Woman's Hour - Weekend Woman’s Hour: Bishop Rose Hudson-Wilkin, Corridor care, AI & IVF

Episode Date: January 18, 2025

The Right Reverend Rose Hudson-Wilkin, the Bishop of Dover, is a trailblazer, who has been right at the heart of a changing nation for over 40 years. Despite discrimination due to her gender and ethnic minority background, Bishop Rose has never wavered from the call she received to enter ministry at the age of 14. She joined Nuala McGovern to discuss her memoir, The Girl from Montego Bay.A Royal College of Nursing report, On the Frontline of the UK's Corridor Care Crisis, which came out this week, found that the situation in A&E is the worst it has ever been and that a lack of hospital beds means corridor care has been "normalised". One nurse described caring for a 95-year-old woman dying with dementia who had spent eight hours lying on a trolley in a crowded corridor next to a drunk person who was vomiting and being abusive. Others describe women having a miscarriage in side rooms. Professor Nicola Ranger, Chief Executive of the Royal College of Nursing joined Anita Rani to discuss what is going on.Holly Bourne, bestselling author of How Do You Like Me Now? and the Spinster Club series, is back with So Thrilled For You, her most personal novel yet. It’s a story about four friends navigating motherhood, career ambition, and societal pressures, all unfolding during a sweltering summer’s day at a baby shower. Holly joined Nuala and explained what inspired this book. Can AI improve the success rates of women undergoing fertility treatment? Anita discusses the impact of AI on IVF with Dr Cristina Hickman, an embryologist, co-founder of Avenues, and Chair of the Global AI Fertility Society, and Dr Ali Abbara, a Clinician Scientist at Imperial College London, and Consultant in Reproductive Endocrinology at Imperial College Healthcare NHS Trust.Hermine Braunsteiner was the first person to be extradited from the US for Nazi war crimes. She was one of a few thousand women who had worked as a concentration camp guard and was nicknamed ‘the Mare’ by prisoners because of her cruelty; she kicked people to death. In 1964, Hermine’s past was unknown: She was living a quiet existence as an adoring suburban housewife in Queens, New York when she was tracked down by a reporter from The New York Times who exposed her past. Angharad Hampshire, a Research Fellow at York St John University, joined Nuala to talk about The Mare, her novel based on Hermine’s life.The all-female, Welsh-language, post-punk trio Adwaith are the only band to have won the Welsh Music Prize twice, for their first two albums. They are about to release their third album, Solas, all about returning to their hometown in Carmarthen. Band members Hollie Singer, Gwenedd Owen and Gwen Anthony performed live in the studio. Presenter: Anita Rani Producer: Annette Wells Editor: Rebecca Myatt

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. Welcome to Weekend Woman's Hour with me, Anita Rani. On today's programme, a woman that some say could be the next Archbishop of Canterbury, the Right Reverend Rose Hudson-Wilkin, the Bishop of Dover, on her extraordinary life. The author Holly Bourne, whose new book follows four best friends who find their relationships on shaky ground as children are introduced to their lives. Also, a report out this week surveyed 5,000 nurses in the past four weeks

and revealed some shocking truths about their experiences within hospitals, particularly in A&E. And the novel based on a horrifying real-life story of a woman who was a guard in Nazi female concentration camps. It explores how an ordinary woman could descend so quickly into evil. And music from the post-punk band Adwaith, who sing in their native Welsh. Lots to get through, so let's begin. The Right Reverend Rose Hudson-Wilkin, Bishop of Dover, is a name you might recognise. She's been a trailblazer throughout her life, from staging a protest on the roof of her church in Hackney to being consecrated as Britain's first black woman bishop in 2019. Now she's written a memoir, The Girl from Montego Bay. It tells of her

childhood in Jamaica, the call she felt to enter the ministry and the subsequent discrimination she faced due to her gender and the colour of her skin. Rose joined Nuala in the studio and Nuala started by asking her, might she be interviewing the new Archbishop of Canterbury? It cannot be me. Why? It cannot be me. I don't know why. It just cannot be me. Absolutely not. I have no such desire. And, you know, my desire is to share God's good news with those around me. I have a passion for the gospel of Jesus Christ. I want to tell everyone what God is doing about the goodness of God. That makes my soul sing.

My soul does not sing sitting in a boardroom in discussions with people who don't want to be led. My soul does not sing being in a space with people who simply want to play games about whether I am fundamentalist, I am conservative, I am Anglo-Catholic. I don't play those games. So I could never possibly be in that space. I might come back to it. But, you know, this is Woman's Hour and reading your book, you have had part of your career alongside Bishop Gulli Francis de Caney, another woman who is also a potential contender. I mean, do you have any thoughts on whether the

next Archbishop of Canterbury could be a woman? I think the next Archbishop of Canterbury could be a woman? I think the next Archbishop of Canterbury should be whoever is laid on the hearts of those on the Crown Nominations Committee, which is the committee which was charged with that responsibility, will not be sitting there thinking, great, I get to choose someone in my image now. I think they ought to be on their knees constantly in prayer and seeking the will of God, not their own will of what they think, but what does the Spirit say. But I do want to move on. Sure. Because you are the girl from Montego Bay and you have written your memoir. How was that process, looking back and seeing the life that you have had from this young girl who had a difficult upbringing with biological parents that weren't there for you in the way that you have had from this young girl who had a difficult upbringing with biological parents

