Death doula Thanadoula Death Midwife Midwife to the Dying Life Coach for the Dying
These individuals offer unique services to the dying and their families. While titles and skills sets may vary, they are gaining acceptance and growing in numbers.
Imagine having continuity in care as you or a loved one dies. Someone who knew what was was going to happen and coached you as you navigate the health care system. The same person with you through the dying process AND there the next day, and the next day and the nest. Someone who knows you well enough to go with you to the funeral home or to help you plan a Home Funeral. Someone to help you navigate the paperwork or the legalese. And someone to share your grief. A Death Midwife.
I am certainly intrigued! However, I have some questions:
- How are Death Midwives different from Death Doulas?
- How might this change the experience of dying for the dying person? For the family and loved ones?
- What questions do we need to ask if this body of service providers continues to develop?
- Currently there is no recognized professional body that certifies Death Midwives. Should there be?
- Do Death Midwives need a professional background?
- Are there lesssons to be learned from Birth Midwives and the process that they have gone through to be recognized and certified? If so, who will take this on?
Would you use a Death Doula or Death Midwife? Why does it appeal to you? Why doesn’t it appeal?
Leave your answers in the comments on this posting.
For more information, have a look at the websites below. We’ll also be exploring this topic in September in the course “Death and Dying in the 21st Century.”
- Cassandra (Nova Scotia) – https://www.deathmidwifery.ca/
- Donna (Texas) – https://beyondhospice.com/?page_id=2
- or Pashta (Victoria BC) – https://www.cindea.ca/midwifery.html
Kath
35 Responses
Hi Kathy, great blog. thank you. You questions are very good. Yours is a work in progress. I have stepped away from the contemplative end of life care program I started at The Institute of Traditional Medicine but it was an outstanding program. It made a significant difference to the families we worked with.
The midwife and doulas distinction is simply following the tradition of medicine-midwife for the birthing/deathing. Doulas simply for the person doing the birthing/deathing. The thanadoulas I trained worked with families as a whole. Many of them were already professionals in health care , education , integrated health. Those who were not, still came out of the training and did well….just a bit more wobbly about the “system issues”. I found that people in H/P/EOLC were more reactive than grateful. The professionalism that has gone on , shifting us from palliative care to palliative medicine, is disconcerting. The thanadoulas are a humane response to this shift. They do not duplicate any other discipline…but they surely do make families feel less reactive to how they are cared for. There are two groups in the thanadoulas -some want to be a community of practice and be a profession. Some want to do this as volunteers. Both could be done. Best regards-Michele Chaban
Thank you for getting in touch with us. Your clarification of these terms is helpful. It seems that as these practitioners emerge, they will forge ahead in providing the care that each is best prepared for.
Regards
Ann-Marie
Hi Michele,
You have been in my thoughts over the past weeks as I have prepared to write this blog. I would love an email update on what you are involved in and how you are doing.
You discuss the distinctions between doulas for the dying, thanadoulas, and midwives. I would like to talk with you more about this to get a clearer picture of the distinction that you make. In my mind I see the thanadoula or the death doula as the same as a birthing doula. I see them working with the dying person and family, and providing some support following death.
I wonder if a “death midwife” on the other hand would/could work more like a traditional Birthing Midwife. This person would come from a professional background – nursing, provide wholistic assessment, identify symptoms as well as other needs,work with the team to prescribe and manage symptoms. Prepare family and individual for the dying process. Attend the death. Provide the support for calling the funeral home if needed. And then, unlike a Hospice Palliative Care nurse, the Death Midwife could/would be able to continue to support through the preparing of the body, planning and implementing of a ritual to celebrate the life and/or grieve the loss. The Death Midwife, like the Birthing Midwife would provide follow up services in the weeks and months following death, assess needs, provide suggestions and support, link with resources as needed, help family and loved ones to identify their personal and group needs, and intervene as necessary.
As you mention, I see some wanting to do this as a private practice and earn income from the service they provide. I see others doing it as volunteers.
As a child I was raised by an aunt who was the “master family caregiver”, or in this lingo, she was a Death Doula. During my teens and twenties she cared for numerous family members, neighbours and friends who died. My future was inspired by the work that I witnessed her doing. She is now well into her 80’s and still helps out in her community. As exceptional as she is, her contribution is not unique to her. Her contribution is as “old as the hills”. People have provided this service since the “beginning of time” I am sure. However, in the past decades we have forgotten this service, have lost the name for it, and have forgotten to honour the people who do it as part of their daily walk.
