In August 2020, already suspecting something wasn't right, Laura Santiago went into hospital for a scan to find out if the baby she was carrying was okay. Her baby wasn't and she was told the baby wouldn't survive and she would miscarry. After being given the news Laura was told she could have some time in a side room to take the news in. But she did all that alone as Covid rules meant her husband was sat waiting in their car in the car park. Laura then had to leave the hospital and go tell her husband the devastating news.
That was traumatic enough for anyone to endure but since then she has miscarried twice more, and needed four NHS scans, and at none of those was her husband allowed with her due to rules in her health board area. Each of those scans have been offered to her early as a result of a referral because a complication was suspected. After each Laura has had to take that lonely walk by herself out of the hospital to break the news to him.
For Laura, now 37, the part she says she is most bitter and angry about is that at her most recent scan – after falling pregnant again and where she was given good news – her husband also wasn't allowed to be with her to share what they hope is the start of an exciting and not traumatising journey.
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In August 2020 Laura went for an early private scan and was told her baby wasn't measuring as expected so she was referred to the NHS for an emergency early scan. While partners are allowed at private scans they were not at NHS ones at that time so husband Mike had to wait outside in the car park.
After being told the pregnancy was not viable Laura describes being understandably devastated and upset. "It was the first time we were going through this experience but I understood that there were so many different measures in place and things were changing so quickly. I felt like the whole country was on this journey of trying to figure out exactly what was going on and my part of that I had to go through this by myself and those were the rules."
The hospital staff were "amazing" she said and she was told she could use a waiting room for as long as she needed – but she was alone. "He's my husband and the baby's father but I'd already started that really traumatic journey on my own and I think I then almost kind of continued in terms of dealing with it emotionally. It just started the feeling of being really alone with what I was going through".
When she fell pregnant again she had a private scan that again caused concern and when she was referred to the NHS it wasn't clear whether it would be a viable pregnancy so she needed three scans – none of which Mike could be there for – along with blood tests before it could be confirmed the pregnancy was not viable. Then she had to be admitted for a procedure, again, alone. "It just felt increasingly and incredibly shocking and cruel," she said.
Her third miscarriage was lost early on before any scan. "I think what I find really frustrating is that we were in the middle of Six Nations. I'm a big rugby fan and I was watching the incredible scenes with people back at the Millennium Stadium and seeing 70,000 people there but I had been alone in hospital."
She is now pregnant again and has seen a private consultant who once again referred her for an early scan. This time Mike was allowed in the hospital waiting room but still not into the scan room with her so by the time Laura got to the scan she was sobbing. "I had to go in to the scan and I was sobbing because I've been here so many times before and I just I didn't know what news was going to be given to me and then the first step is to see the heartbeat and it was a flood of emotion and I was so happy and so excited but I didn't get to share that with my husband."
Last week, after being given the good news, she went to the waiting room to tell Mike but saw another patient there who was in tears. Not wanting to add to that woman's apparent pain she tried to mask her joy. "What I think I'm actually more bitter about is getting the good news on my own after what we've been through. I think that's what's really stuck with me because this has been one hell of a journey for us and an incredibly painful one. If this pregnancy is successful this will be our second and our last child – I don't intend to do this again and I wanted to enjoy the full experience of it."
She is now booked in for another scan at the 12-week point but as it has been referred through the early pregnancy unit she is not clear whether her husband will be allowed to be there. "You're only given an early scan on the NHS for a reason – if you've got medical history or it's suspected that something is wrong. So why are those [the time] you can't have support? It is really mind-boggling," said Laura.
The rules are different in all Wales' health boards and she can't understand how, two years into the pandemic, a testing system isn't in place so partners can be there and the rules aren't consistent. At her most recent scan the phone call with the staff member explaining the rules are still in place should have lasted a few minutes but instead it was much longer, and much angrier. Laura knew it wasn't that staff member's fault but was so incensed she was in the same position as two years previously when the rules have been relaxed so much.
Her story was raised in the Senedd on Tuesday by Plaid Cymru's South Wales West MS Sioned Williams. Laura wants to speak out so that the rules are looked at consistently across Wales so that in "every part of the pregnancy journey, pre and postnatal, I think it's time for partners to be allowed to be there for the support and the experience of it at every stage". She added: "You're bringing life into the world or being told that you're not bringing life into it and there are very few things in life that are more profound than that and for some bizarre reason someone has decided that you have to go through parts of that alone."
There are added complications for Laura too. She was diagnosed with a brain tumour on the day she went into labour with her son Theo which affected the decisions being made into her care. The tumour was slow-growing and she had regular scans to monitor it until she felt ready to leave her son to have the operation but, given the complications she had, she felt even more passionate about being able to enjoy a second baby and to get the rules made consistent for all women.
"Because of everything that happened was my pregnancy with my son. I was going through the symptoms and trying to get diagnosed with what became the brain tumour I didn't get to really enjoy that pregnancy. So I consciously made a decision that even with my experiences now I'm treating every pregnancy as optimistically and positively as I can because I think every pregnancy deserves that. I don't want to lose the first three months by just being worried and concerned and anxious about what's going to happen as much as I can."
