Traditionally birth doulas were the original (often unofficial) midwives who helped women give birth at home. They were there to answer questions and support a woman prior to the birth and to help in the immediate aftermath. Similarly a death doula would be there at the end of someone’s life to help sit with the dying and/or to help lay out the body afterwards.
In the same way that women in recent times have been choosing home births with less medical intervention there has been a movement to promote this choice at the end of our lives. At the very point in our lives when we want to appreciate familiarity, security and peace it can be alarming to be placed in a noisy, clinical environment surrounded by unfamiliar faces and without a lifetime’s accumulated knickknacks and treasures.
The hospice movement has worked hard to provide more “homely” environments in specialist care homes and there has been a concerted effort to enable people to remain in their own homes with support through “hospice at home” provision. However these choices can be difficult to make for both patients and carers. There can be a sense of security in being in a environment with nurses and 24-hour care, but this can be at the cost of losing everything that is familiar and valued.
When my mother was dying it was clear that the local over-subscribed hospice was reluctant to take her in when she could still “manage” at home. But my brother, sister and I all lived over 100 miles away and could not pop in daily. The reality of an otherwise fit and intelligent 91 year-old woman living on her own with a diagnosis of terminal cancer did not take into account issues of loneliness and fear – she clearly needed more support and this would increase as her illness progressed. All three of us offered her a place to live but she was reluctant to leave her home, her friends, her local WI and her two nights a week playing cards at a local club. It felt tragic that having maintained her independence for the previous few years of being a widow that she would have to effectively give up her way of life at the very end. My circumstances were such that I was lucky enough to be able to arrange things so I could live with her for six months and with some respite care from my brother and sister my mother remained happy up until the end of her life. Sadly, not everyone’s family and friends can do this but an end of life doula can help to make it a possibility.
The role of death doula has emerged to fill the gaps and complement existing services. A doula may be anything from a companion at the bedside to a dog walker to an advocate. I have helped a client unfamiliar with social media trace an old friend on Facebook in order to send a message of apology for an old disagreement. I took another client to see the house they grew up in. I escorted a frail elderly client to look at fridges because he couldn’t get his head around ordering one online. The role can facilitate a retrospective inventory of a life well lived as well as assist in preparing an Advance Care Plan for a difficult and sometimes scary future. At the end of one’s life our families and the state will often guarantee that our basic needs are met but sometimes a person needs something more. Most importantly it can be a sounding board for talking about death and dying when all around you don’t want to talk about it.