Coroner Issues Stark Warning Over Doulas Impacting Midwifery Care After Tragic Infant Death
A coroner has issued a significant warning regarding the potential for doulas to adversely affect the work of midwives, following a distressing inquest into the death of a baby girl just fifteen days after her birth. The caution comes from Henry Charles, the coroner for Hampshire, Portsmouth and Southampton, who presided over the investigation into the passing of Matilda Pomfret-Thomas last month.
Tragic Case Highlights Systemic Concerns
Matilda's parents had engaged a doula as part of their plan for a home birth, a decision influenced by a traumatic hospital birth experience with their first child. A doula is defined as an unregulated, non-medical professional whom parents can hire to offer continuous emotional, physical, and practical support throughout pregnancy and childbirth. This role exists amidst considerable controversy, with some medical professionals, including doctors, arguing that doulas may inadvertently place women and infants at risk.
Matilda tragically died on November 13, 2023, from neonatal hypoxic-ischemic encephalopathy (HIE), a severe form of brain damage resulting from a lack of oxygen to the brain either before or shortly after birth. Mr Charles concluded that Matilda developed HIE over several hours during labour at home. He found that the presence of a doula at the scene did negatively impact the ability of the attending midwives to advise the mother and deliver their standard care.
Detailed Account of Labour Complications
During the home labour, midwives observed decelerations, which are decreases in the foetal heart rate. Despite these clear signs of complications becoming apparent, the mother was not transferred to Queen Alexandra Hospital in Portsmouth until 12.13pm. In his comprehensive report, Mr Charles detailed the sequence of events, noting that labour commenced in the early hours of October 29, 2023, with prompt midwife attendance.
An initial and appropriate offer for hospital transfer at 7.19am, following the discovery of meconium, was not accepted. Subsequently, the implications of a deteriorating situation involving decelerations against the background of meconium presence, including further clear signs at 10am that necessitated hospital transfer, were not communicated effectively enough to prompt a move to hospital.
Mr Charles stated: The background is of a traumatic first birth that impacted upon decision making for this second pregnancy and birth. Matilda's parents had seen a home birth as the best way forward. He explained that the parents were focused on achieving a different birth experience by employing a doula for support.
Atmosphere of Restriction and Miscommunication
The coroner highlighted that a difficult atmosphere had developed, with midwives feeling their access was being restricted by the doula. He found that while the doula did not actively discourage midwife access, she was perceived as, in effect, a buffer by members of the midwifery team. The doula was adhering to the birth plan and supporting the parents accordingly, which appears to have been interpreted as grounds for hope that a home birth remained feasible, even as signs of foetal distress emerged.
Mr Charles emphasised: An element of what occurred is that the presence and work of a doula did on this occasion negatively impact upon the effective provision of midwifery services in terms of building a rapport conducive to effective advice and care being given.
Lack of Regulation and Guidance
The coroner pointed out that Doula UK, while the largest representative body for doulas, is not a regulatory authority and does not represent all practitioners, with many doulas operating outside its membership. He noted that Doula UK has established membership requirements, training offers, and guidance, but the role of a doula remains clearly diffuse in practical terms and capable of multiple understandings not just by doulas but their clients and midwives.
Furthermore, Mr Charles referenced the Maternity and Newborn Safety Investigations (MNSI), which examines patient safety incidents in NHS maternity care. MNSI has acknowledged issues regarding how doulas and midwives collaborate, stating there is no regulation of doula care or any guidance on how the two services interact. MNSI has identified twelve cases where doulas worked outside of the defined boundaries of their role and in which the care or advice provided by the doula was considered to have potentially had an influence on the poor outcome for the family.
Calls for Review and Action
In light of these findings, Mr Charles has raised significant concerns about doula registration, regulation, and training, recommending these areas for urgent review. His report will now be forwarded to key stakeholders, including the Department of Health, the Nursing and Midwifery Council, and Doula UK, to prompt necessary discussions and potential reforms in maternity care practices.
This case underscores the critical need for clearer guidelines and improved communication between all parties involved in childbirth, ensuring that the safety of both mother and child remains the paramount priority in all birth settings.
