— Death doulas—a growing profession nationwide—are changing the way we approach end-of-life care.
By Uvie Bikomo
When individuals near the end of their lives, they often face a profound journey filled with uncertainty, fear, isolation, and questions. Amid this complex weave of emotion, a compassionate and increasingly prevalent presence has emerged: the death doula. In Houston, a growing number of these people are quietly changing the way we approach the end of life.
Death doulas provide physical, emotional, and spiritual support to those in their final moments, usually people with terminal illnesses and older individuals. Sometimes referred to as “end-of-life doulas,” “death coaches,” or “dying guides,” they are like guardian angels for the dying, navigating the delicate threshold between life and death, offering solace and guidance as they usher both the patient and their families through this passage. They do everything from helping plan funerals to getting the individual to come to terms with death and consoling their family through the grieving phase.
Ebony Leary, a former hospice nurse in Nebraska, entered into the profession after the death of one of her patients, who had Huntington’s disease, had a profound impact on her life, prompting her to move to Houston in 2018.
“He was my age,” Leary says. “We grew up in the same neighborhood and had similar music tastes. We just connected on a deep level. He became my friend, and his family did too. I knew when he died I was going to need a break.”
While Leary knew she did not want to work in hospice anymore, she wanted to remain in the end-of-life care space because of her connections with her patients. Through her research, Leary stumbled upon a video by Alua Arthur, the most prominent death doula in the nation, which shed more light on the work and Arthur’s calling to it. Leary found her new path. She started her consulting business, My Sunset Doula.
Death doulas have grown slowly over the past couple of decades, and more recently as a result of the COVID-19 pandemic, according to the Cleveland Clinic, but there isn’t as much regulation as other end-of-life medical care. Leary got her training from Arthur’s Going with Grace program, while others look to organizations like the National End-of-Life Doula Alliance (NEDA) or the International End-of-Life Doula Association (INELDA).
Lindsay Maxfield transitioned from a career as a health care analyst and a circus aerial performer. She found her calling to death doula work like Leary. After getting her certification from NEDA, Maxfield opened her practice, Sacred Solstice Collective, in Houston where she offers a variety of services to her clients and their families.
“I like to consider myself a radical self-care advocate,” Maxfield says. “I really like to make sure that comfort care is provided for those that are actively dying as well as their family members. So, that can look like cooking home meals, doing a little bit of laundry, helping them get organized, making sure their paperwork is done and ready.”
Maxfield also works with her clients to find ways to memorialize their lives before they pass on. She views these “legacy projects” as pieces that show the dying’s life journey and passions. It is also an opportunity to give them an extended life after they have gone.
“A lot of times, when we get kind of towards the end, we think that life was meaningless or we just sort of forget all of the little things that happened along the way,” Maxfield says. “Some people will journal or have their death doula help journal for them. Some people create video projects, some people will just get a photo album together. Some people have amazing histories and we can donate some of their work to archives, museums, art galleries, and all sorts of things. Just to kind of show what amazing things they were able to accomplish while they’re here.”
According to the Centers for Disease Control and Prevention, at least a quarter of deaths in the country occur in hospice facilities or nursing homes. People in these facilities often have a doula as a supplemental aide. Maxfield explains that it is crucial people understand that even though this work is nonmedical, it is there to bridge the gap between the patient, hospice, and the family. She says the job of the doula is to “sit aside and listen and know their advanced directives,” such as instructions on their medical care in any situation where they cannot enforce their desires themselves.
Beyond the technical aspects, the most important part of the job is just being with the patient. Passing on is often a lonely requirement of life and doulas are there to provide that companionship that is so often needed.
When it comes to helping the dying accept this new phase of life, some doulas also work with the spirituality of their clients. Demitra Green, owner of Liberating Transitions, a Houston death doula practice, offers this as a part of her work. She believes it is a good holistic healing option and a great way to help the patient talk through what they believe might happen after they die.
“I do healing touch and if they are open to me assisting them energetically removing any blockages or things like that, I can help with that,” Green says. “It’s basically helping them to talk about their spirituality or their religion and helping them to navigate through it. It’s mostly talking while you assist them in asking, ‘How do you feel about that? What do you think is gonna happen? How do you think it’s gonna happen? Are you okay with that?’”
Green, like many others in her profession, also makes the dying process less painful for the families by having pre-death sessions with the members, helping with funeral planning, and sticking by after the patient is deceased to make sure the kin is managing the grief well.
These women view death as a natural part of the life cycle that is often masked as a taboo, leaving those facing the end of their lives as unwanted and uncared-for parts of our society. Their profession helps more people talk about this organic occurrence by bringing those facing it to the forefront.
As the work of death doulas continues to gain recognition and acceptance, it represents a vital shift in our approach to dying. “I think that people have the right to choose how they want to transition,” Green says. “This is something that we all have to do.”
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