this career. And sadly, I now say to them, you know, if there's anything else that you like doing, do that instead. Goodness me. I am thinking about our listeners this morning and what they might be thinking, listening to you saying this, because it's such a vulnerable time and physically and emotionally surely this is adding to the mental load and it can't help women relax

knowing that they have to go in and give birth in a maternity unit so what should women let's give them some practical advice what can they do to ensure that they receive good care? Well, in a way, I love this question because it aims to empower women at what you've said is a really vulnerable time. But in a way, I hate this question as well, because it puts the onus on women and birthing people and service users to somehow try and optimise their care. And that really shouldn't be the case. As you've said, you know, people at this time have enough to think about. And they're, you know, it's a transformative and very potentially dynamic and changing time in their physical, emotional, social health. So they shouldn't also have to worry about arming themselves against, you know, uncaring, stressed midwives or medical practitioners. So all the advice that I would give is really, you know, on caring stressed midwives or medical practitioners. So all the advice that I would give is really, you know, just try and inform yourself, but don't make it an obsession. You shouldn't have

to. If you feel safer bringing somebody with you to appointments, by all means do that so they can help advocate for you as well. But, you know, I do get asked this question quite a lot and I think I've decided in essence just not really to answer it with all due respect because it shouldn't be the responsibility of service users to optimize their own experience. That's fine. I'm just going to reframe the question then and see if you'll answer it a different way. If I was a pregnant woman and I was coming to you, I was walked into like, what question should I ask to make sure that I'm listened to or my partner? Again, I mean... How do I make sure that I'm heard yeah it really is down

to the individual it absolutely should be up to the midwife or the staff member in front of you to listen to you and sadly if they're not listening there's nothing you can really do to make that happen and I would like to think that every practitioner in the maternity services is a good listener, is compassionate, has the time and space in their day to listen appropriately. Sadly, I know that's not always the case. I think, I guess I would just say, if you have specific concerns in that appointment

or that encounter, maybe try and get them straight in your head before you go in, make bullet points on your phone or, you know, whatever, if that's helpful to you. But ultimately, again, you know, with all due respect for the question, and I completely understand where it's coming from, it's not your responsibility to make people listen to you. They should be doing that already. Yeah, but they're not, are they?

It's quite scary to hear, I bet, Leah, especially if they're women who are pregnant listening. How can you reassure them? Well, I think I would like to reassure people by saying, again, that, you know, the vast majority of people in the service really do want to do a good job. You know, they don't want to go home at the end of the day feeling disappointed or frustrated or having spent the day apologising, as is often the case, we really are there to help you. And it is absolutely possible to have a positive birth experience in the NHS. We are still a kind of a landmark service in the world, and we should be rightly proud of that. I do see

positive births happening all the time and another kind of antenatal and postnatal encounters going well. So I would like to reassure people it's not all doom and gloom. You absolutely can, you know, come through this safe and even joyful and empowered. But obviously, that doesn't take away from the fact that there are serious problems in the system. And we midwives are on your team. You know, we want to shout about this as loudly as you do. The report found, and I know you're aware of this, discrimination in maternity care for mothers from ethnic minorities and mothers from working class backgrounds. Are all women being listened to in the same way? Sadly, no. And as you've said, you know, the data supports that fact.

We know that there are vast disparities for black and other minoritized women in the health service. And that's absolutely inexcusable and it has to change. And I certainly don't want to be an apologist for people who have demonstrated racism or bad behaviors. So that's where the kind of working culture piece of this comes in. Sometimes I think in the media, it's very easy to approach the maternity crisis with a very kind of binary black and white view of it's either about the numbers, or it's about the culture. It absolutely has to be both. And so we need the right number of staff, the right resources. And we also do need to enforce some serious behaviour change for that minority of staff who aren't treating people

equitably. So how is this report going to affect midwife morale this morning? Sadly, this report comes off the back of many, many years of similar reports from within and outwith the profession. This is not news to us and that's already been reflected to me in comments I've been receiving on social media today. I don't think it will really change how midwives feel about themselves or their role. But I think it just adds to a massive pile of evidence that this is a system in crisis. You know, we hear all the time, quite rightly in the news about violence against women and girls, but the chronic failure to resource and fund and restructure the maternity services is an institutional form of violence against women and girls. And we all know this has to change. It must change.

