Understanding the doula’s role in maternity safety investigations

A doula, according to Doula UK (2022), provides ‘support in pregnancy, birth and in the postnatal period by providing information, advocacy, and practical and emotional support to the whole family’.

Our interest evolved after several cases came to our attention. We were limited by the Department of Health and Social Care Directions to only investigate NHS care and a small group of us wanted to find out if our experiences were common across the HSIB.

As part of our review, we found that doulas may or may not have received any training, and as they are not trained medical professionals should not take on a clinical role. There is no national data on what percentage of women in England use a doula and there is no regulatory body to support and oversee the care that doulas provide.

We found doulas supporting mothers in 29 of the 2,827 (Jan 2023 figures) completed HSIB maternity investigations. In many cases the care provided by doulas was found to be positive and beneficial to the families who chose their additional support.

However, HSIB found evidence in 12 of the 29 investigations that doulas worked outside of the defined boundaries of their role. The care or advice provided by the doula was considered to have potentially had an influence on the poor outcome for the baby.

Moving forward, we feel that there is a need to explore families understanding of the role of the doula and how this informs their choice to employ a doula. Families also need information on the importance of recognising how their choices in pregnancy and labour may be influenced by a doula. Staff working within maternity units need to understand the role of a doula and the expectation of their role in supporting mothers.

HSIB will be meeting with the Regional Chief Midwives with a view to national learning which supports the introduction of national guidance for health professionals, doulas and mothers combined.