Inquest into child lady’s loss of life sees coroner warn of the hazard of doulas affecting midwives’ work

A warning has been issued about doulas affecting the work of midwives following the death of a baby girl just 15 days after her birth.

The coroner for Hampshire, Portsmouth and Southampton, Henry Charles, gave the caution after last month’s inquest into the death of little Matilda Pomfret-Thomas.

Matilda’s parents hired a doula as part of their plan to have a home birth after they experienced a traumatic hospital birth for their first child.

A doula is an unregulated non-medical professional parents can employ to provide continuous emotional, physical and practical support throughout pregnancy and birth.

There is controversy surrounding the use of doulas, with some – including doctors – arguing they put women and infants at risk.

Matilda died 15 days after birth on November 13, 2023, from neonatal hypoxic-ischemic encephalopathy (HIE) – a type of brain damage caused by a lack of oxygen to the brain before or after birth.

Mr Charles concluded Matilda developed HIE over a period of hours during labour at home and that the presence of a doula at the scene did ‘negatively impact’ the ability of present midwives to advise the mother and provide usual care.

Decelerations – decreases in foetal heart rate – were also observed by midwives attending to the mother at home; however, the mother was not taken to hospital following those complications becoming apparent until 12.13pm.

A coroner’s report into Matilda Pomfret-Thomas’s death concluded the presence of a doula during labour did ‘negatively impact’ how midwives advised her mother and provide care (stock photo of Queen Alexandra Hospital, where the baby girl was born)

Matilda was eventually delivered at Queen Alexandra Hospital in Portsmouth.

In his report, Mr Charles said: ‘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.

‘Labour started in the early hours of 29th October 2023 and there was prompt midwife attendance.

‘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.

‘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.’

Detailing the events of Matilda’s birth, Mr Charles said the parents suffered a traumatic birth with their first baby and were ‘focused on achieving a different birth experience’ for their Matilda by using a doula to provide support.

He said: ‘The hospital’s preference was for a hospital delivery, there was discussion as to what circumstances would result in the mother being blue lighted to hospital.

‘Signs of foetal distress developed but the mother was not immediately transferred to hospital.

‘A difficult atmosphere had developed, the midwives felt access was being restricted by the doula.

‘I found that she did not actively discourage midwife access but that she was seen as, in effect, a buffer by members of the midwifery team.

‘The doula was following the birth plan. The doula was supporting the parents per the birth plan, and this appears to have been perceived as grounds for hope that a home birth was still possible.’

Matilda’s parents believed a home birth with the support of a doula was best after previously experiencing a traumatic birth in hospital (stock photo Queen Alexandra Hospital)

Mr Charles noted the organisation 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’.

He said: ‘Doula UK have put in place membership requirements, training offers and much guidance, but the role of a doula is clearly diffuse in practical terms and capable of multiple understandings not just by doulas but their clients and midwives.’

Mr Charles also highlighted the Maternity and Newborn Safety Investigations (MSNI), which investigates patient safety incidents in NHS maternity care, has acknowledged issues with how doulas and midwives work together.

‘MNSI acknowledges that there is no regulation of doula care or any guidance on how the two services interact with each other,’ Mr Charles said.

‘MNSI considers the dynamics of a situation, where a third party are involved can provide additional challenges for staff, such as making clinical recommendations against personal recommendations or views and providing usual care that could be viewed as interference rather than surveillance.’

He said MNSI has 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.

‘The issues of doula registration, regulation and training are therefore points of concern I would commend for review.’

Mr Charles’s report will now be sent to the Department of Health, the Nursing and Midwifery Council, Doula UK and others.