Private birth coaches called doulas can put expectant mothers at risk by giving bad advice, a pregnancy safety watchdog has warned.
Doulas, self-employed and not medically trained, provide emotional and practical support to women before, during and after birth and are becoming increasingly popular with middle-class mothers.
But alarming research from the Healthcare Safety Investigation Branch (HSIB), a government-funded agency that investigates poor maternal care in the NHS, has reported a series of cases where doulas ‘worked outside the defined boundaries of their role’.
In a blog post on its website, the HSIB said it had reviewed 29 worrying incidents involving doulas. It said that in many cases the care was positive and beneficial, but that in 12 of these births, doulas’ advice to mothers was judged to have contributed to “poor outcomes.
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Alarming research from the Healthcare Safety Investigation Branch (HSIB), a government-funded agency that investigates poor maternal care in the NHS, has reported a series of cases where doulas ‘worked outside the defined boundaries of their role’
The body confirmed that it is considering a thorough review of the fast-growing industry, with the aim of making regulatory recommendations.
In one case, a mother who gave birth at home went into labor early and reported that the baby was moving less than usual. The doula assured her that a change in the movement pattern was normal during labor because the baby has “less room to move.” When the mother went to the hospital the next day, it was discovered that her baby had died.
In another case, midwives who advised a mother to rush to the hospital said they were then “excluded from the birth team” by the doula, who instead encouraged the woman to stay home. The significant delay in getting medical attention contributed to the baby suffering a serious 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 conflicted with that of the healthcare professionals.
According to Doula UK, which represents approximately 700 doulas working across the country, their role is to “provide support during pregnancy, birth and in the post-natal period by providing information, advocacy and practical and emotional support to all the family ‘.
The organization offers training programs, and members agree to a code of conduct that states that doulas “do not perform clinical, obstetrical, or medical duties, diagnose medical conditions, or provide medical advice.”
Doulas are not regulated by the Nursing and Midwifery Council or any other professional body as they are not required to be medically qualified. They assisted nearly 1,500 births in 2020, according to Doula UK, and demand should increase as minimal medical intervention births become more popular. Celebrities, including Hollywood stars Nicole Kidman and Anne Hathaway, are 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 are not required to be medically qualified. They helped nearly 1,500 births in 2020, according to Doula UK, and demand should increase as minimal medical intervention births become more popular
A large-scale study by the medical research group Cochrane in 2019 found that labor counselors, such as doulas, bridged “communication gaps” between health professionals and women and provided “a positive birth experience.” It also found that doulas can help with non-drug pain relief, such as meditation or relaxation.
However, one senior obstetrician isn’t so complimentary, saying, “I’ve been to deliveries where the woman refused to talk to me directly and instead the doula speaks for her.”
“Maybe you give advice, explain 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.
“In this situation, it’s hard to know if a woman came to her own decision or was influenced by the doula.”
The Mail on Sunday has also been made aware of ‘dangerous’ practices by some doulas who may be ‘dogmatic about natural births’. This includes encouraging women not to engage in maternity care – meaning no caregivers are present at the birth – without acknowledging that this is not appropriate in all circumstances.
“It’s toxic positivity,” said a source.
“Some doulas don’t realize there are pregnancies that require medical attention.”
A spokesperson 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 Doula UK spokesperson 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.
“If an emergency arises during childbirth and a woman refuses treatment, that is her right. The doula is there to support a woman’s choices.’
An HSIB spokesperson said: ‘We will meet with the Regional Chief Midwives to discuss whether the development and introduction of national guidelines would help health professionals, doulas and mothers. Our blog was written prior to any possible report, and the examples cited would be part of any investigation and addressed.”
Additional reporting: Rosie Taylor