Leah Hazard, thank you for speaking to us this morning. Lots of you are getting in touch on this. 84844, by the way, is the number to text. As a midwife of over 30 years, I'm appalled by the state of midwifery today. I also teach student midwives and the dropout rate is high. I hope to inspire student midwives to support women, but how can I when I can't face

going to work myself? Another message here saying, I had my babies years ago and I felt I had great care. The news about maternity units this morning makes me very angry. Childbirth is a very wonderful, very important and very difficult thing to do.

It infuriates me that women's care is not prioritized but sadly it doesn't surprise me thank you for that message linda um another one here saying i have worked for five years in a busy city hospital maternity unit and this has been a desperate situation of understaffing midwifery is a brutal occupation all the midwives and staff raise every day that they haven't got enough staff and from xena she says i had my baby in january and she needed major intervention immediately after birth i was taken care of at every step of the way and couldn't have more love and gratitude for the maternity care from midwives to doctors to the cleaning staff at the hospital the care was outstanding keep your thoughts experiences and opinions coming in.

You can email us by going to our website or you can get in touch by text. It's 84844. Now, can you believe it? We've had 30 years of Monica, Rachel, Phoebe, Joey, Chandler and Ross being household names. And amazingly, Friends is still just as popular as it was when it first started. Since it was added to the UK's version of Netflix in 2017, it's often been the most watched show on the streaming platform. Well, Betsy Bourne was a writer and producer on the show's second season. She joins me now from New York, along with journalist Emma Lagardian, who is a fan,

even though it was created before she was born. Betsy and Emma welcome. Betsy I'm delighted to speak to you because you are the woman who wrote Smelly Cat which I can still sing word for word today. Tell us the story behind it. Thank you very much. I enjoy hearing it. It was a joy to write it. It was actually like many things on TV based on my dog, who smelled so badly that his name was Gouda. And the smelly dog didn't rhyme quite like, not rhyme, it just sounded ridiculous. And for some reason, smelly cat, completely normal. Now I'm going to go down a tunnel of asking why your dog smelled of cheese, but we can save that for another day, Betsy. You actually co-wrote Smelly Cat with the pretenders Chrissie Hynde, who also appeared on the show. Tell us about

writing it. What was that experience like? Like all experiences, you're in a room with mostly screaming guys, which is why I tend to scream now as a habit. And we were trying to figure out an interstitial piece to keep going back to. And so it just, it was usually work till four in the morning, if we're lucky. And you get a little punchy and tired. And I just, it was so late that I was eating gummy bears and thinking of my jog. And the Chrissy Hynde character is named Stephanie after my sister. And just as it went on, and it had different versions. There was the Smelly Cat remix episode and then a Smelly Cat ad.

And it's a joy. It was a joy. It was really, really exhausting at the time. Again, it was four. But, you know, in the morning, it seemed, wow, this is I've become my grandma who wrote Smelly Cat. But no, I absolutely cannot believe it. Why do you think it's endured? You know, it's funny. I have heard it on TV, the show in Italian, in French, in Hebrew. And for some reason, comedy is very hard to translate historically because of expressions and things like that that don't translate. And for some reason, the song and the characters hit a note. And it's a catchy tune. You know, the Rembrandts did the music.

I'm a catchy tune. You know, the Rembrandts did the music. I'm a musical idiot. And it just, the song, Smelly Cat, the Rembrandts song, and there's humanity. I mean, you can see Phoebe struggling through it. So there's some humanity, even in the most ridiculous things. And it's all in the writing. I mean, every single episode, they are just brilliant and flawless.

You mentioned being in the writing room then with all the men and staying up till 4am. I don't think we fully grasp what a writing room is. Can you just explain how an episode comes together? Like, what did you do? Right. I don't know. There have been movies made about the French Revolution and it it's not funny. And this is sort of the the equivalent of that with jokes.

But each writer will get a script, go off and write the script. Then you bring it back to the room. Hopefully it's funny. And it's, you know, eight screaming people saying, I can beat that joke. I can beat that joke. And that's how it's done. And the show has to be written every day, rewritten. You read it on Mondays. Then the next day, the actors have it. And either it's funnier than what you wrote or it's oh my god what was i thinking when when i wrote that um and that's the main process and it has to be ready for the friday night taping no matter what um and we actually wrote new lines even on stage while it was being filmed after after a scene you'd'd go, eh, I don't know. Monica, scene.

