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What is Death Midwifery?

Author: Cassandra Yonder
18 October 2012

In conversation with a fellow home funeral guide the other day we came to notice that we were using the terms ‘death midwife’ and ‘home funeral guide’ interchangeably even though neither of us believe that they are the same thing.

In the UK a death midwife works with people who are actively dying like a hospice volunteer might serve here in Canada. There are others who offer support for end of life and afterwards who call themselves thanadoulas, death doulas, end of life coaches, spiritual midwives etc since the terminology is in a state of flux. When Paul Hensby asked me to write a guest blog for Final Fling I figured it might be a good opportunity to offer my own interpretation of what death midwifery is at this point in time when the entire field of death and dying is coming increasingly into awareness.

For me, death midwifery is more of a concept than a job description. It’s more like a philosophy that speaks to a way of practicing as opposed to the delineation of a practice itself. To my way of thinking, one wouldn't say that a death midwife plays any specific role in community, except to say that the role she does play is one that exemplifies a conscious awareness of the naturalness of death and dying. A death midwife accepts death, dying and grief as normal and healthy parts of life, and so models a willingness to bring presence to those areas that our deeply death denying culture would otherwise have us avoid.

Death midwifery recognizes the entirety of the pan death experience from individual, family, community and wider social contexts (and considers it from primarily a psychosocial spiritual perspective). Conscious awareness of death doesn't necessarily begin with a terminal diagnosis. It is a more deeply entrenched cultural attitude concerning how we chose to live given the conditions of our own mortality. Theorists point out that we have become increasingly alienated from death and dying. Death midwifery accepts such alienation as the condition we presently find ourselves in and uses that as a starting point for an exploration into what it means to die.

When I call myself a death midwife it has a tendency to rub many people the wrong way. In drawing the connection with birth midwifery, folks expect death midwives to be proficient in a specific set of standardized skills that may be employed to oversee, support or direct a physical or medical process we call dying. Of course some people working in the field of death midwifery (such as a hospice nurse) might do just that. Other death midwives (such as shamans or psychopomps) might work with folks at end of life as well but on a more purely spiritual level. Still other death midwives might not typically be involved with end of life at all, instead supporting families after death has taken place (such as home funeral guides or celebrants). What they all have in common (and what, in my opinion, makes them more than simply a hospice nurse or a home funeral guide) is a willingness to accept the universality, irreversibility, non functionality and causality as well as the non corporeal continuation of dying. In thanatological terms, they model a mature understanding of death as described by Mark Speece. Just like the understanding that birth midwives bring to the field of obstetrics, death midwives understand that dying doesn't necessitate palliative intervention. Birth and death are going to take place regardless of (rather than because of) the professional services that are offered to assist with the process. Midwives support a process that takes place primarily within a context that is best described by the dying individual and their family and community. In other words, I believe that the practice of either type of midwifery places individuals and families at the centre of their own experience.

In addition to the uncomfortableness around the use of the word midwifery, the other part of the title can be even more daunting; the word death. Death midwifery carries connotations of mysticism verging on the occult, and here we come face to face with the very taboo which makes the practice of death midwifery itself so essential: the denial of death. Just to say the word is considered radical, so we prefer to comfort ourselves with euphemisms. This can be a very real and practical roadblock; my business card says "death midwife" so who do I expect to call me? When? And to do what? I can tell you who doesn't call: dying people and their families. Calling a death midwife at the end of life must feel like giving up hope. In a sense the title estranges us from the very people we wish to support because we pro port to accept something that the individual and family most often do not want to happen, even though accepting death doesn't necessarily mean wanting or even being ready for it to happen to oneself or loved ones. People who do call are those whose personal denial of death is still almost entirely intact, those whose morbid interests feel enlightening because they have not yet entered the awareness of their own dying. The more I do this work the closer I come to understanding it as an expression of my own attempt to keep death under control and at bay even as I feel the life affirmation of walking ever more closely with my own dying. Denial of death is an important and valuable attitude; one that death midwifery at its best seeks to engage and honour rather than eliminate.

So death midwifery is very broad indeed. I think of it like an umbrella under which many services, practices, beliefs and ideas might be placed in order to view them as an interconnected whole rather than in a fractured and compartmentalized way. Some organizations recognize death midwives as practitioners who offer a full range of services across the pan death spectrum, but I would say that a death midwife is anyone to practices relatively to the pan death spectrum (and with awareness of the broader context and the psychosocial spiritual dimensions that affect dying here and now). I might say that end of life doulas or home funeral guides are to death midwifery what palliative nurses are to hospice; that is, practitioners who realize that their offerings are just one piece of a puzzle, and that it is the individuals themselves (and as a member of their communities) who create their own dying by living it.

So when I call myself a home funeral guide or a grief counselor I'm referring to rather specific professional offerings and skillsets that are defined by tangible codes of ethics and regulatory bodies. When I call myself a death midwife I'm referring to something much more holistic and ambiguous; a willingness to witness death, dying, post death care and grief. A willingness to be non expert, nonspecific and noncapitalist and to answer to an ancient calling regarding a role that I am meant to play within my community.

Cassandra Yonder BA, MArch, CertG&B
Death Midwife; Education, Home Funerals, Bereavement Support
BEyond Yonder Death Midwifery


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