that weren't there for you in the way that you wanted them to be to this moment? It was challenging, harrowing at times, difficult, painful, sad. But in that, my faith discovered something more than the experiences that I had. It was for me learning that I was loved by God through my reading of scriptures and actually through the people connected to my church, people of faith themselves, extending that love. And I remembered at that point thinking, my goodness, if this great big God, you know, this omnipotent being thinks that I am of value, then I must be of worth. Then I cannot just live as if I am the abused girl that people think is of little value. Because you had this difficult upbringing with abuse, assault at times

as well. And you very much bear your soul in the book by telling those stories. And I wonder why you decided to include all aspects, even child sexual abuse, which I know you hadn't spoken about for much of your life. Do you know, I hadn't even thought when I began writing the book, that was not going to be part of the book. And it's not because this was hidden. It was simply because I do not live my life as a victim. You know, I am nobody's victim or nobody's survivor. I am a child of God. And so I live into that light. And so it wasn't until I was asked to do a speaking engagement with the WI. And yes, the Women's Institute. And when I sat down with my staff in the office, you know, going through what I was going to be doing that week, they said, oh, you know, when you go there, they don't want you to speak about anything religious. And I remember at the time thinking, how odd, you know, how odd

that they should ask a bishop to come and speak to them, but not to do anything religious. Never thought anything else of it again. And then when I arrived at the venue a couple of days later, the person who met me at the car, at least two or three times before we, as we were walking into the venue, sort of nervously said, oh, please. And, you know, nothing, nothing, nothing religious. And by then I'm thinking, oh, I'm a bishop. That's what we do. Anyway, so I went in and I thought, you know what, I'll just tell my story. I'll talk to them about my story. I'll tell them I'm writing a book. And it was in the process of telling, sharing my life story with them that this, you know, at that sort of age, this came up.

And I just paused and then said to them, you know, something has just come up. And, you know, I hadn't even thought of including it in the book. But, OK, I guess I'll share it with you. And I told them. And then they said, but how is that possible? You know, there you are. You are all together. You don't look and appear as if you've been through any of that. And so the faith that they didn't want to hear about, they got to hear about it.

Because, you know, I have no other explanation as to why I am who I am today, but the fact that God's grace and why I am who I am today. And you became the first black woman bishop in Britain in 2019. You said you felt imposter syndrome. I imagine you've got over that by now. But, you know, reading your story, it was gobsmacking the racism and sexism that you came up against. Do you mind telling our listeners a little bit about that? is that people are, they live a certain ignorance that says you can't possibly be intelligent or you've got to be less than I am, either because you're a woman or because you're black. And so those, for example, who says, I don't want you to do my family member's funeral because you're black or because you're a woman. I had someone once who said to me, you know, my mother didn't like women priests and she certainly didn't like black people. And when we asked for you to be the priest, you know, we didn't know at the time that you were black because I don't necessarily sound black, whatever that means.

And he said, you know, we got to the crematorium and you came and stood there. We knew we were risking the woman thing, but you stood there. And we went, oh, expletives in the car, he said. And he said, my brother says mother is going to turn in her grave. But he said something else. He said, but, you know, you did such an amazing funeral that when my wife died subsequently, I just had to have you. So people are willing to have their thinking changed. And that's a good thing. But as you wrote, as women

you can cope. We can afford to let you but as a black woman you don't have the option of being mediocre or second best. That pressure I thought consistently to never be able to be, I don't know, a little

off your game someday. It is always there my sister. It is always there because you know, I don't know, a little off your game someday. It is always there, my sister. It is always there. Because, you know, I know that I want black people, people who look like me, to come after me in this role. I actually want people to stop saying the first. Because if you're still saying the first, it means that I have not been accepted as normal. And it also means that hundreds of other black women are being told no, no, no.

And that's not right. So, you know, I want to live in a society, and I want my children and my grandchildren to live and grow up in a society where they are normal, seen as normal, treated as normal, accepted as normal in this society. I'll throw two more in. Black woman, wife, mother. You said in some ways that could have stood in your way to ordination. It could have. But I remember being told, you know, ought you not to be at home looking after your husband and your daughter?

And my instinctive response was, my husband is perfectly capable of looking after himself. I also remember in the book, I loved this, that you said you overheard your husband at one point saying that he was babysitting. And you're like, dads don't babysit, it's their children. And that a mother would never really say, I'm babysitting tonight.

You know, we just do that. We just do that. I also like the couple's advice. I'm going to throw this out. That you should figure out the irritation points as a couple and then do less of that for a successful marriage. Amen. Amen. That's your advice.

It is. And I practice it. I practice it. It really is important, you know, because when you have been in a relationship with someone, you get to know what the other, what rubs the other person up the wrong way. Yeah, yeah. And, you know, and you love them. So why do the things that rub you up the wrong way? Just love each other, you know. And my life is about love. It is about forgiveness. It is about compassion and reaching out to others. And that's at the heart of my Christian faith and the faith as well. The right Reverend Rose Hudson Wilkins with statement earrings, of course, today.