To tailor it to the actors or would the actors have a say? What was it like once you were with the cast? It's before Friday, it's for the actors, it's for the producer, the director, the network is there saying, eh, you can't really say that or that's not really funny, which is always a great note to get. And so you're hearing different people. And I don't know if you know the show Roseanne, I wrote on that for a long time. I mean, hugely successful. I was obsessed with Darlene. Sorry,

I'm just aging myself there. Dating myself. Well, I'm aging myself because I wrote it so you can imagine um oh no it's it it's great characters um but in that case the actress had more say yeah and on Friends um you know there were six people so each actor uh their opinion was a bit diluted and sometimes they would come specifically Matthew Perry could come up with great stuff on stage during filming. And that's how things change. It's almost a year since Matthew Perry, Seth, you've brought him up and people felt like they knew him from his role in Friends. How close was he to his character, Chandler Bing? When I was there, if you had told me this guy has a drug problem, I would have thought you were insane. And he was, but like most actresses or actors I've met, they're not as funny off screen, which is because generally they don't have writers following them saying, say this, say this in life. But he was delightful. And he made that character his. Everybody did,

but it was so specific. And when you give him a line, I mean, he would make it funny no matter what and a very kind kind person um you know and it was it was sad but i i hadn't worked with him in so long he was a different person how did friends change tv at the time i mean this was a time of telly where we only well in the uk we only had like four or five channels friday night it was on with this appointment to view, you'd invite your friends around. And if you missed it, you missed it because it was a while until we got the, you know, the DVDs. How did it change telly? Did you know what you were doing at the time? In the beginning? No, I was on Roseanne. And I met a guy who I was trying to impress. And he said, you know, there's this really funny show

that just started called Friends. And I thought, okay, I got to get on that show. So he'll just be overwhelmed with me. Married him immediately. But not knowing that this would change TV, it changed the status of my dating life. But then when it went on, it was appointment TV and it would be the show Seinfeld and Friends. And everybody showed up and would talk about it the next day.

And I don't recall that in my life as being normal. And it was so different because it was younger than most shows. And it was, the characters were so well-defined. And it was one of the, we used to say in sitcom writing, first write the story, don't think about jokes. And I think a lot of shows before that had thought about jokes and wrote the story around it. But this had real moments. But then they were broken by something. And I'm thinking of the scene where Ross and Rachel are about to kiss. And you're waiting. And then out of nowhere, an angry cat jumps on Ross's shoulder.

And it goes from awe to ah, which is a lot of my life, frankly. But it was so silly and so in depth. And I've seen people in other countries watch it. And I'm thinking they kind of have no idea what's really going on with the expression, with the expressions. But I think it became popular because it just hit people in their lives. Yeah, it was something so universal about it. I'm going to bring Emma Lofagen in because Emma wasn't even born when it was first on TV, but she's a diehard Friends fan. Why are, Emma, Generation Z or Z just as attached to the show as the Generation Xers that first watched it 30 years ago?

Morning. Yeah, I was not not born i'm born in 99 so all right don't need to rub it in we know you're young don't kid again methuselah should be my uh my pen name um so i started watching friends when it was on reruns on comedy central and then obviously it came onto netflix and that opened up to even more audiences but I think what you were saying about it being universal is probably the biggest draw like no matter when you're in your early 20s those themes of kind of bumbling through life and trying to figure out what you're doing with your life they they're always relatable but I think more than that it's kind of the balance

that it strikes between being relatable and still being kind of aspirational like you know Monica and Rachel have this amazing apartment and they all dress really well and you know all the characters are beautiful and very conventionally attractive so it's this like kind of relatable but also very glamorous version of being kind of floating around your early 20s not knowing what you want to do with your life um i also think there's something about it being so some people just just to pick up on that because some people use that as a criticism of how it's not actually aged well because there is that kind of you said aspirational it's not really that real and there is that kind of, you said aspirational, it's not really that real. And also the lack of diversity, he said, conventionally beautiful.

What do you think about that? I mean, yeah, that is obviously I think a lot of people are a little surprised that it's still so popular with Gen Z because we're seen as a generation that's very critical of that kind of oversight. And, you know, you're right, it is in this kind of fictitious version of New York where there are only white people. But I think that kind of thing, it kind of underestimates us as a generation because, yeah, there are bits of the show that are dated.

