What Is A Death Doula?

What They Are, How They Provide End-Of-Life Care, and How You Can Become One

A death doula is someone who provides care for a person when there are nearing the end of their life. As a person who may be terminally ill or an older person, a death doula is there for you in the final stage of your life and picks up where medical professionals leave off. A death doula, also called end-of-life doula, death midwife, transition guide, soul midwife, or death coach, provides emotional and spiritual support to someone during a challenging and personal time.

Death doulas can also be called end-of-life doulas, end-of-life coaches, soul midwives, death midwives, or transition guides.

Many people have heard of a birthing doula who supports women as they work through pregnancy and childbirth. A death doula provides care for the other, sadder side of life.

Death or End of Life doulas are not a new concept, and they have been around in cultures throughout the course of history. However, their role is becoming more defined and more prominent in the modern age.

Support through death is extremely rare as this topic is challenging for people to work through and discuss. Even members of your family may struggle. A lot of this has to do with grief and the failure to accept that death is coming. Most people struggle through handling a loved one’s death. A death doula helps bridge that gap between medical care and family support, speaking as an advocate to support the dying person in their needs and wishes in the moments before and after death.

This guide is essential for understanding what a death doula is and the services they provide. We also go into an in-depth coverage on how to become a death doula.

The History Of Death Doulas

The role of a doula was introduced in the 1970s during the natural birth movement. This movement brought about many alternatives to childbirth, such as water births, home births, and doulas. Doulas are there to provide emotional support through childbirth and are not serving in any medical capacity. The same generation who utilized birth doulas in the 70s is now asking for the same support as they navigate death, allowing doulas to expand their scope to support the dying.

Preparing For Death: Emotional & Physical Changes

Dying is the final step in life, and for some, it can come earlier than they expected. No matter what stage in your life, death is hard to come to grips with when you are given a terminal diagnosis.

There are many physical and emotional transformations your body and mind go through when death approaches. Understanding the challenges you face emotionally and physically and knowing how to cope can get you to a safe place where you can let go and say goodbye to everything you have known.

EMOTIONAL CHANGES

Emotionally, you may begin to disconnect from the outside world, becoming uninterested in the happenings around you, and you may only choose those you love to be close to you.

In the days before your death, you may experience a unique conscious awareness that those around you could interpret as confusion. Usually, this is a feeling of euphoria in that you can leave this existence into another.

You may begin to reminisce, and events of your past begin to intertwine with things that have happened in your distant past. You may begin to talk more about people who have died before you.

Mentally confusion or delusion may set in. You may begin to see people or speak to people who have died previously. Delirium is caused by several factors, which could be the disease or the symptoms of the disease, or it can be caused by failing organs.

Signs of delirium are setting in are agitation, hallucinations, and consciousness that comes and goes. This can be frightening for those who are around you. Usually, medications are given to help with delirium.

PHYSICAL CHANGES

Physically, you may begin to notice your appetite is diminishing. This is related to general weakness and slowing metabolism that occurs as death approaches. You may be fed small amounts of liquid foods to help with nutrition and ease the pain.

Your breathing may change and come in rapid bursts or begin to slow. It is not unusual for breathing to stop completing and start again. You may become congested caused by moisture trapped in your lungs. This is often referred to as a “death rattle.” A doctor may put you on oxygen in your final days.

When death approaches, your body’s ability to regulate your body temperate begins to fail to transition you from very cold to extremely hot. This is usually combatted with ibuprofen or acetaminophen.

You may become drowsy and become weak, and you will be harder to wake up. You may need assistance to perform regular care activities such as using the bathroom, bathing, and eating.

Urinary and bowel movements are affected by the kidney's function as it begins to fail. You may experience constipation, and the amount of urine your body produces is lowered. Visual and hearing changes occur when you are close to death. You may begin to see or hear things that others around you do not. Your sight can also start to diminish.

These changes are difficult for your family to observe, but it is a natural part of the dying process. A death doula can help ease your mind and work with your family to help them understand what is happening.

Death Doulas - How They Help

Many people who have worked in the medical field have experienced or witnessed the death of many people. Death is often sudden, and death doulas are not traditionally available for these kinds of deaths. 

