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Doulas 'compromising patient care'

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The increasing amount of doulas hired by pregnant mothers is compromising patient care and reflects badly on the current level of service provided by the NHS, a doctor has claimed.

Dr Abhijoy Chakladar, a trainee in anaesthesia, said doulas, who act as pregnancy and birth partners, are not regulated and should not be involved in medical decisions.

He added: “This trend may be a sad reflection of failures in the delivery of medical and midwifery care, a sticking plaster concealing greater problems.”

Furthermore, the “doula business” could be exploiting women’s fears about the quality of NHS hospitals and the “seemingly limitless market for birth-related products and services”.

The Royal College of Midwives responded by saying there was ‘no doubt’ some doulas were performing a role that should be carried out by midwives.

Writing online in the British Medical Journal, Dr Chakladar, who works at Worthing Hospital in West Sussex, said a doula had compromised the care he offered one patient.

He gave the patient a top-up of epidural pain relief during labour after she complained of discomfort.

“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.”

The doula spoke to the patient and told the doctor she had decided not to move.

Doulas are not usually medically qualified but have been growing in popularity.

  • 3 Comments

Readers' comments (3)

  • It's the nurses' own fault

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  • Daphne Woodhouse
    As a former midwife with experience both in hospital and the community, including home births, I am sorry that this single incident is receiving rather unbalanced press. There is no comment by even one practising midwife. It is widely publicised that there are insufficient midwives and that care is suffering. As a mother I am glad there is a service available for women when basic comfort issues may need additional support. It is vital that medical staff learn to communicate with assertive service users, whether it is a labouring women or a person present to assist and advocate for her. Although I can't know that this communication was inadequate, it would be interesting to know how it was explained to both women why it was important for her to move following the epidural top-up.
    It would be a shame for one briefly reported incident experienced by one trainee anaesthetist to adversly affect the very good support being given by many doulas.
    Assistance like this needs to be accommodated by maternity services as some women feel the need to safeguard themselves in this way. As a midwife I was glad to work with those who accompanied women in labour and would develop a team approach for the woman's care. Getting defensive because another person may provide some comfort that I was unable to provide due to service demands would not have helped. This was certainly my prefered option to leaving women's needs unmet!
    Dr Chaklader's concern that the doula service could be 'exploiting women's fears of poor NHS service', shows little insight into the effect the shortfall of midwives has on women's experience in labour and the long-lasting impact this has on women's lives. Women are choosing to take control by bringing a doula with them, where there is a very real possibility their attention will be useful. This has never been popular with certain members of the medical profession. The pholosophy of healthcare now rightly puts much responsibility on the individual but some medics still want to control patients, in unquestioned paternalism, rather than upgrade their communication skills to cope with assertive patients.
    Let's hear what midwives with experience of the doula service have to say.

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  • Man-woman-labour-threat to power= attack.
    Or am I just being cynical?

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