I mean, some of the jokes about Monica, for example, being overweight is just a punchline in and of itself and seen as a kind of moral failing. And the jokes about Chandler's dad as well being trans, that is also a punchline. And it is uncomfortable, those things. But I also think we can kind of put it in the context of when the show was made. And it doesn't tarnish the entire show and much of the brilliant writing. I think, you know, there are a few episodes that I don't watch back, particularly the ones with Chandler's dad.

But yeah, it's one of those things that I think we can put it in that context and still enjoy the fun of it as well. What about, Emma, the fact that there are no mobile phones or internet? Yeah I think that is also a really big draw like the 90s I mean especially for people like me who are really within touching distance of it we kind of see it as this utopia where nothing was ever bad and you know it's very easy to say that when you weren't really there. But yeah, I think the lack of social media is really nice to see. And those relationships not being impinged

by the internet at all. It is kind of this nostalgia that we all, you know, that seems like the good old days to us. And it's kind of like a period piece now. Like you look back and you're like, oh wow they have all this connection without ever being on the phone i'm just going to bring betsy back in for that a period piece betsy um yeah i uh i feel like i was co-writing with oscar wilde at this

point i'm really i promise you uh even though apparently none of you were sentient when it was born. It was great. But I think of it now as almost the plot destroyer after cell phones and internet, because most sitcoms then were, oh, my God, he can't know and I'm here and I can't call them because there's no pay phone. And now it's sort of, oh, my gosh, you know, she's isolated. Will she pick up a cell phone for God's sakes? And, you know, you have a big secret. Well, I can look it up on Facebook. And so it makes complications. It decreases them. And also, I think with the internet, you can get in more trouble. For I used to love to use people and situations from my life. And now I think, wow, those people wouldn't be talking to me anymore, including my parents, including your dog as well.

My dog. And also, I had a situation that an episode was written about when I was eight. We were camping and my parents took off. It was a family gas station. And when I walked out, they're completely gone. And I thought, you know, I'm a pretty good kid. I don't know that they would have abandoned me. And it was on Prince Edward Island. And there was a ferry off and I was eight and it was getting late and the family wouldn't let me in.

Anyway, four hours later, they realized I was gone, even though we just had two kids. And so I wrote the one with the baby on the bus about that. And I wasn't a baby, but that's how I felt. And being able to use your life, I think also made it relatable. And I wanted to comment on the lack of diversity. Yes, please. I absolutely agree. And I, with Chandler's dad, I mean, you wouldn't think of making that joke. It's incredibly insensitive. On the other hand, Ross was married to a woman who was a lesbian and left him for that. And when I was on Roseanne, we did that story. And as far as I know, on Friends, that was the other story. And we got network notes saying no, too much.

So you were pushing the grain at the time. Right. Yeah. It's been fascinating speaking to you both. Thank you so much, Betsy Bournes and Emma Luffigan. Thank you for joining me. 84844 is the number to text. 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 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, have you heard of breast implant illness? Well, the health regulator in the UK, the MHRA, is planning a study to find out more about it. It comes as thousands of women are getting their implants removed because they think they're making them sick.

Some medics question whether it exists, hence the need for more research. But other countries are already treating it more seriously than here in the UK. Our reporter Melanie Abbots has been looking into this and she joins me now. Morning, Melanie. Morning. What kind of symptoms are women reporting? Well, I suppose this really is one of the problems. It is a very broad range.

There's anything from joint pain to debilitating tiredness, hair loss, problems with memory, depression, skin rashes. It really is quite varied. Is there a way of diagnosing it? Well, another problem, if you like, I suppose. There are no tests or specific criteria for diagnosis, but there are lots of women who say they're suffering from it. One Facebook group has almost 200,000 members,

and symptoms generally develop some years after the implant operation, maybe up to 15 years later. I spoke to Caroline George who had her implants fitted back in 2017. She's had quite a tough time. She's had lymphoma twice. She had to have a cell stem transplant to treat that and she was then told she was at greater risk of breast cancer so she decided to have a double mastectomy with a reconstruction. Her implants were removed earlier this year after she began feeling ill. I started to develop symptoms that I thought were maybe linked to the implants. I did go for scans and tests and things and they couldn't find anything really evidently wrong with me so

