The death of a baby girl has prompted a warning over the use of doulas during births after one had “negatively impacted” midwives.
Henry Charles, assistant coroner for Hampshire, Portsmouth and Southampton, issued a prevention of future deaths report after an inquest last month into the death of Matilda Pomfret-Thomas.
Her parents had chosen to hire a doula as part of plans for a home birth, having previously experienced a traumatic hospital delivery with their first child.
Doulas are non-medical support workers who are not regulated, and are employed by some families to provide emotional and practical help during pregnancy and labour.
Their role remains controversial, with supporters saying doulas offer valuable support to women, while critics – including some medical professionals – warn they may increase risks for mothers and babies.
In this case, Matilda died on 13 November 2023 at 15 days old after suffering neonatal hypoxic-ischaemic encephalopathy (HIE), a form of brain injury caused by a lack of oxygen before or during birth.
Mr Charles said Matilda developed HIE over a period of hours during labour at home and the presence of the doula did “negatively impact” midwives being able to provide advice to the mother and usual care.
He said meconium – a baby’s first bowel movement that can indicate distress – had been detected.
Midwives attending the home birth also noted decelerations, which are drops in the baby’s heart rate.
“An initial and appropriate offer at 7.19am of transfer to hospital upon meconium being found was not accepted, thereafter the implications of a deteriorating situation involving decelerations against a background of the presence of meconium – including further clear signs of it at 10am, requiring hospital transfer, was not communicated in such a way as to lead to a transfer to hospital,” said Mr Charles.
Despite these warning signs, the mother was not transferred to hospital until 12.13pm, where the baby was eventually delivered.
“The background is of a traumatic first birth that impacted upon decision making for this second pregnancy and birth,” Mr Charles wrote in his report.
“Matilda’s parents had seen a home birth as the best way forward.”
He added: “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.”
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The coroner said Doula UK “is the largest representative body for doulas, but it is not a regulatory body, it does not represent all doulas, indeed many doulas are not members of Doula UK.”
Mr Charles said doulas “have been increasingly used and increasingly offer services – as here – on a paid basis”.
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The Maternity and Newborn Safety Investigations (MNSI) body, which examines safety incidents in NHS maternity care, said there were problems in how doulas and midwives work together.
The coroner said MNSI identified 12 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”.
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In his report sent to the Department of Health, the Nursing and Midwifery Council, Doula UK and others, he said concerns over doula registration, regulation and training should be reviewed.
A spokesperson for Doula UK has 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.”
