A chilling warning has been issued by a coroner, highlighting the potential risks associated with home birthing assistants, or doulas, following the tragic death of a newborn baby in Hampshire. This case has sparked a much-needed conversation about the role of doulas and the need for clearer guidelines to prevent future tragedies.
The Tragic Story of Matilda Pomfret-Thomas
Matilda's story is a heart-wrenching one. In November 2023, she succumbed to a brain injury, just 15 days after a difficult home birth. The inquest, which concluded last month, revealed that the mother's decision to stay at home, despite signs of fetal distress, may have been influenced by the presence of a doula.
A Call for Action
The coroner's report, published on Wednesday, urges the Department of Health and the National Institute of Health and Clinical Excellence to take immediate action. The report emphasizes the need for better regulation and guidance regarding doulas, who provide emotional and practical support during pregnancy and birth. The concern is that without clear boundaries, doulas could inadvertently delay crucial medical interventions.
The Doula's Impact
Assistant Coroner Henry Charles noted that midwives from Queen Alexandra Hospital in Portsmouth felt their access to the mother was hindered by the doula. On October 29, 2023, when the mother went into labor, a midwife offered to transfer the mother to the hospital at 7:19 a.m. due to the discovery of meconium, a sign of fetal stress. However, this offer was declined, and despite the labor's deterioration, the family was not convinced to transfer until later in the morning.
Charles stated, "The doula's presence and work negatively impacted the effective provision of midwifery services. It hindered the building of rapport and the delivery of effective advice and care."
He further explained, "The doula did not actively discourage midwife access, but she was seen as a buffer by the midwifery team. She was following the birth plan and supporting the parents as per the plan, which gave the impression that a home birth was still feasible."
The Diffuse Role of Doulas
Charles raised concerns about the potential for fatal misunderstandings arising from the role of doulas. He emphasized that the role of a doula is open to multiple interpretations, not just by the doulas themselves but also by their clients and midwives. Many doulas are represented by Doula UK, which provides training and guidance, but it is not a regulatory body and does not cover all doulas.
"Experienced midwifery professionals have highlighted the need for guidance when doulas are present at births. This would benefit all parties involved," Charles added.
The Lack of Regulation
A separate report by Maternity and Newborn Safety Investigations (MNSI) echoed these concerns. It highlighted the absence of regulation for doulas and the lack of guidance on their interaction with hospital maternity services. MNSI suggested that doulas could be perceived as an interference rather than a helpful presence.
In 2023, when MNSI was part of the Healthcare Safety Investigation Branch, they noted that doulas were involved in 29 of the 2,827 maternity investigations they had completed. In 12 of these cases, the care or advice provided by the doula was considered to have potentially influenced the poor outcome for the baby.
In one instance, a doula encouraged a mother to stay at home, directly contradicting the advice of the midwifery team to transfer urgently to the hospital. This delay significantly contributed to the baby sustaining a severe brain injury.
Doula UK's Response
A spokesperson for Doula UK acknowledged the seriousness of the coroner's report. They stated, "We have policies and practices in place to ensure doulas remain within the scope of their practice. In light of this report, we will review and strengthen our policies, guidance, and continuing professional development in consultation with our members and approved course providers."
Additionally, in September 2025, Doula UK collaborated with the Nursing and Midwifery Council to produce a video series clarifying the distinct roles of midwives and doulas.
The Need for Clear Guidelines
This case highlights the importance of clear guidelines and communication between doulas, expectant parents, and healthcare professionals. While doulas provide valuable support, their role must be well-defined to ensure the safety and well-being of both mother and child. The question remains: How can we strike a balance between empowering expectant parents and ensuring the highest standards of care during childbirth?
What are your thoughts on the role of doulas and the need for regulation? Share your opinions in the comments below!