the more I thought about it the more I was thinking gosh maybe it could be the implants maybe what kind of symptoms were they so I was unbelievably tired and this was like a sort of complete exhaustion a lot of the time also things like joint pain my memory is not it's still not actually back to normal I wouldn't say thinning hair dry eyes difference in my skin and weird lumps and bumps like in my neck and things that I couldn't well I've been scanned and it was nothing serious I just couldn't get past the thought that it could be the implants so So you decided to have them removed? So yes I decided to have them removed. Doctors don't believe in the breast implant illness so that was kind of difficult. My consultant who I really like, he's not a believer and he was very

understanding about my concerns that's why he agreed to take them out. And then when I said I want to go flat, he said, OK, well, let's think about that. Let's not rush into it. It was a big step because if I was getting them out for no reason and then I'm left completely flat. And still feeling poorly. So how do you feel now? I do feel better, I would say. I'm not 100% better particularly from a psychological point of view as well I think getting them out is just such a relief that I don't need to worry

anymore about what they're doing because I was starting to worry about the future risks of having them in because I don't have any more implants I'll never have to worry about what they're doing. Were any tests done on the implants taken out or to see if they'd leaked or anything like that? During the operation they found that one of them had actually ruptured. I think they send most implants when they take them out if not all away for testing to pathology. It came back saying that there was a giant cell reaction related to silicon in what they call the capsules your body forms a capsule around the implant so it's like your body's protecting itself from this foreign body my surgeon did say that most pathology reports come back with something similar now you've been through so much much you say you feel a bit better physically but

you've got well your body has been changed dramatically. Yes it is a lot to get used to it's a lot to get your head around but I'll never be sorry that I had the operation the mastectomy to reduce my risk because I want to be here to see my children grow up obviously and I'm not sorry I've had them out I mean it is a lot to get used to I think what I'd like to maybe change is is this perception with maybe doctors in particular that you can't be happy if you don't have breasts you know we're all sort of conditioned to think what a woman should look like they're just breasts at the end of the day aren't they you know I still have some recovery to do I'm still very tired and and some of the symptoms like memory loss things like that are still there and the joint pain so we'll see how that kind of pans out further down the line

it's early days isn't it like you say only four months it is it's really early days but even in the first few weeks I was relieved and I could feel a difference even since then I can feel my body sort of calming down a bit. Caroline George talking to me and Anita she had her implants removed for free under the NHS but many women are having to pay for the operation themselves if they want them removed. And Caroline, she also had the Allergan implants, which have been linked to the cancer BIA-ALCL, but she was fortunately clear of that. Now, I have spoken to quite a few other women about this, including one diagnosed with chronic fatigue syndrome,

and that does seem to be a diagnosis coming up with this. And that was 16 years ago. She had her implants removed or explanted, to give the medical term, in April and now says that she feels much better. Another woman told me that she developed a strange allergy to melon and suffered episodes of facial paralysis that she put down to her implants and it did all clear up after she had the operation to remove them. Now Caroline, who we just heard you speaking to there,

said some doctors don't believe in this illness. We'll talk to someone from the Association of Breast Surgery shortly, but there are some clinicians taking this very seriously, aren't there? Yeah, absolutely. In the Netherlands, there is a clinic devoted to breast implant illness, and we do believe that this is the only one in Europe at the moment. It was started 12 years ago by Professor Prabhath Nanikar. He's from Amsterdam University Medical Centre.

And he told me how it came about. I saw a patient who has had implants for six years and she developed a very severe reaction around her implants and also systemic reactions. What I mean is outside the local area. That reaction was it rashes and things? Rashes and even infection of her eyes and lungs and liver so the whole body was involved so if we took out her implants they were not leaking they were looking okay but when we took away the implants, she completely healed from this disease.

We started this clinic and then it really took off, you know. They have a waiting list of 13 months and we have even started a consortium in the Netherlands where specialists treat these patients under our supervision. There were lots of skeptics about it, but we just wanted to give these patients a podium to describe their complaints. And we have published more than 13 papers. So the treatment that the women are having, is it all paid for by their health insurance? Explantation is paid for. If they want a new implant, they have to do it themselves, pay it themselves. So the clinic fees to come and see you and the explantation is all paid for.

