EBB 417 - Similarities between Birth and Death Doula Work with Anne Kathryn Rice, Founder of the Global Doula Project

0:00Dr. Rebecca Dekker: Hi, everyone. On today's podcast, we're going to talk with Dula and Kathryn Rice about supporting families through both birth and death.

0:12Dr. Rebecca Dekker: Welcome to the Evidence-Based Birth Podcast. My name is Rebecca Dekker, and I'm a nurse with my PhD and the founder of Evidence-Based Birth. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com slash disclaimer for more details. Hi, everyone, and welcome to today's episode of the Evidence-Based Birth Podcast. Today, I'm excited to bring a really important topic to you about the similarities between birth work and also death doula work at the end of life.

0:52Dr. Rebecca Dekker: And today we have with us an honored guest, Anne-Katherine Rice. Anne Catherine is a Tennessee native, a graduate of the Harvard Graduate School of Education, a mother of three, and a birth and post-partum doula in Genoa, Italy. Anne Catherine founded the Global Doula Project in 2022, a nonprofit whose mission is to transform the way we experience birth and death by making doula support accessible and affordable to families around the world. Anne Catherine, welcome to the Evidence-Based Birth Podcast. Thank you so much for having me, Rebecca. And I just wanted to give a heads up to our listeners.

1:26Dr. Rebecca Dekker: You know, obviously we're going to be talking about some sensitive subjects today and the similarities and differences between birth and death and how doula work is supporting both ends of the life spectrum. We were looking at, you know, researching who could we have to come on the podcast to talk about this subject. And Anne Catherine, you were our first pick. So we're so excited you're here to talk with us. Yeah, thanks. I think maybe it is tricky to find people who are interested in both birth and death, but that is definitely neat. Yeah, I think for me personally, I experienced the death of my father earlier this year, and it was a really difficult death experience.

2:08Dr. Rebecca Dekker: It was a home death that was, I think, unfortunate in that a lot of it was terribly wrong. not that death can be wrong necessarily, but it was, there was so much suffering. It was so traumatic. And it made me think about the similarities between like a traumatic birth and a traumatic death and really wanted to, you know, merge those worlds. Cause I often kept thinking how different it would have been if my parents had a death doula and maybe like what that could have brought to the process. That's kind of like where I came from when wanting to cover this topic on the podcast. And Catherine, I know this is a big topic.

2:49Dr. Rebecca Dekker: It's pretty heavy, but it's also really important. And I wanted to know your origin story. Yeah. Well, I'd like to say first, the fact that you are mentioning death as this heavy topic, I think that it would be a beautiful thing if we could talk more about death and maybe it wouldn't seem so scary and heavy if we talked about it more because it is actually something that we all are going to do and it is it might sound funny but you actually can plan for it and loved ones can plan and you can have wishes for end of life like you can have a birth plan you can also have a death plan and it makes it makes takes a lot of guesswork out of for loved ones you know when navigating that.

3:39So I'm happy to be able to talk about death today and how important support is during death, both for the dying and for their loved ones. I'm so sorry to hear about your dad. And I also lost my dad. And that is what brought me to death doula work. Yeah.

4:00Dr. Rebecca Dekker: And I agree. When I worked as a staff nurse in the hospital, I took care of a lot of hospice patients. And I saw a lot of beautiful deaths that were, you know, just amazing experiences for me and the families I was supporting. And so that was, I think, one of the things that made this experience so eye-opening for me is like, even though we had what felt like a lot of support, it was such a difficult and long process that it burned us all out by the end, which I think is different than, like I said, most of the other deaths I'd seen up to that point had been beautiful, at least the ones in hospice care.

4:40Dr. Rebecca Dekker: So when I was at involved in this death that wasn't beautiful, it just made me think more about how doulas can support families in both ends of the spectrum of life. Yeah. Sometimes we'll just like with the beginning of life needs are different depending on the situation and the family. And so it sounds like in your situation, you maybe needed a lot more practical support. Right. Yeah. It reminded me of like a long, a long birth, you know, that goes on for an extremely long time and how you need more support in some of those situations. So, yeah. So I think that was just like, I didn't, I didn't want to start on such a negative foot because I do believe that, like you said, you can plan for death and it can be a peaceful experience for everyone involved.

