I became a birth doula in 1998 and spent the next many years supporting women through labour, birth and the postnatal period as a birth and postpartum doula, prenatal educator and breastfeeding counsellor.
As a fledgling doula, I had my own ideas as to what made a positive birth experience and did my best to help women achieve that. When a birth unfolded in a low intervention, natural way, I deemed it a success. If a birth resulted in a cesarean birth, I would feel deflated and somewhat of a failure that I did not help my client achieve the birth she had hoped for. My training had not prepared me for the intricacies of true labour support and very quickly I knew that in order to support my clients, I needed to put my own expectations and judgements aside and have them lead the way.
Experience brings learning that cannot be achieved through a three-day training course nor the reading of books. After attending many births and observing the outcomes and reactions of couples in the postnatal period, I recognized that some births, that appeared to me to be amazing, were not perceived in the same way by the postnatal mother. And other births that seemed to go off the rails and that I might imagine as deeply disturbing, were perceived as positive by the new mother. It turned out that what was a positive birth ‘on paper’ was not necessarily reflective of the experience of the mother and her partner and vice versa. On top of that, everyone in attendance could have a variety of reactions and memories to what occurred. Oftentimes, the mother emerged on the other side feeling powerful and strong while her partner or other family members were left feeling traumatized by what they witnessed.
I began to observe a common thread in births that were perceived as difficult or even traumatic. It didn’t have a lot to do with what happened but instead, how it was experienced and perceived by the mother and her partner/ family or friends. We know that trauma in general is often caused by a sudden turn of events or anytime a person feels out of control or senses that they are in danger. In birth, if a mother perceives that her unborn baby could be in danger or at risk even if this isn’t the case, it can result in trauma. You see, it was irrelevant what I, or anyone else for that matter, thought about the birth, it only mattered what the labouring mother and her partner experienced. It was not my role to express my feelings or perceptions at how the birth. My job was to support this family in having a positive birth experience however they defined that.
In our postnatal visits, a debriefing of the birth was a valuable aspect of the care I provided. I would simply ask them to tell me the story of their birth. Although, I was present through all of it, it was crucial that they shared their memories of what occurred. One thing that was so important was that I listened and then adjusted my version to what theirs might be. For example, if I walked away from their birth feeling it was magnificent only to discover that the mother was now suffering with PTSD because the birth happened so incredibly fast (precipitous labour), I did not try to convince her that it was a wonderful birth and that she should be happy about it. Instead, I trusted and honoured her experience and gave her space to share her anger, fears, and thoughts about her birth. My role was to offer non-judgmental support and to refer her to other resources when I felt we exceeded my scope of practice. Most importantly, I validated her experience and then offered guidance in helping her to process and integrate what had happened.
After fifteen years, my birth work gradually came to an end. Now, twenty-one years after being trained as a birth doula, I now train end-of-life doulas. In my work with families going through the death of a loved one, I cannot help but compare my role as an end of life doula to that of a birth doula. It most cases, one only needs to replace the word “birth” with “death” to see the similarities. The transitions are different yet the ingredients in caregiving are remarkably similar.
I came to this conclusion in 2010 as I helped my mother care for my paternal grandmother as she died at home. Long before the term “death doula” was appearing in the media on a regular basis, I wrote about it in my newspaper column. I didn’t have a name for it but wrote about my realization that caring for someone in their dying was akin to caring for someone in labour and birth. I learned that, like labour and birth, dying can be hard work. This very natural process takes time and a smoother transition often involves the loving support of trustworthy caregivers. As I spent time sitting with my Grandma, I reflected on how similar the care is when one helps to usher in a new soul as in birth and when one helps to send a soul on its’ way. The comfort measures, skills, support and caregiving that helped to make a birth experience more positive were the same in helping to make a death experience one that could be described as positive and good.
Like birth, death has the potential to not only be a profound experience for those witnessing and caring for the one who is dying but for the dying person themselves. We cannot ask the deceased what their experience of death was like but we can certainly provide a level of care that leads to a good death (however they define that) and leaves their loved ones feeling positive about the events that unfolded as their loved one was dying. Granted, the family may still feel shocked and bereaved after the death but their days, weeks and months following may be less complicated if they perceive the dying and death process as positive.
As in labour and birth, the end of life doula is a unique and valuable part of the care team. Yes, people will die whether there is an end of life doula present or not however the experience of the dying person and their caregivers can be enhanced by the specific role of the end of life doula.
There have been numerous studies performed on the positive outcomes of doula attended births. One in-depth study on normal births looked at aspects that were associated with childbirth satisfaction (Hodnett 2002). These can easily be applied to dying and death. The psycho social factors that emerged from this study include: personal expectations, caregivers attitudes and behaviour, and personal control and decision making. We are still so early on in providing this unique care in dying and death that it will take time before we begin to take note of the factors that influence satisfaction with a death experience.
Continuous support for the dying and their loved ones, especially in the last days and final hours of dying, can be lacking. The presence of the doula can fill gaps in care and by doing so, protect the death memory of those who are loving and caring for their family member or friend through their dying.
By offering informational support after a diagnosis, for example, and connecting families with community resources, a doula assists in helping the person who is dying along with their caregivers to feel more in control. The continuous, on-call support of the doula gives a sense of security and assurance that there is someone to call on at anytime with questions or worries. A doula provides guidance in choosing where to die (home, hospice or hospital) as well as preparing for end of life and offering after-death care options for the family, friends or caregivers. Acting as a guide through the normal process of dying can reduce anxiety and stress in all involved. The emotional, physical and comfort measures given to the person who is at end of life as well as those who are the primary caregivers and supporters is immeasurable in working towards a positive death experience.
Protecting the death memory can be a point of reference in guiding the end of life doula in the care she or he provides. Keeping this at the forefront of the doula’s mind can help in making suggestions, providing information and leaving one’s own ego out of the equation. By doing so, the doula puts the power back into the hands of the person who is dying as well as their family and friends where it belongs.
©Julie Keon 2019