That's part of the look, right? I love my earrings. I feel naked without them. I have been known to have forgotten my earring and think, oh my God, I've got to get to a shop, I've got to buy, or can I borrow your earrings? I can relate. The Right Reverend Rose Hudson-Wilkin, and you can listen to the full interview by going to BBC Sounds and selecting Monday the 13th of January. Now to the testimony of over 5,000 nurses who have shared their experiences of the realities of the job in a Royal College of Nursing report that came out this week. It found that the situation in A&E is the worst it's ever been and that a lack of hospital beds meant corridor care has been normalised. One nurse described caring for a 95-year-old woman dying with dementia

who had spent eight hours laid on a trolley in a crowded corridor next to a drunk person who was vomiting and being abusive. Others describe women having a miscarriage in side rooms. Last week, more than 20 NHS trusts declared critical incidents as high levels of flu and the bad weather put huge pressure on hospitals. Now, of course, the vast majority, nearly 90% of nurses are women. Well, Professor Nicola Ranger, the Chief Executive of the Royal College of Nursing, joined me and I asked her why she wanted to conduct this research.

It was a very difficult decision to make actually. We could start to see that post-Covid, patients being put in places that they previously wouldn't have been. We've always had winter pressures. It's always been difficult sometimes in the winter, but sometimes a bed would be open in a place that it shouldn't be for 24, 48 hours then close back down again. But what we've started to see over a gradual period of time that these inappropriate places are becoming more and more the norm. There are nurses in this report that talk about those escalation areas being open for two years. And as a college, we started to see, and we called this out in June of this year to say, come on, this has to stop. And I went to lots of hospitals over the

summer and I saw extra beds in places they shouldn't be. And increasingly, this is becoming very, very difficult for patients, shocking, but increasingly for a profession that actually really are the ones that can't walk away. I'm not saying that other people in hospitals and in places don't matter, doctors, physios, OTs, but they can move from patient to patient. Nurses are the safety critical people who are there if you need care, if you need a safety intervention. And for them to be working in those environments is becoming increasingly hard for them to do that. So we said, tell us what you think. And we opened it just before Christmas and closed it in January. We didn't think as many people, when they're in their time off off they want to be with their families and friends

they would do our survey in the volume that they have and also in the heart-wrenching way that they've told their story and we decided not to edit it not to cut things out well it's for use their words yeah 400 pages of testimony can you give, yeah, you've got it in front of you there. Can you give us some specific examples that really shocked you? There were really some very heartbreaking moments. Key themes that talk about oxygen and suction and people sitting in people's chairs, that's because nurses are responsible for the safety. And they absolutely talk about how difficult that is in the environment they are. But the real harrowing bit to read is the human side. It's watching people at the most

vulnerable times in their lives, not being able to give the care that they know they would want for their own family member. And one nurse very simply describes that she walks through her department and keeps her eyes down because she feels so ashamed of what she's seeing that she doesn't almost want to make eye contact somebody else talking about the fact that they all the big stuff around trying to keep people safe and the challenge of that, but then describing almost the silent scream of an elderly patient who realised they're not going to get to the toilet on time. And it was that, that absolute lack of humanity that's made her hand in her notice after years of nursing

and say, do you know what, I'm out without a job to go to. That for us as the Royal College of Nursing is absolutely heartbreaking. And that's why it's of course about the patients, but it's also about the profession that looks after them. I'm just thinking about the nurse who couldn't make eye contact because of shame. You know, that's not her shame for starters, but also you can't do your job. If you can't make eye contact with a patient you're not doing your job a hospital in north london has posted adverts calling for nurses to apply for corridor care shifts due to pressure on the nhs which has been exacerbated by the winter crisis and and this report your report

says that you know corridor care has now been normalized i think we need to understand exactly what what you mean by corridor care so what that that means is, so when someone comes into an A&E department, sometimes if there aren't enough cubicles, they can no longer be looked after in the department. So they start to come out of A&E. So you'll start to see people kind of spilling out of the A&E department. But as the years have gone on, because the pressure in the A&E department, we've then started to say, well, let's put extra patients on wards as well. So if you think of a bed space in a hospital that's built for one bed, you can have the patient's locker, an emergency call bell, oxygen and suction, that's built for one bed. We're starting, we've seen an extra bed put in the middle of that

we've seen ward sisters offices made into a bed space so the pressure in A&E has spilt out to the entire hospital and actually what that means is that there's no emergency equipment there's no proper curtains there's no toilet facilities all of those things have a real, real impact. NHS England Chief Nursing Officer Duncan Barton said increasing demand has put extreme pressure on the health service over recent months and described this winter as one of the toughest the NHS has experienced. He also spoke about the extraordinary efforts from staff who are doing everything they can to provide safe and compassionate care. He mentioned the very difficult winter period. Is this just a tricky patch given the winter pressures we're seeing?