Nurses would notice that when a person receives a terminal diagnosis, they become invisible to their family and friends. While likely not intentional, people have a hard time handling death, especially with their loved ones. They never really want to say goodbye.

Doulas provide comfort to a dying patient that medical professionals and families may not be able to provide. There are there for a majority of the time a person is dying, and they build strong relationships.

They enrich the dying person's life and strengthen the relationship with the family members to the client. They are trained professionals who provide assistance and guidance with holistic services to individuals and their families during transformative life changes.

Hospice Or Death Doula?

Hospice steps in when a person is terminally ill and provides care for those dying by giving treatment for the symptoms of the disease, but not the disease itself. Hospice care involves the family and the patient in making decisions.

A hospice worker ensures a person's last days are comfortable and they have their medications, and they are able to spend their final days with dignity and quality.

HOSPICE WORKER'S PRIMARY DUTIES INCLUDE:

Palliative care and symptom control – Palliative care is meant to treat the symptoms and side effects of the disease or general pain associated with the final days of death. A hospice worker will look at how the patient is doing as a whole and treat them as needed.

Home care and inpatient hospice care - Hospice workers' care is centered around working with the patient within the home. They help with household duties and help with anything a person dying cannot do on their own

Host family meetings – Hospice workers will regularly hold family meetings to go over the terminal person's care and condition. These meetings allow the family to go over their feelings and discuss what may come next and what is needed.

Coordinate care – Hospice workers work with a team to coordinate care for a person 24 hours a day, 7 days a week. The workers in charge of care include inpatient care, doctors, pharmacists, and clergy, and funeral directors.

Respite care – Respite care is caring for the terminally ill while their family is away. This can be done either in a care facility or at the person's home with the right equipment.


Doulas are more there for emotional or spiritual support. They do not provide medical care, but they do help where family and medical staff cannot.

DEATH DOULAS PROVIDE THESE BASIC NEEDS:

Companionship – The death doula provides a certain comfort that can only be obtained through building a relationship. This can be through watching movies or reading books together or simply holding the person's hands. Death doulas are empathetic and understanding just enough without pitying the dying.

Answers questions – When people are dying either from natural causes or from a terminal illness, a death doula is their resource to help answer their questions or find them an answer when they don’t know.

Listening – A death doula is there to listen and offer understanding and comfort as they talk about their life. A dying person may want to discuss their end-of-life wishes, or they may want to talk about how they have wronged in their life and get unresolved guilt off their chest. A death doula is there to listen and not judge.

Performing basic tasks – A death doula can be there to take up tasks that the family or the person dying may need. These can be running errands or helping with household chores, or bathing and dressing the dying. The dying and their family may struggle with performing regular tasks, and a death doula can support them in helping.

Death Doulas & Transitional Life Care

A death doula can be a vital caregiver and helpful person in preparing for the death of a loved one. Death doulas are often tasked with duties above emotional support, but all encompass the overall well-being and support the dying wishes. Death doulas help with delivering and advocating for the advanced directives of the dying.

They are also helpful in preparing for the funeral and the memorial. A death doula and a dying person often develop a strong relationship. They can help with unique and personalized suggestions the family may not have been aware of.

Usually, a death doula can help communicate with funeral directors and the family to help convey their family member's wishes. A person’s wishes can vary from having an open casket service to wishing to be cremated. If a person would like to be cremated, consider these urns.

Death doulas offer a safe space for dying people to talk about their beliefs in what happens after and help them come to terms with their death and prepare them for what’s next. They can help with paperwork such as writing out directives, helping draft the will, making a list of accounts and passwords.

They can also assist with creating arrangements to make the patient's final days enjoyable, including organizing pet visits, maybe permission to do an activity.

Death doulas work closely with the family and friends of those who are dying to offer relief and allow the family some time to themselves to be able to practice self-care. They can help the dying prepare for death by creating legacy projects, including scrapbooks, transcribing memories into a memoir, or writing out messages to loved ones.

A death doula’s support doesn’t end when the person dies. They are there for the family as well. A death doula can be a resource in helping the family with funeral planning. They also provide support to help the dying create meaningful goodbyes and work to settle the estate of the dying.

