{"id":2437,"date":"2025-10-12T18:59:28","date_gmt":"2025-10-12T18:59:28","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjsrh\/?p=2437"},"modified":"2025-10-13T16:14:51","modified_gmt":"2025-10-13T16:14:51","slug":"doula-regulation","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjsrh\/2025\/10\/12\/doula-regulation\/","title":{"rendered":"Exploring the role of birth doulas as liminal actors in medical law and regulation"},"content":{"rendered":"

By Beverley Clough and Anna Nelson<\/em><\/p>\n

Birth doulas are not medically trained, but are seen as a source of physical and emotional support for the birthing person. <\/span>Doula UK<\/span><\/a>, the <\/span>largest <\/span>UK Doula Organisation, has explained the doula role as: \u201cproviding practical, emotional and nurturing support to the whole family during pregnancy, labour and after the birth of a baby.\u201d\u00a0<\/span>\u00a0<\/span><\/p>\n

However, it is vital to recognise that \u2018doula work\u2019 is not always clearly boundaried, and the definition of what counts as \u2018doula work\u2019 is far from settled. Different doulas offer different services, and work in different environments. <\/span>Definitions may be contested. <\/span>Some doulas support for the full pregnancy journey, some only during labour birth; some will only work outside of clinical spaces or in the context of vaginal birth, others are happy to support any birth. Doulas also work in different capacities: privately, through community \/ voluntary organisations, with some alignment to NHS or social services, or some combination thereof.\u00a0<\/span>Equally, individuals may be undertaking activities akin to a doula, but without badging it as such.\u00a0<\/span><\/p>\n

Though more research is needed to empirically evidence this, anecdotal evidence and media attention suggests that there has been growing interest in birth doulas over the past decade. In 2017, the Royal College of Midwives published a <\/span>Position Statement<\/span><\/a>,<\/span> which included the claim that \u201cthe number of women engaging doulas throughout their maternity pathway is increasing\u201d (p3). More recently, the issue was raised in a <\/span>BBC File on 4 Investigation<\/span><\/a> in November 2024, and has been the subject of several news stories (see, for example; <\/span>Sky News, Jan 2025<\/span><\/a>; <\/span>BBC News, Nov 2024<\/span><\/a>; <\/span>The Times, June 2024<\/span><\/a>).\u00a0\u00a0<\/span><\/p>\n

 <\/p>\n

Contextualising Birth<\/b><\/p>\n

When we are looking to understand the socio-legal dynamics of birth, it is valuable to situate the discussion in the historical and cultural context as this helps us to more fully understand the contours of any tensions or concerns which arise.\u00a0<\/span><\/p>\n

The Midwifery Act, passed in 1902 is credited with the <\/span>development of professional midwifery<\/span><\/a> and provided the first formal and statutory recognition of the profession in the UK. Prior to this, however, midwives’ actions were still subject to various forms of community regulation \u2013 often based on testimonials from \u201c<\/span>women whose children they had delivered as well as from parish clergy, and local medical men.\u201d (<\/span>Fox and Brazier<\/span><\/a>). It is important therefore to trouble the notion of a neat regulated \/ unregulated binary; something which is central to our project as it also arises in the doula context.<\/span><\/p>\n

 <\/p>\n

Birth Doulas as Liminal Actors in Medical Law: Regulatory, Conceptual and Professional Tensions<\/b><\/p>\n

Our interest in birth doulas was piqued when, in 2023, the Health Services Safety Investigations Body (HSSIB) published a <\/span>blog based on their own research<\/span><\/a>, which – alongside noting positive stories and outcomes in relation to doula involvement in births – raised some concerns about the fact there was no regulatory body overseeing the work of doulas and which highlighted incidents of doulas acting \u2018outside of the defined boundaries of their role\u2019. We suggest that a closer look at the status quo reveals a more nuanced and complicated picture than these statements necessarily capture.\u00a0<\/span><\/p>\n

First, the claim that doula work is unregulated \u2013 at least entirely \u2013 can be called into question. Critically interrogating the suggestion that doulas are entirely unregulated at present matters, because such a claim feeds into concerns about accountability and the safety of birthing people \u2013 which in turn have the potential to shape and support interprofessional tensions between doulas and healthcare professionals involved in birth.<\/span><\/p>\n

While it is true that there is not a central regulatory or credentialing body nor set of professional regulatory standards which govern doulas as an overarching \u2018profession\u2019, doulas nonetheless hit against a number of other legal and regulatory frameworks which operate to shape their behaviour and practice. As socio-legal scholars, we are keen to interrogate what we mean by regulation in this context, and to recognise the ways that various legal and regulatory frameworks work together to shape doula and birth work practices.<\/span><\/p>\n

The most obvious example of this is Art 45 of the <\/span>Nursing and Midwifery Order 2001<\/span><\/a> which makes it a summary offence for a person \u2018other than a registered midwife or a registered medical practitioner\u2019 to \u2018attend a woman in childbirth\u2019 except where sudden or urgent necessity requires them to. Though there is a lack of clarity as to what \u2018attend to\u2019 means, we nonetheless argue that this provides an example of a clear regulatory boundary that doulas encounter.<\/span><\/p>\n

