Woman's Hour - Maternity care review, Weight training and weight loss drugs, Bows in fashion

Episode Date: December 9, 2025

Baroness Amos, who was appointed by the Health Secretary to lead an independent rapid investigation into NHS maternity and neonatal care in England, has said nothing prepared her for the scale of "unacceptable care" that women and families have received. Presenter Krupa Padhy is joined by the BBC’s Social Affairs correspondent Michael Buchanan and Theo Clarke, former Conservative MP who also chaired the UK Birth Trauma Inquiry and hosts the podcast, Breaking the Taboo, to discuss those initial reflections and what comes next. We examine a new report which highlights the crucial role of strength training and exercise for people on weight loss drugs. Data gathered by fitness professionals, Les Mills and the not-for-profit industry body, ukactive, shows the impact of weight loss drugs on skeletal muscle mass. Their report says that 20-50% of weight loss is lean body mass, which poses significant health risks such as frailty, disability, reduced metabolism, and increased mortality. Physiotherapist Lucy McDonald and Dr Sarah Jarvis join Krupa to discuss the importance of strength training to mitigate muscle loss. Yesterday, nurse Sandie Peggie, who objected to sharing a female changing room with a transgender doctor, won part of her employment tribunal against NHS Fife. She was suspended from her job after she confronted Dr Beth Upton in 2023. The tribunal ruled she was harassed by NHS Fife but other allegations of discrimination and victimisation were dismissed. We hear more from Lorna Gordon, the BBC's Scotland Correspondent, who has been following the case. From Kate Garraway’s iconic jumper on The Celebrity Traitors to Lily Allen’s album launch dress, bows are everywhere right now. But are they practical or a deliberate gesture of femininity? And why have we seen this resurgence of bows in fashion? The Guardian’s fashion and lifestyle editor Morwenna Ferrier and Dr Sarah Grant from the V&A join Krupa to discuss the history and sudden popularity of bows. Presented by: Krupa Padhy Produced by: Sarah Jane Griffiths

Hello, this is Krupa Pardi, and you're listening to The Woman's Hour podcast. Good morning, thank you for being with us. As we've been hearing in the news, we now have the initial reflections of Baroness Amos, who is chairing a review into maternity care. Having spoken to families over several weeks, her findings suggest that things are far worse than she had anticipated. So how have we got here? What needs to change?

What isn't happening? What is getting worse? we'll be speaking to our correspondent Michael Buchanan and former Conservative MP Theo Clark who was also the chair of the UK birth trauma inquiry and this is something I come at as a journalist, as a woman but personally as a bereaved mother with my firstborn having lost her life due to negligent care

during my own labour over a decade ago. It is something I have spoken about before on this programme and this might be something that has impacted you as well will have all the details of support links during our conversation shortly. Plus, Sandy Peggy, the nurse who objected to sharing a female changing room with a transgender doctor,

one part of her employment tribunal yesterday against NHS Fife. We'll hear more from our correspondent on what this means. Also, our weight loss drugs costing you your muscle. We're going to talk about the call for women on these drugs to take up more strength training. We'll have two experts on the show,

physiotherapist, Lucy MacDonald, and GP Sarah Jarvis. They'll talk us through this new search and offer their advice. If you've a question or strength training experience that you'd like to share, do get in touch. You can text the program. The number is 84844. Text will be charged at your standard message rate. Over on social media, you'll find us at BBC Women's Hour. That's X and Instagram. You can, of course, email us through our website or send us a WhatsApp audio note using the number 0300-400-444. All of our terms and conditions can be found on our website. And it is the season to get out the sparkles, sequins, velvet and maybe even the bows.

We're going to talk about how bows are bouncing back and why they may even have a place in your attire all year round. Maybe the last time you wore them was part of your school uniform. Maybe you feel like you're past the age of wearing a bow if there is such a thing. Maybe you are embracing your bows. We'd love to hear from you wherever you stand on the matter or indeed on any of the program's subjects that we are covering today. First, Baroness Amos, who's leading the investigation into NHS maternity and neonatal care in England, has said nothing prepared me for the scale of unacceptable care that women and families have received and continue to receive the tragic consequences for their babies and the impact on their mental, physical and emotional well-being.

She was appointed by the Health Secretary in August to lead an independent, rapid investigation to urgently improve care and safety. And this morning, we've heard more from her in her interview. Report. It makes for grim reading. Here is Baroness Amos talking earlier this morning on the Today program. My focus is given that these harms continue to be done, given that babies continue to die, given that this is happening across the country. And that is one of the things that has surprised me, which is that some of the consistency that we are seeing, across different parts of the country. So are there things that we should be doing

to standardise the level of care across different trusts? Yes, there are guidelines, but do we need more than that? Joining me now to discuss this all is Michael Buchanan, the BBC's social affairs correspondent and Theo Clark, former Conservative MP and chair of the Birth Trauma Inquiry and author of Breaking the Taboo, why we need to talk about birth trauma. Michael, I'm going to start.

with you, it seems like we have had countless investigations, reviews and findings into maternity care. What is behind this one? What is it hoping to achieve that others haven't? Well, it's because of those countless reviews in the sense that things simply haven't improved, it haven't improved on a sustained level that this review has been called. It was essentially in the past decade there have been three reviews into poor maternity care in Morecambe Bay in Cumbria, in Shrewsbury and Telford and in East Kent. The largest one is ongoing in Nottingham and a new one has been announced for Leeds. So that gives you a sense of the problems.

On the three that have been completed in Morkan Bay in Shrewsbury and in East Kent, as well as other investigations that have taken place into patient safety and broader maternity services, they've led to hundreds of recommendations, now on 750 recommendations, but fundamentally there is a feeling that care simply isn't good enough in many different areas of the countries. So fundamentally the question is, why? have them in 750 recommendations and things aren't improving. And that is a question that West treating the Health Secretary for England has been grappling with since he came into office, frankly.