Choosing a death doula can help you and your family provide peace of mind and a sense of closure for those grieving and overall help in the healing process.

How To Tell If A Death Doula Is Right For You

Deciding if you want to include a death doula in your end-of-life plans is an important decision. You may have been diagnosed with a terminal illness, or you may just be coming to the end of your life naturally. No matter how you are dying, you may want to include a death doula if you feel like you need additional support for yourself or even for your friends and family.

YOU NEED PRACTICAL SUPPORT

If you feel you need more support through the death process, helping plan out your memorial, funeral, or even your will, a death doula may be a good idea. A death doula can be helpful when there is a lot of planning and preparations that need to take place before and after the death.

YOU NEED EMOTIONAL SUPPORT

If you have a family member who is dying and it’s hard for you always to be there, or if you have other duties or jobs that prevent you from constant care, a death doula can fill in those gaps. Additionally, your family member that may be dying might benefit from creating a strong relationship with someone who can emotionally handle the idea of death. A person that supports the dying needs to stay strong and supportive, and when you are watching someone you love die, you may find it hard not to break down.

YOU NEED SOMEONE TO FACILITATE CONVERSATIONS

Doulas can help facilitate conversations between hospitals, care workers, and family members to discuss treatment, care, and the needs of the dying. A doula works on paperwork and ensures everything is organized for ease of understanding for those involved.

YOU OR A LOVED ONE IS DYING AT HOME

If you or a loved one is dying and would prefer to die at home, a doula can make that possible by creating an ideal space for going through the end-of-life process.

Doulas are a valuable resource when going through handling the death of a loved one or coming to terms with death on your own.

Family Involvement With A Death Doula

A person dying who has chosen to involve a death doula has made the decision likely to help them cope and to help settle their affairs before they pass away. This does not mean that the person dying doesn’t have family or close friends to help them. It usually means they have decided that they did not want to burden those close to them while preparing for death.

Even though a death doula is handling a good portion of the death process, a family should always be involved in some capacity. Including family members can be messy, but both need to be emotionally able to handle the death and understand the wishes.

Death doulas can help resolve any family conflicts that result from the wishes of the dying. No matter the ask or who hired the death doula, they are there to serve the patient and ensure they choose their end-of-life and the family leaves their wishes out of it.

Even if the family does not always agree with the wishes, a doula is there to help them understand that it is the dying’s persons wish and help them understand and learn to respect it.

How Death Doulas Assist The Families Of The Dying

It isn’t just the dying that needs support, and death doulas can also help the family. Death doulas can help support the loved ones of the dying in many ways.

FAMILY SUPPORT

Often family members will need a trained set of eyes and an objective view to go over paperwork or planning for the dying loved one. If the family needs to rest or needs to get away, a death doula can be there to help alleviate some of the responsibility. They can even just be there for the family so they can go eat and practice self-care.

The family may need some transitional help to understand the new normal after their loved one has passed away. A death doula can provide emotional support to the family and listen to them as they grieve. Sometimes they can help go through a deceased person’s belongings after death, helping the family catalog the items and get them where they need to go.

HELP WITH DECISION MAKING

Many times, when a loved one is dying, the family does not want any more medical advice. It’s likely they’ve heard it all, and they just need support in many key decision-making details and support emotionally. A death doula can provide guidance in decision-making and support for each member of the family no matter how they are taking it.

GRIEF ASSISTANCE

Everyone’s grieving process looks a bit different a death doula is able to help with many types of grief no matter where they are in the five stages. A doula can also help in preparation for how the family continues on living life after the death.

They can also help arrange memorials such as paintings or gifts for the family to keep as a memento. There are many options for choosing a memorial gift perfect for all family members to cherish forever here.

How To Find A Death Doula

If you’ve made the decision to include a death doula in your end-of-life care, you may not know where to start. As death doulas become more prominent in our society, they are becoming increasingly easier to find. A death doula focuses solely on one person to ensure the time spent is personal and they have the availability to be there when needed.

ASK A DOCTOR

Finding a death doula can be as simple as asking a doctor for a referral or if they may know of anyone available to take them on as a client. The hospital may have resources, or many nurses may have come across a doula they would be willing to recommend.

