Doula services are designed to be as unique as the individuals we serve. In general, there are three phases to doula work:

• summing up and planning
• conducting vigil
• reprocessing and early grief

In the first phase, doulas use deep active listening skills to help explore all aspects of a person’s life, uncover guiding values and reinforcing what is most important as you face death. During these conversations, a person’s legacy will often emerge from which a tangible object can be created that can inspire family and friends and help them reconnect to their loved one after they are gone.

The summing up phase also brings an opportunity to address the harder experiences in life by exploring any regrets, unfinished business, guilt or shame (RUGS) with an approach of curiosity and grace allowing transformation to take place.

Creating a vigil plan gives a person the opportunity to make choices about symptom management, how the vigil space will look, feel and sound, and invites loved ones into the experience in a way that best supports the dying person’s wishes. Approaching the vigil with intention creates a sacred space that can bring a sense of calm and peace that can ease a person’s transition and support loved ones throughout the dying process.

In the second phase, the doula will help conduct the vigil by follow the vigil plan as much as possible, helping loved ones understand the labor of dying, and hold space for all involved by providing a calming and peaceful presence in the vigil space.

In the third phase, doulas help reprocess the death experience. It gives loved ones an opportunity to retell the dying story from their perspective and for the doula to offer viewed experiences from a different perspective. It is a time to share grief, continue legacy work, and honor the beauty inherently present at the threshold of life.

Hospice is a wonderful model of care and is indispensable for people at end of life. The transition to hospice can be difficult for someone who has been working with the same healthcare team for any length of time. A person gets to know and trust the doctors and nurses that have been providing life-extending treatment. However, when it’s time to elect hospice, that team goes away and a whole new set of healthcare providers steps in with new medications, schedules and systems to navigate. It can be a very confusing and disorienting time. Doulas can step in to smooth the transition, help organize and set up new systems, and prepare caregivers as to what to expect throughout the dying process.

A common misconception about hospice is that there is always a healthcare provider physically present, which is not the case. Because it is a medical model, hospice is subject to regulations that limit how much time they can spend with each patient. Doulas can help fill the gaps and prepare the family to fulfill much of the caregiving that their loved one will require.

Doulas do not replace hospice. As the role becomes more understood, doulas can become an integral resource for the dying person and their families, as well as the hospice team.

At this time, doula services are private pay and are not covered by insurance. Many in the field prefer that private pay remain the model as doulas are then able to practice in a way that gives maximum flexibility respecting the individuality of each client they serve. Just as every life is unique, so is every death, and being able to honor both in a way that respects each individual is of utmost importance to the process.