And his solution at the moment, at least, is this rapid review, as he calls it, which is chaired by Baroness Amos. He set it up in the summer. It was due to be completed by December. It's slipped a little bit. But now she's saying that her recommendations, which she describes as national recommendations, will be published in the spring.

And the reason she says that this will be different. and to all the other reviews is that West Streeting is committed to ensuring that they are implemented. We've heard the word commitment many times there, and there'll be women who have gone through the most traumatic experience, families who have lost babies, who will be questioning that commitment. You mentioned the 750 recommendations. Could you just remind us what subjects they tackle and what they raise? Well, they raise a variety of subjects,

and some of them have been tackled to a greater degree. than others. So for instance, they've been talking about a lack of staff and staffing pressures, and there has been some investment into that. There's been an investment as well into digital medical records so that it's easier for women to carry around their particular charts. It doesn't work as consistently as it should do, but it is an improvement in some areas. The difficulty it has often found is cultural, and that has simply been something that NHS maternity units have struggled to cope with. When I say cultural, that can mean anything from an ideology over what is the best way for a woman to give birth

and there has been much discussion about a normal birth campaign which was running for a number of years and basically placed a premium and vaginal deliveries over what was best for the woman. But it's beyond that as well. It is an unwillingness to listen to women, even when they're reporting reduced fetal movements. It's an unwillingness to investigate properly when things go wrong. It's often blaming the woman or making the woman

feel less of the blame as hers for the fact that her baby has died. And then if an investigation is carried out, it is often deemed to be cursory. It doesn't get to the fundamental issues in the unit. It sometimes maybe blames individuals. And crucially, it doesn't lead to lessons being learned. And so what you get is you get the same mistakes happening, not just within the same units, but across the entire maternity system in England. Theo, as former chair of the UK's birth trauma inquiry, these are themes that you will have

heard talked about time and time again and indeed yourself. You came on to this programme two years ago to share your own personal experience. Absolutely. I did and I find it incredibly frustrating that I'm still back here today talking about how maternity care has not improved. So firstly on Baroness Amos's reflections today, how incredibly frustrating. I mean, is that it? I sat down this morning at breakfast to start reading her findings and I thought it was just the introduction. And then I realised that was actually the end of her report. And there are no. no policy recommendations in there at all. When it was announced by Wes Streeting several months ago

that this was going to take place, he made clear that there would be recommendations. That has now slipped, as Michael has said. Is that just kicking the can down the road for families like myself who've been affected by birth trauma and have not received good postnatal care? And the terms of reference that she's been given are absolutely huge.

They're going to require sort of herculean efforts to be reporting back by spring of what to do. And I think Michael made the key point, which is I shared a cross-party inquiry in Parliament which heard from 1,300 families and we know very clearly what the issues in maternity are and families have reported so many times about what the issues are with systemic reform needed in the NHS.

And quite frankly, the government has now been in power for a year and a half they could have chosen to prioritise and fund better maternity care and to be honest, I don't think it's good enough today that there are no policy recommendations. We had a list of more than 40 in our report to the previous government. The first, which was our headline recommendation, was in fact adopted by the previous government.

I remember standing up in the Chamber of the House of Commons and asking the then Prime Minister Rishi Sunak to adopt the National Maternity Improvement Strategy, which was our solution for the point that's just been made about this fragmentation of services because what we found in the inquiry was that there was this postcode lottery in maternity care. So depending on where you live in the UK,

you will actually receive a different level of care. It is not the same care pathways. So I think that's the first thing the government could do is to agree to the previous recommendations of previous governments and implement them and they've chosen not to do so today. You mentioned, well, you questioned whether this is it and where the policy recommendations are,

but of course we have heard that the full findings of this report, as I understand it, will be released in spring where we hope to hear more. Michael, turning back to you, there are many bereaved families who are questioning the way this report is being produced, is being researched. Not all families want the same thing. Some prefer a statutory public inquiry.

Just help us understand what's been said here. Yes. I mean, Mr. Streting chose this as the way that he wants to improve maternity care, but it is not by any stretch of the imagination accepted across the harmed families that this is the right way to go. There are undoubtedly some families who do. do think this is the best way to do it. But they feel that Mr. Streting has got a personal commitment to improving care, that he should be given a chance, that Baroness Amos should be given a chance,

and that in the words of one campaign that I was talking to, this is the best opportunity in at least a decade, perhaps a generation for maternity care to be improved. But there is absolutely another school of thought, and she, Baroness Amos is well aware of the criticism and the skepticism. The people who are pushing for a national statutory inquiry are saying that she does not, The terms of reference, as large as we heard they are, they're not as big as some people who want them.

They don't, for instance, look at NHS resolution, which is a crucial part of this. This is the body that pays out or is legally responsible when errors are made. They don't talk about accountability. And for a lot of families who have been harmed previously, they simply see people walking away from the harm that they have caused, not just the midwives and the obstetricians, but the clinical directors, the chief executive of these organisations,

they simply think that this review is incapable of bringing that accountability. And they believe that by having a judge-led statutory inquiry, these people would be forced to explain what they did or what they didn't do and there'd be an opportunity for those families to get the accountability that they often feel they have been denied. On the subject of accountability, is there not something to be said about empowering women with the information that they need about their rights,

about this whole conversation around better births that the conversation has moved towards so that they can ultimately advocate for themselves or their families can advocate for them because let's face it, when you are giving birth, when you are pregnant, you are your most vulnerable. You need information to empower yourself to advocate for yourself and for your baby.

