Baby girl’s death in Hampshire raises concerns over role of doulas in home births | Health
A coroner has warned more babies could die unless greater clarity and guidance is provided on the role of home birth assistants following the death of a girl, and raised concerns that doulas are delaying access to hospital treatment.
Matilda Pomfret-Thomas died of brain damage in November 2023, 15 days after a difficult home birth when her mother was not immediately transported to hospital despite signs of fetal distress. The investigation was completed last month.
A. report on preventing future deaths, The report, published on Wednesday, called on the Department of Health and the National Institute for Health and Clinical Excellence to take action to avoid similar tragedies involving doulas, non-medical professionals who provide emotional and practical support during pregnancy and birth, often alongside NHS midwives.
Hampshire’s deputy coroner, Henry Charles, said midwives at Queen Alexandra hospital in Portsmouth felt their access was “restricted by the doula” when the child’s mother went into labor on October 29, 2023.
The coroner said the midwife attending the home birth first suggested transfer to hospital at 7.19am after meconium, a sign of fetal stress, was discovered. The offer was rejected and came back at 10am because it had not been “delivered” despite the workforce having “deteriorated”. [to the family] leading to hospital referral”.
Charles said: “The presence and work of a doula in this case negatively impacted the effective provision of midwifery services in terms of creating a rapport that would assist in the delivery of effective advice and care.”
He added: “I found it [the doula] it did not actively discourage midwife access but was actually seen as a buffer by midwifery team members. The doula was following the birth plan. “The doula was supporting the parents according to the birth plan, and this was apparently perceived as the basis for hope that home birth might still be possible.”
Charles noted that doulas are increasingly used by expectant mothers. But he suggested their roles could lead to other fatal misunderstandings.
She said: “The role of a doula is clearly messy from a practical perspective and may have multiple understandings, not only by doulas but also by their clients and midwives.”
Charles noted that many doulas are represented by Doula UK, which provides training and guidance but is not a regulatory body and does not cover all doulas.
She said: “There was evidence at the inquest presented by experienced midwifery professionals that highlighted the benefit of providing guidance for all those involved in birth where a doula was present.”
A separate report into Matilda’s birth by the Maternity and Newborn Safety Inquiry (MNSI), cited by the coroner, highlighted that there were no regulations on doulas or guidance on how they interacted with the hospital’s maternity services. She said doulas can be seen as “intervention rather than supervision.”
A. 2023 report MNSI noted that while part of the Health Security Investigations Branch, doulas were involved in 29 of the 2,827 birth investigations they completed.
MNSI said it “found evidence in 12 of 29 investigations that doulas were working outside the defined boundaries of their role.” It said the care or advice provided by the doula was considered to have a potential impact on poor outcome for the baby.
In one of these cases, the doula had “encouraged the mother to stay at home in a manner that directly contradicted the midwife team’s recommendation that she be transferred to the hospital immediately. The significant delay in transport to the hospital contributed to the baby suffering severe brain damage.”
A spokesperson for Doula UK said: “We take the implications of the coroner’s report extremely seriously. We have policies and practices in place to protect members and the families they support to ensure doulas remain within the scope of their practice and, in light of the report, we will be taking steps to review and strengthen our policies, guidance and ongoing CPD provisions in consultation with our members and approved course providers.
“In September 2025, Doula UK and the Nursing and Midwifery Council also collaborated on: a video series Clarifying the different roles of midwives and doulas.”
