Birth Doulas: A Collaborative Partner for Families, Midwives and the NHS
- Jacqueline Harler
- Jan 20
- 5 min read
In conversations about maternity care, doulas are sometimes framed as an “extra,” a private add-on in a system already under pressure. But what if we looked at doulas differently, not as a parallel service and not as a replacement for clinical care, but as collaborators who can support birthing people and help ease some of the strain on midwives and NHS maternity services?
With UK maternity services facing staffing shortages, rising intervention rates and increasing complexity of care, it’s time for a more nuanced, evidence-based conversation about where birth doulas fit in a stretched system.
This isn’t about “us versus them.” It’s about how we care for people together.
What Is a Birth Doula?
A birth doula is a trained, non-clinical professional who provides continuous emotional, physical and informational support during pregnancy, labour, birth and the early postnatal period. Doulas do not perform medical tasks, make clinical decisions or replace midwives or obstetricians. Their role is relational and supportive: staying with the birthing person, offering comfort measures, facilitating communication and helping people feel informed and grounded.
In a healthcare system where clinicians are responsible for safety, assessment and intervention, doulas focus on continuity, presence and personalised support.
These roles are different but potentially complementary.
The Evidence: Continuous Support Improves Outcomes
One of the strongest bodies of evidence in maternity care concerns continuous one-to-one support in labour.
A landmark Cochrane review (Bohren et al., 2017), analysing data from over 15,000 women across multiple countries, found that continuous support during labour (often provided by doulas) is associated with:
Reduced rates of caesarean section
Lower use of instrumental birth
Reduced need for pharmacological pain relief
Shorter labours
Higher satisfaction with the birth experience
Better Apgar scores for babies
Importantly, these benefits were most pronounced when the support person was not part of the hospital staff and had no competing clinical responsibilities.
In other words, when someone’s sole job is to be with the birthing person, outcomes improve.
This does not diminish the role of midwives. It highlights how relational care and emotional support are essential components of safe, effective maternity services.
The Reality for NHS Maternity Services
UK maternity units are under extraordinary pressure. Chronic understaffing, increasing birth complexity and rising acuity mean that even the most dedicated midwives often care for multiple women simultaneously. Time, perhaps the most powerful ingredient in compassionate care, is in short supply.
Midwives consistently report:
Limited capacity for continuous bedside presence
High administrative and clinical workload
Emotional fatigue and burnout
Moral distress when they cannot provide the level of care they want to offer
This is not a failure of individuals. It is a structural challenge.
In this context, doulas are sometimes misunderstood as duplicating care or operating outside the system. But when their role is clearly defined, doulas can offer something the system currently struggles to provide: uninterrupted, relationship-based support.
How Doulas Can Support Birthing People
For families, the benefits are often immediate and tangible:
Emotional grounding: Continuous reassurance, calm presence and validation during intense or uncertain moments
Physical comfort: Non-medical pain relief techniques such as positioning, breathing, massage and movement
Information and advocacy: Helping people understand options, articulate questions and feel confident in shared decision-making
Trauma-informed care: Supporting those with previous birth trauma, anxiety or complex social circumstances
Feeling supported and heard isn’t a “nice extra.” There is growing evidence that positive birth experiences are linked to improved postnatal mental health, bonding and long-term wellbeing.
How Doulas Can Support Midwives and the NHS
When doulas work with maternity teams, not in opposition to them, their presence can offer practical and emotional relief.
1. Protecting Midwives’ Time for Clinical Care
Doulas handle the continuous non-clinical aspects of support, comfort, reassurance and presence, freeing midwives to focus on monitoring, documentation, clinical decision-making and managing multiple patients safely.
2. Supporting Communication and Consent
Birth can be overwhelming. Doulas often help families process information, reflect on choices and prepare questions. This can make discussions with clinicians more focused, informed and collaborative rather than rushed or adversarial.
3. Reducing Intervention Through Support, Not Substitution
By helping people cope with labour through non-pharmacological means and emotional reassurance, doulas may contribute indirectly to lower intervention rates. This aligns with NHS priorities around personalised care, informed choice and reducing unnecessary medicalisation where safe.
4. Supporting Continuity in a Fragmented System
With rotating staff and shift changes, continuity can be difficult to maintain. Doulas provide relational continuity: a familiar face who knows the person’s values, fears and preferences. That continuity can ease anxiety and improve trust between families and clinical staff.
5. Emotional Containment in High-Pressure Environments
Labour wards are intense places. When doulas help keep the emotional environment calm, supported and grounded, it benefits not just the birthing person but everyone working in the room.
Addressing Common Concerns
“Do doulas interfere with medical care?”
Doulas are not trained or authorised to provide clinical care. Ethical practice requires that they defer to medical professionals on all clinical matters. When boundaries are clear, doulas enhance, not obstruct, safe care.
“Are doulas only for privileged families?”
This is a real and important concern. Access to doula support is currently unequal. However, community doula projects, volunteer schemes and NHS-linked initiatives have demonstrated particular benefit for those facing health inequalities, including migrant women, survivors of trauma and those with limited social support. If we care about equity, the question isn’t whether doulas have value. It’s how to make supportive models accessible.
“Does this replace one-to-one midwifery?”
No. Doulas are not a substitute for adequate staffing. Investment in midwifery is essential. But while systemic change takes time, collaborative models can provide meaningful support now without undermining the need for properly resourced NHS care.
A Collaborative Vision for Maternity Care
The future of compassionate maternity care does not lie in choosing between professional expertise and relational support. It lies in integrating both.
Midwives bring clinical skill, safety and accountability. Doulas bring continuity, emotional care and presence. When these roles are understood as complementary, everyone benefits:
Birthing people feel heard, supported and empowered
Midwives are better able to focus on safe, high-quality clinical care
The NHS moves closer to its commitments to personalised, trauma-informed and respectful maternity care
This is not about creating parallel systems. It is about recognising that birth is both a medical and a human experience and that excellent care must address both.
Conclusion
In a maternity system under strain, the question is not whether we can afford to think differently about support in birth. It is whether we can afford not to.
Birth doulas, when working collaboratively with NHS teams, offer evidence-based, person-centred support that benefits families, clinicians and the system as a whole. They do not replace midwives. They stand beside them.
At a time when compassion, time and continuity are increasingly hard to deliver, collaboration may be one of the most powerful tools we have.
If you’re interested in learning more about collaborative birth support, or wondering whether a doula could be right for you contact me for a no-obligation call to discuss your needs.
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