Is that where they're going wrong that women just don't have that information, Theo? Well, I agree with you. I do think that is part of the problem. And I can give an example from my own personal experience. You know, when I had my antenatal classes, birth injuries were really not talked about. I had very little understanding of what a third-degree tear was, which is what I went on to suffer having the birth of my daughter. And it was an incredibly terrifying experience that I was in labour for 40 hours, had a postpartum haemorrhage,

and ended up going on to Sagnufer, significant birth injury, which had to be repaired in theatre. And that was not something that anyone had talked to me about before. And sadly, my experience is not unique. I mean, I've heard from literally thousands of families across the UK in the last few years with very similar shocking stories. So I absolutely agree we need to better inform mothers. And I think we also need to trust women. Like we know our own bodies and we also need to be listened to by NHS professionals.

And that's something that came through strongly in Baroness Amos's reflections today is that families are not being listened to. But that's not breaking news. We already know that. And back to my point, and Michael illustrated very well, talking about the previous inquiries that have been done in other hospitals. We actually already know today what the issues are in NHS maternity care. The issue is the government actually taking action to address it

by either increasing funding or actually implementing these policy recommendations. And one of the policy recommendations that I think would really help to address this situation and ensure that no mother endures these horrific stories that we've heard today is by having a maternity commissioner. I think that having a dedicated person who is really apart from party politics, who was appointed by the Prime Minister is not going to come and go in government reshuffles, but whose job it is is to oversee and make sure that these policy recommendations are implemented would go some way to relieving some of these problems.

Is there anyone you think would make a good fit for that role? Well, that would be a job for the Prime Minister to decide. But I go back to my point. I mean, I got the previous government to agree to cross-party recommendations and what happened a few weeks later, the general election was called and then there's no onus on the new administration to agree to the same. So I think we really need to make sure that maternity is cross-party. It is far above party politics.

We need to ensure that every government is committing to the same. And I really hope that there will be teeth to the findings for Amos next year. But I also don't have a lot of faith that that is the case. I mean, we are still here talking about this and nothing has changed since I published my own report in Parliament last year. Well, Michael, let's expand on that with your insights here because this is happening under Labor's government. But what steps did previous Conservative governments take to address? address these issues? Well, they certainly set up the three inquiries into Morecambe, into Shrewsbury and Telford and to East Kent. And these were

absolutely crucial and much wanted by the families in those areas because it allowed them to get the answers to the questions that they had been raising in some cases for many, many years. And these were really, really important for the families. I think it's fair to say, however, that whilst they were important for the families involved, they did not change the dial on improving maternity care across England and I think there are a number of reasons for that crucially. There was

a failure by the previous government to pursue the implementation of the recommendations. And so if you look at what happened in Markham Bay, for instance, there was recommendations come out of that. Then Markham Bay was effectively left to mark its own homework and there was no

oversight from ministers or from the NHS system in terms of pursuing it. I remember the day after the Shrewspirit report came out, there was a Conservative of Health Secretary at the time who said we will go after the people that were responsible for this harm and to my knowledge and I am willing to be

corrected if I'm wrong. I don't think anybody's been held accountable for what happened in Shrewsbury and that's when we get back to the accountability point I made earlier on as a lot of families are saying you can't simply keep telling us what the problem is you have to A, change it and B hold people responsible because they

believe that only if you hold people responsible will meaningful and sustain change happen And a lot of people say that comes from a grassroots level, that comes from a cultural change. I want to say thank you to the midwife who's just sent us in a message because sometimes it's really hard to hear from midwives about their struggles because they're scared of speaking out, let's be honest. And here's one who says, I am a burnt out midwife. I'm currently off work because of this.

There are not enough midwives, no jobs for newly qualified midwives being offered. I work for a trust, I feel has a good ethos culture and provides good care. but how can this be provided when midwives are valued and certainly not paid enough for the work and responsibility they hold? And I want to expand on that with this statement from the Royal College of Midwives that says midwives are committed to safe, compassionate women-centred care but chronic understaffing and inadequate resources are undermining their ability to deliver it.

So we know that efforts are ongoing to recruit more midwives, to train more midwives. But I've had conversations with midwives who talk about a hierarchy within the system that makes them voiceless, so that when they do have concerns, they often struggle to voice those concerns. I wonder what you both think. Theo, come on in here.

Well, firstly, and thank you for reading that comment out from the midwife. I think it's important to say that there are some fantastic midwives out there doing very good care today in the NHS. But it's also fair to say that there are some very bad examples. I mean, I came out of surgery in hospital, was left alone with my baby who I couldn't pick up after surgery. And I pressed the call button. and the NHS person who was meant to be looking after me

came in and said, not my baby, not my problem, and walked out and left me there. So there are also examples of really shocking care. So I think we're right. We need to be looking at the culture within the NHS and I do think there is a point about training for midwives. But a lot of the stuff we're talking about is actually not even requiring extra additional funding.

I mean, some of the examples of stories I heard were really basic things like mum's not being offered at a glass of water, being told when they've had a C-section to go and water, to the canteen and collect their own food when they've just come out of major abdominal surgery. Those are not things that require additional funding from the government. They are about compassionate levels of decent care. But I do think the government has a choice. Do they want to invest in maternity care?

And they should. And I find it really shocking that maternity negligence compensation claims are in fact larger than what we spend on the frontline on maternity care. So let's just think about that for a moment. That is mothers who are having to sue their hospital for poor care, during or post-delivery of their baby. And in fact, if we were able to reduce the level of things like vaginal tears being misdiagnosed or missed and mothers being sent home and having to come back to A&E with their newborn baby

and then discovering they've actually suffered at a third or fourth-degree tear, which will be a lifelong changing injury, then in fact the government would have more money to put back into frontline maternity care. And I'm also concerned that this reflections today is only about NHS England. What about the rest of the UK? I have mothers writing to me every day on my show, breaking the taboo, to say, we live in Wales or Scotland or Northern Ireland with incredibly long distances to get to access mental health services, they don't have access to women's health hubs. And so how do we have a comprehensive approach to the whole of the United Kingdom? And I do think it's a problem that we just have guidance and a lot of the things are not mandatory.

