What is a Death Doula?
The significant events in our lives are often punctuated by ritual, preparation, and acknowledgement. However, in western society this is often not the case with death. The topic is frequently avoided for as long as possible. We as a society pretend it will not happen, despite the fact that this is one part of life of which we can all be absolutely confident.
In previous generations, birth and death took place surrounded by the women of the household. The witnessing and personal involvement in these touchstones of life kept us rooted in the reality of our essential transient nature. The major differentiating attribute of humans compared to other forms of life is that we have an awareness of our own mortality.
There was a massive change in society in the care of the dead during the Civil War due to the huge number of bodies that required preservation and transport. This resulted in the advent of the mortuary business, the practice of embalming, and the use of funeral parlours. At the end of the war, the popularity of this trend continued. Whereas death care had previously been a duty fulfilled by the women of the house, it became a task that was outsourced to professionals.
The relocation of death, together with after death care, resulted in a disarticulation of our understanding and ability to face death and dying. It was no longer an event witnessed by the family at home, but in large institutions such as hospitals. Ritual bathing, dressing and displaying the body in the front parlour became less acceptable.
We are going through a period where the gradual reawakening of this ancient knowledge is taking place and death is beginning to once again be recognized as a rite of passage to be discussed, planned, and considered ahead of time. We are also finding parts of society are discovering that they can become more involved in the decisions of end of life care, such as where it takes place and how and by whom it is carried out.
Sacred passage midwives, also known as Death Doulas, are slowly beginning to play recognizable and important roles in the community.
A client can choose to have a compassionate caring presence who is dedicated to bringing the sacred back into this time and help midwife the soul out of the physical plane. A conscious holistic approach to end of life care can help the client take the opportunity to re-evaluate priorities and achievements and approach death with more acceptance and less fear.
Doulas may work in many different situations and at different stages of end of life. In all instances, however, they bring with them the skills of attentive listening, questioning, and compassion that enable them to help the client and family formulate an end of life plan. They are there to help enable this and to accompany the client on their journey.
During this time, the doula will coach the client and will help them to consider several different aspects of their life. These aspects are commonly referred to as the seven elements of end of life care. They include the physical, mental, spiritual, emotional, legacy, after death care and memorial wishes of the client.These opinions are very fluid and may change with time, the important factor is such events begin to be considered.
The doula will work to illuminate what, in the clients mind, would represent an ideal passing.
Their questioning may cover such topics as:
Where would you like to be when you die, at home, hospital, hospice?
Who would you like with you in the room?
Would you like to be alone at any time?
What items are important to you for physical comfort?
Would you like a religious component to the vigil?
These are just some examples of the points that may be considered. In taking time to address these questions, and many more, the client becomes deeply familiar and comfortable with their own wishes. They begin to explore the sacred mystery of end of life and can approach it with less fear and confusion.
The doula acts as a source of support and knowledge for the family and client and can play a role as an intermediary between the client and outside world. She can help in supporting the care team and advocating for the client, but is not involved in any medical treatment or decisions.
She may be brought in to help a family at varying stages of illness or fragility. In some cases, this can be when a loved one has received a terminal diagnosis. Guidance and assistance are needed to navigate this period of change and stress. The doula can help by accompanying the client to appointments and treatment, organizing the treatment timetable, and putting together a self-care program. It is at this time that the 7 elements of care can be introduced and the conversation around life, death, after death, and the feelings that accompany this transition period are introduced.
Families may get in contact when a loved one is nearing the end of their journey or after a prolonged stay in hospice care. This is a very intense and exhausting time for everyone. The doula is there to “hold the space” for the loved one and to bring a grounding, healing, compassionate presence. The family is often very relieved to have someone totally focused on the dying person, who can be attentive to all their needs. This gives the family space and permission to be truly present.
A fundamental tenet of a doula’s practice is that no-one dies alone. The period of the last couple of days or hours leading up to death is called the vigil. This can vary in time and may be a 24 or 72 hour period. If it extends beyond this then a doula team can work together to ensure compassionate, caring, holistic cover.
As the concept of the fundamental connection between life, death, and dying reawakens in society, it becomes more mainstream to approach this sacred transition time with love, care, planning and conscious attention.
Different healing modalities are brought by the doula when she cares for a client. These may include such practices as gentle massage, healing touch, essential oils, guided meditation, music, candles, incense, clearing spaces with sage, and singing bowls. Some doulas focus on all of these and others have a particular specialty.
The doula may also offer support after death. They may aid in the ritual washing, anointing, and shrouding of the body. Their assistance may also be needed with burial and memorial planning. If this is the case, then the doula and the client will have discussed these wishes while going through the 7 elements of care. There are now many choices with regard to after death care. Some clients choose traditional burial, entombment, and/or embalming. Others choose cremation, green burial, or a combination. The doula can act as an intermediary between the family and the representatives of these services.
Essentially, the more discussion and preparation time a doula has with her client and their family, the more confident they can be that the wishes and priorities of the loved one are closely adhered to and that the client has had a large influence ensuring that the plans carried out are in alignment with their wishes.
For the doula, the midwife of the soul it is truly a sacred honor to help rekindle the message that death is a beautiful and mysterious part of life and to help a soul approach this time with loving care.
“For life and death are one, even as the river and the sea are one”