And has that always been the case? No, until a couple of years ago, the clinic fees were paid because we are an academic hospital, but the explantations patients had to pay themselves. We talked to the insurance companies and came up with our data, and then eventually the insurance companies agreed to pay for the explantation. Your research has shown, though, that two thirds of women who have them explanted do get better, but a third don't get better. Does that perhaps cast any doubt on the fact that it's related to the implants? Is there a possibility it could be something else? The one third who doesn't get better, there are a couple of possibilities. One is they have reached the point of no return. So they came to you late perhaps. Yes, late. And we have published that probably women who

have implants for more than 10 years do not get better that well. Second, of course the diagnosis can be wrong, but that two-thirds get better and some people really, really get better. What percentage of people who have breast implants might develop breast implant illness? Is there any way of knowing? I was scared that you were going to ask that. It can vary from 5% to, I saw in our registry, 12% has taken away the breast implants because of breast implant illness. So we don't know. But there are thousands of patients who walk around with these complaints. It is relatively uncommon. But when a patient says that she thinks that this is, then you've got to take them seriously. Professor Nanakar speaking to me there, and he thinks the UK should set up a similar clinic to this and that medics do need to work together to get more research in the area.

Do we know how many women are suffering from breast implant illness? It's really impossible to get any figures. We can't even be sure how many women have breast implants in the UK. There was a registry introduced in 2016, but many women will have had their implants fitted before then. In the US, they've been compiling figures. The Food and Drug Administration has had 9,450 reports of breast implant illness between 2008 and the middle of last year. But we don't have any kind of detail for the UK. Exactly. The MHRA, as you mentioned, is doing this study. It's in the initial stages of setting up research protocol.

It said it couldn't give me any timescales for when it will begin, but it will be looking at electronic health record data from over 2,000 primary care practices. Melanie Abbott, thank you. I can talk now to Stephen Thrush, a surgeon from the Association of Breast Surgery. Stephen, welcome to Woman's Hour. Do you think there should be a special clinic here?

Firstly, I'm delighted that the trial is going ahead. This is something we've been talking about for a number of years. It is a condition that we're not sure about. And I'll be honest, women are obviously suffering. They are having symptoms that is affecting their quality of life. And we're hearing that removing the implants can be very beneficial to some individuals. Do we need a specific centre?

No. What we need is data and information. And that's why the trial is so important. By having a dedicated center, it's almost giving people a sort of worry out there. And what has happened with the use of implants in augmentation and reconstruction? We're getting more information, and we're better at warning people of the future risks. I'm delighted you've had a session before on ALCL, which is, of course, very important. Whatever, both breast implant illness and ALCL is extremely uncommon. And I heard the previous speaker talking about that rate. That's not what we're seeing. We're not seeing a large number of women coming to ask for explantation, but we are seeing some. And that's why it's important we understand

who is getting these symptoms. Are they related to the implant? Are there other conditions? Are we investigating in a unified manner? And are we treating the same? Because there's still discussion on is it just removing the implant or removing the implant and capsule? What advice would you give to women who feel that they're affected and feel that there's nowhere for them to go? Or that they're being told that it's just in their heads or whatever, but they feel for whatever reason, all the things that Melanie's just been telling us, they feel that they fit into that category. What advice would you give them? I think the first thing is to rule out other causes so you know the symptoms are very non-specific and they could be caused by a multitude of things so it's really

seeing their GP and being investigated for things like thyroid disorders and endocrine problems. If it's still a problem, the issue we have, as has been pointed out, we don't recommend the NHS can take out implants for symptoms like this, because yet we have no evidence that that is definitely the way forward. So there is an issue, and that's why the trial is so important, to know who will be the ones who benefit so i think the first port of call is going to your primary care are women given enough information when they have the implants fitted in the first place i don't think they used to be and this is where we're working in really to make sure that there is a standard of care in terms of information given preoperatively.