So we need to have a national standardised approach to paternity care in the UK. And quite frankly, that is not the case at the moment. and these reflections today do not deliver that. Michael, there is an announcement from the Health Secretary for a separate national maternity and neonatal task force. How would that differ from what we're seeing here? Is the million dollar question. Well, thanks so much for that one.

This task force is going to be charged with enacting the recommendations that come out. Principally, his role is going to be charged with enacting the recommendations that come out of the Amos Review in the spring. And that when you speak to Barron, Amos is why she thinks of this review that she's conducting at the moment is going to be different because the health secretary himself West Reading will chair that task force

and according to her and according to him he has determined that in two or three years' time maternity care in England will be much better and that will be the crucial test of whether this was the right review or not or whether this was the right approach or not. One thing I think it's important to point out

is that we are talking about poor maternity care because it matters but I think for pregnant women out there at the moment who are listening to this, the overwhelming likelihood is that they will have a safe birth and that they and their child will walk out of a maternity unit as happy

as the day is long. And I think we always need to remember that. The problem we are talking about is that too often it doesn't go well and there are reasons for that not going well and there are things that lots of people believe can be changed to ensure that more and more women and families

are walking out of maternity units with that happy bounding baby. Thank you for sharing that really important point about maternity, safety and pregnant women, the likelihood of their babies being born safely is far, far higher than any negative outcome. Thank you both for joining us, Michael and Theo. I'll just read you here the statement from the Health and Social Care Secretary West Streeting who says, I know that NHS staff are dedicated professionals who want the best for mothers and babies and that the vast majority of births are safe,

but that the systematic failures causing preventable tragedies cannot be ignored. Harmed and bereaved families will remain at the heart of both the investigation and the response to ensure no one has to suffer like this again because every single preventable tragedy is one too many. Please do keep your messages coming in. I will try and read a few more throughout the course of the programme. But next, we are increasingly hearing about the benefits of strength training for people as they age. Now a new report is shedding more light on the crucial rights.

that strength training can play for people who are on weight loss drugs. Around 2.5 million people are using GLP-1s or weight loss jabs in the UK. For many, they've been called game changes in tackling obesity and related illnesses. Data

gathered by the fitness company, Les Mills and the not-for-profit fitness industry body UK active shows that the impact that weight loss drugs can have on our body's lean muscle mass, that is the mass of everything in your body except fat, that That can be worrying.

Their report says that 20 to 50% of weight loss is lean body mass and this poses significant health risks, but muscle loss can be countered by strength training. Lots to unpick here. Let's speak to Lucy McDonald, a musculoskeletal physiotherapist who specialises in muscle, joint and bone problems and GP, Dr. Sarah Jarvis. Welcome to you both.

Thank you very much. Lucy, I'll start with you. How do weight loss jabs impact muscle mass and strength? Just like any cause of rapid weight loss, it not only, you end up not only losing weight, not only losing fat, but also muscle. So it will occur if you're on a diet and not taking the weight loss meds or if there's another cause of reduction in appetite or say, for example, cancer treatment or anything where you're suddenly losing a loss of weight. you'll lose both fat and muscle. And are women more vulnerable to this kind of muscle loss whilst on these weight loss injections more than men?

As a complicated answer to that, because we have a lower proportion of muscle mass anyway. So that's in part why we carry more, why we find it more difficult to lose weight potentially because we find it more difficult to build muscle mass. because, for example, we have lower levels of testosterone. So in a way, yes, in diarrhea, yes. Sarah, I'll turn to you.

Why is losing muscle mass such a serious health concern? Oh, it's a hugely important health concern. And what we're seeing, particularly as people get older, is that the more muscle mass you've lost, the greater the risk of falls. And, of course, we know that falls could be associated with fractures and even if they're not, they are absolutely linked to lack of independence, to losing your independence.

And we cannot underestimate that. Now, what we're seeing with the GLP ones is that in the studies, people were given lots of advice on, for instance, exercise on protein intake as well as resistance training and so on. But of course, what we're seeing in real life is that that's not happening. And that's what really worries me about the difference between these studies which are, you know, very much what a drug can do and the real life, which is about what a drug does do. And particularly because now so many of these weight loss drugs are being given privately, which means that we don't have the same degree of control over what advice people are given. And so as standard practice, if you were offered these resources, these drugs within an NHS GP surgery, what?

What advice is offered to women when it comes to strength training and taking these drugs? So the first thing we need to point out is that it's great that these drugs are now sometimes available through GP surgeries. Until June this year, they were only available through what we call Tier 3 weight services. Now they're sometimes available, but to put it into perspective, by 2028, as we gradually ramp up the number of people who will be eligible for these drugs, it's estimated that there'll be about 220,000 people who'll be eligible out of about 3.5 million people who should be eligible according to what Nice the National Institute of Health and Care Excellence says. And that means that of perhaps 1.7 million people

who are taking these drugs, the vast majority over probably about 1.6 million, are getting them privately. Now, if you went into a tier three weight service, then they've got all the bells and whistles all associated. They've got physiotherapists. Fantastic. They've got advice on protein intake. They've got advice on how to reduce your portion size and how to maintain, how to stay on these drugs. What we're regularly seeing and what the real life studies of what's happening out there in the real world show is that people aren't. I mean, I've had people who have come in and said, you know, oh, well, I can still afford the weight loss drugs because I've given up my gym membership.