5:36Dr. Rebecca Dekker: And that's what I'm like, hopefully we can talk with you about today and learn like, what are ways that doulas are making a difference in this field? Yeah. And there are a lot of them and they're making a big difference. So hopefully after this podcast, a lot of people will be Googling death doula near me and people will be inspired to become death doulas themselves. I was thrown into doula work. Well, not thrown in. I was called to become a doula after my experience with becoming a mother here in Italy. And I experienced firsthand, you know, what it felt like to not exactly be treated as a human, going through a human experience.

6:22It felt very much, it just felt cold. And like there were a lot of numbers involved and a lot of focus on the baby and the APGAR score and, you know, the centimeters and how many diapers and just things and not so much the transformation of me into this. I just had this transformative experience and people weren't really talking about it. So I didn't even know that that's what had happened. I just felt weird. And so I became a doula. And when my father passed away from complications with cancer, he passed away in the hospital. He passed away in the hospital where he was a doctor for 40 years. Wow.

7:08And well, you know it, St. Francis, because you grew up in Germantown. When my dad passed away and I was with him in those moments, I was astonished that I felt the same feelings that I feel when I'm at a birth. I agree. That feeling that let's stop and just process what has just happened because something huge has just happened. It's kind of mysterious. There's a lot of unknown here. We don't know who this baby is. We're getting to know the baby. We don't know where my dad went. He left, but where is he? You know, it's very, you just feel that something sacred has happened and we should be quiet for a minute and honor that.

7:59So it was a very similar. And when my father, before he passed away, he established a fund for charity and education. And I knew that I wanted to do something to help people have a good experience in birth and death, that we should have more doulas in the world. We should focus on the human experience and supporting each other during these major life events. They're not getting the attention that they need. And so that's how the Global Doula Project was born. And that's where my love of birth and death doulas comes from.

8:37Dr. Rebecca Dekker: That's amazing. So your father basically left a gift to you and you're turning it into this Global Doula Project. Yeah, the Global Doula Project is my dad's legacy. That's incredible. Yeah, he was pretty incredible. Yeah. I feel like death is, you know, we're talking a lot about the similarities, but it seems like just like very few people are at a birth of a new baby. Very few people are present at a death, so they don't know what to expect. And you and I have both probably been at a lot of both. And it feels like, I agree, the feeling in the room, like you can feel this heightened energy in the room.

9:21And some writers and going back to ancient times talk about the veil being thin.

9:28Dr. Rebecca Dekker: It's hard to describe the atmosphere in a room during a death. And it is very, like you said, mysterious and spiritual and sacred. and yeah I want to talk more about how do people prepare for this so that it can be as peaceful as possible yeah I've been thinking about the word the veil is thin the the phrase the veil is thin and how we experience that in both birth and death is it okay if I if I talk about that first and then I'll talk about how death doulas can support the process I think that in a home birth or a birthing center birth, we can sometimes sense that veil because there's a little bit more space to be quiet and experience it.

10:22But I've noticed that in death, it seems like it's possible to experience it more in the hospital. And I've been reflecting on why. I think that when a baby is born, we do have that moment of, okay, where did you come from? This is huge. But there's also a lot of machines beeping in a hospital. There are bright lights. There's someone's immediately checking to see if the baby's okay. And we sort of leave that veil quickly. like okay we move on really fast we move on life has started okay let's go we have a lot of tasks to do now that this baby is here yeah yeah whereas with death and my experience with death doulas is they tend to be very spiritual people and really noticing the veil a lot and i've been thinking about how at the end of life when someone dies then there is there is it's natural to be quiet and and reflect on the life that that person lived and wonder where they are going now and think about that for for a while and so those are when we talk about the veil i i just thought about those two differences how it's the same veil but and one is the arrival and one is the departure and sometimes the departure and is it is is quieter but if we could also have birth be the same way it would we would all benefit from honoring that life and that mother in that moment with respect and with quiet.

