I take a moment, close my eyes, inhale deeply with an audible sigh to center myself before I pick up the phone.  My senses are heightened and palms are sweaty as the phone rings when someone on the other end picks up and says, “Hello.” “Hi my name is Rebekah, I’m calling to see if you are open to a visit to offer supportive presence to you and your loved one?” A silent pause is followed by a timid and soft, “Yes.”

As I ride in the car to the location, my heart fills with gratitude as I whisper a reminder to myself it’s an honor and sacred gift to be invited into an intimate space when someone is actively transitioning. My awareness intensifies and I acknowledge this will be the first time meeting these humans. I am accompanied by my doula comfort kit: a red suitcase filled with sound instruments, essential oils, wireless speaker, tea lights, crystals, Barbara Karnes’s Gone From My Sight: The Dying Experience booklet, mouth swabs, and other various items that may come in handy during my visit.

Before knocking on the door, I take a moment to straighten my posture to tell myself to keep a strong back, open heart, and be fully present as I pass the threshold and step into the unknown. Each time I walk into a new environment it is different, so I lean in with presence, curiosity, unconditional love, and an intention to be of service not knowing what will unfold. My goal is to provide support during a difficult and sacred time.

A few examples of magical, meaningful moments that occurred when meeting people for the first time:

• Sitting down with family to gently explain the dying process and answer questions
• Playing my Peruvian shaker while singing along with La Cucaracha playing on my iPhone while the family danced around their loved one
• Called in to provide a calming and compassionate presence to a loved one dying in the hospital ICU
• Provided a calm, grounded presence and allowed space for uncertainties and fears to be shared and expressed, and allowed people to feel seen, heard and supported as they navigated the profound experience of dying. I’ve worked with people from many backgrounds, including veterans, holocaust survivors, and young adults facing terminal illness
• Listened to stories about loved ones and offered sound instruments for a great grandson to play for his great grandfather as I intuitively sang and the family took videos
• After a loved one transitioned I performed a ritual of having each person take petals from a rose, quietly sharing something about the person they were thankful for, and in turn helping them with the grieving process

How often are you navigating challenging scenarios where you have to be comfortable in the uncomfortable?  How many times in a week are you intensively strategizing ways to have difficult conversations and provide support to help with transitions? Do you ever wish you had more time to collect information or hear more stories from the clients and patients you work with? Do you ever wonder if there are resources that you could collaborate with to bridge gaps in facilitating the complicated topics and discussions around end of life?

Have you ever heard of an End of Life Doula? The word doula is Greek in origin and means “one who serves.”

Core Components of the Doula Model of Care: 6 Guiding Principles

• Non-medical support. Doulas refrain from performing any clinical or medicalized tasks.
• Non-judgmental support. The doula does not impose her/his values on the client such as acting on biases.
• Family-centered approach. The individual and their family form the unit of care. Doulas do not take the place of partners, family members or other care providers.
• Holistic care. Doulas recognize the biopsychosocial and spiritual aspects of the whole person and provide services in the context of this understanding.
• Doulas promote informed decision-making and foster maximum self-determination for the individual and family.
• Team members. Doulas are team players within the end-of-life care ecosystem.

Reference https://nedalliance.org/for-doulas/model-of-care/

A Brief Timeline of the Death Doula Movement

Pre-1900s — Community Care
Death is a home-based event. Family, midwives, and religious leaders provide emotional, spiritual, and practical support.

1900s–1950s — Medicalization of Dying
End-of-life care shifts from home to hospital. Traditional death care roles decline as medicine and funeral industries expand.

1967 — Birth of Modern Hospice
Dame Cicely Saunders founded St. Christopher’s Hospice in London, promoting comfort-focused, person-centered care. 1974 was the first hospice in the United States.

1980s — Home Death Revival Natural death care advocates reintroduce home funerals and community-based support, inspiring today’s doula model.

1990s — “Death Midwife” Emerges
 Early practitioners begin offering holistic, non-medical end-of-life companionship and education.

Early 2000s — The Doula Concept Expands
 Borrowing from birth doulas, caregivers adopt the term “death doula” or “end-of-life doula.” Small training circles form.

2010s — Formalization & Growth
Organizations like NEDA (National End of Life Doula Alliance) and INELDA (International End of Life Doula Association) develop structured programs, ethics, and certifications. Media attention rises.

2016–2020 — Death-Positive Movement
Cultural openness toward discussing death fuels demand for personalized end-of-life support.

2020–2021 — Pandemic Spotlight
COVID-19 highlights emotional and spiritual gaps in medical end-of-life care; doula services expand, including virtual support.

2024–Present — Mainstreaming the Role
Hospices and hospitals increasingly collaborate with death doulas. Professionalization and public awareness continue to grow.

