A death midwife or death doula is a person who assists in the dying process much like a midwife or doula does with the birthing process. It is “a community centred response that recognizes death as a natural, accepted and honoured part of life. – Wikipedia
I am a Thanadoula. Recently I have read articles written about death doulas and their work, and have also read hostile comments from social workers and members of the hospice community complaining about how we charge for services that people can receive at no cost. This is my story.
In my life I have played many traditional roles as wife, mother, aunt, friend, etc. In this capacity I have been present as a birthing coach for three different women and have loved this experience, sharing in bringing new life into the world. This being said, I have also been present with a few people at their moment of passing. The sacredness held in each of these moments is palpable, and yet I feel my calling is more towards the end of life.
Many people ask me why I do what I do and I tell them that I love being of service to others and I hope to bring a feeling of peace to those experiencing chaos and loss of control at the end of life (theirs or a loved one’s) so that they may live the best life possible to the end, and then to experience the most peaceful death possible.
As a Thanadoula my responsibilities are varied. Generally speaking I visit people in their homes or in a hospital/care facility and provide a wide variety of services.
Visiting in home I may be asked to do some light housekeeping (preparing meals, washing dishes, tidying living room or bedroom where they may spend most of their time), perhaps drive clients to and from appointments, sometimes pick up a few groceries or necessities. As a Spiritual Counsellor I provide a shoulder to cry on, a sounding board to reflect their thoughts, fears and ideas, most of the time I listen. I am not family, or a friend (though friendships may develop over time) and this allows people to share intimacies with me that perhaps they would not feel comfortable expressing to a spouse or family members. By unburdening themselves, asking question that may seem taboo to others, or by expressing their thoughts and feelings without concern about hurting or frightening close loved ones their mind is cleared, many times fears are put to rest and they often find relief at finally having expressed these thoughts and shared them with another person. It is a well-known fact that spiritual trauma or stress can increase physical pain perception, and by relieving emotional and spiritual burdens can actually result in a lessening of physical pain.
Other responsibilities in the home may involve cleaning and changing the client, feeding, gentle massage of hands or feet, physically assisting them in moving from bed to a chair or another room. I am not a nurse and do not claim to be one. However, I am able to remind the patient to take their medication at the appropriate time. I liaise with nurses, PSWs and doctors by leaving notes in a common journal, indicating progress or regression, sleep patterns, feeding patterns, toileting, etc.
Many times a fear people speak of surrounding death is not being remembered, or not leaving anything behind for loved ones. My training has allowed me to assist with various aspects of what is called legacy work. This may take the form of a scroll (indicating significant events during their lifetime), written cards to leave to their children on specific occasions, putting together a book, writing their life story, making a video or audio message, putting together photo albums. The list is endless. One woman was at the end of her life living with cancer. She had two young children. We had her lay down on a sheet and used a permanent marker to outline her body. This way after she had died her children could wrap themselves up in this sheet and think of their mother giving them a hug. Legacy work takes on many forms.
Music therapy is also a part of my work. I have a significant CD collection with various genres of music, and I also have a choral group (four individuals) upon whom I can call to come to the bedside and sing. Music is a very soothing medium, often evoking memories that can ease transition from life through death for both the individual passing and their family.
As a Thanadoula I am not only there to support the individual who is dying, but also their family. Caregiver burnout is a very common occurrence, and my presence in the home or sitting with their loved one while they get away for a few hours is often a blessing. They are able to do some shopping, get their hair done, meet a friend for coffee, lunch or an appointment, and just generally get away from everything for a few hours. I listen while they talk, expressing fears and concerns, and help them navigate through anticipatory grief stages.
When I visit a client in a long term care facility or hospital, obviously my duties are very different from those when I am in the home. Here I am more of a companion, relieving family caregivers for a few hours, perhaps doing some legacy work, mainly to sit and talk, listen, perhaps help with feeding. Because my duties are lessoned does not mean the work I do is less important. Spiritual and emotional caregiving and support is a necessary part of maintaining a sense of overall well being.
I have also been trained in vigiling and home funeral work. I am there to support the family and individual as they experience the transition from life through death, and do whatever I can to make this transition as peaceful as possible for all involved. After their loved one dies I may sit with the family for a while should they request that, and am also able to guide them in final preparations of the body before it leaves the home/facility should they wish a funeral home wake or a cremation. This involves washing the body and hair and dressing the body. This time is very special for all involved. Some people have never touched a corpse before and it can be a new and frightening experience. Some people do not wish this experience at all, yet others are grateful at having this time to perform one last service for a person they loved very much. Washing a body evokes the understanding of a ‘dimension of purity’ that is universal in religions and seeks to move us away from disgust and fear and to uplift us towards purity and divinity.