12:22Dr. Rebecca Dekker: Mm-hmm. You mentioned that sometimes deaths have that more quiet in the hospital. Can you talk a little bit more about that? I'm talking about, I'm referring to the end, end of life. So active dying has happened and we're coming to the very, very end. in the days before the death it's usually not quiet there's the there's a hyper medicalization of death just like there's a hyper medicalization of birth in a lot of places okay yeah protocol protocol rules and that's why it's good to have a death plan because it will help what happens in the hospital be according to what the family wants and what the dying person wants rather than just the protocol, the hospital protocol.

13:22Dr. Rebecca Dekker: But when you get to the very, very end of the dying process, everything seems to slow down and there's a lot more respect in from the staff. I think because medical staff, healthcare professionals are trained to keep us alive. and save us. So they really do their best to do that until the very, very end. But then there comes a time when their job is done and they step back. So the quiet is usually because they have stepped back. And it becomes family and it becomes a waiting and it becomes an honoring and the human experience.

14:12Dr. Rebecca Dekker: so let's get started in talking about like death doulas so for someone who's never heard of one what is a death doula and what role can they play a death doula has pretty much identical definition as a birth doula so they provide emotional support practical support and informational support to the person who is dying and also to their loved ones. Birth doulas do support partners and family members, but death doulas really do a lot with family members, especially after the person has died and the family is grieving. The death doula is still there supporting family. And what would the training look like then to become a death doula?

15:01A lot of the trainings that I have seen first include in their curriculum a sort of making friends with death module. So what is your relationship with death? What do you think about it? And do you have any feelings of fear? And let's talk about it. So take away the taboo right away and explore that. Just like when becoming a birth or postpartum doula, we have to know what's going on with us before we can fully be in service to other people and really listen to them with that active listening. So that's sort of a first step. A lot of the trainings that I have seen tend to be longer than the birth and postpartum doula trainings.

15:49I haven't seen very many trainings that are like a weekend. Usually death doula training is a little bit longer. But it's pretty similar to birth doula training. You need to know the stages of death, just like you need to know the stages of labor. You usually have a mentor or someone that can give you feedback on your thoughts about death and dying. You usually have a part where you explore the resources in your community so that you can bring those to your future clients. And then there is usually a practical part where you are supporting someone through grief or death and coming back with your trainer or your mentor to debrief.

16:42Mm-hmm.

16:43Dr. Rebecca Dekker: And do you see a lot of birth doulas go into death doula work? Like, is it a natural companion practice or not? I wouldn't say it's a natural companion practice, but a lot of our scholarship recipients say, I did this, you know, birth doula training, and now I just learned that there's death doulas, and I think I want to do that too. And it actually makes sense because the skills are very similar. You need to be a person that deeply cares about other humans and is curious about other people and really good at putting them at the center and really listening to what they need in that moment, even if they're not saying it to you with words, you know, you're sensing it.

17:38So highly sensitive people make great doulas, both birth and postpartum and death and bereavement.

17:44Dr. Rebecca Dekker: And also, I would imagine people who are highly intuitive would also be a good fit for that. Yeah. I did speak with a bereavement doula the other day who specializes in training people, healthcare professionals to support loss, who firmly believes that it really should be in every birth and postpartum doula training is a part about loss because one in four pregnancies does end in loss. It's going to, it's going to happen. So hopefully if people hear this podcast and you're becoming a deaf, not a deaf doula, if you're becoming a birth doula, see if your training has a piece about loss and bereavement.

18:31That's great advice.

