One of the great celebrations in our world is the anticipation of a new life being born. At the moment of birth, and the first moments thereafter, life can be filled with heightened emotions, confusing paperwork and plentiful reactions from those surrounding the new mother, father and baby.

Many of us have come to see that life’s final moments are very much the same. Providing emotional, spiritual and psychological support for women and their families during childbirth has been extended these days to providing very similar services at death.

In recent decades, there has been a sweeping movement resulting in a growing number of doulas (Greek for “woman who serves”) helping in many ways to ease the process of dying, grieving, and acknowledging both death and birth as sacred acts. Like birth doulas, death doulas don’t play a medical role. They work collaboratively with doctors, nurses, hospice teams and other caregivers to provide practical support to families and individuals at the end of life. Their roles are often seen as end-of-life guides, soul midwives, death coaches, or “death doulas” among others.

Birth doulas guide souls into life; death doulas guide souls out.

The role itself isn’t always well-defined. Death doulas can work in a health care setting, in the home, or in senior living centers. They are often called upon by medical professionals, by the family, or the client themselves. An end-of-life doula may step in early in the process, helping both the healthy and the terminally ill make sure their medical care, paperwork and end of life wishes are in place in the way they prefer.

A death doula often becomes engaged closer to the act of dying itself, helping those at the end spend their final moments in the way they choose—perhaps helping to shape their legacy, doing a life review, making sense of their own story or in a ritual of their own creation. Their primary role is simply to be fully present to the person dying and/or the family to ensure compassionate and caring companionship at the end. “Grieving doulas” support families after a loved one has died.

Among midwives and doulas, there’s a belief that no one should feel alone during life’s mystifying, sometimes terrifying beginnings or endings. The death doula philosophy focuses on the idea of a “conscious death,” allowing people to have the death they really want. Of course, this means different things to different people. Some want to tell their life stories, some want to simply hang out and play cards, while others want to hear beautiful soft music. Many doulas say their greatest offering is sometimes to simply be a compassionate presence.

The first such organized doula service has its roots in New York City in the late 1990s with a woman named Phyllis Farley. She says, “It occurred to me that you need the same qualities at the end of life as you do at the beginning—helping people in the labor process.” She knew that a disturbing number of people die alone, or in hospitals plugged into machines, who didn’t want this to be the case. 80% of people report that they want to die at home, surrounded by a loving presence of supportive family or caregivers, while only 27% actually experience this. In a world where doctors and nurses are pressed for time and family and friends are often upset or anxious during a loved ones impending death, death doulas willingly support and accompany those in need to face life’s inevitable end with conscious dignity.

There is a growing recognition that the spirit must be attended to as much as the body. And the soon-to-be-bereaved need help, along with the dying, to facilitate meaningful interactions between them. As a doula, it is important to encourage people to say everything they need to say so they don’t look back one day with regrets.

An increasing number of hospitals and hospices offer end-of-life doula programs. Doula services are tailored to meet the specific needs of each patient and his/her family. They can include plans for their advanced directives and celebrations for their end of life, including how their wishes will be carried out.

Author Elaine Millam has been an accomplished leader and educator in the corporate world, has published three leadership books, and at this time in her life, is passionate about serving those at the end of life. For more information, contact Dr. Millam at (760) 512.0142 or visit

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Comments (5)

  • Sue Greenwood

    I know that people in the UK are beginning to talk about death and we have death cafes, which I suppose started in the US, but whether we have Doulas I do not know. I shall try to find out. Meanwhile, thank you for this interesting article.

  • Gloria Wallace

    This is a terrific article that addresses the arc of life. Help and guidance has been available around birth and the early months of life for many years but so little has been written or extended regarding exiting life. I particularly love the idea of doulas being available in the beginning and at the end of life. Comforting just thinking about it.

    • Lauren Del Sarto

      Thank you so very much, Gloria! I will pass that on to the author.

      Lauren Del Sarto

  • Dennis Coyne

    Thoughtful, informative and practical insight and a resource for the passage all of us takes. Thanks to you, Elaine!


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