End of Life Doula Education

There is currently no standardized regulation in the end of life doula industry, although that may change in the future. When you complete a course you receive a certificate of completion. There are lots of various trainings and programs out there and there’s a growing global awareness of the value of an end of life doula.  There are a multitude of programs currently being offered both in  person, as well as online.

It’s important to recognize that every birth and every death are different and similarly every doulas is unique.  There is no “one-size-fits-all doula”. Each one will have their own personal gifts and offerings. The biggest trait they share is having a heart to educate and serve others.

Pricing varies and if you are looking for a doula in your area most doula training programs have a directory featured on their websites. Many you can search by state or regions. It gives individuals the ability to reach out to one that may fit the specific needs they are seeking. A few examples of doula directories are listed below.

• https://nedalliance.org/directories/find-a-doula/
• https://inelda.org/find-a-doula/
• https://goingwithgrace.com/death-doula-directory/

Personal Story

December 23, 2023, Instagram post

My Italian Grandmother, Maria Hespen, is a classic divine elder. I cherish each moment my beloved Finn Family gets to hang out and get down to her level and meet her where she is. Each time I visit I wonder if this will be the last time I get to hear her laugh or witty Italian accent, wise cracks, or listen to another story about her life. I will enjoy the interaction whether it’s a good, bad, or another confusing story as all of them are sacred. I‘ve inherited so many traits from her that the anticipatory grief has been feeling heavy on my heart this trip.  I’m open and this visit brought tears to my eyes knowing in my gut the end is drawing closer. Working in hospice and trying to help my own family with advice and knowledge hasn’t been an easy task. I want to honor her transition with grace, humility, respect and so much unconditional love but also to advocate for all her wishes. My greatest dream is that I can be present and help assist her to get the best support during her final days so she can be comfortable, without pain and stay in her home for the remaining duration of her physical life on this earth. It would be the most sacred opportunity and I hope she lets me be a part of it.

Fastforward to July 17th, 2025

My cell started ringing; it was my cousin Niaomi, and I instantly felt a knot in my stomach. My heart skipped a beat and I immediately answered on the second ring. My intuition kicked in and I know something wasgoing on with our 95-year-old matriarch Grandmother, Maria. “Hey Ni,” I said nervously.

“Hey Beck, I wanted to reach out because I think it’s time we take action, knowing you work in hospice and have been trying to provide education and resources for two years with no receptivity. I feel it’s time for you to step in and intervene,” she exclaimed with assertiveness.

“Oh,” I said, “please tell me more.”

My heart was openly receptive and I’dbeen anticipating the day this call would come. She further explained, “Grams has declined significantly and I feel it’s time to get her the comfort measures that hospice provides.” I shared my appreciation and thankfulness for her reaching out and advocating for Grams’ best interest.

I promptly dial my Gram’s landline where my aunt picked up the rotatory phone with a gentle, “Hello.”

“Hey Auntie Dori, how are you and Grams doing?” I could hear an audible sigh of relief and concern in her voice reaffirming some of the information my cousin Ni shared. As my aunt was speaking I could hear a soft moaning in the background. My end of life doula hospice hat was immediately ignited as my biggest fear was beginning to unfold. I took a moment to pause wide eyed and mouth open to acknowledge silently to myself, oh my goodness, it’s worse than I thought, as it sounded like she was actively transitioning.

I knew I needed to keep this to myself as I didn’t want to enhance the panic and stress I heard coming from my aunt’s voice as we continued the conversation. It took effort to maintain a confident, calm, cool and collected tone to reassure my aunt I would look at flights from San Diego and be there as soon as I could. In the interim I wanted to urgently address both of our concerns that Gram didn’t look or sound comfortable. I asked her if she was open with me sharing a “painad” pain assessment scale which is a tool we use for patients who cannot verbally communicate their pain. My Aunt promptly agreed and I walked her through the chart step by step to get her input to have her give a score to each section that included breathing, negative vocalization, facial expression, body language, and consolability. I further let her know this was a tool that caregivers and non medical people could use to paint a picture of the patient’s level of comfort.  Upon completion we calculated Gram’s pain was between 4 and 5 on a scale of 10.  I mentioned if she was on our hospice we would advise to give some pain medication to help get her comfortable. My aunt said Gram has a prescription for Tylenol with codeine, so she smashed them and mixed it with pudding to give her some relief.

By the following morning, I had booked a flight, packed my bag and was on speaker phone to listen to Gram’s compassionate doctor sharing that she had lost 12 pounds in the last 3 months and her kidneys were shutting down. She also discussed many conversations she had with Grams when she was healthy and she never expressed interest in pursuing any aggressive treatments, as she only chose comfort measures. The doctor further expressed how different Maria looked since the last time she physically saw her and it might be a good idea to look into short term caregiving and she may only have a week left.

The doctor told us she had a really good relationship with the local hospice that kept her updated on all of her patients. Working in hospice, I knew what the underlying compassionate words meant. The reality might look closer to a few days and I understood the doctor using an empathetic tone that she had lots of experience having these types of difficult conversations and knew how to navigate with sensitive language and unconditional love.

