The recent File on 4 episode, "The Labour Market: Women Who Have Babies Outside the NHS," broadcast on BBC Radio 4, explored the increasing number of women choosing home births, freebirthing, and personalised support through doulas. While it raised valid concerns about the state of maternity care in the UK, the portrayal of doulas was often unbalanced and relied heavily on fear-driven narratives. This approach not only risks misrepresenting doulas but also diverts attention from the deeper systemic issues that are driving these changes.
The episode began by acknowledging the strain on NHS maternity services: staff shortages, rising medical interventions, and publicised scandals that have eroded trust in the system. However, instead of delving deeper into how doulas fill the gaps created by these challenges, the narrative shifted to one of blame. Doulas were painted as potential risks in childbirth, with anecdotes of rare incidents being used to generalise about their role. This kind of scapegoating undermines the valuable work doulas do and perpetuates a fear-based approach to maternity care.
One example highlighted in the programme involved a woman who allegedly required a colostomy bag after being advised by a doula not to have a tear repaired in the hospital. While the story is alarming, it was presented without any context or corroboration. Were there other factors at play? Was this a case of miscommunication or misunderstanding? Without answers to these questions, such anecdotes risk creating unwarranted fear and mistrust. Similarly, claims that doulas “kept midwives out of the room” at home births were presented without evidence. These narratives, while provocative, fail to represent the vast majority of doulas who work professionally within clear boundaries. They also ignore the systemic pressures that drive women to seek alternative care in the first place.
The programme missed an opportunity to explore why doulas are in demand. The growing reliance on doulas is a direct response to the gaps in NHS maternity care.
Women who feel unsupported, rushed, or coerced during their pregnancies and births are turning to doulas for the compassionate and individualised care they feel is lacking in the system.
Instead of examining this trend as a symptom of systemic failings, the episode too often framed doulas as problematic disruptors.
This narrative is not only unfair but also fails to address the deeper questions at hand. Why do so many women feel the need to seek alternative support? Why do they feel their voices are not being heard within the NHS? Rather than placing the blame on doulas, the focus should be on addressing these systemic shortcomings. NHS maternity services are undeniably under strain, with shortages of midwives, over-medicalisation of births, and a lack of continuity of care. These challenges leave women feeling vulnerable and disempowered, and doulas are stepping in to fill that gap.
The suggestion that doulas should be regulated was another troubling aspect of the episode. Doulas are lay supporters, not medical professionals, and their role is fundamentally different from that of midwives or obstetricians. Regulation would not only be inappropriate but also counterproductive. If doulas were to be regulated, where would the line be drawn? Would it apply to all birth partners? A partner, friend, or family member providing support during labour is not regulated—nor should they be. Regulation of doulas would undermine women’s autonomy, stripping them of the right to choose who supports them during childbirth.
Moreover, regulation would not address the root causes of the issues highlighted in the programme. It would not solve NHS staff shortages, reduce unnecessary interventions, or restore trust in the system. Instead, it would create additional barriers for women seeking the support they feel they need. If regulation were imposed, doulas would simply adapt, perhaps calling themselves something else, to continue providing the invaluable support women deserve.
The push for regulation also reflects a deeper discomfort with the role doulas play in empowering women. Doulas inform and support women, encouraging them to advocate for their choices and ask questions about their care. This can challenge the status quo in maternity services, where coercion and scare tactics—often referred to as playing the “dead baby card”—are sometimes used to pressure women into compliance. Doulas remind medical professionals of their duty to centre women in their care and respect their autonomy, even when it complicates the process. This accountability should be seen as a positive force, not a threat.
The programme’s language choices further undermined the role of doulas and the choices women make. Terms like “wild births” to describe freebirthing are dismissive and sensationalist, reinforcing stereotypes rather than fostering understanding.
Comparing maternity care to passengers questioning a pilot trivialises the importance of informed consent and bodily autonomy, portraying women as obstacles rather than individuals with legitimate concerns.
Such rhetoric alienates women and devalues their choices, perpetuating a narrative that is neither constructive nor respectful.
While the episode did touch on important issues, such as racial disparities in maternity outcomes and the pressures on NHS staff, these points were often overshadowed by its fear-driven portrayal of doulas. For instance, the programme noted that Black women in the UK are four times more likely to die in childbirth than white women, yet it failed to explore how doulas can play a crucial role in advocating for marginalised women. This was a missed opportunity to highlight the positive impact doulas have on reducing disparities and improving outcomes.
Rather than focusing on rare incidents where doulas may have crossed boundaries, the conversation should centre on how doulas and medical professionals can collaborate to improve maternity care.
Doulas are not the problem; they are part of the solution.
By providing non-judgemental support, helping women navigate their options, and advocating for informed decision-making, doulas fill a critical gap left by an overstretched system.
The rise in demand for doulas reflects their value and the need for a more compassionate, individualised approach to maternity care. Collaboration, rather than regulation, is the key to improving outcomes. Doulas and medical professionals can and should work together to ensure that every woman feels respected, informed, and empowered during childbirth.
The File on 4 episode also failed to address the systemic pressures that lead to conflict between doulas and medical professionals. NHS staff are overworked and under-resourced, which can lead to frustration when doulas advocate for women’s preferences. However, this tension should not be seen as a reason to blame doulas. Instead, it should be a call to action to address the underlying issues in maternity care.
The suggestion that doulas are keeping midwives “out of the room” at home births is another example of how the narrative unfairly targeted doulas. This claim lacked evidence and ignored the fact that the majority of doulas work professionally and respectfully alongside midwives.
Doulas are not there to replace medical care but to complement it, ensuring that women feel supported and heard.
Framing them as adversaries does a disservice to the collaborative potential of the birth team.
The growing reliance on doulas is a symptom of systemic failures, not a problem in itself. Women are turning to doulas because they feel unsupported in a system that is stretched to its limits. By addressing these challenges—investing in staff, improving continuity of care, and fostering a culture of respect and autonomy—we can create a maternity system that meets the needs of all women.
Doulas will continue to stand beside women, offering the care, compassion, and advocacy they deserve. Instead of focusing on regulation, the maternity system should embrace collaboration, address its shortcomings, and centre the voices of birthing women. Together, we can create a future where every woman feels supported, respected, and empowered during childbirth.
This is the true vision of maternity care: one that values collaboration, celebrates autonomy, and ensures that no woman is left feeling unheard or unsupported. Doulas are not the problem—they are a vital part of the solution. It is time for the narrative to reflect that truth.
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