Private birth coaches called doulas could be putting expectant mothers at risk by offering bad advice, a maternity safety watchdog has warned.
Doulas, who are self-employed and not medically trained, provide emotional and practical support to women before, during and after birth, and are increasingly popular with middle-class mothers.
But alarming research from the Healthcare Safety Investigation Branch (HSIB), a Government-funded body which looks into poor maternal care in the NHS, has flagged a series of cases where doulas ‘worked outside the defined boundaries of their role’.
In a blog published on its website, the HSIB said it had reviewed 29 incidents of concern where doulas were involved. It said that in many cases the care was positive and beneficial, but in 12 of these births the doulas’ advice to mothers was judged to have contributed to ‘poor outcomes’.
Alarming research from the Healthcare Safety Investigation Branch (HSIB), a Government-funded body which looks into poor maternal care in the NHS, has flagged a series of cases where doulas ‘worked outside the defined boundaries of their role’
The body confirmed it is considering an in-depth review of the burgeoning industry, with the aim of making recommendations towards regulation.
In one case, a mother giving birth at home went into labour early and reported that the baby was moving less than usual. The doula reassured her a change in the movement pattern was normal in labour as the baby has ‘less room to move’. When the mother went into hospital the following day, it was discovered that her baby had died.
In another case, midwives who advised a mother to urgently get to hospital said they were then ‘excluded from the birth team’ by the doula, who instead encouraged the woman to stay at home. The significant delay in getting medical help contributed to the baby suffering a severe brain injury.
In a third example, midwives were repeatedly asked to leave the room so that the doula could have private discussions with the mother – and often the doula’s advice conflicted with that given by the healthcare professionals.
According to Doula UK, which represents about 700 doulas working across the country, their role is to ‘support in pregnancy, birth and in the postnatal period by providing information, advocacy and practical and emotional support to the whole family’.
The organisation provides training programmes and members agree to a code of conduct which stipulates that doulas ‘do not perform clinical, midwifery or medical tasks, diagnose medical conditions or give medical advice’.
Doulas are not regulated by the Nursing and Midwifery Council or any other professional body as they do not need to be medically qualified. They assisted in almost 1,500 births in 2020, according to Doula UK, and demand is said to be rising as births with minimal medical intervention become more popular. Celebrities, including Hollywood stars Nicole Kidman and Anne Hathaway, were said to have had doulas during their pregnancies.
Doulas are not regulated by the Nursing and Midwifery Council or any other professional body as they do not need to be medically qualified. They assisted in almost 1,500 births in 2020, according to Doula UK, and demand is said to be rising as births with minimal medical intervention become more popular
A major review by medical research group Cochrane in 2019 found that labour companions, such as doulas, bridged ‘communication gaps’ between healthcare workers and women, and provided ‘a positive birth experience’. It also found doulas could help with non-pharmacological pain relief, such as meditation or relaxation.
However, one senior midwife is not so complimentary, saying: ‘I’ve attended births where the woman refuses to speak directly to me and instead the doula speaks for her.
‘You might give advice, explaining the risks and benefits of certain choices, and then the doula will ask you to leave the room so she can discuss it with the mother.
‘It’s hard to know, in this situation, whether a woman has come to her own decision or been influenced by the doula.’
The Mail on Sunday has also been told of ‘dangerous’ practices from some doulas who may be ‘dogmatic about natural births’. This includes encouraging women to avoid engaging with maternity services – so no healthcare professionals are present at birth – without acknowledging this is not appropriate for all circumstances.
‘It’s toxic positivity,’ said one source. ‘Some doulas don’t realise there are pregnancies where medical help is required.’
A spokesman for Doula UK said: ‘The role of the doula is to listen to what a woman wants and support her in making her own decisions and help her understand her rights
A spokesman for Doula UK said: ‘The role of the doula is to listen to what a woman wants and support her in making her own decisions and help her understand her rights.
‘During labour, if an emergency arises and a woman refuses treatment, that is her right. The doula is there to support a woman’s choices.’
An HSIB spokesman said: ‘We will be meeting with the Regional Chief Midwives to discuss if the development and introduction of national guidance would help health professionals, doulas and mothers. Our blog has been written in advance of any possible report, and the examples highlighted would form part of any investigation and be addressed.’