And those who have not had it will get it if they're seen later on. Because before 2016, we weren't really talking about ALCL. And now it's ALCL, it's other lymphomas and things associated with it. Again, extremely rare. But with things like breast implant illness the um and the symptoms women describe concerning this we know that they might be more at risk if they have psychological or um disease beforehand so it's identifying people who may be at risk of this sure um as we know it's something that was just beginning to be spoken about in the uk and we will continue to talk about it on woman's hour but for now uh now Stephen thank you very much for taking the time to speak to me. If you would like to send us your experience of this if any of this has

triggered something with you then please feel free to get in touch in the usual way you can email us by going to our website and lots of you are getting in touch with your thoughts on the thing we talked about at the beginning of the program which is maternity care in the UK. Someone has said the current state of maternity care in this country is yet another symptom of our culture's profound undervaluing of the fundamental role of mothers in society another one here saying i work with a community midwives team and most nights this week a midwife has been called out to a home birth she will have worked an eight hour shift and then often not leaving the home birth until eight or nine in the morning staff are often physically and mentally drained someone else saying i'm pregnant with my third

child and find this report terrifying as ever women and women's health is not prioritized i'm trying to get through quite a few of these because so many of you are getting in touch and someone else has said here i've had twin pregnancies i had incredible care throughout both pregnancies the nicu staff extraordinary. The midwives were amazing. Now, on to my next guest. Stand-up comedian, writer and actor Lucy Beaumont is a familiar face on TV. She's known for shows like Meet the Richardsons, Taskmaster, Hull Raisers and Radio 4's sitcom To Hull and Back. From next month, she'll be touring the UK with Lucy Beaumont Live, including a show at the London Palladium.

You can expect offbeat stories, unusual anecdotes and bizarre journeys through modern womanhood. She'll be touring the UK with Lucy Beaumont live, including a show at the London Palladium. You can expect offbeat stories, unusual anecdotes and bizarre journeys through modern womanhood. And I'm sure stories from her hometown of Hull. Morning, Lucy. Welcome to Woman's Hour. Am I right? What are you showing me? I'm about to turn the video. You just see in my kitchen. Oh, here we go. Here we go. Can I just explain? Lucy just had her video facing the wrong way and I just saw her drinks cabinet that just had a bottle of cordial in it. Very good.

Yeah, that says a lot, doesn't it? So what can audiences expect? Oh, well, this, you know, it feels a bit like a well-oiled machine now and because this is yeah this is the third and final leg so I started last October and and and the show's grown really and what's been lovely is I've had gaps you know I've had like a few months and then something funny will happen and I'll write that into the show and yeah so the show's grown with me as well and and it's I mean it's just a laugh and and what's been lovely is you know having the confidence to know that you get the same reaction wherever you go you know one of the best nights of the tour was you know Guildford and Cheltenham

and you know I think I used to think oh I'm a northern comedian I'll go down better in the north and and that's not the case really but I think it's just very surreal and storytelling you know but just about my life you know being in my 40s and and the sort of where I've come from you sort of sort of look back and to where I from where I've come from to where I am now really well yeah from Hull to the London Palladium can't be bad yeah I know that yeah that's the one if you want to come see me and you come to the Palladium can't be bad. Yeah, I know. Yeah, that's the one. If you want to come see me, can you come to the Palladium? We need to fill it out. Now, Hull features prominently in your shows.

What makes it so rich for your comedy? Well, do you know, I get messages whenever I do an interview, someone always says, I wonder how long it would take before you talk about Hull. And I think I drive people mad because it's hot. Well, it's Yorkshire, isn't it? We can't help ourselves. I know yeah I

mean I don't I live in Sheffield I don't live in Hull but no but I want to it's just I can't really because of work it's so bad but it's just that's where all my friends and family still are and that's where you know I'm there most you know every couple of weeks and um that's just you know where all your references are from you know it's sort of in in my heart really and then it's just full of funny people as well so it helps for this job you know and very and different characters very different from london which you talk about you know i'm getting less this well it's a capital isn't it you know it's sort of like sort of well-trodden material, isn't it?

The sort of difference between, you know, in the South. But I don't know. I think people are people. I think what I've noticed is that when you go to certain areas, there's a confidence. People can laugh together, you know. I always think with, like, Hull and Leeds and Manchester you you'll never drink alone they'll always be correct we'll have a five with you maybe I don't think

it's like that in London what got you into doing stand-up you've been doing it for over a decade now yeah oh my god yeah I said imagine it when I heard like this like young girl talk about the 1990s the way I would talk about the 1950s and it really really threw me yeah I suppose I've been doing it quite a while haven't I um well what we had no choice I knew I wanted to be a performer and I was working in a pub I was cleaning in the day and I was working in a pub and I was testing material out on the regulars and it was the equivalent of me going to a new material night in London something had happened to me and I'd make it into a story and then they're like I'd tell one group of people and then and I'd be thinking oh well where's the punchline and if I take these words out and then and I'm I tell one group of people and then and I'd be thinking oh well where's the