As I boarded my flight I knew the education and experience I’d gained in the last 3 years was going to come in handy. I pondered whether my role as an End of Life Doula and having a deep close relationship as the youngest granddaughter could coexist or if I would I lose it emotionally and fall apart. I planned to put all my skills into practice as I meditated, recited silent affirmations, prayers, and asked for guidance from all my ancestors and all of those who came before during my flight. I hoped they could give me strength, resilience, courage—mentally, physically, and spiritually—for what was in store.

Over the following 72 hours my aunt was receptive to me taking the lead, and adrenaline kicked in as the two of us supported each other, bonded and strengthened our relationship through many heart to heart conversations, laughing, crying, and encouraging each other the whole way through.

I brought in hospice, ensuring she was comfortable. My mom, cousin Jon, his fiance Brittney and I were given the sacred gift to be present as she transitioned and became our ancestor right before our eyes. She took her last breath while I was singing and playing an intuitive song to her on my harmonium. I paused suddenly because I saw her breathing slowing down and wanted to start counting the breaths, instantly realizing she sighed a soft final exhale on 7/21/25 at 7:07pm. I gazed at my watch to take note and magically that was the last one. My mom captured the experience on video. I was able to be a bridge of calm and be the anchor for my family to give them firsthand experience of what my new career has done for bringing comfort during a difficult time. It was the best validation that I am truly living my soul’s purpose as an End of Life Doula. This personal experience will enhance my effectiveness as an End of Life Doula to all future end of life journeys I participate in.

It was the first experience close to home in my immediate family and I’m so glad I could bring my skill set to ensure Grams had every benefit available, including getting her on hospice to ensure comfort, dignity, and respect as she left this earthly plane. I gave her a home funeral, dressed her, washed her, picked out her casket outfit. My heart is forever grateful she let me care and advocate for her. Her legacy will continue to live through me until I take my last breath. Thank you for teaching me how to die with divine grace. I love you.

It’s never too early to get educated and learn about your preferences and options for end of life. Our society plans for everything and most people prefer autonomy to make their own decisions on everything in life. I also know thinking and contemplating about what brings comfort now could also bring comfort at the end of life. I wonder if collaborating with end of life doulas could help provide more time and be an additional resource when navigating difficult conversations. Building relationships with end of life doulas in your area could give more options to help case managers manage the complex and dynamic caseloads. Do you have a strategy that helps start difficult conversations? Sometimes taking a long, slow, deep breath can be a small and necessary step to center and step into the unknown of any given day.

References

Figure 3: National End-of-Life Doula Alliance End-of-Life Doulas: Bridging the Gaps, http://www.nedalliance.org/scope-of-practice.html, accessed June 15, 2018

References for the Timeline -Historical Roots & Hospice Movement (collected from Chat gpt)

Saunders, C. (2001). The evolution of palliative care. Patient Education and Counseling, 41(1), 7–13.

Clark, D. (2013). Cicely Saunders: A life and legacy. Oxford University Press.

National Hospice and Palliative Care Organization. (2020). History of hospice care in the United States. NHPCO Press.

Home Death Care & Death Midwifery

Mitford, J. (1998). The American way of death revisited. Alfred A. Knopf.

Lyons, J. (2010). Final rights: Reclaiming the American way of death. Upper Access Press.

Rubin, S. (2019). Community-based end-of-life care: The rise of home funerals and death midwives. Journal of Medical Humanities, 40(2), 247–260.

Death Doula Movement

INELDA. (2018). End-of-life doula training manual (2nd ed.). International End of Life Doula Association.

Rawlings, D., & Tieman, J. (2015). End-of-life doula services: An emerging model of care. Progress in Palliative Care, 23(3), 159–165.

Samuel, A. (2020). The role of the death doula: Supporting the dying and their families. Omega: Journal of Death and Dying, 82(4), 597–615.

Death-Positive & Cultural Shifts

Doughty, C. (2014). Smoke gets in your eyes & other lessons from the crematory. W. W. Norton.

Smith, R. (2018). The death-positive movement: Challenging Western death taboos. Social Science & Medicine, 214, 22–29.

Rebekah Bio

Rebekah Finn has a B.A. in Psychology from San Diego State University, is a graduate of Alua Arthur’s “Going with Grace” End of Life Death Doula training course, and received her Proficiency Badge with the National End of Life Doula Alliance (NEDA). Additionally, she is currently the Bereavement and Volunteer Coordinator at Topkare Hospice, is part of their “Threshold Care Team” that helps create plans of care for the last 7 to 10 days of patients’ lives, leads free community events that include acupuncture, grief gatherings, and sound healings, and has been a certified yoga instructor with over 25 years of practice.

Image credit: ISTOCK.COM/TATIANA_KUZMINA