Private birth coaches, known as doulas, can put expectant mothers at risk by giving bad advice, a pregnancy safety watchdog warns.
Self-employed and non-medically trained, doulas provide emotional and practical support to women before, during and after childbirth and are becoming increasingly popular among middle-class mothers.
But worrying research from the Healthcare Safety Investigation Branch (HSIB), a government-funded agency that investigates poor maternal care in the NHS, reported a number of cases where doulas “worked outside the defined boundaries of their role”.
In a blog post on its website, HSIB said it had reviewed 29 worrying incidents involving doulas. It said the care was positive and beneficial in many cases, but that the doulas’ advice to the mothers contributed to “poor outcomes” in 12 of those births.
Worrying research from the Healthcare Safety Investigation Branch (HSIB), a government-funded agency that investigates poor maternal care in the NHS, reported a number of cases where doulas “worked outside the defined boundaries of their role”.
The panel confirmed it was considering a thorough review of the fast-growing industry to make regulatory recommendations.
In one case, a mother who gave birth at home went into labor prematurely and reported that the baby was moving less than usual. The doula assured her that a change in movement pattern during labor is normal because the baby has “less range of motion.” When the mother went to the hospital the next day, it turned out that her baby was dead.
In another case, midwives who advised a mother to rush to the hospital said they were then “cut off the delivery team” by the doula, who instead encouraged the woman to stay home. The significant delay in medical care contributed to the baby suffering a severe brain injury.
In a third example, midwives were repeatedly asked to leave the room so the doula could have private conversations with the mother—and often the doula’s advice contradicted that of the health care worker.
According to Doula UK, which represents around 700 doulas working across the country, their role is to “provide support during pregnancy, childbirth and the postpartum period by providing information, advocacy and practical and supportive services to the whole family to provide emotional support supply”.
The organization offers training programs, and members agree to a code of conduct that states that doulas “do not perform any clinical, obstetric or medical duties, diagnose diseases or provide 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. According to Doula UK, they assisted almost 1,500 births in 2020 and demand is likely to rise as minimally medical intervention births become more popular. Celebrities, including Hollywood stars Nicole Kidman and Anne Hathaway, reportedly 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 nearly 1,500 births in 2020, according to Doula UK, and demand is likely to increase as minimally medical intervention births become more popular
A large 2019 study by the Cochrane Medical Research Group found that labor counselors such as doulas bridged “communication gaps” between health professionals and women and provided “a positive birth experience”. Doulas have also been found to help with non-drug pain relief such as meditation or relaxation.
However, one chief obstetrician is not so polite, saying, “I’ve been to births where the woman refused to speak directly to me and instead the doula spoke for her.”
“You might give advice, explain the risks and benefits of certain choices, and then the doula will ask you to leave the room so she can talk to the mother about it.
“In this situation, it is difficult to tell whether a woman made her own decision or was influenced by the doula.”
The Mail on Sunday has also warned of “dangerous” practices by some doulas who may be “dogmatic about natural childbirth”. This includes encouraging women not to be involved in maternity care – meaning the absence of caregivers at birth – without acknowledging that this is not appropriate in all circumstances.
“It’s a toxic positivity,” a source said. “Some doulas are unaware that there are pregnancies that require medical attention.”
A spokesperson for Doula UK said: “The role of the doula is to listen to a woman’s wishes and support her in making her own decisions and to help her understand her rights.
A spokesperson for Doula UK said: “The role of the doula is to listen to a woman’s wishes and support her in making her own decisions and to help her understand her rights.
“If an emergency occurs during childbirth and a woman refuses treatment, that is her right. The doula is there to support a woman’s decisions.”
An HSIB spokesperson said: “We will be meeting with the regional chief midwives to discuss whether the development and implementation of national guidelines will help health professionals, doulas and mothers. Our blog was written before any possible report and the examples given will be part of any investigation and addressed.”
Additional reporting: Rosie Taylor
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Crystal Leahy is an author and health journalist who writes for The Fashion Vibes. With a background in health and wellness, Crystal has a passion for helping people live their best lives through healthy habits and lifestyles.
