In a heartbreaking case, the death of baby Matilda Pomfret-Thomas has prompted a coroner to call for greater clarity and guidance on the role of doulas – non-medical professionals who provide emotional and practical support during pregnancy and birth.
The inquest into Matilda’s death in November 2023 revealed that midwives from Portsmouth’s Queen Alexandra Hospital felt their access was “being restricted by the doula” when Matilda’s mother went into labour. Despite signs of foetal distress, the offer to transfer the mother to the hospital was repeatedly turned down, with the coroner noting that the presence of the doula “negatively impacted upon the effective provision of midwifery services”.
Coroner Henry Charles emphasised that the role of doulas is “clearly diffuse in practical terms and capable of multiple understandings” not just by the doulas themselves, but also by their clients and midwives. He highlighted that while Doula UK provides training and guidance, it is not a regulatory body and does not cover all doulas operating in the UK.
The coroner’s prevention of future deaths report has urged the Department of Health and the National Institute of Health and Clinical Excellence to take action to avoid similar tragedies involving doulas. A separate report by Maternity and Newborn Safety Investigations (MNSI) also found evidence in 12 out of 29 cases that doulas had worked outside the defined boundaries of their role, with the care or advice provided potentially influencing poor outcomes for babies.
In one case, the MNSI report noted that a doula had encouraged a mother to stay at home “in direct conflict with the advice from the midwifery team to urgently transfer to the hospital”, leading to a significant delay that contributed to the baby suffering a severe brain injury.
Doula UK has acknowledged the seriousness of the coroner’s report and stated that it will be taking steps to review and strengthen its policies, guidance, and ongoing professional development provision in consultation with its members and approved course providers.
This tragic case highlights the urgent need for clearer guidance and regulation around the role of doulas within the healthcare system. As the use of doulas continues to increase, it is crucial that their interactions with midwives and hospital maternity services are well-defined and understood, to ensure the safety and wellbeing of mothers and babies.
