From Birth to Death: Lessons from a Birth Doula

by Lara Stewart-Panko

As someone who attended her first birth as a lay doula in 1992, became a pro in 2001, and continues to attend births to this day, I have seen many changes in the birth doula community. I’ve also spent years working as a postpartum doula, helping families after they’ve had their baby, often supporting them while they live with mental health concerns or medically complex situations such as feeding tubes and surgeries. I have also served as a childbirth educator and social worker in private practice.

Over the years, I’ve watched the concept of a birth doula go mainstream, grateful that the days of explaining the term are mostly behind us. I foresee that end-of-life doulas (EOLDs) will have a shorter path to becoming established. But there are trends in the perinatal doula world I hope don’t cross over into the death doula realm: increasing competitive behaviors among colleagues, over-commercialization of services at the expense of what best meets the needs of clients, and the departure at times from the whole-person model of care to a more medicalized practice.

Before my INELDA training, I read Henry Fersko-Weiss’s book Finding Peace at the End of Life: A Death Doula’s Guide for Families and Caregivers. I was struck by how much of what he said about end-of-life doula work conveyed what the birth doula world used to be like: bringing “deeper meaning…a sense of the sacred, and tender moments of love” to people going through a major transition.

As I reflect on how birth and death work compare, I humbly offer the following principles in hope they will support and enhance our work as end-of-life doulas.

1. Know your strengths. Within the scope of EOLD work, we have the opportunity to provide advance care planning, education, vigiling, assistance with after-death care, and help with funerals at home or elsewhere. We can facilitate legacy work, communication, and decision-making, and can provide limited bereavement support. We can offer physical, emotional, and spiritual care throughout the dying process. Within this rather sizable range of services, you want to know your strengths. Perhaps there are areas of service you have become rusty at and need to brush up on. Perhaps you want to learn about new forms of service to add to your toolbox. Just because we can do it all doesn’t mean we have to. If clients need something that isn’t a strength, refer them to another, more suitable provider. It takes ongoing self-reflection to know our strengths and where we need, or want, to keep developing. We owe this to ourselves in order to keep enjoying our work and delivering the best care we can to our clients.
2. Honor yourself and your limits. We must acknowledge the biases and boundaries we’re bringing to our work. That means knowing your social identities and how your lived experiences make you more or less available to particular clients. Are there populations you’re genuinely unqualified to serve and therefore ethically you must refer them to other doulas who can better meet their needs? Are there client situations that strike too close to home and trigger interpersonal dynamics that would be too difficult for you and make you the wrong doula to serve in those situations? For example, one of my loved ones has a mental health condition, and I can’t work well with clients who share that particular condition. I would refer them on so they can receive appropriate care. In knowing who we are, we protect ourselves and others from harm, and we’re better able to heal and grow in the areas that have that potential. It can be scary to look at our blind spots, our places of arrested development, our unresolved traumas, and the aspects of oppression we’ve internalized. When we find the courage to do so in ways that are safe and healthy, we are gifting ourselves. And when we can work through these personal issues, we make ourselves more available to future clients in a way that offers them more wholeness, integrity, love, and respect.
3. Honor colleagues and allied professionals. In our early years as birth doulas, many—but not all—midwives, doctors, and nurses were skeptical about our services and resistant to our involvement. Some of that was territorial behavior, some of it was because they didn’t understand what doulas did, and some of it was simply because it was a departure from what they were used to. Sadly, sometimes that resistance was warranted when doulas practiced out of scope, inappropriately criticized caregivers, or put clients at genuine risk. Today within birth doula circles, there’s also a mix of supportive and adversarial behaviors. It’s difficult to pay one’s bills on doula work alone, and sometimes this reality has led to unsavory business practices, including undercutting, malicious gossip, and unethical use of others’ products. As end-of-life doulas, how might we avoid these pitfalls? When it comes to others in the death world, let’s assume most are there because they care. Let’s also acknowledge that their roles are important and beneficial to our clients. We are partners together in serving the needs of dying people and their loved ones. Just as we practice compassion for our clients, we can practice compassion for fellow death workers, giving them grace on their bad days. We can tactfully offer suggestions, gratefully learn, and focus on building connections. In seeing colleagues and other professionals as whole human beings, we move forward not only our individual practices, but the death doula profession in its entirety. With the end-of-life doula role in its toddlerhood, we’re all still very much ambassadors. How we represent the field matters a great deal.
4. Keep growing. There’s always more to learn, yes? And hurray for that! In building one’s sense of confidence as a doula, learning from books, workshops, webinars, and more is essential, as is time at the bedside and time spent in conversation with clients and colleagues. However, as in other helping professions, much of the power of our care comes from who we are, not just what we know. Our doula work helps us weave together our personal and professional development, allowing us to become more integrated as human beings. Paradoxically, the more I’ve matured as a birth doula, the more open to learning I’ve become. I’ve been able to soothe my ego and bolster my spirit by recognizing that continuous growth is both to be expected and celebrated. When we give ourselves permission to not know it all, we essentially give ourselves permission to be human, and this frees up energy to stay open to what life is offering while simultaneously improving our capacity to provide care. As we orient ourselves to ongoing development, our dance with life is that much more joyful and fruitful.
5. Let each one teach one. Just as each of us gets to continually learn, we also get to continually teach. We get to teach our clients, colleagues, allied professionals, our friends and family. Given how death has been hidden and handled in many “developed,” capitalist countries, there is so much for everyone to learn about it. Birth is somewhat less hidden, but as a doula and childbirth educator, I’m still hearing some of the same misconceptions I’ve heard since I started in the birth world almost 30 years ago. Education and social change can take time, so let’s get to it! Whether you share your knowledge and wisdom through casual conversations, community events, or in service with a client, spreading the word about better ways to die is valuable. How you use language, convey compassion, give representation to marginalized people, and help folks connect important dots are all indispensable contributions you can make as a doula. As I strive to model helpful touch, validation, affirmation, patience, and compassion, my ability to do all these things is enhanced. Sometimes being accountable to an “audience” can bring out the best in us, and if we let know-how and artistry take the stage while the ego hangs out in the wings, we can even serve as teachers to ourselves, letting Life’s powers manifest in their fullness.

Bio: Lara Stewart-Panko is passionate about individual, family, and community issues. She feels privileged to be doing work that is so intimate, sacred, and profound. Her greatest joy is connecting with others to bring that much more peace and well-being into the world. She is currently sitting on INELDA’s LGBTQIA2S+ Advisory Council.