What Is A Death Doula?
Support And Care During The Last Days
When end-of-life doula Michelle Montgomery’s client received a terminal diagnosis, he wrote a letter to his wife every day, asking Montgomery to give them to her upon his death. Unbeknownst to his wife, Montgomery also digitized the letters, sending her a book of his writings on the first anniversary of his death. Not exactly a typical funeral home service.
Montgomery is part of a growing group of professionals known as death doulas or end-of-life doulas—non-medical practitioners who assist in the dying process. ‘Doula’ comes from the ancient Greek word meaning ‘woman who serves,’ and the word today is typically associated with people who assist during birthing.
Similar to a midwife, a death doula helps both the dying and their loved ones in any way needed. Sometimes it’s providing companionship or emotional support, organizing legacy projects like photo albums and letter writing, or helping with funeral or memorial service arrangements. The country has seen a steep rise in the popularity of death doulas in the past few decades.
While the modern-day death doula movement in the States is relatively new, the work of death doulas has been done across cultures for centuries. Care for the dying has historically been the responsibility of women, often family members, neighbors, or midwives. Before the Civil War kickstarted the advancement of medical care in the U.S., professional women, often widows, specializing in death care would tend to physical needs at the bedsides of the dying or dress and preserve corpses after death.
Many cultures in the U.S. and beyond deal with death in different ways—during Mexico’s Día de los Muertos, families celebrate the souls of their deceased relatives in a holiday blended from Mesoamerican and ancient European cultures. To the Gullah Geechee, descendants from enslaved Central and Western African people based along the coastal south from North Carolina to Florida, death is regarded not as a fearful thing but as a passing on of a soul to the next realm.
Death doulas work across all religions and spiritual beliefs, explains Dr. Jamie Eaddy Chism, director of program development for the International End-of-Life Doula Association (INELDA), noting that “what matters is what is important to the client.” Montgomery says that religious or spiritual topics are actually the most explored topics in many of her chats with clients.
The dominant cultural framework in the U.S. regards death as a solemn event, usually revolving around hospitals, funeral homes, and black clothes. Because of this limiting framework, “so many people end up navigating their last days with little meaningful support,” says Chism.
“We feel dread around matters of death and dying, and we don’t want to face it,” says Montgomery. The majority of Americans haven’t discussed end-of-life planning with their parents, according to The Conversation Project.
It’s true that the American idea of death involves trepidation and denial. “We live in a death-denying culture,” Elizabeth Johnson, executive director of the Peaceful Presence Project, a nonprofit end-of-life doula collective in Oregon, told WebMD.
Montgomery was confronted with this denial during the passing of her sister from heart transplant complications in 2012. Her family never discussed death with her sister while she was sick, echoing the way most Americans brush off the topic.
“How often has the subject come up and our knee-jerk reaction is to wave it off and tell the person, ‘Don’t talk like that!’ or ‘That’s just morbid!’” says Montgomery. “We treated the subject like so many do…like talking about death would somehow make it happen.”
And conversely, not talking about death won’t prevent it. “Death is promised, and it’s my personal belief that we should hold as much reverence for death as we do a birth,” says Montgomery.
Think all this talk about death is morbid? Then you might understand why a death doula’s work can be so meaningful. “I think the most important thing we do is help facilitate conversation around death,” says Juanita Perez, an herbalist and alternative healing practitioner who specializes in death doula work. “I believe America is hungry for this conversation.”
Along with providing emotional support or coaching for the dying and their families, a death doula might provide other, practical services, too, like meal prep, running errands, and making funeral arrangements. Dr. Chism explains that INELDA calls their practitioners end-of-life doulas instead of death doulas since they serve clients in the time leading up to death, not just during the actively dying period.
Perez says she feels especially “honored” when she’s asked to support the children of the family, explaining and normalizing what’s happening in a way they can understand.
She also notes that death doulas aren’t medically trained professionals like those in hospice care. “We’re meant to be another member of your death support team, not replace any of your medical team,” she says.
Ultimately, a doula’s work prioritizes the client’s needs and wants in a highly personalized way. Montgomery detailed a touching funeral service she organized that felt more like a wedding, set in a botanical garden with a catered dinner and live band, after a client’s mother told the client, “I should be planning your wedding, not your funeral.”
Dr. Chism says that one of INELDA’s doulas encouraged her client to write letters to each of her children to open every birthday until they turned 21.
For the most meaningful death doula experience, whatever that might look like for you or a loved one, Perez suggests reaching out to doulas individually to determine who might be the best fit. “Most of us will be happy to do a free consultation call to talk through what you might be looking for,” says Perez.
The site goingwithgrace.com, founded by death doula Alua Arthur, provides a range of end-of-life planning services, including a doula matching program.
Sites like deathdoulas.com and inelda.org/find-a-doula help you search for death doulas by location but keep in mind many practitioners also offer their services virtually. Montgomery’s business, for example, is 99% virtual. Inspired by her experience with her sister’s transplant, a facet of her business called Rumble with Failure provides support to those going through the organ transplant process, and she’s soon launching The Transplant Doula to train doulas in transplant patient support.
“There’s something powerful about having someone who is not a family member in your corner, with zero judgment,” says Montgomery, “and who is committed to advocating for your needs and hopes.”
Natalie Gale is a Boston-based freelance journalist. When she’s not writing about art, food, or sustainability, you can find her biking to the farmers’ market, baking, sewing, or planning her next Halloween costume. Say hi on Instagram!