I think winter has always been there. But actually, I think it's bigger than that now. I think that there's no respite in the summer. As I said earlier, there are patients in inappropriate settings all year round. Listen, nurses have always worked in winter. They've always worked where it's been difficult. But what we're seeing is the impact of unprecedented care where there's nowhere to escalate to. If you've used all of your capacity because you've got no space throughout the summer, when the winter viruses come, there's no flex in the system so i listen and and you know i know many colleagues you know i've worked at very senior nurse level myself people will be trying to do their best this is not about a person failure or hospital failure or leaders there is

something that absolutely is this has to be a moment when everyone comes together to say, what are we going to do differently? This has to change. The Health Secretary, Wes Streeting, said he agreed the problem should not be tolerated, but laid the blame on the previous government. He said his ambition is to undo the damage, as he puts it, to the NHS. What's your reaction to that? I think there's no doubt, if you look at the objective data, performance in the NHS started to deteriorate in 2015, whether that was elective care, emergency care. So there's absolute truth in that. And we can see that actually we've got objectively, compared to other countries, we have less hospital beds and we have less hospital staff.

So there is something absolutely right around the legacy that they've inherited. This is a symptom of not having enough community care, not enough social care, not enough hospice care. But there's one thing we haven't heard from this government actually, is all of those things, they all require staff. And the largest workforce in the NHS is nursing staff and we have an absolute recruitment and retention crisis in the UK. So what's the solution? We have got to look at conditions so this is all about patient safety they're not proud we've got to work on on those symptoms to get their work life better we have got got to look at their pay. We have. We are objectively, on OEC data, we are 33rd out of 35th country for nursing pay compared to the rest of

the world. Do I think it's because we're 90% women? Yes, I do. So actually, pay, conditions, progression, and actually don't treat nurses like normal students they're not we now have to pay for the privilege of being a nurse professor nicola ranger there now as the best selling author of how do you like me now and the spinster club series holly bourne has tackled topics like feminism mental health and the challenges of modern relationships inspired by her own experiences of early motherhood and friendship, her latest novel, So Thrilled For You, explores the pressures women face and the jealousy we often keep hidden.

Well, Nuala was joined by Holly, who started by setting the scene. So, So Thrilled For You is set at, like, the world's worst baby shower. It's sort of like the Kardashians on acid, in terms of, you know, it's all made for content, it's sort of like the Kardashians on acid um in terms of you know it's all made for content it's all made for Instagram and it's about these four women who are best friends from university but who are all basically having the worst day of their lives and then you kind of it ends in arson and the kind of and then it's a whodunit and you're looking at these four women who all have very different relationships to motherhood. One's a newly postpartum mum who's really struggling.

One whose baby shower it is kind of is feeling very freaked out because she basically got pregnant with the wrong person because she was so scared that she wouldn't be able to have a child. There's the friend who's thrown the baby shower to prove how fine she is, even though she's really struggling with fertility. And then there's a friend who's child-free and happily child-free, if only somebody would believe her and it's kind of the sort of yeah how these friendships can really fall apart when you get to the kind of the baby years I'd say from like 28 to 42 where I find like women are usually

so amazing at holding on to each other through big life changes and back jobs and emigrations and terrible relationships and there's something about motherhood where we get quite factionalised, quite tribalised. We kind of stop talking to each other. Lots of friendships dissolve. And yeah, so the kind of this ridiculously gauche baby shower is sort of a backdrop to kind of examine what happens to women's friendships as we hit this period of our lives and how painful it is. How did you research it? I wrote this book very newly postpartum because I'm self-employed. I didn't really have any maternity leave.

And I really struggled with that transition to becoming a mother, mainly because my child, though she was wonderful, just did not sleep like at all to the point where... That is rough. We hired a sleep consultant and they gave us a refund after three days sorry I don't mean to laugh because I'm sure it was tragic it was just like and I had this baby guide that said don't worry if your baby's crying they literally can't stay awake for more than 90 minutes and my baby had been awake for six hours and I was just like well this book's going out the window and so I think the so one of the suspects is a mum who's

really struggling postpartum and didn't have the sort of support network so I think the one of the suspects is a mum who's really struggling postpartum and didn't have the sort of support network that I had to kind of help me through that period of my life. So that kind of really played into it. And then I've got lots of friends who really struggled to have kids and some of them still haven't been able to have children. I have lots of friends who are happily child free. And so I kind of was just talking to them about it. The part, let's just take a moment on the postpartum. You mentioned that you were writing a lot of this when you were going through that really difficult period.

And that writing it was almost like a fever dream. Tell me more about that. I always say I don't have much memory of writing this book. And obviously because it's a whodunit, it's very intricately plotted and it's set in real time. And I look at my notes and I had a spreadsheet of where each character was and what all the red herrings were and I'm like I have no memory of writing this graph because I think I wasn't I think you have to be asleep for a certain amount of time before

your body goes into REM sleep and you have a dream and you're able to make memories and I wasn't at that level and my child would only sleep whilst fully attached to my breast in a dark room and I was like she doesn't seem to mind me typing so I just kind of tapped it out and I think that's why mothers who have read early copies of this book seem to be just really connecting because I think it's so visceral. But I wonder do people speak do young women you think of your age speak openly about what they're going through, about their emotions? I don't think we do very much about this topic. That's what I'm talking about, specifically this topic. And I think it's because it's so emotive and because there's so much judgment and pressure on women to have babies or to not have babies, to have a set amount of babies.

