Doulas: Supporting the Bookends of Life
Did you know that doulas originally helped women through childbirth in ancient Greece? Back then, they were servants offering support. Fast forward to the 1960s, and the role reemerged, but this time with trained professionals giving emotional, physical, and informational help. The heart of doula work has always been about being "of service."
Doulas build meaningful relationships with the families they serve, learning about their goals, fears, and wishes. During labor, a birth doula remains by the side of the expectant mother, offering constant support. They might hold her hand, grab water, suggest different positions, or offer words of encouragement. The doula stays calm and steady through the ups and downs, fully believing in the woman and the natural process of birth.
More recently, doulas have extended their care to people who are at the end of their lives. Strangely enough, there are many similarities between birth and death. Both can be unpredictable, with a unique unfolding of events. Time seems to stretch and bend, and the usual distractions of everyday life fade away. Doulas listen deeply, staying present, and knowing they can’t assume anything. People facing death often go through a mix of emotions and spiritual or physical struggles. The doula remains grounded, offering comfort as dynamics shift around them.
Birth and death are both powerful transitions—what we call “liminal spaces”—where people stand at the threshold of something unknown. Doulas respect these moments as rites of passage. During birth, women might return home, shifting their focus to their new journey into motherhood. At the end of life, people often sleep more, become less communicative, and seem to exist in a realm separate from the rest of us. In both cases, there’s a unique sense of presence as their awareness moves between different states.
Eventually, both processes reach a transition phase. For laboring women, this is when they start pushing, feeling a shift in their bodies as they near the final stages of giving birth. For someone who is dying, this is the "active dying" phase. It’s a time of deep rest, and for some, it may feel peaceful, while for others, it might involve discomfort or agitation. Family members and caregivers step in to do their best, trying to make the person as comfortable as possible while grappling with their own emotions.
Birth and death often arrive suddenly, but the impact is monumental. The birth of a new life changes a woman into a mother, while the end of life brings a finality that leaves us with more questions than answers. While birth gives us something new, death leaves us reflecting on what we’ve lost.
So, how do doulas fit into these moments?
Their primary role is to offer emotional support. Whether it’s with a reassuring word, a comforting touch, or just a calm presence, doulas focus on the well-being of the people they serve. They believe in the strength of their clients, honoring both life and the mystery of death. They listen closely and provide personalized care that empowers their clients.
Doulas do many things: they discover a client’s wishes, help them work through anxieties, hold space for reflection, and even assist with life reviews and legacy projects. They guide clients and their families through the process, offering referrals when needed and helping with things like vigil planning.
Doulas also support the client’s family, knowing that by helping with logistical tasks or emotional needs, they create space for the dying person to focus on what matters most. Every family experiences grief differently, and doulas meet them wherever they are, whether they’re feeling disbelief, anger, sadness, or acceptance.
Just like a birth doula helps families prepare for the postpartum period; an end-of-life doula helps families think about what comes after death. They help answer questions like: What are your expectations? What will help you feel most supported? How can we arrange things in a way that respects your wishes?
These conversations require sensitivity, and doulas know when to bring them up or when to wait until the family is ready. By helping families plan, doulas can reduce surprises, making the process less overwhelming.
This kind of planning is at the heart of doula work. It’s how doulas ensure that support is personalized, and that each client’s dignity is honored. They help families prepare for loss and manage things like schedules, energy levels, and the priorities of their loved ones.
Doulas work alongside other care team members, too. If a social worker is already helping with funeral plans or a chaplain is offering spiritual support, doulas don’t duplicate their efforts. They provide complementary care, honoring the roles of everyone involved in the process.
But why does doula care work so well? Studies show that birth doulas have positive effects on labor outcomes, reducing the need for interventions like C-sections. Researchers believe that having continuous support from a doula builds a mother’s confidence in her ability to navigate pregnancy and childbirth. The same principles apply to end-of-life care—doula support fosters a sense of connection and can even lower healthcare costs by helping people make informed choices.
As the field grows, doulas continue to educate others about their role and work alongside care providers. They aren’t there to take over or make medical decisions, but to offer gentle, supportive care. With time, more people are seeing the value doulas bring to the end-of-life experience, adding harmony and respect to the care teams they join.