Preface by Julie Keon: This past fall, I was notified of an inspirational article that had been published in International Doula magazine (Vol. 23, Issue 3, 2015) that was written by a woman I met many, many years ago in Victoria, BC during my birth doula training. At the time of its publication, I was experiencing a deep internal struggle as I left my birthing world behind and crossed over a threshold into unknown territory; that of death midwifery. I was in the midst of my hospice volunteer training and was about to embark on a 12-week course in death midwifery. I felt like a fledgling, ill-prepared, and I was feeling all of the insecurities and anxieties one feels when you have breathed in just enough courage to propel yourself off the cliff into the unknown. Reading Marty’s words was a gift to me in my time of need and although she thanks me for my “doula” love in a time that she needed it most, I share this story with everyone as a chance for me to thank you, Marty Sutmoller, for writing this piece. In my time of need, you doula-ed me, too. Your words validated that I do have what it takes to walk this new path I am on. XO


Picture this: You are being cared for by some of the people you love most in the whole world.  The lights are low, and beautiful music is playing.  There are expert helpers present, normalizing the evolving process.  No one feels rushed, and time ceases to matter.  Moments are measured only in breaths.  Everyone present emanates gratitude for the great work you have done, and for your current intense efforts.  Your pain is manageable, and if it not, you can choose to have pain relief if you want.  You realize you cannot fight or change this process – it just is what it is.  You surrender, carefully supported by those you love.  You allow yourself to let go.  You are deeply loved.  You are dying, and this is your home death.

Providing bed-side hospice care is one area I have been trained in by our local hospice society.  Some might think it odd to work with both the beginning of life and the end, but the experiences can be strikingly similar in many ways.  I most often work with families deep in grief after the death of someone they love.  In hospice terms, it is called bereavement support.  The people I am with are immersed in grief, and are learning to cope through one unimaginably painful moment at at time; not so unlike labour — only the pain arises from a different place.

I recently facilitated a grief support workshop to train new hospice volunteers.  What struck me was the similarity between the content of this grief support training and that of the birth doula workshops I also facilitate.

As a hospice grief support volunteer:

  • you are essentially a listener
  • you place your heart forward first, and work next with your ears
  • you follow the family’s lead, and guide gently with open suggestions
  • you are intimately involved, and yet know this is not your experience
  • you ask open-ended questions, and don’t avoid difficult topics
  • you know local resources for further physical, mental, social, spiritual or emotional assistance
  • you carefully observe family dynamics
  • you always notice who in the group needs extra attention, a gentle touch, and/or a hot cup of tea
  • you realize there are moments when everyone is okay, and when everyone is not, and you try to restore the changing energies in the room
  • you align yourself next to the family, to buoy them should they go under
  • you know when it is the “right time” for you to leave, and you trust the family has the tools required to continue on their own
  • you create real and meaningful connections

And later, a family member might express to you, “I’m so glad you were there.”  Does any of this sound familiar?  I know that doulas everywhere have the skills to become grief support workers and hospice volunteers.  Whether people are “incoming” or “outgoing,” your heart-support and care is the same, and essential.

My doula career has been intimately tied to death from the onset.  My mom died four days before my birth doula training.  She died at home with family and hospice volunteers surrounding her.  After her passing, her body remained with us at home for two days.  My brother played low swoopy tones on his violin, we lit candles, told stories, sat with mom, and cried a lot.  We were lifted out of our regular life — time suspended for days.  I was registered for the birth doula workshop, and was very uncertain about attending.  My family encouraged me: “You’ve waited a long time to do this,” and “Mom was so happy you were going to become a doula.”  So, I decided to go.

I’m usually an extrovert, but at my birth doula workshop, I was quiet and withdrawn.  I sat at a back table, and observed this room full of beautiful women. They were dressed in bright swirling dresses, long hair tied up, all smiles and laughter — a positive vibe permeated the room.  Their life-filled vibrance could not have been in sharper contrast to the quiet, mournful, place of solitude I had surrounding my heart.  An engaging young woman, Julie, sat next to me, and we talked briefly before the session started.  She was concerned about becoming a doula because she wasn’t a mother yet herself.  Would clients take her seriously?  I began to re-assure her, and burst into tears.  Julie became my doula at that moment, and she doula-ed me through the whole workshop.

After introductions, our first exercise at the doula workshop was to share with one other person, the story of our own birth.  Describing my mom birthing me, thirty years earlier, was just so intense!  At times I couldn’t even breathe.  Julie mopped up a bucket of my tears.  She had her hand on my knee, asked me gentle questions, listened and stayed quietly present with me.  For the rest of the workshop, she stayed close by the whole time — through lunchtime, and even to the bus-stop afterwards.

She met me the next morning outside the classroom, hugged me and looked straight into my eyes to see how I was doing.  Later on, when the instructors asked us to switch partners, Julie didn’t — she just stayed with me.  And I never asked her to do this.  She simply tucked me, wounded, under her wing and kept me there.  During that two-day workshop, I learned, from Julie’s gentle care, how to be a doula.

Tibetan philosophy teaches that the dying process follows four natural elemental stages of outer dissolution.[1]  First, earth, as our body loses energy and strength, it becomes hard to stay up right.  Second, water, we lose control of our body fluids and begin a process of dehydration.  Third, fire, we lose the ability to regulate our temperature, and begin to get cold, at the extremities first.  And finally, air, we take fewer and fewer breaths.  In birth, the process is reversed.  The baby begins taking breaths (air), starts to regulate temperature (fire), seeks out breastmilk(water), and establishes musculature and skeletal coordination (earth).

Family support around these two deeply human experiences are very similar.  Privacy, respect, patience, and reverence are essential.  I believe all trained doulas “have what it takes” to provide exceptional care for families of the dying.  I encourage doulas everywhere to seek out community hospice centres and become involved.

In Gratitude

I’m ever grateful to my mom, my guiding light.  I am thankful to families who have invited me into their intimate circles during their huge life transitions — with all else stripped away, it is here I have glimpsed humanity’s glimmering core.  And to my dearest doula Julie, “I’m so glad you were there.”

[1] Rinpoche, Sogyal. The Tibetan Book of Living and Dying. New York: Harper Collins, 2002. p.255-257.

This appeared in the most recent issue of International Doula (Vol. 24, Issue 1, 2016) and was inspired by Marty’s piece.