SEARCH ONLINE

Additionally, there are a wealth of independent death doulas available everywhere. You may do a simple search online or start with Hospice resources such as the National Hospice and Palliative Care Organization (NHPCO). You can also check with the National End of Life Doula Alliance (NEDA) for a reference.

CONSIDER TRAINING AND BACKGROUND

When choosing a death doula, consider their training and background. Working with someone with a background or certificate from a highly esteemed program can guarantee the care you will receive will be quality.

PERFORM INTERVIEWS

You may want to perform interviews. The role of a doula is intimate and personal in nature. You want to choose someone you feel connected with to ensure the last days of life are enjoyable.

COST VARIES

The cost of a death doula varies on your or your family's needs and is usually on an hourly basis due to the uncertainty of when death will actually arrive. A death doula is not covered under insurance, so you will want to ensure you and your family are able to afford this service. Some death doulas are willing to work on a sliding scale to ensure you can receive the care you need without bankrupting your family. Usually, death doulas can charge anywhere from $25 to $100 an hour.

Many death doulas specialize in different areas and have a host of skills and talents they can incorporate or enhance the way they care for their clients. You will want to look into the offerings of every death doula, as they do not always offer the same services. In comparison, most can provide the essential services of a doula, but many work privately and set very strict boundaries.

Searching for a death doula that provides all you need can be a daunting task in a time that is tough emotionally. Although it is tough, you want to ensure the end of life for you or your family member is enjoyable.

How To Become A Death Doula

Anyone who would like to help people and who has a passion for serving can become a death doula. The work, although sad, can be rewarding and give you a sense of great pride. Working with the terminally ill and those who are dying naturally and being able to build beautiful memories that you can throughout your life is priceless.

There are many people who tend to end up choosing a career in becoming a death doula. These include grief counselors, hospice personnel, social workers, healthcare professionals, members of the clergy, and people who have witnessed a death that transformed them personally.

WHAT YOU SHOULD KNOW ABOUT BECOMING A DEATH DOULA

Before you make the decision to become a death doula, there are some essential things for you to consider making sure this is the right choice for you.

Emotional & Physical Demands

While being there for someone at the end of their life is fulfilling, it can be emotionally exhausting. Even though you are a professional, it still can take its toll to watch someone die.

Being a death doula can require long hours as it is never certain when the exact moment a person will pass. You can also be asked to take on some emotionally intense tasks.

You must have a sense of emotional security and the ability to know when to set boundaries to become a successful death doula. When working with someone at the end of their life, it may be more difficult to set healthy boundaries as they navigate this challenging time in their lives.

Practicing self-care and ensuring you have a certain level of mindfulness can help you prepare to handle the death for yourself and your client.


Experience With Death

While being there for someone at the end of their life is fulfilling, it can be emotionally exhausting. Even though you are a professional, it still can take its toll to watch someone die.

No matter how much you read or what people have told you, the moment you first witness death can be emotionally devastating. In this role, you will need to understand that death is a part of life, and you should come to terms with your own mortality.

 

If you are unprepared or emotionally unable to handle death, you might want to reconsider becoming a death doula.


Compassion & Empathy

To become a death doula, it takes a certain level of compassion and empathy to guide someone through death. The role of a death doula is to listen to people expressing regrets, discuss mistakes they have made, and tell stories to relinquish their guilt or things they will miss. They’ll share moments of sadness and grief they are experiencing, and it is important to listen and provide comfort. Listen with an open heart and never judge. It is your job to make them feel safe.

Training To Become A Death Doula

Becoming a death doula can be obtained by taking a course that ends in receiving a certificate or a license. There is only one prerequisite: having the ability or experience to witness the death of a person and supporting them through the process. The training involved can happen online, or you may be able to find an institution that allows for in-person training. The hours and involvement depend on the course you choose.