Michele, Do you know, is there a group developing guidelines or certification for any of these titles in either Canada, US, Britain or Europe?
One of the feedback comments we have received is the concern about adding yet “another” member to the health care team. I appreciate this concern, however my concern is that our system is currently fragmented. The continuity of care and follow through is just not there.
It is disappointing to hear that people in Hospice Palliative and End of Life Care were reactive vs grateful for the service of the Thanadoulas. I wonder if they felt that their qualifications were not sufficient to do the work, if they felt that the role of caregivers was not useful… or?
I feel so strongly that there are more needs than any government program can address. Thinking “outside the box” will be an essential tool fine tune the education for all our heath care workers and to to addressing needs as the Boomers age!
Re palliative medicine…. I think it is valuable to have a variety of offerings… from Palliative Medicine to Hospice Care. There are benefits in each approach. The challenge is in providing the education to the public who remain confused about the basics! As you suggest in your final few lines… “both could be done”.
Kath
Before the early 1900’s families of the dying were the death doulas. Families held vigil by the bedside and after death, washed the body, built the casket, dug the grave and transported the body. It was a natural process, death was very much a part of life. In fact 1997 Nova Scotia, I was part of a caregiving team for a very special friend who wanted to die in her own home and she did. We washed her body and laid her in a casket beautifully built by a woman in the community, we borrowed a big old station wagon transporting her to the local cemetery where friends had gathered forming two lines from the gate to the grave. The casket was passed by the pall bearers to the people and they each touch and shared her passing to her final resting spot. I didn’t even know there was a name for it until years later and then I attended the first Natural Home Death Alliance conference in Boulder, Colorado.
Thank you for continuing this tradition forward.
This experience of yours sounds wonderful, natural and healing. Thank you for sharing this with us.
Hi Rayne,
How are you doing?
Yes, families of the dying were the death doulas… as I mentioned in my response to Michele, my aunt was one of those death doulas.
Oh, and the traditional work and rituals following death provided such focus for the loved ones. SO much easier to acknowledge the loss and feel the grief when you are in the midst of the work of preparing and burying or cremating our loved one.
Please mention more about the Natural HOme Death Alliance in Boulder Colorado.
Have a great day!
Kath
Well, that is a new term to me…never hear of a Death Midwife, but my interest was piqued just from the title. Not only would I utilize that service, I would be very interested in providing that service, with adequate training. I’ve done the Palliative Care course and Kath Murray’s 2-day seminar…and cared for my husband for the year preceding his death. Nothing that I’ve read or learned in this last four years has caught my interest like this philosophy: Death Midwife. I’m going to search your reference links and watch for more from your site. Thanks!
Thanks Freda – it IS interesting isn’t it!
Hi Freda,
So good to hear from you. Hope you are doing alright. So interested to hear your story. I am intrigued that you were able to attend a palliative care course and the 2 day seminar – before you cared for your husband. I hope that the year of caregiving was rewarding. I hope that you gave yourself a great big pat on the back for caring over a fairly long period of time. It is one thing to do this as a friend or professional, it is quite another to care for a loved one. Having said that… I would not want to do it any other way!
You mention that you would like to provide this type of service with adequate training. What do you think an education program or certification program would include? And would people need a professional background or not?
Warm regards,
Kath
I am a birthing doula and I also work as a community client coordinator at Surrey, BC’s only Hospice.
Just want to say how pleased I was to see and read this article – I have always known the two processes are similar and make a positive difference in both journeys.
Thank you.
It is so interesting that there are similarities. That practices from the opposite ends of life can make such positive differences to the people involved. I wonder – can it be as simple as having a personal advocate and caregiver to see you through the process???
Hi Joy,
You might want to check out http://www.cindea.ca We do list Death Doulas — and if recognized formally by CINDEA, you can get a recognition seal.
Hi Joy,
Lovely to hear from you. (JOY is one of my favorite names!)
How interesting that you are currently working as both a birthing doula and helping to coordinate support for people at the end of life…
What are your thoughts as you listen to the dialogue about death doulas. How do hospice volunteers differ from death doulas?
