For our inaugural blog for the “Red Tent End of Life Doula Preparation” training I will begin with addressing one of the most commonly asked questions: Why do we call ourselves “Doulas”? As this blog unfolds if anyone would like to ask Awen and myself (Alexandra) a question to be explored please do get in touch.
There are many layers to the answer as to why we call ourselves “Doulas” but let us start with the most basic response which is really what a doula is. Anyone working either as a birth or end of life doula is likely to be asked this at least 4 times a day if speaking to people unfamiliar with the world of birth and death. The word “doula” comes from the Greek meaning “servant” and rose into common usage in the mid to late 20th century describing a person (often but not always, a woman) who attends births in a lay capacity to give practical, moral, emotional (and if appropriate) spiritual support to a woman in labour and her household.
At birth a doula does not perform the role of the midwife in the sense that “midwife” and “midwifery” have come to mean the trained medical professional who assists in birth. The term “midwife” predates modern medicine, however, which I will touch on more later but let’s just say for now that what most people think of as a midwife is the medical professional and as such a doula does none of the medical stuff.
Which is just as well really since the “business” end of things does not need more intervention than is necessary. A doula knows that to attend to the environment to create peace and harmony, to meet the holistic needs of the labouring mama, to keep lights, voices and tempers low… is what the natural course of labour really requires. A doula will have spent time with that woman and her family in the preparation for birth, will attend at the first signs of labour and stay right through the whole process for as long as it takes and can continue that relationship of support right through into the postnatal period and perhaps beyond. Unlike the modern medical midwife the doula provides a continuous presence over the days and weeks with a depth and connection that most midwives would secretly long for in their work. Free of the constraints of the System; a doula is attending to the emotional wellbeing of the family field by their very presence; a reassurance, a support… grounded, balanced and 100% there attending to the needs of the mother and her baby.
So it is at the start of life so it is at its close.
In the past 150 years death has become a medical event; modern medicine does everything it can to preserve life; and death is a failure. Whereas for millenia people lived and died in tribes and villages, in close knit communities, with the advent of the Industrial Revolution the poor migrated en masse to live in the cities and serve as fodder to the great factories and mills. Separated from their small communities and unfamiliar with their neighbours death was not only a lonely affair but also a risk to health since the slums of victorian towns could hardly bear life without risk of horrendous infection never mind having bodies lying around. And so the profession of “undertaking” evolved from a side line for carpenters and farmers into a massive industry. The word “undertaker” comes from the fact that they “undertook” to dispose of the body on behalf of the family. And with much pomp and circumstance, tinged with the victorian fear and fascination with the macabre, and in a flurry of pot pourri and pumped full of formaldahyde, dead bodies were dressed in best with a face full of make up dramatically staged behind heavy velvet curtains and lit by candlelight. With each successive generation further removed from the concept of death as a natural and community event we have collectively become more and more afraid and more and more alone; yes in most things, but especially in death.
There have always been those people, women and men, who were called upon when someone was dying to BE there, to perform what has come to be known in medical circles as “last offices” (laying out the dead) and assisting emotionally with the fallout in the immediate days and weeks after death. In fact we hear of these people in small communities often; however in general this is a gap in the fabric of our communities. It is in response to this gap that there is a rapidly growing movement of courageous and open hearted people who feel the calling to accompany people through death and beyond. These people are “end of life doulas”.
So birth and death are much alike in many ways. First breath and the last. So often removed from the community context and placed in sanitary and clinical conditions, medicated and monitored, spoken about in hushed tones and euphemisms, taken out of the hands of the people involved and directed by “professionals”. Like at birth we “end of life doulas” believe in upholding the preferences of the individual, in supporting them to create an environment around them, both in practical terms and in their relationships, that is conducive to peace and in letting Nature take her course.
I just want to return for a moment to the reference I made earlier to the “midwife” which is something far bigger, wider and deeper than the NHS role that it has become. I often describe the Midwife as an archetype; in bygone days he or she would have been the healer, the shaman, the wise woman or man of the village. And they would have attended births and deaths and marked all the rites of passage in between. In their hundreds the women-folk of this archetype were hunted down, falsely tried and burned at the stake or drowned. This is a screaming wound in the psyche of the western world; the persecution of the indigenous healer; in touch with the land and local plants; known to all and trusted with the deepest and most private of all human experiences and also a spiritual leader.
The term “midwife” means “with woman” and as such is not as gendered as it first seems (the “wife” is the labouring woman not the midwife themselves). One of the many reasons I personally resonate with the word “Doula” is that it transcends that semantic distinction of being with a woman; in fact, if you were to ask me, I would say personally speaking that what I am in “service” of as a doula is the Soul. At a practical level at a birth I am there for the Mama and at death I am with the person that is dying; but what is taking it’s first and last breath is the individual but I am also honouring and welcoming the Soul into the world; and bidding it farewell at death. This is me personally, each can form their own relationship with the words and concepts we are talking about here.
So often the image that comes to mind of attending to the dead and dying might well be someone in a hospice or care home environment; or on their death bed at home. However, in my personal journey as a natural psychopomp (companion of the soul) I have often found myself working in roles where people died tragically and suddenly; car crashes, murders and suicides only latterly coming to sit by the side of those dying in a bed. So, I want to bring into this rising death consciousness that “end of life doulas” have roles beyond the bedside to attend also to the lives and deaths marked by sudden death too, or miscarriage or any other circumstances where the death was unplanned but we can still attend to the aftermath.
Additionally, just as there are doulas in the birth world that do not attend labour and birth but specialise in planning and in postnatal care; so I also believe that we need a legion of post-mortem doulas who may not need to get directly involved with death but can be of bereavement support, cooking nutritious food, helping families, loved ones and communities adjust to this new life beyond loss. I believe we are part of a renaissance of keeners and lamenters who touch into raw emotion courageously without fear of grief; who can be alongside others in grief without being lost to it ourselves.
I cannot go without making mention of the political angle of this work. End of Life doula’ing is a feminist act, regardless of your gender. Remember the link I made between the industrial revolution and the demise of death as a community event? Well, it is a defining characteristic of capitalism that we have been brought up to believe in infinite expansion, that there are infinite resources placed here simply for human consumption, that we have a right to life, to live indefinitely and that to die is to fail. The patriarchy that burned our foremothers is still alive today stoking its fragile self esteem through great industries of pharmaceuticals, conventional medicine, the funeral services industry not to mention all the consumer goods we buy to compensate for the void left in us by the loss of community connection and the relationship with our soul and the sacred. In the pursuit of expansion, enlightenment and growth we neglect to embrace the cycles and seasons of life, the autumn and winter, of death. It is in the denial of the Feminine that we fear death.
To die well is a radical act. To love someone enough to allow them to die is a radical act. To die simply, peacefully, surrounded in Love is a radical act. To know yourself well enough to die in accordance with your values is a radical act. To return peacefully Home is a radical act.
This work requires hearts of tremendous courage; of good faith and sound standing; for we cannot know where it will take us. Although we may sometimes find ourselves working alone we cannot do it without a community at our back. Both a community of kindred spirits and your local community; and we must attend to strengthening both.
A “doula” is in service; and we surrender to that service in full knowledge that we are building a world in which we ourselves can peacefully die. We are in service of the individual person, of the soul, of their family, community and of this world. Death becomes the great Teacher that cracks through all our defenses and illusions of importance and shows us what really matters. And what really matters is Love.
Doulas are in service of Love.