Medical Experts Caution Against Risks of Unassisted Childbirth

Experts have stated that a growing practice of women giving birth without the presence of trained medical professionals poses a risk of “reversing [care] to the middle ages.” Data indicates an increase in the number of women utilizing doulas, individuals who offer support to pregnant women before, during, and after childbirth, often in the context of a home birth. Medical professionals have reported instances where doulas encouraged women to disregard medical recommendations. One senior consultant stated that expectant mothers are jeopardizing both their own health and their child’s life through births without medical supervision. She cited a case where a patient required a colostomy bag after a doula recommended against stitches following a fourth-degree tear. This consultant now advocates for the government to implement regulation for doulas. Trudi Dawson, Director of Doula UK, informed the BBC that doulas do not undertake medical procedures, primarily offering “advocacy and support.” She elaborated, “It’s really more about comfort measures, advocacy, support, hand-holding, encouraging.” She emphasized that members are prohibited from influencing women towards specific birth choices, stating: “We would signpost them to the evidence. “So research might say, for example, if you have a twin, a home birth, you may be more likely to experience X, Y and Z, and that would still be their choice. “It might also be that with a twin birth, if you’re going to hospital, you may be more likely to receive interventions that you don’t want. “So it would be evidence based, but it would be the whole picture from both sides should they want it as well.” Mrs. Dawson disagrees with proposals from obstetricians for doula regulation. She further explained: “Obviously we can’t be the doula police but we are trying to make sure that there is kind of a gold standard by having a register of doulas who have done specific training, who’ve had a mentored period, and who stand by the philosophy and a code of conduct.” Conversely, a senior obstetrician and gynaecologist, who remained anonymous, expressed being “terrified” regarding women giving birth in medically unsupervised environments. She stated: “I just feel like freebirthing and allowing women to take that sort of risk with themselves, their bodies and their baby, is risking their baby dying and them potentially dying in that very unsupervised environment. “I think it’s reversing back to the Middle Ages.” Doula UK has 700 registered doulas who supported over 2,000 births in 2022, an increase from 1,835 in the preceding year, and this figure is projected to keep increasing. Doulas frequently serve as facilitators before and during childbirth. While they are not government regulated, registration with Doula UK requires completing an approved course and a mentored period. Nevertheless, membership with Doula UK is not mandatory to practice as a doula. Doulas are legally prohibited from providing any form of medical intervention, including the performance of birthing techniques that are exclusively within the scope of midwives and obstetricians. The anonymous senior obstetrician and gynaecologist further stated: “I have had to care for women who had to come into hospital as an emergency after home, unsupervised home birth, either with a severe tear or sometimes haemorrhaging.”I have seen with a colleague, for example, that a woman was persuaded [by her doula] not to have a fourth degree repair in hospital.”And this woman ended up with a colostomy. So there’s some limited evidence that doulas are working outside the bounds of what they should be doing.” The government announced its commitment to training thousands more midwives and expressed its “determination to learn lessons from recent investigations into maternity care to make sure that all women and their babies receive safe, personalised and compassionate care”. However, the Royal College of Midwives (RCM) asserts a deficit of 2,000 midwives in England, which is creating a “real problem when it comes to choosing to give birth at home”. Two senior midwives, representing different trusts in England, have reported cases in which doulas prevented midwives from entering home births, resulting in them waiting in their cars. One of these midwives stated: “It’s just the unregulated nature of them and the patchiness of the knowledge. “In shared conversations with doulas, I heard birth reflections about shoulder dystocia [when the baby’s shoulders are stuck] and criticising midwives for intervening.”I have heard recently of a midwife arriving and finding equipment for Entonox [pain-relieving gas] and for an episiotomy for a doula. This is where you really are crossing boundaries. “We’ve had cases where the midwife has been asked to sleep in the car for 12 hours just in case. “We feel very, very compromised on that, if you look at the NMC [Nursing and Midwifery Council’s] code of conduct with the expectation on us to attend if called.” Another senior midwife commented: “In the last two years, more doulas I have never heard of are appearing on the scene that don’t approach me or midwives caring for the woman. I don’t really know what they are advising women on.” However, numerous women have reported highly positive experiences with doulas. Rebecca delivered her daughter Luna two years prior, following a caesarean at 41 weeks. She stated that the presence of a doula proved to be significantly helpful, adding: “She was just amazing. She helped me with breastfeeding in the hospital. “She knew all those things to ask for, which I would have probably quietly and passively sort of sat in a corner suffering and not bothered to kind of stand up and ask for help.” Mimi, from Bristol, successfully had a home water birth with two midwives present during the delivery of Nala. She stated: “I didn’t want to feel like a patient when I’m doing something that should feel really empowering.”I just feel really lucky that I didn’t have to have a baby in hospital because I think for me personally it would have been a very different experience.” Meanwhile, Isida Mitre, from London, engaged a doula following the birth of her first son, but the doula was on holiday when Isida went into labour, necessitating the couple to find a substitute. “Baby was born. I contacted her and she came straight away, so she worked for us like two days, but it was staying like three or four hours,” she said.”The day after, I was waiting for her to come. And then she texts me saying that she’s not able to come.” Isida expressed disappointment and stated her desire for broader regulation of doulas. In 2023, England and Wales recorded 598,400 live births. A report last year by Maternity and Newborn Safety investigations, which examined 3,000 fatalities of babies or mothers during childbirth, indicated that doulas were involved in 29 incidents, constituting under one percent. Furthermore, fewer than half of these cases involved doulas performing duties typically reserved for midwives or doctors. Fiona Gibb from the RCM reported hearing from some members that doulas have confined midwives to a separate room, preventing them from monitoring or assessing the birthing mother. She stated that lack of consistent access hindered their ability to assess if paramedic staff were needed for transfers. She added: “It’s one of the reasons why the RCM wouldn’t recommend freebirth just because of the associated risks that can be involved with it.” Over the past decade, caesarean sections have risen to nearly 40% of all births, and inductions have increased by 10%, with one in three labours being artificially induced. Nadia Higson from the Association for Improvements in Maternity Services (AIMS) stated that a succession of maternity scandals has generated apprehension that medical professionals are not adequately listening to women. She commented: “Many people will turn to doulas because they just feel they’re going to at least have somebody there who is supporting them, advocating for them, and that that may be a helpful thing for them.” The Royal College of Obstetricians and Gynaecologists informed the BBC: “Women should have the right to give birth in an environment in which they feel comfortable, and should be supported in their birth choice. “However, safety is paramount and women should be given all the information they need to make an informed decision.”