punchline and if I take these words out and then and I'm really I sort of subconsciously was doing it before I realized I wanted to do it if that makes sense yeah yeah how easy was it then to make it onto the comedy circuit it was a nightmare that first like year I worked for free and it was the hardest year of my life I couldn't do it from pull I had to move I had to take there was no comedy clubs and there was hardly any in the north and the ones that were in the north were unbelievably sexist they didn't it was about you know it was you know comedy men on stage doing penis jokes, you know, that was, and it felt a weird atmosphere.

And I can remember doing some clubs and, like, women, like, going bright red, just the sight of me on stage, they were already embarrassed. And I was used as an act that you could go get a drink, you know, that you see a woman come on the mic. Yeah, so half the audience would get up and wait for the man to come back on so that that was my ground grounding you know what keeps you going um well you know i hate i've just been honest london wasn't the same central london wasn't the same you know weekend gigs would gigs were tough, but you could learn by doing midweek gigs, you know, in London, which there just wasn't many outside of London,

because you would only be booked, like, once every couple of months as a woman, you know. I've got emails saying we've had a woman this month. Yeah. Yeah, so I had to move, and I had a woman this month. Yeah. Yes, I had to move. And I just, it was my last shot. I just, I knew I wanted to perform and I could only do a whole accent.

I wasn't going to get in the RSC. Yes. I was going to ask you whether the landscape's changed, but actually reading your tweets, you've actually been calling out the lack of female comedy, female comics in comedy clubs. Is it still a huge issue? Oh, God, yeah.

And I'd been noticing it for months and I kept my mouth shut. And, you know, I hate to ruffle feathers because, you know, essentially you're criticising someone's business and, you know, it's hard enough to get people in pubs and clubs and you know and and I just reached a point where I went I did over an hour I sat and I looked at every city outside of London for a Friday and Saturday night just so at least I'd know you know I wasn't just doing it frivolously um and it was like it literally was like 80 percent you know either just had one woman on the bill or maybe one woman that that month and and I couldn't help it

and I had to delete the tweets that I put because of the horrific trolling the just the trolling was awful just and I think it was surprising for other people it upset a lot of people I got messages saying I can't believe the the sort of sexist you know bigoted abuse you're getting and I thought you do you just get just used to it you know that it's nothing's changed there's still you know a small percentage of people that um you know biologically they don't think women are funny so how do you change that culture I've been funny you know and I started out being like I nearly gave it up because I was like you know men are funnier than women and and that's what we see on tv you know they're they're male panel

shows that that book a woman and they're not female they're not they're not balanced they're male they're male panel shows and we should just call it's okay but we should call them that um you know um that but that's what they are you know so you do sort of go you just spend so long being the only female comic yeah and also northern comic i'm really aware of time but i really need to ask you about hull raisers because you've got a lot of fans in the woman's hour office because yes just very quickly just getting that to screen that must have been such a proud moment for you to be able to tell the sort of northern story on national telly oh i can't yeah it was yeah it was a the toughest thing I've ever done yeah

getting that through and trying to get it off as authentic as you could when you know you work with a production company and a channel and everyone's got ideas of what what it can be but yeah um I tried to get as many native hull accents accents and I tried to get the area. You did. You did it proud, Lucy. You're doing us all proud and we are delighted that you're back on tour and we want to wish you all the best

and thank you for joining me. Lucy Beaumont performs her latest stand-up show, Lucy Beaumont Live, across the UK, including at the London Palladium on Friday the 4th of October. Thank you, Lucy. Join me tomorrow for more Woman's Hour. That's all for today's Woman's Hour. Join us again next time.

I was definitely too young when I was leader of the opposition, not to do many of the other jobs I did in government. Emissions and insights from the people who shape how we think. I would say my family, well, gave myself and my two siblings a critical eye. And because it's not just politicians who mould our lives, we also hear from economists, comedians and best-selling authors. It's the fastest way to change things. You do need politics, but if you want to change something overnight,

culture is the quickest way to do it. Conversations, not newsy interrogations. That's Political Thinking with me, Nick Robinson, from BBC Radio 4. Listen now on BBC Sounds. I'm Sarah Trelevan, 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 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.

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