Death Doulas Used to Be Rare. The COVID-19 Pandemic Changed That

Excerpts from September Dawn Bottoms for TIME, JANUARY 26, 2022 6:00 AM EST

Since COVID-19 emerged in early 2020, organizations that support and train U.S. death doulas have seen significant spikes in membership and enrollment. The National End-of-Life Doula Alliance grew to more than 1,000 members in 2021, from just 200 in 2019.

The ‘wake-up call’

That’s no surprise as the U.S. death toll from COVID-19 surpasses 866,000. In the past 22 months, the awareness of death was in all of our faces. Whether we wanted to look away or not, we really couldn’t. That’s what has forced many Americans to reckon with their own mortality in new ways.

What it takes to be a death doula

Besides a whole lot of compassion, not much is required to become a death doula. During a recent day’s work with a woman who had stopped treatments for breast cancer, Yost helped her jot down stories to share with her children about her childhood visits to her family in Italy. When she noticed how animated the woman had become, Yost pulled up Google maps so they could virtually walk through the same mountain village where her grandparents lived. The woman cried as the memories came flooding back.

“The gift of time is what makes doula work so special and meaningful,” says Angela Shook, president of the National End-of-Life Doula Alliance. Since doulas do not administer or prescribe medication, the industry is unregulated and does not require a license. Most prospective doulas take training courses or have served in the hospice industry.

Death doulas often work in tandem with hospice workers, who are authorized to give pain-relief medication, treat wounds, monitor vitals and assist in other clinical tasks that the doulas aren’t qualified to do. But death doulas, who are usually less restricted by work schedules, step in to fill the emotional voids, something the hospice workers don’t have enough time for.

They can help write farewell letters or stockpile memos to surviving loved ones for milestones they’ll miss, such as weddings, birthdays and graduations. They can listen to someone’s life story for hours on end or hear out their proudest moments and worst mistakes. Upon request, death doulas can make sure Whitney Houston is playing in the background, fill the house with scents of Christmas cookies at the moment of death or find new homes for pets that will be left behind. They help a woman find a loving new family for her two cats, which was instrumental to giving her peace. Before the woman entered a hospital for the last time, Shook brought her stuffed animals that looked just like the felines, so that she’d have them near as she died.

"It's very human to want to nurture and support somebody through any type of suffering."

To free up family members to focus solely on their dying loved one, death doulas can help make funeral arrangements and handle other logistics. They can assist the primary caregiver by creating care checklists and meal schedules, crafting responses to people who call and text, and limiting making only one important decision a day.

The impact, and not the pay, is why many are drawn to the work. Some doulas offer their services on a sliding scale based on the client’s ability to pay. Others, including those who have their own private business, typically can charge $45 to $100 per hour, though prices depend on many factors, including location and duration of service. Many doulas offer packaged rates that go from $500 on upwards. These costs are not covered by any health-insurance plans.

A misunderstood job

The job is often misunderstood, partially because many feel it’s a morbid occupation. But death doulas disagree, saying there’s often more dignity in the work than sadness. Dying is one experience every person has to go through. But that doesn’t necessarily get easier to accept with time. “Fear is present at all ages”. And because there’s only one chance to do death right, several doulas say it’s common for personal grief and regrets to drive many toward end-of-life work.

"I can't stop people from dying. All I can do is be there to support them."

The history of how we die Death wasn’t always so industrialized. More than a century ago, before there were coroners and funeral directors, it was normal for families and communities to take care of the deceased, according to Nukhet Varlik, a Rutgers University professor who specializes in the history of pandemics.

Hospice care wasn’t introduced in the U.S. until the early 1970s, though people were still informally taking on the role of a death doula. Death used to be revered as a sacred part of life’s journey, and we’ve completely removed it from our awareness. In fact, we’re doing everything to run the other way.

Death doulas today are trying to change that. In January 2021, when a dying man in frigid northern Michigan said he wanted to be back on a beach but was too sick to leave his house, the doula dipped his hand in a bowl she’d filled with sand, then lit citrus-scented candles around him and brought in a sunlamp to warm his body as the sound of ocean waves crashed out of speakers in the background.

A doula realized when a dying woman who loved lilacs would not live long enough to watch them bloom again in her yard, she burned lilac candles in the woman’s room, hung large photos of the purple plants on her walls and massaged her hands and feet with lilac-scented oils.

“Death isn’t medical event, it’s a Human one.”

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