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Doctor hits out at doula trend

A doctor has criticised the growing trend among expectant mothers to hire doulas, claiming it implies a failure in NHS support and could compromise patient wellbeing.

Trainee anaesthesiologist Dr Abhijoy Chakladar said the lack of regulation of doulas could jeopardise medical decisions during labour and the growing popularity of the service may be indicative of a lack of faith in midwifery services available on the NHS.

Writing online in the British Medical Journal (BMJ), Dr Chakladar described how a doula had compromised the care he offered one patient who had been given a top-up of epidural pain relief.

"I gave the top-up and advised that she turn to lie on her side," he wrote.

"At this point the doula interjected to say that the mother was comfortable as she was and asked whether repositioning was necessary. I said it was for the top-up to be most effective."

Some 1,000 doulas are currently working in the UK with demand rising substantially in the past 15 years following the popularity of the service within celebrity circles.

The Royal College of Midwives (RCM) said there was "no doubt" some doulas were performing a role that should be carried out by midwives.

Copyright © Press Association 2009

Royal College of Midwives

Your comments (terms and conditions apply):

"I agree with Pam from Berkshire. I had not heard of doulas before. I worked on obstetrics when there were plenty of midwives and nursing auxilliaries as they were called then. We had time to spend with labouring mums. There was strong support post delivery, particularly around breastfeeding. What
has happened to the NHS? Mums will get support where they can. Do something about staffing the NHS wards adequately and stop making childbirth such a rushed negative experience for many women" - Glynis Collins, Huddersfield

"As the premier doula organization, representing over 7,000 doulas, DONA International takes the opportunity to offer a rebuttal to this article.
The importance of fostering relationships between parents and infants cannot be overemphasized, since these early relationships largely determine the future of each family and of society as a whole. The quality of emotional care received by the mother during labor, birth, and immediately afterwards is one vital factor that can strengthen or weaken the emotional ties between mother and child.
DONA International is the largest certifying organization for doulas in the world. While the doula field is not currently regulated, parents and providers can find reassurance in the scope of practice that all DONA doulas agree to - and are governed by - in becoming certified through, or members of, the organization. This scope is defined as such:
Doulas specialize in non-medical skills and do not perform clinical tasks, such as vaginal exams or fetal heart rate monitoring. Doulas do not diagnose medical conditions, offer second opinions, or give medical advice. Most importantly, doulas do not make decisions for their clients; they do not project their own values and goals onto the laboring woman.
DONA International believes that doulas are an integral part of the maternity care team supporting their clients emotionally and physically" - Stefanie, DONA International

"The doula's role is to act as advocate for the mother, ie, speak on her behalf. Of course not all doulas act as they should, but studies show that the presence of a doula is associated with better labour, birth and breastfeeding outcomes. Many women feel unable to ask professionals caring for them to give information, possibly - in this case - why the doctor asked a woman to move from her comfy position. As a patient, I have often felt cowed by some health professionals and unable to challenge their care of me. If health workers were better able to communicate with their patients, there would be less need for this sort of discussion" - Alison Blenkinsop, Aldershot

"I did not know what a 'doula' was until I read this article! Seems a bit strange to me, but when there are not enough midwives to go round what are expectant mothers supposed to do?" - Pam, Berkshire

"This doctor was threatened because someone asked him a simple question to obtain information? THAT's his example trying to support his claim that doulas pose risks? This is ridiculous and clearly the opinions of a doctor who is threatened by someone having a different opinion" - Name and address supplied