18:32Dr. Rebecca Dekker: So what does that look like in practice then? Like, can you walk us through like the emotional support, the practical support and the informational support? Yeah. All the death doulas that I talk to when I say, when is the best time to call a death doula? They all say right now, because one of the things that they can do is help you to get that death like what is your how do you envision your death and what like where do you want to be buried what music do you want to be playing who do you want with you who do you not want there and it is so much easier to talk about all of these things over dinner maybe even laughing because no one is sick and no one is dying and you can really talk about all of it maybe not in one sitting but it's nice to go through your wishes when you're healthy and death doulas can help with who do you want to speak for you if you cannot speak so they you might not even think of that question but a death doula can say okay let's write down these wishes this is my first question for you who would you like to speak for you if you cannot speak?

19:53Who would you like to handle your finances? Like if you, if someone needs to be paid and there needs to be a check written, who do you want to take care of that for you? And choose people and write it all down. You can even have it notarized. Some death doulas are even notaries themselves.

20:10Dr. Rebecca Dekker: Oh, wow. And so that is sort of what death doulas can do for everybody now. And then if there is a diagnosis or if there is an imminent death, death doulas can make phone calls, they can cook, they can play with siblings, they can be present, just like at the beginning of life. That nonjudgmental presence that helps people feel supported. There needs to be someone with the person who is dying, but just like when you're caring for a new baby, like you also have to take care of your needs. So the death doula can be there with you, with your loved one who is dying, or they can be there without you.

21:09They become sort of part of the family.

21:13Dr. Rebecca Dekker: so they're kind of like a third party who's not emotionally enmeshed with the person who's dying but can kind of help create a safer more supportive space for everyone you mentioned emotional support how can a death doula help someone like work through their emotions to accept the fact that they have a terminal diagnosis so that they're going to be actively dying sometime in the near future? I think that having someone near you who is not afraid to talk about the diagnosis and the fact that it's time to talk about the end of your life is very comforting.

22:05and when we are uncomfortable to talk about death maybe we don't want to to face the fact I remember when my dad was diagnosed with cancer for some reason I just stopped taking pictures of him because I thought I'm not going to take this picture because I am because he's going to die because that means he's going to die. And I'm not going to take this picture thinking it's going to be maybe the last picture. Right. So, but I should have. Anyway, that's just to illustrate the fact that I was afraid that he was going to die and I didn't want to talk about it. A death doula will not be afraid to talk about it.

22:49And people who do know that they're coming to the end of their life and who know that their family members are uncomfortable about that, what are they going to do? They're not going to talk to the family members about it.

23:03Dr. Rebecca Dekker: Yeah. But they can talk to a death doula. Mm-hmm. Yeah, you mentioned the word afraid, and I was thinking of fear as a big emotion that people face. So what kind of informational support can a death doula provide that helps lessen that fear a bit?

23:24I think that lessening the fear of dying to really lessen that fear needs to start when we're children talking about it. But, you know, crash course in not being afraid of death, you know, because it's coming.

23:48I don't know. I think that sometimes when we're afraid or we have certain feelings, maybe it's not appropriate to say, you know, or to try to diminish those feelings. If someone is afraid, then they're afraid and it's okay to be afraid, but I'm going to be with you and we can be afraid together or you can let me know how you're feeling and whatever you're feeling is okay.

24:20Dr. Rebecca Dekker: Are there some fears that can be assuaged, like such as the fear of pain or the fear of suffering or not being able to breathe? well death doulas really can explain what physiological dying looks like so just knowing what the phases are like just like we labor into life we labor out of life and there is uh there are steps that our body goes through so just telling someone just like you you do when we're talking to people who are going to give birth. About the stages of labor. Yeah. Yeah. Of course, you're going to be afraid of giving birth if you have no idea what your body is about to do. But if I explain it to you, this is what happens and then this happens.

25:07You can do the same with death. You can let people know. And you can also let people know about what their options are. There are options for pain medication at the end of life. And that's why it goes back to the beginning. Let's talk about it before anyone is sick so that maybe that person has questions. Well, what are the options for pain medicine at the end of life? Let me just choose one now and write it down for me.

