You may have heard of a birth doula or midwife, who supports an expectant person and their inner circle through gestation, the completion of the pregnancy, and the early post-partum period. A death midwife provides similar support at the other end of the life continuum, guiding people through the dying process and what comes after. Like birth doulas, death doulas undertake professional training (and often certification and mentorship) to work in this role.

A death midwife is a compassionate, empathetic, unbiased non-medical professional who provides enhanced support to individuals nearing the end of their lives, as well as to their families. Also known as death or end-of-life doulas and death coaches, our work is fundamentally cradled by intimate interpersonal relationship—the simple yet profound act of merely being with a client from a place of deep connection and respect.

A death midwife offers a range of services that encompass physical, emotional, logistical, social, and spiritual support for people who are nearing the end of their lives, as well as their families and caregivers, throughout the dying process. This can manifest as everything from helping to organize paperwork and disposition wishes to offering education and support during the active dying process, supervision of after-death rituals, early grief support, dreaming up legacy projects, and more. We create a safe space for anyone to explore the mystical, esoteric, existential, spiritual, and mundane aspects of death. The specific tasks a death doula assists with will vary depending on the needs of the individual, but they are typically divided into three categories:

• Pre-vigil: before the person enters the active dying/transition stage

• Vigil: during the active dying/transition stage

• Post-vigil: after the death has transpired

As a dues-paying member in good standing, I abide by the codes of ethics determined by the International End-of-Life Doula Association and the National End-of-Life Doula Alliance. I also hold professional liability insurance with Alternative Balance.

It’s important to begin by explaining that hospice is a model of care—neither a place one goes when one is nearer to death (though one may receive hospice care in a setting that is not their home, such as an assisted-living facility) nor a single national company offering its services. Delivered by an enormous range of both for-profit and nonprofit organizations, hospice care in the United States is a Medicare benefit meant to maintain the best quality of life possible for individuals who, generally speaking, have a prognosis of six months or fewer and are ready to cease curative treatment of their primary diagnosis.

Hospice isn’t something that happens automatically, but rather one of many decisions a person and their loved ones may make over the course of one’s decline. One must be dying to be on hospice service, but one need not be on hospice service to work with a death doula. In fact, many people find that bringing a doula into their support system before the hospice stage makes that transition, and the rest of their journey, easier in many ways.

While our skill sets may in some ways overlap, death midwives do not take the place of hospice workers; we are not substitutes for medical or hospice advice or care. Rather, we are additive to a strong, proven model of palliative care that focuses on the comfort and dignity of those at end of life. Collaboratively, the hospice staff compassionately oversees the care of a terminally ill person. The interdisciplinary team is made up of specialists: doctors and registered nurses, medical social workers, chaplains, certified nursing assistants and aides, and volunteers.

A death midwife is a non-clinical, non-medical support professional who can act as a comforting liaison between the family and the hospice team. Rather than narrowing our focus as specialists do, we cast a holistic gaze that takes in one’s spiritual, social, environmental, physical, emotional, and practical needs as they shift over time. Hospice staff can skillfully alleviate tremendous strain in some ways, such as attending to pain and other matters of the body as decline progresses and connecting families to resources like durable medical equipment and funeral homes. They help to set up basic systems to aid people in taking on the big job of attending their loved one—demonstrating how to take care of interventions such as ostomy bags or supplemental oxygen, to administer scheduled medications, to make observations about the dying person’s symptoms and decide how to address them—yet they do not absorb the full complement of caregiving tasks. The primary responsibility for a loved one dying at home will still fall on the shoulders of those who love them—atop the demands of life before dying entered the conversation. Doulas can help lighten stress for both the dying individual and their circle of care by facilitating communication with the hospice team and collaboratively resourcing how to cover what hospice does not. Independent of the hospice process, death midwives can offer emotional support as well as physical assistance with certain light caregiving tasks, and share knowledge about the natural end-of-life process. We often also volunteer with hospice organizations, and are thus experienced in working in tandem with professional caregiving staff under that model.

Hospice workers are warm, heart-centered, dedicated people who take care of the body and spirit’s intimate needs while also helping families to navigate our complex end-of-life healthcare system. They are indispensable resources—and yet they are restricted by Medicare regulations, their individual specialties/licenses, and the caseload priorities of their hospice organization, often unable to spend as much time or lend as much support as they would like to each and every patient to whom they are assigned. Death midwives, however, are independent professionals working outside of the medical and insurance systems. We are free to customize our services and our schedules to cater to the unique needs and wishes of each dying person and their loved ones. As such, we make excellent bridges between the rigid structure of hospice care and the ever-changing (and often messy) demands of everyday life.

In concert with a dying person and/or their loved ones, a professional funeral celebrant helps to plan (and generally officiates) funerals, memorial services, and celebrations of life in a way that eloquently honors the departed’s beliefs, values, and desires. Whether you have firm plans that you need help implementing or you could use a hand in shaping a ceremony to venerate the memory of someone who has passed, a celebrant will work to do so in a sensitive and empathetic manner. We can even hold these ceremonies while a person is still alive and with their guidance, often called “living funerals,” giving them the chance to deeply enjoy the heartfelt remarks, stories, and presence of those who love them best.

A funeral celebrant typically takes the place of clergy for these events. They do not formally represent a specific faith or religious organization, and they are qualified to officiate for spiritual, secular, agnostic, or atheist traditions. They are trained in designing a special ceremony that tells the narrative of the deceased person’s life while incorporating their unique wishes and history. Celebrants frequently work in their unique area of responsibility alongside funeral arrangers and directors, who keep an eye on the big picture of a service and often handle body transportation, preparation, custody, disposition, committal, and more. We also sometimes partner with clergy to deliver blended funerals and memorials where certain elements must be conducted by a person ordained by a particular religious tradition.

Taking a compassionate, collaborative approach, the celebrant personalizes each service to elevate a person’s legacy in a deeply meaningful way. You can hire a celebrant to help you mark a loved one’s death in any of the following ways, whether at your own home, a funeral home, or another location:

• Celebration of life

• Viewing, visitation, or wake

• Memorial or funeral service

• Graveside gathering

• Committal ceremony

• Scattering of ashes (cremains)

A funeral celebrant’s role involves different aspects that are performed before, during, and after the ceremony, including but not limited to:

• Providing support & guidance throughout the process

• Spending time learning the wishes of the family and/or the dying person & helping to ensure they are observed

• Explaining how the celebrant will run the ceremony so that you know exactly what to expect

• Writing a remembrance speech or eulogy with your close input to honor & reflect on the life of the departed

• Coordinating & managing timing during the ceremony, ensuring it runs smoothly & limiting interruptions or overages while remaining flexible in respecting attendees’ grief

• Composing a ceremony that is meaningful to the family & tailored to the departed individual, offering all who attend an opportunity to participate in holding their memory with love & respect

Funeral celebrants are frequently able to be hired at additional cost through your funeral home. If your funeral home does not offer this option, or you will not be utilizing a funeral home for your services, please inquire below about how I may be of service.