That is the worst thing you can do. Well, that leads me nicely onto the many messages that we have in for both of you who are looking to tap into your expertise. This message says, I'm a 75-year-old woman. She regularly weight trains at the gym and she says, I love it. It's improved my strength and my positive outlook. However, I have just discovered a small hernia. I don't intend to stop, but I now.

have to modify my training. And a question also about the intensity of weight training. This person asked, I am a 49-year-old female. I don't enjoy strength training. So contrary to what we've just heard from our previous message. But I do assume a lot, though, will that suffice? Maybe Lucy, you can take those questions. Yeah, sure. The first one, that's brilliant. We need more and more stories like that. And I certainly come across plenty of very fit older ladies who are very strong, which is brilliant. With any kind of exercise comes the risk of injuries. And the great thing about your listener is that they have said

that they're going to modify their routine rather than stop. And that's really, really important because a lot of people may, with the first sign of injury, might just entirely stop their program for fear of making it worse or other injuries. So that's a really important component to modify and then progress and build up from there. And then, yes, I would say the vast majority of us, strength and conditioning training isn't top of our list of fun things to do. So the best thing to do is to do it with friends. I mean, as women in particular, we really do research shows as well as I'm sure all of our personal experience that we're much more likely to exercise if we're with friends.

friends. So joining a local community group or getting a couple of mates together and, you know, going around to someone's house and, you know, working at in the garden or whatever, that's the way forward. We're more likely to do it and we're more likely to stick to it. And with all these things, consistency is key. You know, everything from a bit of solidarity on the days where you're feeling, you know, pretty low motivation. And then on the other side, you know, a bit of healthy competition never goes Australia. I couldn't agree more. I do one such class on a Monday and honestly

it makes me cry and laugh in equal loads because it is so intense but watching all of us crumble at the same time there's something joyous in that isn't it? You're not alone. Sarah, come on in here. No, I would absolutely agree with you and funnily enough you may be going to the same class

I was at last night. Well, we all laughed and crumbled because we were trying to do our exercises while wearing funny Christmas headpieces. Oh, very However, the only thing I would add to that is that if it's difficult for you to do it with somebody else, and I know that for many of my patients, you know, they don't necessarily have that many social engagements and so on. If you can do it, something that becomes part of your routine. So, for instance, if you think about resistance training, you know, whether it's using resistance bands or using small weights,

I use resistance weights when I'm out walking my dog or when you're out for a walk and you can actually use them. another friend of mine uses her dog lead and she does the sort of, you know, strength training and flexibility training going from front to back, moving her arms over her head, that sort of thing. It's really, really easy

to build that into something you're already doing. Now, we know the theory is that it takes a month for habit to get built in, but actually what we see, sometimes it's less than that, sometimes it's a lot longer than that. But if you tag it on, If you have it to stat, if you add it to something you're already doing, it makes it much easier.

So, you know, if, for instance, you go out for a walk every day, put your resistance bands or your lightweights in with your keys so that when you leave the house, you don't forget to take them, and then you will do it. And either that or doing with a friend, I entirely agree about doing it with a friend, is really important. The importance is consistency. That's really good advice. Sarah, I also want to ask you about how menopausal women respond to weight loss jabs in terms of muscle retention. So we know that when you get to the menopause, you sadly are much more likely to lose more weight. We know that the lack of estrogen in the body, as the eastern levels in your body drop, it has a fundamental impact on your body. We've already heard that women, unfortunately, have less muscle mass. They also, sadly, as a proportion of their weight, have more body.

fat. And unfortunately, as I can attest, that body fat increases when you reach the menopause naturally, even if you don't gain weight. But that doesn't necessarily mean that you need to give in to the inevitable. It doesn't necessarily mean that you need to accept that you're going to gain weight and so on. It just means that you need to pay that much more attention to a combination. And it's not just resistance exercises. Resistance exercises are really really important. These are exercises that push individual muscle groups but aerobic exercise of course is also a really generally good idea.

Julia's been taking your advice. She has messaged in to say I don't drive so I walk everywhere and carry my own shopping and this is my exercise as I lack the motivation to exercise in the normal way and that's important isn't it because not everyone enjoys going to the gym. Oh it's huge. Yeah it's a really important point. You do things that will fit in with your life So make a vow that you're going to walk up the stairs. You're not going to take the lift or the escalators. Make a vow that you're going to park at the far end of the car park.

Get off the bus one stop earlier. All these things will add up. Now those are, of course, aerobic exercises. And we do also to maintain body muscle. We do also, especially, sadly, as we reach a certain age, need to do those individual muscle strengthening exercises too. but you know you do need to bear in mind that you know resistance training is pulling or pushing against the resistance of an object and that could be your own weight that doesn't we don't need to be doing heavy weights we don't need to be building up lots of muscle and indeed I would say from the point of view of continuity that it's actually better to be doing light reps or resistance training that you can do more repetitions of light weights more reps I love this message from someone who was teaching 10 to 15 cardiotype clatters a week, but says I hate the gym, I hate lifting weights. I decided at the age of 61 to

take up pole fitness. I've never looked back. My flexibility is out of this world and I can't recommend it enough. Not only will your body change, but you find peace and confidence walking about in a bikini. Thank you so much for your message. Lucy, I'll leave the final word to you, to those women who are still reluctant to take up exercise, who might not understand that weight loss alone doesn't equate to good health. What do you say to them? You can, just to add on to what Sarah was saying, really, just that you can be creative at home. So if you're, often if you're taking the weight loss meds, you might not feel great, you might not want to do a whole routine. So you can use things like a rucksack, stick a load of tins of beans in there or a casserole dish and put some packets of flour or whatever in there.

And then you can use those as weights. So you don't need to get fancy equipment. There's so many different ways of doing it. It's so valuable. You'll reduce your risk of injuries. Your things like symptoms of arthritis will be less, back pain less. There's so many advantages to doing resistance training. And, yeah, you don't have to go and join the gym bros in the local gym to do it.

Lucy and Sarah, thank you so much for joining us here on Women's Hour. Do get in touch on what you've heard at BBC Women's Hour on. any of the subjects that we are covering today. Like Gillian, a midwife who has written in to say maternity care is unaccountable and sometimes uncompassionate or negligent because too often there is no actual relationship between staff and mothers or families. A service delivery model which promotes continuity of care where a woman is cared for by a known person is the way of addressing all the problems that have been mentioned.

