What Are Death Doulas?

When people say that someone had a “good death”,

They usually mean that someone was comfortable and not in pain. But what if you could help them celebrate things they value in their last days, such as their favorite song, who is at their bedside, even the smell of a candle in the room, so they feel at peace. This is why some people turn to doulas at the end of their lives. They are among the professionals who can help someone prepare for death and reflect on their life: their greatest joys and regrets, any fears or worries, and how they want to be remembered.

This is a job that many do not want to think about.

“We live in a culture of death denial,” says Elizabeth Johnson, executive director of the Peaceful Presence Project, a nonprofit doula collective in Bend, Oregon. Doulas can be part of a team that helps prepare people for death by opening conversations about it, as well as providing comfort and resources. Hospice teams and other palliative care professionals also work in these areas.

Doulas and hospice

Hospice care often involves a group of people, such as a social worker, a chaplain, and a nurse, who check the patient’s vitals, administer medications and change dressings. Doulas, on the other hand, do not have the necessary medical training and do not perform any clinical or medical tasks. They may read aloud to a patient, clean up a mess, or sing with someone. “Dolls can enter these unsupported spaces,” says Johnson. Where a social worker or hospice chaplain can visit once a week, “doulas have more time and bandwidth. They are available for deep listening during times of great need,” says Johnson, board member of the National End of Life Doula Alliance (NEDA).

Doulas can help patients outside of the hospice. Marilyn Rush, RN, a doula in Ann Arbor, Michigan, and vice-chair of the NHPCO End-of-Life Doula Advisory Board, recalls a client who was overwhelmed after taking her husband home. die from the hospital. Rush told her about palliative care, the social worker, the hospice, and the hospital bed. “She had no idea about all this. Nobody in the hospital will tell you,” says Rush, who was also a former president of NEDA.

Similarly, Cynthia Schaufler of central Oregon contacted Peaceful Presence about a friend with terminal cancer. “My friend asked me when she should call the hospice and I didn’t have the funds, resources, or contacts to help her.” Doulas from the group began to visit a friend twice a week. The visits included reiki, art therapy, and a conversation with a priest. They organized hospice care for her and talked to her family about what to expect.

No typical cases

  • You may hear end-of-life doulas referred to as soul midwife, end-of-life coach, death midwife, transition guide, or death doula. Unlike a hospice, Medicare does not cover the cost of a doula.
  • Private insurers also do not reimburse doulas. But some doulas provide volunteer services through a hospice or non-profit organization.
  • Doulas may charge an hourly rate of $45 to $100, or on a sliding scale. Or you may be assigned a flat fee of $500 to $5,000. The cost will vary depending on the number of visits, location, overnight doula stays, or other service requests.

Like a doula at birth,

A doula at the end of life tailors services for each client. In addition to making wills and advance directives, they encourage the dying to reflect on their lives. Is there a relationship they want to restore? Is there anything they need to say or do before they leave? Who do they want to see again before they die? There is no such thing as a typical doula. “It’s everywhere,” says Rush, a former hospice nurse, and midwife. According to her, it is like an old tradition when a neighbor, friend, or aunt comes to the rescue.

Doula visits can be daily, weekly, or span several years. They can help with letter writing, laundry, funeral planning, or creating an inheritance. A legacy project might include photo captions, creating scrapbooks, or organizing recipes to pass on to the family. One of Johnson’s patients had an extensive record collection. She helped him write meaningful stories about his life that fit with every album. She hung the stories in his room for visitors to read and discuss with him.

There is someone to talk and cry with

Sometimes the family needs more practical or emotional support than the person who is dying, especially if that person is unconscious or unconscious. Joanna Harmon of Finksburg, MD, described her doula as an “outstanding advocate” who helped her through the stress and emotional strain of her father’s death in 2019. their clients since 2010.

“She sat with my father for 3 hours and held his hand so that I could leave the room.” The doula also helped her take her mind off the “inevitable” by asking her about growing up with her father. “She was someone you could talk to, cry with, get all those thoughts out of your head,” says Harmon. Schauffler says her friend’s doula gave up everything to be around her friend’s last hours and kept in touch with her husband after that. “It made a huge difference,” she says.

Where to find a doula

To find a doula at the end of life, contact local hospices who can work with volunteer doulas. Or start with the National End of Life Doula Alliance State Guide to Doulas.

These end-of-life doula training programs can also connect you with people who have completed their coursework:

  • International Doula Association at the End of Life
  • International Institute of Duladaws
  • University of Vermont Larner Medical College
  • Lifespan Doula Association

If you choose a doula

Ask potential doulas about their training, experience, and pay, as well as their availability and support, advises Rush, who also teaches doulas as the owner of The Dying Year. Also, see if they offer the services you need. Massage therapy? Meditation? Cooking? You can hire a doula at the end of life who has completed training courses and is certified. But the practice does not require a license or certificate. “There is no generally recognized local, state, or federal agency, regulatory, or accrediting body that is responsible for or provides end-of-life doula monitoring,” states the National End-of-Life Doula Alliance website. “More and more organizations are offering certification, but it’s voluntary.”

Get references and also consider if they have experience but no official credentials. “A person can have a lot of experience and lack of certification, so don’t rule it out,” Rush says.

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