Not everyone who wants to have a baby is able to have a baby, which is obviously deeply painful. And I think women are trying to look after each other's feelings a lot, but it also means we're not opening up. And I think female friendship is so wonderful because women are so able to get so deep so quickly. Within like 10 minutes of meeting a friend, I've not seen for two hours, we're like, we're in it. And we totally understand each other. And there's something about motherhood where it's a stumbling block and you might feel judged or you might feel that you can't say something or you might feel that you have to be like, I know I'm really lucky, but I'm finding it really hard. And also just the fact that having kids, I didn't truly understand it until I was trapped in my dark room five times a day is very life limiting for at least a year or so you know like there were so many important friendship things that I missed during that time did you speak to

your friends about that I didn't and I think that was one of the reasons I got like I started writing the book because I was like why am I not talking to my friends about this why am I've always talked to my friends about things and I was so lonely and part of it was just like I literally couldn't make a phone call without waking my child and also pure tiredness I'm sure yeah but part of me was like well I don't want to upset my friend who's pregnant and scare the living daylights out of her I don't want to upset my friend who's struggling to conceive part of me and my deranged exhaustion for maybe my childhood free friends would be looking at me going well this is why I haven't made this decision um which isn't what they thought but in that dark space I went there and

I think that's why I started writing the book but weirdly when my baby broke the sleep trainer and I tweeted about it I'm just thinking what her career might be you know further on the line I tweeted about it just going what do you do you do if your sleep trainer gives you a refund and says they're totally baffled by your child? And I asked that genuine, like, I don't know what to do. And the tweet went like hugely viral. It had like over a million likes and reshares. It seemed to really hit people. And I think that's when my friends started going, oh, Holly's not just become a mum and dropped off the face of the earth because she's in mum land and doesn't care about us anymore.

She's been going through actual hell. And all my friends activated and was so incredible and within two days I was like why didn't I tell you why did I just sit and alone and just stomach this it seems to be something and coming in your book as well what comes across to me is a fear of being judged I think it's definitely a fear of being judged and I think when you sort of said about the title of the book so thrilled for you and there's so many different ways you can say it I think it's it's something you type more than you actually say to somebody it's a kind of something you comment under an Instagram post of one of your closest friends

because we're not having these face-to-face shares it's virtual the relationship is too virtual and i think it flattens female friendship holly born there still to come on the program music from the welsh post-punk band adwaith and remember you can enjoy woman's hour any hour of the day if you can't join us live at 10 a.m during the week just subscribe to the daily podcast it's free via bbc sounds now earlier this week the prime minister keir starmer announced the government's artificial intelligence action plan promising to turn the uk into an ai superpower he mentioned how ai is already being used in the healthcare system to aid stroke victims well can it also help women going through fertility treatment in the, one in

seven couples have difficulty conceiving and over 50,000 patients go through IVF each year. Currently, around 31% of IVF treatments result in a live birth. Can AI improve that figure? Well, joining me to discuss this was Dr. Christina Hickman, an embryologist, co-founder of the Fertility Clinic Avenues, and the chair of the Global AI Fertility Society, and Dr. Ali Abara, a clinical scientist at Imperial College London and consultant in reproductive endocrinology at Imperial College Healthcare NHS Trust. I started by asking Christina how AI was being used right now within IVF. So we're actually the first clinic to incorporate AI throughout the journey of the patient. So at the moment that the patient joins us, we can use AI to compare their demographic information

to that of other patients who have had care in the past to help manage their expectations of what are their chances of conceiving and start identifying what is the right journey for them. Then as they're going through the diagnostics, we use AI in the ultrasounds to try and identify and see details that might be missed if only assessed by a human. We then start making decisions as they're going through the IVF journey, if IVF is right for them. And at that point, we need to decide what's the right dose, what's the right protocol. So AI can help us identify, based on all the knowledge of many patients, millions of patients who have had treatment before, what is the right decision for this particular patient. We then get to the lab. And at this point, we're trying to decide,

is it the right time to get to the lab? What we call the trigger. So missing the right time of trigger can compromise the right chances for you. We maximize that by using the AI decisions. Now we see the egg. And the egg, we can now identify, is this egg likely to form a blastocyst or not? Is this egg going to be a viable egg? Is it a good one or not a good one? And then we get to look at the sperm and do the same assessment on each individual sperm. We then bring the two together and creating the embryo. And during the ICSI procedure, we're using AI to support the ICSI process. Then we culture the embryos in the incubator for between five and seven days. And at this point, we're capturing billions of data points that we're contributing towards making an accurate assessment of is this going to become a baby or not. So

we're also using AI to help support the patient emotionally. We're using AI to capture data so that the embryologist can treat more patients in less time whilst dedicating even more time to the patient for compassionate care. So it's that balance between compassion and technology that brings the best of both worlds for the patient. I'm going to bring in Dr Ali Abara here as well. How excited should people trying to conceive be by this? Yeah, I think the potential is huge. Yeah. So I think, as we know, AI has really exploded over the last few years and the models are getting so much better so quickly that in the future, the processing power is just improving so fast that obviously it might well be able to make decisions at a far greater level

than what we can at the moment. But obviously, as with all new technologies, it's really important to just confirm the efficacy before we roll these things out. Christina, how's it working? I mean, did you say you're the only clinic using it at the moment? We're the only clinic using the extensive throughout the journey. There are other clinics that might use a couple of tools here and there, but not all of them together. And that's important because when you're making decisions, if you're only looking at the embryo, but you're not taking into context what's happening in the uterus, or you're only looking at the sperm, but you're not taking into account the egg or the embryo development, this siloed information could lead to incorrect decisions for the patients.

