Coroner issues warning over ‘unregulated’ doulas after death of baby
More babies could die if guidance is not provided on the role of “unregulated” maternity assistants, a coroner has warned, after the death of a 15-day-old baby raised concerns about delays in accessing hospital treatment.
Matilda Pomfret-Thomas died in November 2023 from brain damage known as neonatal hypoxic-ischemic encephalopathy, caused by a lack of oxygen to the brain before or during birth.
An investigation last month found her mother had a difficult birth at home and was not immediately transported to hospital despite signs of fetal distress.
Henry Charles, assistant coroner for Hampshire, Portsmouth and Southampton, published a report on preventing future deaths last Wednesday. He called on the Department for Health and Social Care (DHSC) and the National Institute for Health and Clinical Excellence (NICE) to take action to prevent similar tragedies involving doulas, who are non-medical professionals who provide emotional and practical support during pregnancy and birth, often alongside NHS midwives.
Mr Charles believes the doula influenced the work of midwives at Portsmouth’s Queen Alexandra Hospital and felt their access was “restricted by the doula” when the child’s mother went into labour. He added that although the doula did not “actively discourage” midwives, the doula was viewed by them as a “buffer” for their access to the mother.
The report explains how traumatic the birth of the family’s first child was and that they were focused on having a different experience for their second child, which is why they chose to use a doula to provide them with support during the home birth.
However, the doctors’ preference was for hospital birth, and it was discussed which situations would cause the mother to give the blue light to the hospital.
Symptoms of fetal distress developed during home birth, but the mother was not immediately taken to the hospital. Instead, the report described the “challenging atmosphere” that emerged as the doula continued to follow the birth plan, providing “hope that home birth may still be possible.”
Mr Charles said the mother developed complications within a few hours of being at home and the doula had a “negative impact” on midwives’ ability to advise the mother and provide usual care.
He said: “The initial and appropriate offer to be transferred to hospital at 7.19am on the discovery of meconium was not accepted; subsequently, the consequences of a worsening condition involving decelerations against the background of the presence of meconium – including more obvious symptoms requiring transfer to hospital at 10am – were not communicated to require transfer to hospital.”
The medical examiner concluded there were signs the baby was in distress, including meconium, the baby’s first stool, and a decreased heart rate.
Maternity and Newborn Safety Studies (MNSI) stated in its report on doula: “MNSI acknowledges that there is no regulation of doula care or any guidance on how the two services interact.
“MNSI takes into account the dynamics of a situation where a third party is involved, which may create additional challenges for staff, such as making clinical recommendations versus personal recommendations or opinions and providing usual care that could be viewed as intervention rather than supervision.”
MNSI identified 12 cases where there was evidence of doulas working outside the defined boundaries of their role and where the care or advice provided by the doula was considered to have potentially affected poor outcomes for the family.
The issue of doula registration, regulation and training was also raised as an area of interest by Mr. Charles.
The report highlighted evidence presented at the inquiry by experienced midwifery professionals which suggested it would be beneficial to provide guidance for everyone involved in a birth where a doula is present.
Doula UK, the largest representative body for doulas but not a regulatory body, said: “We are deeply saddened to hear of the loss of a baby and our thoughts are with the family. “Doulas support thousands of families each year by providing compassionate emotional, informational and practical care throughout pregnancy, birth and the postnatal period, working with midwives and doctors to help families feel informed and supported.
“Doula UK members undertake approved training, mentoring practice and continuing professional development guided by a common code of conduct. As an organisation, we carefully consider what we learn from reports such as this and are committed to continually strengthening our guidance and support so doulas can provide thoughtful, respectful care to the families they serve.”
DHSC has also been contacted for comment.