25:38Dr. Rebecca Dekker: It's interesting how similar to childbirth with a fear of childbirth and people sometimes avoid information about it. There's the fear of the dying process. So people also avoid talking about it, as you said, avoid learning about it. But then that very education is what can help sometimes prevent unnecessary suffering if people know their options for the end of life. Yeah, it really, there is a taboo. And if we can normalize talking about death, I think we'd all be better off. How common are death doulas right now? And And after you answer that, I want to know, like, what does the training look like for someone to become one?

26:24Well, just like with birth doulas, death doulas have been around since humans have been around, really, because we all need support during these intense life transitions. And historically, there have always been people in the community that were like the helpers, helpers, the healers, the people who who tended to people in during these these transitional times. They looked different in different cultures. And sometimes it was just a collective support. It was just the family and the community gathering around and supporting people as they give birth or as they're dying. And it's only recently that we have moved away from these traditional societies and we are in many cultures in Europe and in the United States and in Canada and North America.

27:30You know, we're living in nuclear, with our nuclear families, and both of these processes have moved into the hospital, and so where it's harder to gather. and so because that kind of human support piece has been extracted now the the doula profession is kind of the answer it's the it's the answer to the problem of that we didn't have before but now we have it and we need to infuse that like human compassion back into into what we've lost So in some cultures, it's still like the community. Like there's no who's the deaf doula of the community. Where can I call it? There's not, that's not a thing.

28:22Dr. Rebecca Dekker: It's just the community members know what to do to support someone. Yeah. And in places like the United States where people are really isolated and alone at the end of life, there are starting to pop up more death doulas. I would say death doulas are more most popular. It's just starting. So it's not like there are a lot, but just starting in North America, second in Europe and not very, the professional doula has not really gotten to other continents yet because it's still that traditional model. That makes sense. It's interesting that you talked about how birth kind of transitioned to a hospital-based experience around the same time that death did as well for most people.

29:20Yeah. And it's hard to, I mean, we also learned how to wash our hands around the same time. So it's kind of, I mean, we saw this.

29:30Dr. Rebecca Dekker: people yeah that was how childbirth um fever the that killed so many women around the world was from deaths in the hospital due to infectious causes and the doctors spreading it with their hands to the birthing women yeah yeah luckily after that people learned how to wash their hands And it seemed like the hospital was this clean and super place to give birth, but the community aspect was lost. And the same with end of life. A lot of people would like to give birth, to die at home, but most people in the global north die in a hospital. So home death is pretty rare these days in Europe and North America?

30:22Yes, because of, I think, we just want to keep people here as long as we can. So even if someone is starting their dying process, there are interventions that can keep them here longer. And so the protocol is the default is let's keep them here as long as we can. If there are no written wishes otherwise, that's going to be the default. Just like if your heart stops and you are at home and a family member calls an ambulance, they have to do CPR and possibly break your ribs to bring you back. That's their default. if you are 90 years old and your heart stops and the ambulance comes and in a lot of countries that's what they're going to do unless you have a written this is what a death doula can do would you like to write it's called a dnr do not resuscitate would you like to put that on your fridge with the magnet and if you do then they they will not resuscitate right i've even read

31:44Dr. Rebecca Dekker: that, you know, in some places, if you enroll in hospice care, which you would have a do not resuscitate order because you're focusing on comfort measures, they can notify the community emergency services that this home has somebody with a do not resuscitate order. I think that's a really interesting point. And, you know, we're not really going to get too much into, I think how Americans have prevented or not prevented, but prolonged, you know, the dying process by doing tons of interventions. But that is definitely something I've seen in the hospital as well. Can you go through some of like the ways the body moves through the transition of death?

32:34There's something really interesting that is, has a similarity between birth and death, You know, right before you give birth, you have a surge of energy sometimes in physiological birth. This can also happen at the end of life. So if someone is declining and they are going through the death process, they might have a surge of energy where they're like, get out of bed. And you think, oh, grandma is like, she's better. She's getting better. And then the next day they die. This is common. So before the dying process starts, sometimes there is a burst of energy. And I also know that at a certain point, people stop eating and stop drinking.

