Birth Doulas and Regulation: A Socio-Legal Approach
One of the claims which is often made by those expressing their concerns about birth doulas is that doulas are ‘unregulated’. The purpose of this post is not to provide a normative argument for or against the regulation of doulas – we realise this is a nuanced and contested issue. Whilst we do want to better capture and understand the different arguments for and against regulation through our research, and to consider the implications of different forms of regulation, what we aim to do here is to add nuance to the claim that doulas are entirely unregulated, and to demonstrate that the reality is somewhat more complex.
The issue of regulation has been prominent in recent years in the UK, particularly following a blog post by MSNI on the role of doulas in maternity safety investigations, in which it was stated that whilst in many of the cases they’d considered, doulas were playing a positive and supportive role, there were instances (12 out of 29 investigations, from a total of 2827 in 2023) of doulas ‘acting outside of the defined boundaries of their role’. A Fileon4 episode in 2024 further raised the question of regulation.
It is true that there is not a single ‘doula regulator’, nor is there a centralised training system or credentialing body for doulas. However, this does not mean that doulas do not interact with existing medico-legal and regulatory frameworks in ways that shape – regulate – their behaviour and their practice.
Most notable in this regard is s45 of the Nursing and Midwifery Order 2001 which makes it an offence anyone other than “a registered midwife or a registered medical practitioner” to “attend” a person in childbirth (unless in an emergency). Anyone who breaches this provision commits a criminal offence, and is liable for a fine. The NMC have stated that to attend to someone in childbirth means to have “direct involvement in the delivery of a baby” and have stated that others in attendance – such as doulas – may provide (only) “non-clinical support and reassurance.” However, there remains a lack of clarity about the exact boundaries of the term ‘attend to’. In the context of potentially increasing use of s45 in the context of doulas, this lack of certainty is likely to further compound concern.
It appears that this is, in practice, something which is having an impact upon doulas, The charity Birthrights have recently flagged their concern about “the rise of punitive, criminalising, and legalistic approaches targeting doulas”. In particular, they raise a concern about inappropriate referrals, or threats of inappropriate referrals being made against doulas. These concerns have also echoed the social media accounts of a number of doulas /doula organisations. Some have linked these concerns to new ‘Principles for supporting women’s choices in maternity care’ published by the Nursing and Midwifery Council (NMC) in August 2025. The organisation Developing Doulas, for example, have published a statement raising concerns that these principles will result in an unjustifiable focus on scrutinising the actions of doulas – in the absence of actual evidence that doulas are “overstepping their role.”
It is important to note that Doula UK, a major Doula Organisation in the UK, was involved in the process of creating these principles. Doula UK also collaborated with the NMC to produce a series of videos about the difference between midwives and doulas, and how the two can work together. However, while Doula UK has a large membership, it does not represent all doulas and there are a wide range of – sometimes quite divergent – views within the doula community.
The recent discussions about this which have been taking place about s45 referrals and the concerns being expressed by doula and doula organisations about what this might mean for those working as doulas in the UK – on social media and though statements issues by organisations operating in the birth / birth policy space – demonstrate the importance of hearing from a diverse range of voices on the question of regulation. Without a careful understanding of how current forms of regulation and quasi-regulation are working, and the interactions of numerous legal, professional and regulatory frameworks, interventions here may have unintended consequences.
Thought it is perhaps the most significant, the Nursing and Midwifery Order isn’t the only regulatory actor with whom doulas interact. Insurance, and the conditions / requirements placed upon obtaining this, may also act in a regulatory capacity by influencing the actions of doulas. Public liability insurance is important to protect doulas in case of claims of negligence, accidental harm or even of damage to clients’ property. In some cases, insurers may – for example – mandate that doulas complete training through a particular organisation in order to be eligible for insurance coverage.
Many doulas are also members of doula organisation such as Doula UK or DONA Internation. These organisations have their own rules, and conditions upon which membership is predicated. For example, DONA International certified doula “are required to recertify every three years”, and Doula UK requires that every member “complete Doula UK approved training, go through a rigorous mentoring and recognition process and comply with Doula UK Code of Conduct, Philosophy, Guidelines and Policies.”
In this sense, the doula space is already subject to various forms of regulation or quasi-regulation, particularly when we take an expansive and more socio-legal approach to regulation here. We are interested in capturing these more everyday engagements with and navigation of medico-legal, organisational, contractual, insurance based, or other regulatory frameworks. In doing so, this will enable a more careful and nuanced approach to the question of regulation- recognising not just what is already there, but also the potential implications and unintended consequences of shifting this legal landscape.
As part of our project, we are currently running surveys for doulas and for healthcare professionals (both broadly conceived). We will also be undertaking focus groups and interviews later in 2025 and early 2026. Please do contact us if you would like any further information or to be involved.
Anna Nelson & Beverley Clough