It's really looking at the holistic approach to the patient that brings that difference, that brings a better clinical decision-making process. And have the results been different at your clinic consequently? So we've only been licensed for a year. It's a new clinic. We are having the first babies are being born this week, actually. So we have, you know, about 50 babies or so are on their way very, very soon. We have seen that our success rates are,

that we're going on their way to being on a 56% live birth rate, but we're still waiting for some of these babies to be born to confirm. So at the moment, we categorize them as ongoing birth rates. And this is twice what we've seen as a national average across the UK. So this is not exactly a randomized controlled trial that we're comparing to demonstrate this improvement. But the way that we have validated these technologies is by looking at each of these technologies on their own. To look at them cumulatively, it's going to take us a bit more time to do these demonstrations. But all our key performance indicators of operations are demonstrating much higher results than we've observed in other clinics before.

And you've done some research into AI and trigger shots. We've just published a paper on looking at exactly which follicles within the ovary are the ones that are most likely to give you an egg. So the follicles are the structure there that support the egg during development. And maybe during a natural cycle, maybe one follicle will develop each month. But obviously obviously during IVF we give quite strong powerful stimulation to the ovaries and you get multiple follicles and you can like Dr. Hickman was saying you can decide when to stop that process and move on to the next process and so it's really important to figure out which of those follicles are the ones that are most likely to give you eggs and that was the research we've just done.

And essentially, if you maximise those follicles, you can improve the number of eggs you get and also the live birth rates. And traditionally, doctors have relied on their own human assessments to make decisions about the health of the sperm or the egg or the correct drug protocol. And I mean, I know Dr. Hickman gave us good overview, but to you as well, Ali, how can AI help doctors make these decisions? So I suppose it's a bit more objective and scientific. So obviously the protocols are designed for the average person and they will work for most people.

And then the doctors will intervene to try and personalise that treatment. So they'll rely on their experience and sometimes intuition and things like that. But obviously, AI can allow us to handle that really complex data that's generated during IVF treatment and be quite data driven in the type of decisions that we can make. So hopefully it should optimise and make it more objective. Do we need to be concerned about the biases within the data that's being used? For sure. So I think it's important. I think one of the benefits of IVF treatment is people, the data is stored on electronic databases. They can be then combined. And so you can get very large data. So in our study, for example, we had more than 19,000 patients. But of course, if there are biases within that data, it will learn those biases.

So that is something that we need to be mindful of. There are statistical techniques to try and account for that and make sure the data is more generalizable and can be applied to different people in the population. And Christina, I guess a big thought about all of this, is AI going to be another expensive add-on that people have to pay for? We know that each cycle already costs over £5,000. Yeah, so at the moment, what I see from AI is that it's one of the first technologies in a while in IVF that might actually be coming to reduce the cost of IVF. At the moment, what we've seen is that in the increase in efficiencies, it reduces operational costs, which can be passed on to the patients. So we've seen that in our clinic at Avenue. So our operational costs are half the operational costs to what is seen in other clinics. So this is something that the AI technology, yes, we have to pay for the technology. As a clinic, we have to pay the providers of technology. And I would

like to keep it that way. Because if we have professional companies making AI, we get robust, medically robust AI, which I much rather prefer than homegrown AI, which then brings the risks associated with bias, generalization, hallucination, even ethics concerns on how it's being built. So it is important to highlight that there is good AI, but there's also bad AI. And we do need to have the necessary frameworks in place to ensure that these technologies are introduced in a responsible manner. And I mean, statistically, only one in three women get pregnant after their first IVF cycle, as I mentioned before, the average success rate is 31%. Will AI be able to increase those odds? Yes, but not in the measure of success that's traditionally used. So the measure of success that's used by the HFEA, for instance, is number of pregnancy per embryo transferred. Now, an example of how AI goes contrary to that is AI might turn around and say, this is a poor quality embryo.

It might look nice, but it's got a low chance. So I would suggest that you transfer two of these because it's got such a low chance. Now, in doing that, you're reducing the definition of success by the HFEA, which is number of embryos. But if you think of it from the perspective of the patient, you're maximizing her chance of having a baby in that cycle with those embryos. You're making personalized decisions down to the level of each embryo. So we have changed our definition of success, which is getting the patient pregnant within a year of them coming to meet us for the first time. In that way, we might actually choose to put multiple embryos if it's relevant whilst minimizing multiple birth rates, or we might choose to do multiple egg collections within the same cycle. So we're using AI then to value engineer their journey all the way to a baby,

irrespective of how many transfers or egg collections are planned for her because we are creating a personalized plan for her and him, right? So we're looking at that couple and thinking for you, we're going to do one egg collection with multiple transfers. And for the other couple, we're going to do multiple egg collections with one transfer. We can use AI to cancel a transfer to say, it's not worth the time. Let's go straight to another cycle so overall the cost to baby across that journey is expected to be lower and this is what we would like to demonstrate once we're opened for a little bit longer but we're already starting to see that with our preliminary patients. Dr Barra it all sounds great but there are there will be some people that it

won't help right their medical problems will be so great that they're never going to have a baby the baby that they want. And this is a reality for a lot of people going through IVF. So we don't want to overplay the power of AI, do we? Or do we? I don't know. No, of course. So obviously there's going to be biological factors that an AI can't necessarily change.