In the “hospice” programs, the volunteers are not currently identifies as death doulas. Do you think that the volunteers in their private lives, do the work of the death doulas? Do you see them using that title?
Kath
This is exactly what I want to be doing and should be doing, actually it is what I do without a title and without $$, I end up being recommended and so I think there is a need and perhaps the two are more similiar than different. I will be following so perhaps I will finally be able to fullfill my life passion as my work. Any help and advice would be appreciated.
Christine
Thank you for your thoughts. We seem to be hearing consensus on the idea of death doula/death midwives being a recognized field. It is going to be interesting to watch this field unfold and establish as we move forward with the increase in dying in the coming century.
Regards
Ann-Marie
Hi Christine,
I forgot to tell Joy that we have a Death Midwifery.ca Yahoo group where those of us interested in this work have a chance to discuss issues. You might also be interested in reading through http://www.cindea.ca — and if still interested in this work, please contact me through the ‘contact us’ at CINDEA e-ddress. We can provide information on how to identify and collect the range of skills and information you need to become a Death Midwife (in terms of how CINDEA speciically understands the use of that term).
Hello Christine,
Wonderful to see your name on the screen of my computer. Hope you are doing well!
Yes, I am sure this is exactly what you want to be doing. THis is what you have been doing!
I hope you are following the other blog posts. Let me know your thoughts as you do.
We will also be going into this in more depth as we enter the “Death and Dying in the 21st Century” online cousre. I can’t remember if you have taken that course.
To be continued….
Kath
OOPs,
Forgot to say YES, this should be a recognized field.
Thanks for this blog post Kath! You have posed a number of good questions:
How are Death Midwives different from Death Doulas?
There isn’t necessarily any difference between them. Though it is an ancient practice (the same woman used to assist with birthing and dying in community. When she helped families to wash and shroud the bodies of their loved ones she became known as a shrouding woman) the contemporary practice that is currently developing has yet to settle on any consistent terminology. Perhaps Thanadoula is the most appropriate term; stemming from thanatology (the study of death and dying) and doula (connotations of serving and supporting women through childbirth) but I think it is less accessible than death midwife. In the US this label is sometimes used interchangeably with home funeral guide or spiritual midwife, but I see it as an umbrella concept under which many skillsets might fall as Kath mentioned above. Many people experience a gut response to the term death midwife which is not positive. I believe it is a reflection of the denial of death in our culture as well as a desire to differentiate between the skills needed to assist birthing and dying (which, in my experience, are not as disparate as they might seem).
How might this change the experience of dying for the dying person? For the family and loved ones?
In many ways our culture treats death as a problem which needs to be denied and prevented. When medicine fails to save us, private professional services are thrust upon us to take care of things so that we won’t become too upset. Death and dying are kept out of sight and as a result we have become alienated from it. As a result I believe that in many ways we have become disconnected from life in a deeply ecological sense. The practice of death midwifery accepts death as a natural and inevitable part of life and supports individuals and families to be at the centre of their own experience. The field of hospice palliative care has made wonderful progress with respect to developing such care for end of life. Death midwifery is an extension of that same philosophy to the greater pan death experience from inviting death awareness into life, through end of life care to spiritual transition at the time of dying, to post death care, memorialization and grief support. Death midwifery is a holistic endeavour. I hope that families who might chose to take advantage of the assistance of a death midwife would find themselves increasingly empowered to find their own authentic expericence. Most death midwifes don’t offer “packages” of service because fundamentally it is not a consumer based model. Death midwives are a community resource. They model acceptance of death, dying and grief and offer public and private education and support, helping families to access the professional services that are right for them while encouraging them to participate themselves. Death midwives facilitate the reclaimation of families’ rights to care for their own.
What questions do we need to ask if this body of service providers continues to develop?
The main question that needs to be asked is, “How shall we reclaim our dying time?” and trust that those of us who are called to do this work will be there to support the answering.
Currently there is no recognized professional body that certifies Death Midwives. Should there be?
