As we age and as we witness others age, our thoughts inevitably move into the uncomfortable territory of death and dying. We rarely think of dying as a birth process, but, just as we need a doctor or a midwife to usher in a living soul, perhaps there is a need for someone to serve as a midwife to aid those who are leaving this life. Such midwifery would go beyond managing physical symptoms, or those handled by doctors, to managing spiritual and metaphysical concerns. Even if a person or members of his or her family do not believe in a life after this one, deathbed midwifery can help ensure that a person leaves this life in dignity, love, and with peace of mind.
When we come into this world most births come about through a process of preparation and sharing. Why should the humanly significant event of leaving this world not be the same?
Midwives to death?
Amy Wright Glenn, a doula and hospice chaplain, says, “Standing with an open heart in the presence of birth is very much like standing with an open heart in the presence of death.” Both are revolutionary biological events that affect multiple lives.
Perhaps to a baby, the birth process seems like death. The warm and comforting water home is suddenly draining. The embracing walls of the womb are in upheaval. Going down the birth canal may be like going down one of those huge, slippery, twisting and turning water slides-will one make a safe landing or is this the end? To be caught in loving hands must be a great relief.
Dying is, of course, an end to life as we have known it too, and as such, people no doubt also appreciate helping hands. Glenn notes that in birth and death, “We seek out the hands of loved ones. Whether a mother holds these hands as she bears down to push a beloved child into our world, or whether an elderly woman holds the hands of her children as she breathes her last breath — we reach for each other. We do.” In fact, she says, the skills set needed to bring someone into this world is not dissimilar to the skills set needed to ease someone’s way out of it.
Embracing the end and to the end
Some feel that death is the natural and inevitable end of all life, from the stunningly beautiful rose shedding its petals to the plants in the garden turning into withered stalks come winter. The earth is, in some senses, one big graveyard of once living beings. Yet out of all that decay comes food, new life, vitality, and energy. As was so eloquently expressed in the Disney film The Lion King, death is part of the circle of life.
Hospice embraces the idea that death is a natural process-not one to be avoided with last ditch, desperate, and ultimately fruitless medical interventions. After all, death always wins. Rather, the last days of a person’s life are thought to be best spent peacefully letting nature takes its course and concentrating on what is most important.
What is most important to many people at death? Elisabeth Kubler-Ross, author of On Death and Dying, noted that on their deathbeds, most people worry about “unfinished business”. Unfinished business usually has to do with relationships with loved ones. Some long for reconciliation and peaceful closure in strained or broken relationships. Some want to be forgiven or to forgive. Others need to know that their loved ones will be all right without them, that they have done enough for those who matter to them. They want their loved ones to know how much they loved them-and they want to die knowing they are loved too.
Therefore, it is important to have someone present who understands how important relationships are during this passage. That someone can be a sensitive relative or a trained member of the clergy or a hospice worker.
Perhaps someday there will be trained death doulas. At the current time there is no such designation; hospital chaplains are the nearest thing. However, just as birth doulas may call themselves such without any certification, so might death doulas, especially those who serve in such a capacity informally, as do loving relatives and friends.
DONA International, the main doula organization in the world, provides certification for birth doulas. DONA has high expectations of their certification recipients, including attending DONA approved birth doula workshops of sixteen hours or more, substantial required reading, childbirth class observation, online courses, and service at three births as a doula, earning high marks from the attending physician and the mother of the child.
Certainly a death doula would need at least as much certification as a birth doula. Yet, as Glenn says, the real requirements for such a trusted position are love and gentleness.
Those last precious moments
Midwifing a person’s passage may include being aware of the phenomenon of “terminal lucidity.” Doctors, nurses, hospice workers, and other medical personnel are aware of such moments, when a patient whose brain is compromised by dementia, Alzheimer’s, or other degeneration, suddenly seems to “wake” up and speak to their loved ones with complete clarity, understanding, and awareness. This usually occurs very close to death.
Those who have witnessed such an event can testify to its transcendent quality, and Professor Alexander Batthyany of University of Vienna likened it to a miracle. There is no scientific explanation for what happens when a loved one, who perhaps did not recognize family members and was incapable of understanding or forming words, suddenly rises up, knows everyone in the room, and imparts singularly appropriate and touching words of love and wisdom. Although terminal lucidity does not occur in all cases, it occurs in enough to have gained the attention of scientists.
Stafford Betty, professor of religious studies at California State University, notes that doctors register no change whatsoever in the brain during these lucid moments, leading some to say that terminal lucidity is not a last hurrah of the fading brain-rather, it is the mind taking over as it separates itself from the physical brain. As the mind or internal self separates from the limitations of the diseased brain, the person is lucid again-as clear as they perhaps have been all along, just unable to express themselves through the misfiring circuits of the physical brain.
In these precious moments of clarity, loved ones can say a most meaningful goodbye. Yet even if the moments of lucidity do not come, it may still be true that the departing loved one understands much, deep in the mind rather than the brain. If loved ones or others can serve as midwives to the dying, imparting to the departing that he or she is loved and that his or her love has been received and appreciated, there can be little doubt that the person’s passage can be made more peaceful, beautiful, and satisfying to all.
Betty, Stafford.When Alzheimer’s Victims Suddenly ‘Perk Up’ Just Before Death — What’s Going On? Huffpost Healthy Living, The Huffington Post, August 31, 2015. Available online at http://www.huffingtonpost.com/stafford-betty/the-miracle-of-terminal-l_b_5863492.html.
DONA International, http://www.dona.org/.
Glenn, Amy Wright. Doula for the Dying. Philly Voice. April 14, 2015. Available online at http://www.phillyvoice.com/doula-dying-connecting-birth-and-death/