My work as a Thanadoula brings me into homes where Christianity may not be the family’s faith. Perhaps they have other religious beliefs, perhaps they have none. Knowing the family and understanding their cultural mores and religious beliefs is an important part of my work as both a Thanadoula and a Spiritual Counselor, as I do not wish to offend by perhaps saying or doing the wrong thing. Spiritual care requires embracing the ground of all beliefs, and having the knowledge and understanding not to force your own views upon others. Again, this is an ongoing learning experience, especially as Canada is a cultural melting pot.
As a home funeral consultant I am able to assist the family in dealing with final preparations – physical preparations of the body and also liaising with the family/executor and funeral home should that be required. Again I attend to the family’s wishes, paying attention to any cultural and/or religious rituals they may have. As a Life Cycle Celebrant I am able to perform memorial services should this be required.
As a Certified Thanadoula I charge $25.00 Canadian per hour, which, in effect, is not very much. I understand that the going rate in the United States is in the area of $40-100 per hour. Some people are taking offence to the fact that we charge money, yet you can see from the services I provide this is a lot of work. I have studied for the past couple of years in order to receive my certification. I took a six month course that cost me approximately $2,300.00 plus expenses (travel, incidentals, meals, printing, etc.). I have taken local courses with CCAC, with hospice, and continue to expand my understanding through online courses, my own website (www.brigidsbalm.ca) and an ongoing Facebook page. I attend seminars and workshops, and have brought clients’ family members with me on occasion. My education is ongoing, both through the services I provide and through agencies I seek to learn more from.
Hospice care in Canada is not as widely available as it appears to be in the United States or in the UK. Should you live near or in a large city the chances are pretty good you will have hospice services available to you. However, those in rural areas or smaller towns may have a very difficult time finding any hospice facilities. This is where either families suffer severe burnout, there may be patient abuse due to high levels of stress, hospital and doctor visits may be day-long occurrences as travel is very extensive. Many times patients are forced to leave their homes, spending their last months in hospital or a care facility hours away from family and loved ones. I am able to step in and assist with compassionate end of life care, liaise on the phone with nurses or doctors, assist in preparing final paperwork and ease the stress and burden of family caregivers and allow the patient to remain at home for the longest time possible.
Yes, I charge for my services as a Thanadoula. However, I also give back to my community by working as a volunteer in a hospice located almost an hour away. There I perform similar services in that I visit clients in their homes, yet I am not allowed to do as much as a hospice worker as I do on my own. I am allowed to listen, yet not give information, that is the role of the hospice chaplain. I am not permitted to drive clients to appointments, or pick up groceries, or receive gifts, this must be done by friends or neighbours. I am not permitted to give or touch any medications, that is a duty of the nurse. I am permitted to do simple moving of people from a bed to a chair/vice versa, and to clean them should they soil themselves. All other work is strictly for the PSW. So as a hospice volunteer I general sit, listen, share time, relieve caregivers for a few hours, perhaps read to the client, share tea and conversation. Should they request it I will assist them with a legacy project. And that’s about it.
Work as a Thanadoula can be emotionally and physically taxing. I am well aware of the dangers of caregiver burnout, and must keep myself safe from exhaustion as well. I have personal rituals that I use to take care of myself, such as smudging my truck with sage after a particularly stressful visit or event, relaxing in a hot bath with candles after a hard day, yoga and meditation are very helpful, and I have friends and family I can call on for emotional and physical support as well. Sometimes I need to get away from everything for a day and walk in the woods, or go fishing, or spend time in my back yard with animals and my garden. I knit, spin and weave, and creating something beautiful always takes me away from the stresses of everyday life.
On the other hand, I continue my work within the community. I will be holding death cafes (a place where people can gather to talk about any aspects of death – preparation, fears, thoughts, paperwork, etc. – and enjoy cake and coffee), Advanced Care Planning seminars, information booths at local functions, and sometimes information nights on just exactly what I do. I have met with numerous people who are interested in the work I do and are looking for ways they can become involved as well.
Being a death doula is a calling, not a job. It is not something I can turn on or off, it is part of how I live my life. I talk about end of life care, about the importance of having an advanced care plan written (I am also an Advanced Care Planning Facilitator), your powers of attorney in order, and a will written. Being prepared is not looking forward to death – it is simply a means of giving yourself a modicum of control over an inevitable fact – we are all going to die. It is time to take the fear away from death and embrace it for the natural part of the life cycle that it is. That is my desire as I assist others in living the end of their life in the best manner possible.