Obviously a definitive contemporary scope of practice has yet to be concretized. Death midwifery is at its core a grass roots, community based offering that might not fit easily within the capitalist model, but death midwives have always and will always be among us. Professionalization is a double edged sword. As the baby boomers age, end of life is brought increasingly into focus, thus the visibility of those who provide support for death and dying is rising. Various related certifications exist. Home funeral guides may be certified in the US (see the National Home Funeral Alliance website for resources). Ceremonialists are trained and certified as are grief counselors and funeral directors. Training and apprenticeships for shamans and psychopomps are available and there are those who are able to help professionally with legal and financial end of life preparations as well. Of course palliative care providers are essential; including those CCAs and LPNs who are doing such important work with families already. The Insititute of Traditional Medicine offers training and certification as a thanadoula in their Contemplative End of Life Care program which focuses on the value of present mindedness that is at the core of death midwifery practice. Cindea has started a registry for death midwives. I hope to offer training myself in this field as well as an interpretive centre for death and dying. To sum up, there are lots of professionals and paraprofessionals offering services in the field of death midwifery already. To me a death midwife is someone who is present to all aspects of death and dying; perhaps the glue between all the other practices and someone who cultivates each individual’s unique experience of living and dying.
Do Death Midwives need a professional background?
I bring a BA in Sociology and Gerontology to the work I do as well as a Certification in Grief and Bereavement from King’s College and UWO’s Thanatology department, in addition to training and certification as a home funeral guide, hypnotherapist and level II shambhala meditaion. I`ve been an evaluator and volunteer with Therapeutic Paws of Canada and I chair my local hospice society. I can`t imagine working without the background I have, but what has really prepared me for this work is growing up in my dad`s veterinary hospital and being a homesteader myself now where birth and death occur daily. It is this openness to a visceral closeness with death that is my greatest teacher, yet still I feel incompetent in so many ways! I wish I were skilled as a ceremonialist and a shaman, but I have committed to bring myself as I am to this practice and find often that it is humbleness that is most needed. This is a long winded way of saying that I don`t know what kind of training should be mandated for death midwives. We are increasingly available to one another in this global village. I believe in the right for each of us to offer our authentic service and trust the judgement of individuals and families to seek the support they want and need, which matches the baby boomer`s demand for choice as consumers.
Are there lesssons to be learned from Birth Midwives and the process that they have gone through to be recognized and certified? If so, who will take this on?
Oh, so many lessons! The greatest of which come from the recognition that the practice of birth midwifery is founded upon the belief that birth is a natural life event. It is not a problem that needs to be solved and it doesn`t necessitate intervention despite the fact that intervention is sometimes required. Death midwifery, also is founded on this same subtle yet enormous distinction.
Thanks for the opportunity to share my voice on this topic about which I am so passionate. Consider watching this UTUBE video about home funerals which touches on many of the topics discussed here: https://www.youtube.com/watch?v=paJAKDU55AU
And of course please visit BEyond Yonder Death Midwifery http://www.deathmidwifery.ca
or Death Midwifery in Canada on FB: https://www.facebook.com/groups/306940662720202/
Sincerely,
Cassandra Yonder
Cassandra,
I am back from holidays, and slowing reading through the postings to the blog. I so enjoyed your thoughts. Thank you for taking the time to respond, share some history and flesh that out with philosophy. My challenge as I read your posting is that I wish we were at the river by your home, sitting on the rocks after a swim, getting ready for a potluck dinner and a tour of your farm… and carrying on this conversation face to face. So much I would like to comment on. For now… I value the ability to come to the work that we do, not filled out with knowing, but eager to learn. And eagerness to learn is the mindset I bring to this topic.
Kath
I am a RN who has worked in the home care setting for 20+ years as a Palliative Care Nurse as well I took the Contemplative End of Life program. There is no doubt that there is a profound need for this service that would be provided by an ‘end of life doula’. I am not found of the term ‘death doula’ or even ‘thanadoula’. I call my self an ‘end of life care practitioner’. I have taught courses for volunteers, PSW’s, RN’s and RPN’s as well as families that care for dying friends and relatives. I feel there is a need to formally create education programs and certificates at all these levels. Not everyone has to be a licensed professional to care for the dying and there does not always need to be someone that is such, and most of the time there is not any available at the professional level to assist. Just go a few miles beyond any urban area and the lack of resources in all areas of health care will be apparent. When I teach Pall. Care, I reinforce this and let them all know they are of value at various levels of care and if the situation is above and beyond their scope that the case can be referred to a different level of care. Persons that are dying or their family members do not necessarily intenitonally think…”I want a health care professional or certified ‘thanadoula’ to assist me with the psycho social spiritual domain of my care”. Often…they just connect with someone and then open up to them. I tell those in my classes, “you may be the one they choose to disclose information, or ask for assistance”. Ofcourse I recognize that there are some highly complex cases that may need a higer level of professional intervention, but I also know that a high percentage of care to the dying is not at this level. Teaching someone to be “present and a listener and have empathy” can work miracles at the bedside of the dying.
