Spain's General Council of Nursing has reported the unregulated practice of doulas to the State Attorney General's Office over risks to mothers and newborn babies.
Representatives from the professional nursing body met with senior prosecutors on Tuesday to raise formal concerns about non clinical practitioners intruding into duties reserved for specialized midwives.
Montserrat Angulo, vice treasurer and midwife spokesperson on the executive board of the General Council of Nursing, attended the meeting alongside Francisco Corpas, the council's director of legal services. They presented their report to Julio Cano, chief prosecutor of the technical secretariat at the State Attorney General's Office, and Bárbara Bande, a prosecutor within the same secretariat.
The nursing representatives reminded the prosecution team that doulas do not constitute a recognized healthcare profession under Spanish law. Despite having no regulated training or officially recognized degrees, doulas continue to operate around pregnant women and newborn infants, creating increasingly severe clinical safety risks and deploying practices described by the council as turning medieval.
In Spain, care for pregnant women and newborns is strictly regulated. Specialist midwives, known as matronas, are registered nurses who complete advanced university training in obstetrics and gynaecology to ensure clinical safety during pregnancy, childbirth, and postnatal care. Doulas are non medical companions who offer emotional support but hold no clinical qualifications or statutory authority to deliver healthcare services.
Unregulated fees and financial concerns
Beyond clinical safety, the General Council of Nursing highlighted financial irregularities surrounding the practice. The organization informed prosecutors that doulas lack a registered heading under Spain's Economic Activities Tax, known as the IAE, creating a potential pool of undeclared self employed income.
Angulo explained that doulas do not provide their services free of charge, noting that their online promotional materials list high fees ranging from 300 euros to 1,200 euros depending on the package of services included.
Expansion into end of life care
The council also alerted prosecutors to a more recent development involving the emergence of end of life doulas. These non healthcare individuals claim to offer emotional, spiritual, and practical accompaniment to dying patients and their families during their final days.
Nursing leaders emphasized that national regulations assign end of life care and patient support specifically to qualified nurses. Council representatives told Chief Prosecutor Cano that doulas cannot perform healthcare functions because they lack both the required professional training and the medical means to do so safely.
Prosecution response and future action
Prosecutors received the warnings with great interest and receptiveness during the meeting. The nursing council had previously brought similar concerns about doulas to the State Attorney General's Office in 2015 and 2023, but the council reported that the problem has continued to expand.
Acknowledging the legal complexities involved, the council stated that it would increase the evidentiary standards provided in future formal complaints. Representatives requested active collaboration from regional prosecutor offices across Spain to protect the health of mothers and infants and guarantee clinical safety nationwide.
Following the meeting, both institutions agreed to collaborate on drafting a formal decalogue of recommendations. The consensus document, to be prepared jointly by the General Council of Nursing and the State Attorney General's Office, will set out clear guidelines for healthcare professionals, midwives, and patients to prevent professional encroachment and safeguard maternal and infant health.