Other aspects which we intend to explore in more detail as the project progresses are the role and relevance of training programmes (even though these are not standardised) and membership of doula organisations, and the use of contracts and\/or insurance. When thinking about this issue, we are mindful of the potential parallels with the history of midwifery and think about the forms of non-statutory community regulation to which midwives were subject prior to 1902; and will consider what we can learn by looking at this issue from this historical vantage point.<\/span>
\n<\/span>
\n<\/span>Second, the claim that doulas may be acting outside of the boundaries of their role presupposes that there <\/span>are <\/span><\/i>set, articulated and agreed-upon boundaries, to which the majority of those undertaking doula work subscribe. Our initial research suggests that this is certainly not the case. Confusion, or even disagreement, about the nature of the birth doula role amongst those involved in birth can lead to increased inter-professional tensions \u2013 and may also put doulas in an uncomfortable situation if they are asked to do something that they feel is outside of their remit. However, for some the flexibility of the doula role is important and powerful, allowing doulas to adapt their practice to best support each individual birthing person. Therefore, while we are interested in exploring the range of understandings of the doula role, and the potential tensions caused by a lack of set boundaries, our intention is not to prescribe set boundaries through our research.\u00a0<\/span><\/p>\n

A further strand of our interest relates to the way that the inclusion of doulas in birth may \u2018disrupt\u2019 some of the assumptions underpinning current medico-legal paradigms. Traditionally medical law has understood healthcare encounters as dyadic in nature \u2013 conceptualising a direct and exclusive relationship between the patient, or pregnant person, and the healthcare professional (<\/span>\u2018the doctor-patient relationship<\/span><\/a>\u2019). However, the inclusion of doulas within the birth encounter troubles the foundational assumption and in doing so may have important implications for core medico-legal concepts such as consent and autonomy, accountability, and negligence. Thinking about these concepts differently – for example, being attentive to ideas of <\/span>attuned or embodied consen<\/span><\/a>t processes – may open up space for rethinking medico-legal norms at a broader level.\u00a0<\/span><\/p>\n

Our research looks to explore these tensions and to identify the challenges associated with situating doulas within the existing regulatory and institutional frameworks of birth.<\/span><\/p>\n

 <\/p>\n

 <\/p>\n

Why This Matters<\/b><\/p>\n

The current lack of clarity surrounding the nature and boundaries of the birth doula role, and the way that doulas interact with medico-legal and regulatory systems, has the potential to lead to \u2013 or at least exacerbate \u2013 inter-professional tensions between different actors involved in birth. This can lead to frustration for both doulas and healthcare professionals, and may negatively impact the quality of care experienced by birthing people. There has been increasing recognition that the existing maternity service is not adequately protecting those who birth \u2013 and work \u2013 within it. This is reflected, for example, through the recently launched <\/span>National Maternity Investigation<\/span><\/a>. We argue that in order to effectively improve maternity and birthing care, it is necessary to take seriously the reality of the (re)shifting birth landscape which is increasingly involving non-clinical actors, and to ensure the frameworks and policy are able to appropriately encompass and recognise the role these actors play.<\/span><\/p>\n

We know that conversations about the potential regulation of doulas <\/span>are <\/span><\/i>happening. Our project seeks to ensure that these are sufficiently nuanced, that they capture the diversity and realities of doula practice and can situate these within a broader social and historical context, and that they situate discussions of regulation within an understanding of the current legal landscape and potential implications of regulatory interventions.\u00a0<\/span><\/p>\n

 <\/p>\n

Get Involved<\/b><\/p>\n

We are looking to engage with as full as range voices and opinions as possible \u2013 including all healthcare professionals who are involved in birth and interact with doulas. These include, but are not limited to, midwives, obstetricians, ambulance technicians, nurses and anaesthetists.\u00a0<\/span><\/p>\n

To achieve this, we have launched a qualitative survey for healthcare professionals:<\/span> https:\/\/mmu.eu.qualtrics.com\/jfe\/form\/SV_eK9EvqAy6NHLZky<\/span><\/a>\u00a0<\/span><\/p>\n

There is also a separate survey for birth doulas, which can be found here: <\/span>https:\/\/qualtricsxm2w4bhmwzy.qualtrics.com\/jfe\/form\/SV_e3TnEWTILjbF7f0<\/span><\/a>\u00a0<\/span><\/p>\n

Please note: these surveys will close on 31\/10\/2025 or once we have received 50 responses \u2013 whichever comes first. <\/span><\/i>
\n<\/span>
\n<\/span>These surveys are the first stage in a wider research project, and we will also be organising interviews and focus groups. If you would like more information on these, or on the project as a whole, please feel free to get in touch!<\/span><\/p>\n

 <\/p>\n

About the Authors\u00a0<\/b><\/p>\n

Beverley Clough: <\/b>Bev is a Professor of Law & Social Justice at Manchester Metropolitan University. Her work sits at the intersection of health and social care, and explores this through feminist legal theory, legal geographies, and critical disability studies.<\/span><\/p>\n

Anna Nelson: <\/b>Anna is a socio-legal researcher with a particular interest in choice, care and consent in childbirth. More broadly, she is interested in critically exploring the way that gendered realities shape experiences of consent in healthcare and beyond. She has a PhD in Bioethics and Medical Jurisprudence from the University of Manchester.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

By Beverley Clough and Anna Nelson Birth doulas are not medically trained, but are seen as a source of physical and emotional support for the birthing person. Doula UK, the largest UK Doula Organisation, has explained the doula role as: \u201cproviding practical, emotional and nurturing support to the whole family during pregnancy, labour and after […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":472,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[599],"tags":[],"class_list":["post-2437","post","type-post","status-publish","format-standard","hentry","category-screening"],"yoast_head":"\nExploring the role of birth doulas as liminal actors in medical law and regulation - BMJ Sexual & Reproductive Health blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmjsrh\/2025\/10\/12\/doula-regulation\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Exploring the role of birth doulas as liminal actors in medical law and regulation - BMJ Sexual & Reproductive Health blog\" \/>\n<meta property=\"og:description\" content=\"By Beverley Clough and Anna Nelson Birth doulas are not medically trained, but are seen as a source of physical and emotional support for the birthing person. 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