Thank you for getting in touch. And I still stress that if you have been impacted by what you heard in our conversation about maternity care, then do go to the BBC Action Line website where you'll find links for further support. Please do keep your messages coming in. Now, Nurse Sandy Peggy, who objected to sharing a female changing room with a transgender doctor yesterday

won part of her employment tribunal against NHS 5. Sandy Peggy was suspended from her job after she confronted Dr Beth Upton in 2023. The tribunal ruled that Ms Peggy was harassed by NHS, but other allegations of discrimination. and victimisation were dismissed. David Henderson, BBC Scotland's news correspondent has been following the case and joins me now. Welcome, David. Can you just remind us of the background to this high-profile case?

Well, this court case has been very controversial and a long drawn-out legal battle. Back in 2003, Sandy Peggy, who was a nurse of 30 years standing, refused to share a woman's changing room with a transgender colleague, junior, Dr. Beth Upton. Dr Upton was born biologically male but assumed a female identity in 2022. They had a confrontation in the changing rooms of the hospital where they both worked on Christmas Eve that year. It prompted a complaint from Dr. Upton. Nurse Peggy was suspended from work. She then faced a long drawn-out investigation and she went on to sue her employers, Fife Health Board, as well as Dr. Upton, in an employment tribunal.

case has been heard in Dundee in court over the course of this year. It went on for 20 days of evidence gathering. It was watched around the world as Sandy Peggy's legal team really took NHS managers to task over how they dealt with her case. It saw medical staff and managers put under intense pressure about their handling of the case about how they balanced or rather didn't balance the rights of the two people involved. And it produced scenes of high drama and you can't always say that about employment tribunals simply because of the issues involved. And so in this written judgment yesterday,

what did we exactly here? Well, the tribunal ruled that the health board had harassed Sandy Peggy in a number of ways. When she complained to her employers about Dr. Beth Upton, the tribunal found that health managers should have acted differently and the NHS should, it says, have stopped allowing Dr. Upton to use those changing rooms until different work rotas took effect, at which point, in effect, they wouldn't still be working together. After she was suspended, the Health Board took months to investigate the allegations against her. This, they say, was an unreasonable time and amounted to harassment. When she first learned in March 2024, that's months after her suspension of a series of unproven claims that she'd put patients at risk,

this too, says the tribunal, amounted to harassment. And at one point, she was instructed not to discuss the case at all, although later this order was relaxed to apply only to the investigation. And this says the tribunal was harassment. Now, she has not succeeded in other legal claims she made against Dr. Upton and against Fife Health Board. But Sandy Peggy is likely to see this as a win because she took on her employers, she hauled them through the courts, and she's proved their treatment of her was unfair, and it will surely mean big changes to come. What response have we had from an HS5? Well, they have issued a statement saying that they're looking at it. They recognise they say that this has been a complex and lengthy and lengthy process and they acknowledge

the careful consideration of the tribunal. They do say that the tribunal unanimously dismissed all of Nurse Peggy's allegations against Dr. Upton and all of the allegations against the board, apart from four specific aspects of the harassment complaint. And they're now going to look through the detail of this judgment, which is 300 pages long, to try to understand what it means. They have, though, probably to be quite careful about how they respond at this point and what they say, because there will be more legal action. Nurse Peggy has not concluded her action against NHS 5.

Their chief executive has also in the last few weeks said that she will step down. She appears has authorized a statement put out at the height of the case which made allegations against Nurse Peggy's legal team. So because they're facing another raft of cases from Sandy Peggy in the coming months, they'll have to study this judgment. And now, as they say, ensure that NHS 5 remains a supportive and inclusive environment for all employees. David, what are the wider implications here of this case

in terms of single-sex spaces, considering the Supreme Court ruling that the legal definition of a woman is based on biological sex? Yeah, it's pretty complicated, but I mean, the first issue that they looked at, the main issue really was can a trans woman use a female changing room? And according to the tribunal,

the answer seems to be yes, but that depends how colleagues react when they have to share that space. The tribunal says that on this front, the law is a grey area, that it's neither legal nor illegal for a trans woman to use female changing rooms. It only becomes an issue, they say, as in this case, when a complaint is made, and then employers, it seems, have to take action. Because now we know, Sandy Peggy was entitled to complain in a reasonable way.

It's not to be treated as necessarily bigoted or illegal or a sacking offence to speak out. Instead, they made clear Nurse Peggy was entitled to complain to her manager, and at that point, the tribunal says NHS 5 should have stopped allowing Dr. Upton to use those changing rooms until their rotas changed, and they stopped working in the same place. Last night, Sandy Peggy's lawyer added to that, saying that women basically have to actively complain before their rights to a single-sex space kick in. Where this is complex is it also overlaps with that Supreme Court. ruling earlier this year, which focused on the key part of the law, on the rights of women,

the Equality Act of 2010. Now, that ruling made clear that a woman means a biological woman, based on sex at birth, not gender identity. We're waiting for detailed guidance from both the UK and Scottish governments on how this will work in practice. But it seems to make clear that employers, like the NHS or anyone else, can create female-only spaces like changing rooms which exclude trans women. And combine that with yesterday's ruling and where there seems to be going is that employers may look to take practical steps like creating individual changing rooms to avoid court action like this in the future. David Henderson, good to have you on Women's Hour. And if you'd like more on that story,

then there is plenty more at BBC News Online. Thank you. to those of you getting in touch with regards to the maternity conversation that we were having at the start of the program. Another midwife has got in touch, she says, as a third year student midwife who is paying 9,500 pounds to train to be a midwife whilst working 12 and a half hour shifts day and night, completely unpaid. The abuse starts here. Maternity is undervalued, underresourced and reliant on the goodwill and hard work of women to make it function. We don't need constant maternity reviews to tell us misogyny is that that that. heart of the issue. Thank you for your honesty and sending in your messages. 84844, if you'd like