Well said Linda; and I especially appreciate your comment about the urban / rural distinction and the differing needs!
Hi Linda Marie
20+ Years in home care as a palliative care nurse… wow. What a rich life experience.
I like your term “End of life care practitioner”.
Sounds like you are involved in planning and offering education to a variety of caregivers. I wonder what your thoughts are on the certifications for all of these levels. Who should develop this?
You mention certification at different levels. I wonder about Mary Hughes’ comment on adding another layer of caregiver to a system where the dying person and the family are all too often overwhelmed by the names, titles, etc..
In theory, the “EoLC Practitioner” would help the family navigate through this. What do you think?
And, your comment about rural vs urban is sooo true. And when you get into the smaller communities, the home care nurse is often called upon day and NIGHT. In many cases they are not supposed to respond to calls and requests… partly due to saftey issues, partly overtime, and other regulations. But in many cases they DO respond. If there were other members of the community who love this work, who are educated to provide the support, then it would/could relieve the burden on the nurses.
Where do you live and teach?
Kath
There might be a confusion of terms here. I offer services as an ‘end of life’ consultant — but that is more focused on completing Advance Directives and Presentation Agreements — that is, planning for ‘end of life’, rather than actually going through the experience ( some others do as well). For me, the two naturally go together, and CINDEA expects a Death Midwife to have a working knowledge of ADs and RAs in their province. Still, I can see the two roles occuring quite separately, especially since one would hope that people would be doing their ADs and RAs long before they might choose the services of a Death Midwife.
Hi Linda Marie
20+ Years in home care as a palliative care nurse… wow. What a rich life experience.
I like your term “End of life care practitioner”.
Sounds like you are involved in planning and offering education to a variety of caregivers. I wonder what your thoughts are on the certifications for all of these levels. Who should develop this?
You mention certification at different levels. I wonder about Mary Hughes’ comment on adding another layer of caregiver to a system where the dying person and the family are all too often overwhelmed by the names, titles, etc..
In theory, the “EoLC Practitioner” would help the family navigate through this. What do you think?
And, your comment about rural vs urban is sooo true. And when you get into the smaller communities, the home care nurse is often called upon day and NIGHT. In many cases they are not supposed to respond to calls and requests… partly due to saftey issues, partly overtime, and other regulations. But in many cases they DO respond. If there were other members of the community who love this work, who are educated to provide the support, then it would/could relieve the burden on the nurses.
Where do you live and teach?
Kath
I have no problem with the concept of Death Midwife or Doula but I hope that we do not create another layer in health care. People have enough trouble knowing who does what. I feel that this work can be done by those already trained in health care but with extra training and a certification just as RNs have certification in palliative care. If we must and only must have a different name what about Transition Coach for the Dying
Hello and many thanks to all who have replied to the post and the questions. Wonderful to recognize names of some of you who have posted, and to read names of people who I have yet to meet. I look forward to reading the posts and responding to themes and thoughts… when I get home next week! 🙂
The purpose of this blog is to create the discussion, create questions and clarify what is current knowledge or practice. I am as excited to hear from those who are “interested” in the possibilities of death doulas or death midwives as from those who are opposed.
What are the core issues? What needs to be thought about?
Meanwhile… I am sitting in a wee cove in Desolation Sound. The water is blue/green, sky is clear blue and the sun is shining. It is warm, in fact, it is hot. The bright light makes it difficult to read the computer screen… and so I will wait until next week to respond in more depth.
Looking forward to continued thoughts!