DEATH DOULA TRAINING INCLUDES:

  • What the dying process looks like and how to handle everything that is involved.
  • Learn how to be empathic and a deep listener
  • How to support the dying and the family members through the end-of-life care process.
  • How to help the dying prepare and process their end of life wishes
  • Understand the care and planning that goes into memorials and funerals

DEATH DOULA SPECIALIZATIONS INCLUDE:

  • Care for the elderly
  • Provide support and comfort to the dying
  • Respite care for the family
  • Facilitating legacy and life support
  • Conducting living funerals
  • Planning and conducting vigils
  • Mourning and post-loss support
  • Facilitating with post-death home organization
  • Pet doula death services

During the training, you will be required to obtain a certain number of hours of experience with a client that needs to be verified by a medical professional. You have the option of working alongside a professional to gain the hours required. Once you have completed training, you will need to take an exam and meet the minimum passing score to receive a certificate certifying that you are now a death doula. There is currently no boards or certified exam required for death doulas to start work.

Benefits Of Becoming A Death Doula

Choosing a career as a death doula can be meaningful work. You have the honor of working closely with people in a vulnerable state. Although it is not a pretty thing, death can be real and beautiful. You have the ability to transform an experience for someone from something that is terrifying to acceptance and understanding of what is ahead.

Death is a sacred part of life, and some cultures celebrate death as much as they do a birth. People should never have to be alone in death, and death doulas are there to provide comfort.

Over time as more enlightened generations pass, the role of the death doula will become more prominent and widely sought after. Being a part of the movement to change the process of death is invigorating.

If a Death Doula career seems like something you are interested in, the International End of Life Doula Association has a training and certification program designed to provide everything you need to become a Death Doula. More information is provided here.

Death Doula Frequently Asked Questions

What is an end-of-life doula?

An end-of-life doula is a non-medical person trained to take care of those who are terminally ill or dying of natural causes. The type of care ranges from emotional and spiritual support to end-of-life preparation and planning. A death doula supports families and individuals as they go through the end-of-life process. 

Why would I need a death doula?

Death doulas are a comfort to a dying person. They are able to go over and prepare you for the dying process and what to expect. Death doulas offer a variety of services to those who are dying and to the families.

How are death doulas different from Hospice workers?

Hospice workers are essential in the care of a terminally ill person or a person dying from natural causes. They provide medical assistance such as medicating and working with the patient’s doctor to ensure they are comfortable and as healthy as possible as they enter death. A death doula is never meant to replace a hospice worker, only to help the dying in ways the hospice worker cannot. Death doulas are trained to offer emotional support and are able to assist with the many stages of grief a person feels as they die. Death doulas also extend the emotional support to the members of the patients family.

Does Medicare cover end-of-life doulas?

The role of a death doula is a non-medical in nature and, for now is not covered under Medicare or Medicaid. This may change in the future as the role of an end of life doula evolves and becomes more in demand.

How can a death doula help a patient with their end-of-life process?

A death doula is there to support a patient emotionally and help walk them through what they will go for. The services a death doula offers also extend to making final preparations for their death, including assisting with their will, funeral and memorial planning, and closing any accounts or affairs they may be leaving.

What training does a death doula have?

A death doula training involves a number of hours in experience working with those who are dying and education on the many roles and responsibilities of a death doula.

Does a death doula have a medical degree?

A death doula does not have a medical degree and is not a medical professional. Sometimes a death doula can have a medical background as many nurses, and hospice care professionals tend to pivot towards becoming a death doula.

What can a death doula do? 

A death doula can perform many duties as they serve a client. These duties include organizing and planning directly with funeral directors; they can also work with medical personnel to go over any care needs and work with the family to ensure the client's needs are met in regards to final wishes. The role of a death doula is primarily a supportive role.

How much does a death doula get paid?

The pay of a death doula varies based on the needs of the client. Some death doulas can work with clients on a sliding scale as sometimes its not easy to afford a death doula. Compassion and understanding are necessary when working with the dying.

Compassionate Care At The End Of Life

End-of-life transitions are personal and unique to every person. No one gets to choose when they die but you have the ability to take control of what comes during and after your death. Using a death doula can provide comfort that family members or caregivers may not be able to give to a dying person. They can be a trusted resource in helping with continuity to families as the process of death moves from medical care to hospice care to death and beyond.

Having a resource to help guide you emotionally and spiritually through death and knowing that your wishes are going to be carried out long after can make you feel good about the decisions you make and the legacy you leave behind.

December 31, 2021 by Frances Kay