to do the same. And a reminder that if you've been impacted by anything you've heard this morning, please go to the BBC Action Line website and you'll find links to support there. Next, if you haven't already found out about our new podcast on BBC Sounds, it's called Send in the Spotlight. And in the first episode, Nula is speaking to schools minister, Georgia Gold, and a range of parents and children about why the system is considered to be broken and what the future could look like. You can also see a video of actors Kelly Bright and Anna Maxwell Martin on the Women's Out Instagram fee

talking about the language of special educational needs and whether it's needed. I would love to go as far as saying I would like the whole terminology around special educational needs to change. I would just like it to be different educational needs. They just have different... Yeah, I feel the same. We've talked about this,

individual needs. Yeah. And then it's actually saying every single child, every child in our country deserves the right to thrive, be seen and thrive. Every child, they do want to contribute. We've got to stop writing off children so quickly. I agree. Yeah, let's remove special and make it individual needs or something, but something that says we all have value. You know, it's not even about inclusion we just all have value and you know everyone has value in their own way and and actually as parents this is one of the things for me that I feel is the fight is that as parents we champion our children to be who they are you are you no one else in the world is like you and that is wonderful and yet we put them into they're in this system which is trying to put them all

in a box and it just just doesn't work it just doesn't work Actors Kelly Bright and Anna Maxwell Martin there. In the next episode, we'll be looking at EHCPs, that is education, health and care plans. And we'll have a legal expert advising on how to approach applying for one. So if you're going through that at the moment and have a question that you'd like answered, please do email the podcast. The address you need is send at bbc.co.uk. And to find the podcast, just search for send in the spotlight on BBC sounds.

Subscribe and do start listening. It is time to talk about bows. They are everywhere, adorning the gifts under the tree, decorations on the tree, and increasingly on our clothes too, because the bow is having a fashion moment. From the catwalk to the high street and on social media fees, it seems impossible to escape oversized hair bows, high heels with bows on the toe, dresses, cardigans, jumpers,

embellished with lots of bows, or one large statement bow. How do you like to wear yours? You may have seen Kate Garroway's iconic white jumper adored with black bows on these everybody traitors recently, or caught Lily Allen's gold mini dress with a huge statement bow detail that she wore to launch her party, to launch, to her launch party rather for her new album, West End Girl. So is this a passing trend or are bows here to stay? I'm joined by Morrenner Ferrier, fashion and lifestyle editor at The Guardian and Dr. Sasha Grant, senior creator at the VNA. Welcome to you both. Thank you. Sarah, help us learn a bit more about the history of the bow, deep-rooted in 17.

17th century France. Yes. So the bow is essentially functional originally. It's to fasten garments before you have zips and things like that. And women in particular didn't have buttons and their clothing the way that men did. So they are to fasten clothes and to keep them closed. But it very quickly, because they're made from silk, they are a very luxurious accessory. They're a form of trimming.

And so they are used with profusion. And actually, Moena was discussing the Elizabeth I, Armada portrait where her, you know, where Elizabeth is shown kind of bristling, her bodice is bristling with bows, almost like a sort of political statement with the fleet, the Armada fleet and behind and behind her. But in the 18th century, they become particularly fashionable and particularly the second half of the 18th century under Marriott. You see this profusion of bows, you know, bows that are almost kind of dusting or sort of trimming every gown. And you have one bow which is called single contentment or perfect contentment. Yes, the

bow has a name. The bow has a name. Yes. So if you wear one bow, it's perfect. contentment. If you wear the ladder of bows, which again is sort of a classic style, that's called, you know, a ladder. But it's sort of there's a sensuality, there's a hyper sort of femininity, there's a sexuality to it as well because they flutter. They were made of the finest silk. They were woven in near Lyon in France, so the silk weaving center in France. So they really move as the woman moves. And so they draw attention. They draw the gaze to certain areas wherever the bows are. But, you know, they were made of this sort of very beautiful silk, but you also find them in jewels as well. So for instance, necklaces at this time, they didn't fasten

with a class. They were fastened with bows. And you find them in all the sort of decorative objects as well, decorative arts. You find bows a repeating motif. So it's the symbol of kind of romance and femininity as well, but also luxury very much in the 18th century. And then that starts to change as the revolution approaches. And you move away from this kind of very sort of Rikoko or high rococo style to a much more streamlined, much more minimalist aesthetic. And really the revolution kills the bow and that's the end you know it's worn by men and women the bow but then the revolution the carcade which is actually a form of bow as well it's a sort of a rosette which is a form of layered boats and it's not really until the 19th century when you have a french

revival in the 1850s that people again start to lean into indulge into this kind of huge amounts of the profusion of bows again and by this time you have mechanised ribbon weaving looms as well so the bow becomes much more democratic it's much it's much more affordable and accessible, a lot like the mass-produced that you see today, suddenly everyone can afford bows. Sarah, I'm amazed because I didn't realize the bow

had so much history and this depth and this storytelling capacity. Moena, it has a recent history as well, doesn't it? Strong women have worn bows. Yeah, I mean, I think that the bow has kind of been in fashion forever. It's just kind of come and

gone. It goes through cycles. It changes shape. I think The main thing is about the context. So, you know, obviously trends are kind of baked into consumerism to make us buy stuff. But I think if you look at the context and how the bows sit within that, that then tells us about where we are now. And the fact that kind of bows are, they're not kind of, well, Sarah's wearing bows now, which are great. But for the most part, they're often quite big and comic and ironic. And I think it's, you know, bearing in mind, these are kind of very blunt ways of symbolizing femininity.

And I think if they're worn in a kind of different way, dark colours, maybe not in an obvious kind of demure way, then they kind of change the idea of what it means to dress in the feminine way. So give us some examples. You've got Bridget Bardot, you've got Whitney Houston, you've got Madonna, Princess Diana, all donning their bows in different ways. Mini Mouse. Mini Mouse.