But I suppose the way I would think about it is it's about optimising the potential for each couple. So it's making the best decisions, selecting the best embryos that are available. So you're quite right, you can't change biology, but you can try and optimise things as good as possible. It's also a matter of using AI to assess which patients we should advise to stop. And that's the power of the information. AI itself is not necessarily going to increase your chance of success,

but it's going to help you make the right decisions for you. And some of these might mean it's time to stop care. Dr. Christina Hickman and Dr. Ali Abara there. And if you've been affected by anything you've heard in this discussion, you can find help and resource links on the BBC Action Line website. Now, Hermine Braunsteiner was the first person to be extradited from the US for Nazi war crimes.

She was one of a few thousand women who had worked as a concentration camp guard and was nicknamed the Mayor by prisoners because of her cruelty. A novel has been written about that cruelty and it can be distressing to hear the details. But we also hear about the other part of Hermine's life. In the 60s, she was living a quiet existence as an adoring suburban housewife in Queens, New York, until she was tracked down by a reporter from the New York Times who planned to expose her past. It's a fascinating, disturbing story and raises questions about how people make choices that can change the course of their lives on what's been famously called the banality of evil. Well, Nuala was joined by Anne Harrod Hampshire, a research fellow at York St. John University, who has written The Mayor, and we

begin by hearing Anne Harrod read an extract from her fictionalised account. It's the moment that threatened to expose Hermine when a reporter comes to the door. The knock on the door changed everything. Until then we were happy, we knew who we were. You've got the wrong person, I told him, my wife is gentle and kind, She wouldn't hurt a fly. After he left, we sat side by side on the sofa and I held you tightly as you sobbed into my neck. Your shoulders heaved up and down and your tears soaked my collar. This will be the end of me, you whimpered. I only did what everyone else did back then. I was no different. You have to believe me. I've done nothing wrong.

I shushed you and calmed you and told you I loved you. I had no reason to doubt you but after that knock everything around me started to wobble and bend. All that was solid became molten. It was as if we were standing in front of the funhouse mirrors on Coney Island looking at our reflections distorted distended versions of ourselves. My whole sense of who I am, who you are, all of it shook. And that begins to bring us into this extraordinary world that was lived by Hermine Brandsteiner and later with her husband, Russell Ryan. Tell us a little bit, but let's start with her, with your protagonist, Hermine. Who was she? So Hermine was a working class Catholic girl from Vienna. She lived in

the outskirts of Vienna in a suburb called Nussdorf. She was born in 1919. She left school, I think around about age of 13 and was working as a domestic servant and her dad died. Her mum was doing laundry locally and her dad was a driver for a beer factory. Her dad died when she was 15 and she ended up going to London and working as a domestic servant in London. And then the Anschluss happened. Germany annexed Austria. She was called back to Austria because if she'd stayed in the UK, she'd have become a prisoner of war. She wanted to become a nurse but couldn't get a job as a nurse. And she ended up working in an armaments factory north of Berlin.

And she was lodging in a place called Furstenberg, which is a village north of Berlin. And Furstenberg was where they were building a prison for women, which became Ravensbrück concentration camp. They were advertising for guards. She took a job as a guard because it was double the pay, no commute. And that's how she entered the concentration camp system. Her story is shocking. I mentioned the novel is called The Mayor. That was the nickname that prisoners within the concentration camp, female concentration camp of which she was a guardian, gave her. And I will, of course, warn listeners that it's very distressing. But do you want to say why? So she worked in three concentration camps. She started off in Ravensbrück,

which is north of Berlin. Then she worked in Majdanek in Poland, which was a death camp. And then towards the end of the war, she was in charge of Genthin, a sub-camp of Ravensbrück. In Majdanek, she was nicknamed Kogia in Polish, which means the mare, female horse. And she was given that nickname because she stomped on people and she kicked people to death. So she was very, she was a brutal woman. It contains these scenes of brutality to describe and explain who she was throughout your book. Are they based on fact? Yes. So I did heaps of historical research.

I wanted wanted it was really important to me I'm a journalist by background it's really important to me that the book was historically accurate so I did an enormous amount of historical research part of which was reading all the witness accounts all the testimonies against her which are horrifying and every single piece of violence that occurs in my book is based on a witness account. How did you decide how much to include? I wanted to portray her. I wanted to make it very clear that she was guilty and to show what she did. But I also wanted to portray her as an ordinary person. So in terms of the brutality,