Kath
Hi Mary,
I must admit that I prefer the term ‘death midwife’, because before the 20th century, the wymyn who supported the birthing and the dying were just referred to as ‘midwives’. The requirements for a birth midwife now include medical training that death midwives do not need — so there has to be some distinction between the two kinds of ‘midwives’ now. However, I would rather continue using the term ‘midwife’ because a) our work does parallel much of a birth midwife’s job (see https://www.cindea.ca/midwifery.html#parallels), and b) to honour the fact that we are reclaiming part of a midwife’s job that stretched back into ancient times.
Hi Mary,
Greetings from the West Coast to the East Coast!
Your concern about another layer of caregivers addresses the concern of the complexity of people, roles, and numbers of people involved in the care of a dying person and their family.
I like the idea of a “COACH for the dying”, a “LIfe Coach” a “Transtion Coach”.
I am curious what your thought is about the need for education. Pashta has suggested that death midwives would not need “medical” training like birth midwives need. Based on your experience as a nurse, what do you think?
Kath
This is the first time I have heard of this very interesting title,it sounds a lot like the role of a Chaplain. Depending on which facility they work out of, some Chaplains do not have the opportunity to continue their work with families in the community. Yet there are are others, who work very closely with the Palliative Care Team in a hospital or hospice and support families who wish to have home deaths, and journey with them from the hospital to the funeral home and then do home follow-ups as well.
Hi Joy,
Interesting to think of the flexibility of the role of chaplain. How appropriate for the chaplain to follow families and loved ones after the death, provide support in the planning of a ritual, perhaps support during that ritual, and helping families get “established” in their grieving. Hm.
Are you a chaplain?
Do you consider yourself a coach for the dying?
Do you provide the companionship and supportive presence?
Kath
I would consider a chaplain a valid background for becoming a Death Midwife — if they are willing to stretch their role into post-death care. Certainly, they have the experience of working with the family (if the family belongs to a parish) both before and after a death; and they already have some of the ‘funeral celebrant’ skills. However, they might have limitations as to how comfortable they are personalizing the all the rites possible in pan-death, and/or might only feel comfortable taking this role within their parish.
Such a wonderful and lively discussion on a beautiful topic…accompanying the dying and their loved ones during a most intimate and vulnerable journey.
Some people are terrified and some are peaceful and simply want more support…and there’s everything in between. I feel so blessed to be able to be with people at this time in their lives. I’ve been a hospice RN since 2000 and have been a personal end of life doula since 2006. Although I prefer my role as an end of life doula over a hospice nurse, the gift of being there for families is the same. Just as a doula, I can be more fully utilized and I cover more gaps. As a hospice nurse, I must stay in my role as nurse mostly and that is hard for me.
I remember a few years ago, I believe it was with Pashta and Cassandra…we were all going back and forth discussing the various terminologies for “the person who accompanies the dying and their families.” Truly it is interesting to see what people call themselves and in their bios, find out a little more about why they do.
In one sense it sounds nice to think of a governing body over the art/profession of death doula but on the other hand, it may attempt to limit the expression of those called to the field. I look around the web and speak with other doulas to the dying and am in awe of how they are called to serve the dying. Each person has been called to serve in a different way…I don’t know how to capture it all.
I encourage anyone who feels the pull to serve the dying and their families to stay on the path and keep searching inside yourself until you find how you want to manifest it. We need you! There are so many people, even with hospice, who need us to support them through what can be the darkest and most lonely nights. Yes it is my wish that it is a beautiful time and it is my intention to normalize it and bring in joy and at the same time, I cannot forget that for most people it is a most grievous time.
Anyway, thanks for your site and article!
peace,
Deanna
Deanna,
Thank you for your posting, for the insights and personal journey that you share. I wonder if you want people to contact you if they are interested in further dialogue. Please let us know, and let them know how to connect with you.
With the changing demographics, the lack of funded resources, and the desire to receive care that is individualized for patients and family… the role of a death doula may help to address many otherwise unmet needs.
Warm regards as you continue to practice as both a hospice nurse and a death doula. We would love to know more about where you are practicing.
Kath
Kath, oh my goodness! 4 years later and I’m just seeing your response. I hope all is well. I’m still doing the work and the mentoring. If anyone would like to contact me, please do: deanna(at)qualityoflifecare(dot)com.
I’m celebrating 11 years of service as an end of life doula this month and 6 years as a mentor of other doulas and having specials on my programs. write me for details. My offerings are here: http://www.accompanyingthedying.com
lots of love to all of you ♥
Deanna