Of course. I think, I mean, you mean a modern day. Yes. I suppose in fashion, for example, two great designers, Simone Rocha, Sandy Lang, also, Cecil Bansson. And they wear these kind of – they would design these big kind of organza dresses that are kind of very feminine, quite kind of over-the-top silhouettes, and they would kind of whack these huge bows on them, sometimes to sort of tie the whole dress together, sometimes just kind of like in a quite over-the-top way, maybe they'd be cascading down the front. So it was kind of – for them, it was partly to do with Cecil Bansson would put them on her dress because the idea was that you could untie the whole dress with a single bow. So it kind of empowers the bow.

but also it's kind of it's not really sexy it's not really bows for the male gaze it's kind of a way of just subverting femininity I suppose Let's expand on that because earlier this year the Welsh rugby player Georgia Evans faced a barrage of online harassment for wearing her trademark big pink bows in her hair during the rugby World Cup

In response Georgia said The bows in my hair the tape around my arm the eyelashes and the full face of makeup that I choose to wear has no bearing on my ability, my passion or my fight for this game. I mean, what's your view, both of your views here, on where the bows are being seen as girly, maybe juvenile, compared to being an item of self-expression and empowerment? Well, I think all fashion is a form of self-expression.

I think it's a bad rap, but I think that's a means of communication. But I think there's an idea that women perhaps need to dress like men in order to be taken seriously. And I think in doubling down on that kind of high-hypemininity, you're proving that that's actually not true. You can dress like a girl, whatever that means, and still be, you know, successful. And I think, you know, I think pussy bow blouses is a good example of that

because that was kind of, they're not, they're quite different, but they are... It's like the power boo. It's the power boo, the power dressing boo. Yeah, but they were kind of a symbol of kind of barrier crossing. And I think that there was an idea that you had to, if you were women in politics, you had to dress like a man to be taken seriously, but then you'd wear a pussy bow blouse just to remind people that you were. were still a woman.

I don't, for that reason, I'm not a fan. We've established this morning that Muenot is anti-booy, actually. She's anti-bo. Yeah. What's your maker's son? Because you are wearing a bow on your wrist. Sarah, let me a bow. Oh, she lent you the bow. Yeah. I don't. I'm embarrassed not of a bow one. I don't have ones. Maybe you need to lend me a bow as well.

I'm awash with bows at home. I have to say, because I've got a little girl, so I've got bows everywhere in the house. But you clearly love them too. You're wearing them beautifully now. How do you wear a bow well? Well, I think it's interesting to hear what Moena was saying, because I think there are power bows, there are sexy bows, and there are feminine bows, and there are ironic bows. And I think some of the oversized bows that you wear, you know, you're almost kind of making fun, you're almost mocking slightly that's sort of the bow. So I think it's how you wear it. It's the size of the bow as well. I mean, I think certainly in the 18th century, as I said, it's a sign of luxury. It's a sign of sexuality as well. Whereas now it's taken on more in association with little girls and kind of, you know, almost an innocence, actually. And I think about, actually, I often think about this. are of Russia, his children, how they always had those bows in their hair and you always see them in these black and white photos.

But I, so I wear a pose in an understated way. I mean, I think I was just saying I would never wear a bow in my hair. I feel like... Oh, I do. I love a bow in my hair. You do. Well, there you go. And let the print one I have. That takes confidence, I think, to do that. Because it is, there is something, it's so

redolent with kind of, with symbols the bow and so many different things that you are definitely saying something when you wear a bow is a statement. And I think you know, I think about the 1920s as well, which personally I love, which again are these really large, oversized witty bows. So they're sort of, you're not necessarily

3D, they are sometimes woven into the fabric. Thinking about the famous Scaparelli bow jumper, for instance, there was a kind of a major trend and women wearing massive bows across their kind of big evening gowns as well. I mean, I think, so it's very much how you choose to wear it and how you style it. And I think Moena and her article as well mentioned

this association with Disney, the Disney sort of bow as well, this kind of fairy tale sort of, character bow as well they're so it's so rich yeah it feels like the easiest way to sort of to sort of show that you're a girl is to stick a bow on you like mini mouth with a bow on her head she looks like Mickey but she's got a bow on head and that's kind of the main difference yes yeah um

but I think the interesting thing as well is is sort of men and bows because that's been I mean like that's been a kind of mainstay of the red carpet for example for the last sort of almost probably 10 years um and it's kind of you know it's it's comes from high fashion um putting you know

Harry Stiles wore a dress the cover of Vogue and like Gucci put a lot of men in pearls and things like that and but it's quite normal almost to see a man in a in a bow on the red carpet and I think there's something quite fun it's kind of that sort of it's kind of I don't know flout the binary I suppose in a way by by showing you don't have to dress in a certain way but obviously men it did wear bows originally yeah so their so their breeches were tied with bows they wore bows and their wigs as well their cravats were tied in a bow so the bow was not a feminine necessarily accessory in the the 18th century and that is a later evolution. You've had 20 seconds each or 20 seconds in total

to tell me your top tips of wearing a bow well this season. Go big or go home. How can I top that? I don't think I can top it. Yes, I mean, you know, imagine yourself as a big present waiting to be unwrapped. That's my advice. There you have it. Sarah granted, Moena Ferrier. Thank you so much for joining us here on Women's Hour. And thank you for your many messages that have been coming in. I'm going to end on a positive. This one says, I still have a 1980s little black dress with two large pink tartan bows on the side. It was all the rage. Thank you for your message.

I'm sure they're just as classic now. And this one on the subject of exercise and strength training, Women's Hour Radio 4, I brought half pound wristbands and I wear them when I am walking and they give me resistance. I don't feel them. They are excellent. Well, keep it up. Thank you for all of your messages. And to all of you listening, thank you for your company.

And do enjoy the rest of your day. Thanks for listening. 20 more from Woman's Hour over at BBC Sounds. Hi, I'm Katie Razzle. And for BBC Radio 4 from Shadow World, this is anatomy of a cancellation. I'm a symbol of a particular time and an extreme version of cancel culture.

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