I picked key things that came up repeatedly in witness accounts. And then other parts of her life, I picked key moments that were important, like during her childhood. And then most of it set during the camps and her fleeing at the end of the war. A lot of it is based on fact, but it is a fictionalisation. So there are certain things about her and her husband it's not possible to know. So the conversation, for example, is fiction. Yes. And we will come to Russell in just a moment. But throughout our reading of her at the camp, for example,

which I found disturbing at times, is how the horror and the cruelty is juxtaposed by her observations of beauty in nature, for example, or birdsong or birdwatching. This kind of two sides to a person is difficult to, I don't know, reconcile. Yes, because I think the historical, if you look at historical accounts of Holocaust perpetrators and all the psychology surrounding it, it points to the fact that most of the people who were involved in perpetration were really ordinary people. They were not sadists. They were not monsters. They

did monstrous things and sadistic things, but they didn't go into those camps as monstrous people. They acclimatised to the violence. And that sort of new world that they lived in, which was very violent, became their new norm. So I wanted to portray her in the full, not just her acts of cruelty, but also the other sides of her, which were much more ordinary and much more normal. And, you know, the reason I wanted to do that is because if you look at the psychology behind perpetration, that is sort of the horrifying reality of it, is that most of these people were, as Hannah Arendt, you quoted earlier, the banality of evil, banal, really ordinary people, but capable of doing horrendous things. She was a female guard, a female prison. Do you think that descent into evil and being perpetrators of this kind is any different between the genders? I mean, so one in 10 guards were women. There were far fewer of them, but they were definitely brutal. So there were fewer women in terms of the actual descent into evil. So there's a really interesting account by a witness called Germaine Tillian.

She was a French political prisoner at Ravensbrück, and she talked about how the new guards, when they came in, would say, excuse me, and please and thank you to the prisoners. But within four days, they were, they'd become rough. I think the word she uses is rough, but, you know, rough and manhandling them. I mean, in Eichmann in Jerusalem, Hannah Arendt's accounts of the Eichmann trial, she says that Eichmann, who was a really senior Nazi, I mean, Hermine Bernstein was a low level perpetrator, not in any way condoning what she did. But Eichmann was a really senior Nazi. She thought it took him less than a month to dehumanize people and commit murder and then have no qualms about it. So I think the descent into evil can be very, very quick. And interestingly, the reflexes that have just been on recently with Dr Gwen Adshead, the forensic psychiatrist,

she talks all about that sort of evil state of mind, how ordinary people can get into an evil state of mind and then how they can disconnect themselves from their crimes afterwards. Which she had. She never admitted culpability. And let me bring in her husband, who she met, Russell Ryan, holidaying in Austria, eventually becomes this suburban 60s American housewife before that knock that you read for us there took place, which was a New York Times reporter coming to expose and indeed did what her past was. But Russell, her husband, all through it, manages or tries to rationalise or justify this woman that he loves and what her behaviour might have been, that she was young,

that she was following orders. But at points she did have a choice to do, you know, to take the right path, but didn't take it. So in terms of, I'll start with whether she had a choice. So when she entered the concentration camps, she was at a point where she could choose to go in. Later, there was conscription. She was not part of the wave of conscription. Yes, but she seemed to say that she was. She did, yes.

But because she would have lied to her husband. Well, yes. So he stayed with her. So that's historically accurate. I mean, I think this is the phenomenal thing about the story. Can you imagine you discover your partner has been involved in mass murder? It's all I thought about while I was reading the book. Because you try and put yourself in her shoes.

Yes. In his shoes. In his shoes. And that is the point of the book. It's written in the first person, both sides, that you're meant to try and put yourself in there. She was incredibly uncomfortable. But he did stay with her. And I had to work out why would he stay with her.

And I think he must have come to understand her or at least think he must have. He must have believed some of her lies. He must have thought, you know, which sadly is what I think now, having studied the Holocaust for more than five years, perpetrators of the Holocaust. It's very hard to say that in a similar position, you wouldn't do the same thing. I use a quote at the beginning of my book from Zygmunt Bauman, which says, the most frightening news brought about the Holocaust and by what we learned of its perpetrators was not the likelihood that this could be done to us, but the idea that we could do it. And if you look at her and the time she lived in and the how quickly psychologically, if you look at psychological experiments, for example, Stanley Milgram electric shock experiments, the Philip Zimbardo Stanford prison experiments,

these famous psychological experiments show that most people follow orders and most people are brutal. It's horrifying realisation. I found it very affecting, the book, reading it. But I'm wondering about the impact on you for doing that research to create that book. Yeah, I mean, it was, I don't want to use the word traumatising because I think that word gets a bit overused. But I would say it was emotionally incredibly draining. And it was reading the witness accounts, particularly of the accounts that were to do with children. I've got children. I had to have counselling because these scenes from the

Holocaust would play out again and again and again in my mind. My whole view of humanity really sunk to rock bottom. And I related everything to the Holocaust for a really long time. I don't do any more. And now I see the good in humanity as well, thankfully. That's fair to say, because you need to come back to that equilibrium. You need to come back to reality. But I guess, you know, it gives you a bit of an insight of what it's like to work with perpetrators. And, you know, human beings are complex. I think this is one of the problems of modern day discourses.

We talk in such binary things about people being either entirely good or entirely bad. But human beings are complex. And I think it's really important to examine the nuance and the complexity. Anne Harrod, Hampshire, speaking to Nuala there. That's it from me on Monday's Woman's Hour. As Donald Trump is inaugurated, what will his second presidency mean for women in the US and beyond? Do enjoy the rest of your weekend. I'm Sarah Treleaven, and for over a year, I've been working on one of the most complex stories I've ever covered. There was somebody out there who was faking pregnancies.

I started, like, warning everybody. Every doula that I know. It was fake. No pregnancy. And the deeper I dig, the more questions I unearth. How long has she been doing this? What does she have to gain from this? From CBC and the BBC World Service,

The Con, Caitlin's Baby. It's a long story. Settle in. Available now.