I recently received a rather curt email from a birth midwife asking all of us who support others at the end of life to stop using the terms Death Doula and Death Midwife. She wrote:


“Please stop using the word midwife and doula in the dying context. We wouldn’t call someone a death doctor why say death midwife? Although birthing and dying are similar it erodes a midwife’s education, responsibility and credibility. A death practitioner isn’t accountable in the same way.”


I was somewhat surprised that she felt threatened but also saddened to realize that we still have a long way to go before death midwifery is considered a credible, valuable and skilled profession. I responded as carefully as possible…

“Thank you for taking the time to express your feelings about our use of the word death midwife. Please allow me to explain the philosophy of Sacred Crossings which echos that of many of my death doula colleagues and may hopefully enhance your understanding.


We uphold that birth and death are primarily spiritual events.


During birth, the mother’s body opens to bring a new soul (also referred to as spirit or consciousness), into the 3rd dimension of physical reality. During death, a person’s body opens to release their soul back into the 4th dimension of spirit.

As this opening occurs, a portal to the divine, mysterious ‘other side’ is created. Some refer to it as the ‘lifting of the veil’ which usually begins a few days before birth or death and extends for two or three days after.

This sacred time of transition when the physical and spiritual worlds merge, is liminal. (Liminal: occupying a position at, or on both sides of, a boundary or threshold). The skilled midwife navigates both sides of the threshold, maintaining safety for the soul entering or leaving and also the mother at birth and the bereaved at death.

Most people who are present to either birth or death attest to the feelings of tenderness and vulnerability that often overcome them. Tears, prompted by the rush of love erupting from open hearts are expressed at both events – awe and joy at birth, awe and sorrow at death.

The term ‘midwife’ means ‘with woman’ and it is widely accepted in most cultures that women, due to their receptive nature and highly attuned sensitivity are naturally suited to guide and support those at the threshold. Today, there are many men who have enhanced this aspect of their own nature and are now also joining these professions.

The similarities of birth and death extend beyond the first breath and the last breath. After a baby is born it takes three days for the mother’s milk to let down. The birth midwife attends to the mother to ensure the milk is flowing and baby is safely latched on to its life source in order to thrive.

After someone dies, it takes up to three days for the life force to completely leave the physical form.


The death midwife supports the family in preparing and preserving the body at home for this wake or vigil to take place. Many people who experience a home funeral report feeling the presence of the loved one around the body for two or three days, but then it appears to leave, perhaps when the soul has latched on to its new form of sustenance.

Up until the last 60 years or so, midwives at birth had no formal education or training. Skills were learned from the elders in the community and experience and intuition were the only requirements. The midwives at the death bed were often the same women and intuition and experience were the only tools required.

It seems natural to me to use the term Midwife and Doula for both birth and death for all of the above reasons. The birth midwife must undergo extensive medical training in order to protect and safely guide the physical lives of mother and child through the transition of birth. The death midwife must undergo rigorous spiritual training in order to protect and safely guide the spiritual life of the journeyer and their family through the transition of death.

Today, Death Midwifery training includes practical knowledge of the dying process, tools for supporting the patient emotionally and mentally throughout the journey, after-death guidance and support and a deep understanding of the spiritual nature of death. We take our work very seriously. Whereas you are responsible for physical well-being, we are responsible for emotional and spiritual well-being – both are equally important and affect the future lives of all those at the birth and death bed.

Let us honor the skills and education of both roles. The tree surgeon does not erode the education of a brain surgeon – both require different skills and training, both are deserving of the title surgeon.

We are the midwives and the doulas. We walk beside our sisters and brothers to the gateway of time and space. A journey that can be treacherous and frightening. We bear witness. We remind our charges that they can do it, that they have what it takes. We offer support in our respective modalities, to help them feel safe, to relax and to open wider than they ever thought possible to give birth or receive death. We are the Midwives and the Doulas of birth and death.

Blog post and photography by Olivia Bareham.

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