She thinks the whole experience has however led to her dealing with the grief alone. "Having gone through it three times alone what it did was make me deal with the whole thing more on your own. I think if my husband had been there for the scan and been told with me I think that's something we would have dealt with more as a couple together. But when you're told on your own you kind of just go into an independent mode because you've gone through that by yourself," said Laura.
Midwives are telling her they also disagree with the rules. "Most of them I've spoken to say these rules would never be a choice and they're they're pretty disgusted with it and it's so infuriating. It is like no-one's listening to the people that know. For them they have to deliver this information time and time again and they must get reaction over and over and over again."
Ms Williams asked the First Minister to ensure the government ensures "better treatment" for women all across Wales and to look at the guidance and ensure a consistent approach to maternity services. Mark Drakeford replied that he felt "enormous sympathy" for Laura. "During the whole of the pandemic some of the most difficult circumstances faced by the NHS has been over maternity and the involvement of both partners in what should, in normal circumstances, be one of the most exciting times in their life. But as I've explained many times the decision about whether people can be involved has had to be a clinical decision made by the person who has the best opportunity to make sure the health of the mother and the unborn baby can be protected to the most extent that depends on the health of the mother, her vulnerabilities, underlying health conditions, and the prevailing circumstances as well as the prevailing circumstances in whatever premises that care is being carried out. It hasn't been right during the pandemic so far to try and issue a set of rules from Cathays Park that would override the necessary clinical judgement that can only be advised by the person who has clinical care for the mother and the unborn child.
"As we hope to recover from the worst effects of the pandemic the Welsh Government will be offering advice to the NHS as a whole and it will for example seek to standardise the length of visits the families are able to make while somebody is in hospital, to make sure the approach to lateral flow testing is consistent across Wales, and the circumstances in which both parents can be involved is also consistent in one part of the NHS to another."
He said that was possible due to vaccinations and the way the NHS has learnt to deal with Covid. "At the depths of the pandemic the view taken by those who advise us in the Welsh Government was that sort of national approach had to give way to the need to allow clinicians to exercise the judgement only they can exercise in order to safeguard mothers and unborn children."
We approached each of Wales' health boards and asked their rules from the first maternity appointments through to scans, checks, and birth. The rules are different for each. In Swansea, for example, if a woman is induced – a process that can take days – a named partner can only visit for up to two hours and at staggered times "depending on where the woman's bed is in the unit". Patients in the Betsi Cadwaladr area have to order and take lateral flow tests before attending and, while it is voluntary, if the partner chooses not to take one they may be told they cannot attend appointments or the inpatient ward. In Cardiff people visiting patients are told not to sit on the beds nor take flowers or balloons.
Betsi Cadwaladr University Health Board
Woman can have a single birth partner or nominated essential other preferably from the same household or part of an extended household. Since July 12, 2021, the health board's rules have been that birthing partners have to order and complete a lateral flow test before attending scans, appointments, labour, birth, section, or visiting inpatients.
"All partners will be required to show evidence of a negative lateral flow test result (SMS, email message, or screenshot), complete a screening questionnaire including a temperature check before entry, and will be screened for any symptoms suggestive of Covid-19 infection or other indication that require self-isolation using the national screening tool. In such circumstances the identified visitor will be requested to leave the clinical premises and return home immediately and seek PCR testing. A temperature check will also be taken and recorded on their screening form." The health board's website says: "Whilst the LFD is a voluntary test if partner or nominated other choose not to take the test then this may result in them not being able to attend appointments or attend the inpatient wards."
Partners can only attend inpatient wards with an appointment made directly with the ward/department due to limited numbers being allowed in an area at any one time. In terms of scans partners can attend the dating scan, foetal anomaly scan, and all scans or appointments. When a woman is in labour she is allowed a single birthing partner. The same is true for elective or emergency caesarean session.
In terms of midwife appointments all first appointments are via telephone to establish information with the rest in person. A partner can attend all community visits but the same rules apply, regarding lateral flow tests and Covid safety, as with hospital visits.
With regard to postnatal health visiting it is in line with Welsh Government guidance, which is similar to pre-Covid practice but with additional risk assessments. The full rules are here.
Cardiff and Vale University Health Board
Cardiff's rules were last changed in April 2021 according to their website which a spokesman directed us to when we asked for answers. The rules were last reviewed in August 2021.
Women can be supported by their birth partner at their 12 and 20-week scans and if they need to attend the Foetal Medicine Department or the Early Pregnancy Assessment Unit. All women who attend for a labour assessment can have their partner with them who can stay for the whole of labour and the immediate postnatal period. If women are not in established labour when they are assessed but want to remain in hospital their partner has to leave.
Women who are being induced can have their partner with them. Women on the first-floor maternity ward for antenatal, postnatal, or transitional care can have a maximum of one two-hour period per day being visited by one birth partner – the same one who was present during labour and birth if postnatal. That is the same whether in a side room or bay. People in odd-numbered beds can have visitors from 10am until noon and from 2pm until 4pm for those in even-numbered beds.
Women in single rooms can choose which two-hour slot they want their visitor to attend. A list of rules about what visitors should do includes wearing masks, only using public toilets, and not sitting on the beds. You can also not take flowers or balloons. Cardiff's rules are in full here.
Cwm Taf Morgannwg Health Board
Rules in this health board were changed from February 19 meaning individual birthing partners, or nominated individuals, will be able to attend antenatal appointments and scans and visit antenatal and postnatal wards for two and a half hours each day.
During labour birthing partners can be present during labour assessment and during all procedures undertaken in a single-occupancy room. When a woman reaches active labour a birth partner can remain with her throughout and until the new mum and baby are transferred to the ward.
Social distancing rules have to be maintained and people must wear a mask for the duration of their visit. Visitors to the antenatal clinic and ward areas must undertake a lateral flow test before visiting and only attend if the result is negative. They will also be asked to complete a Covid checklist before entering the clinic or ward.
A partner is allowed to attend early pregnancy scans in this health board as well as the 12 and 20-week scans and any growth scans. They can also be present if a membrane sweep is taking place on a maternity antenatal clinics or hospital site.
At the beginning of labour all women will be offered an individual assessment and the birth partner can be present. If in active labour the woman (and partner) will stay at hospital but, if not, she will be encouraged to return home. "If you decide to remain in hospital to await events the attendance of one nominated birth partner or support person will be in line with two-and-a-half-hour visiting slots on the antenatal ward areas," the guidance says.
"One nominated birth partner or support person will be able to attend with you for your caesarean birth from the time you are cared for on labour ward in a single room, throughout your birth in theatre, and for several hours after birth (until the point you are transferred to the postnatal ward)," it continues.
For women being induced a partner can visit for a two-and-a-half-hour visiting slot, which is staggered. Slots are between 10am and 12.30pm for odd-numbered beds and 2.30pm to 5pm for even beds. "These visiting times aim to avoid ward meal times and ward rounds to avoid congregation of ward," it says. If in a midwife-led care one nominated birth partner or support person will be able to attend for the duration of labour, your birth, and for all postnatal care after birth as this will be within a single-room facility.
Hywel Dda University health board
Rules were last reviewed on March 22, 2022, and said w omen will be able to have one person with them for all antenatal appointments and 12 and 20-week scans. The partner has to wait outside until the consultation begins when they can be telephoned to join the woman.
Women who are being induced can have a visitor for four hours but no overnight stays. Maternity patients who attend in possible labour may allocate a birth partner (preferably from the same household) to attend hospital with them during admission for labour. This includes assessment for possible labour and the birth partner may stay during the whole labour and birth. If admitted to the combined antenatal and postnatal ward they can have one daily visitor for a specified time period and a maximum of four hours. The partner and the maternity patient must wear appropriate face coverings when a member of staff enters the room and the allocated partner must remain as the only visitor during the admission period and should remain in the household bubble only to ensure reduction in risk of infection. Hours are 10am until 2pm for even beds and 2.30pm until 6.30pm for odd numbered beds. Those who are admitted via the early pregnancy unit can have someone with them for all diagnostic ultrasound appointments.
Swansea Bay University Health Board
The health board say a mum-to-be has to nominate someone as their support partner and they are the only person who can accompany her. If that person is ill or self-isolating they can choose someone else. That person will be screened when they arrive at hospital and both the patient and partner have to wear masks. Partners can attend the dating scan (usually 12 weeks) and the 20-week scan but they must wait outside until they are called in.
If you go into hospital in labour your partner can attend. If the staff decide you are not in active labour it is suggested you go home but if you decide to remain in hospital you can though your partner has to go home. The partner can return once the woman is in established labour and is transferred to the clinical area for care leading up to the birth. If you attend the antenatal assessment unit for any other reason the partner has to leave and only return once she is in active labour. If there are "complications" the partner will be "called" by maternity staff and "if there is bad news staff will talk to the partner about staying with the woman".
For women attending for a caesarean section or induction they can have a visitor only at visiting hours and it is staggered depending on where the woman's bed is in the unit. The visits are limited to two hours. If the woman is in a single room the partner can come between noon and 8pm but can only leave for toilet breaks. "They cannot come and go during this time so should bring food and drinks if they plan on staying for a while."
The named partner can be on the labour ward there for the whole of labour and "immediate postnatal period" but afterwards they are again limited to visiting hours which are staggered depending on where the woman is on the ward. Partners can't leave the ward during that time.
Women who are admitted to Neath Port Talbot Birth Centre can have their named partners present for all assessments in labour and between 10am and 10pm. Women in the Bay Birth Centre may have their named partners present for all labour assessments from 10am to 10pm. The full rules are here. Since November booking appointments for midwives have been face to face – either at home or in a community clinic.