33:22And this is physiological. It's something to not worry about. And this is something else death doulas can do to help ease anxiety is to just let people know what's normal. and death doulas have also told me that hearing is the last sense to go so they can still hear you at the end of life.

33:48Dr. Rebecca Dekker: I think it's interesting you brought up the eating. As a nurse who took care of many hospice patients in the hospital, that was something that families really struggled with. Yeah. And, you know, you would try and explain it to them, but they still couldn't grasp, you know, that, well, why don't we force them to eat? Why don't we put a tube down their nose? Like we need to feed them, talking with them about how research shows that when they stop eating, it's actually a comfort measure that they go into a state of ketosis, which makes them feel happier and more pleasant. And they have fewer symptoms, you know, because their digestive system has stopped working.

34:24Dr. Rebecca Dekker: You don't want to force food down that system. And the same with dehydration as well as normal at the very end of life, which is kind of that, I guess that's one of the differences with birth because we talk about staying nourished and continuing to eat and drink throughout the birthing process if you're able to. Birth and death are both physiological processes that need to be supported. people need to feel safe to give birth and they need to feel safe to die it takes both of them take courage it takes courage i want to pause there because i think that raises a good point in that

35:13Dr. Rebecca Dekker: many nurses and other people who've cared for people are dying probably know that it seems like the person who's dying chooses the moment that they take their last breath. And often it's when a certain person is in the room or is not in the room. Can you talk a little bit about that? Yeah, that was exactly how I was going to elaborate on that. And I was trying to think of how to connect, you know, feeling safe with wanting all your children there when you die. Or not wanting any of your children there. Yeah, yeah, yeah. But yeah, people, it's kind of like when mammals give birth, they prepare their corner in the woods.

35:58It's usually at night, you know, they feel safe. Okay. In physiological death, people, whether consciously or subconsciously, they kind of prepare their corner and they know what their corner is going to look like and how that's, they're going to feel most safe. Maybe safe is not even the word. Maybe comfortable. Or ready. Yeah, ready to let go. I was reading about one man who, he was so in love with his partner. When she was with him, he did not want to let go and die. Yes, I've seen that.

36:44Dr. Rebecca Dekker: Yeah. It's almost like the cord between them is too strong and the one who's dying can't let go or vice versa. Yes. Yeah, so it's really, this illustrates how much of a human experience this is, how much of a, this is a physiological experience that involves mind, body, and spirit. It's all connected. Birth is the same. It's all connected. So if we are supporting all of that whole person, we can help them to have a beautiful experience. If we're just focusing on their physical body and we're missing that they are also a human person with wishes and preferences and ideas, then we're not supporting the whole person and the whole process.

37:37And I think that can go back to a similarity with labor and that sometimes people, their labor won't start spontaneously unless they feel safe or can't progress when they feel unsafe.

37:49Dr. Rebecca Dekker: I know for me with my third baby, I went way too long past my due date. And I later attributed it to the fact that there was a family member in town that really stressed me out. And I couldn't, I went into labor like the morning they left town. and I feel like as a nurse I've seen so many deaths where you know the family is hovering and then when they leave is when the person finally takes their last breath or vice versa sometimes people people wait until a certain person arrives to say goodbye or they wait for a baby to be born. Yeah. Or for a specific news. Yeah. Like, like the new birth of a baby or, and I felt like, um, that seems like another role that the death doula could play is helping educate families about how there are different reasons someone might hold on versus be ready to let go.

38:49Dr. Rebecca Dekker: Yeah. Yeah. Having someone who has seen hundreds of people die, I mean, you just, you have this resource you can ask them questions and what do you think what do you think my loved one is going through and and you know educate me yeah I think you know um my dad had a very unusual death I believe having seen witnessed a lot is that in that he stopped eating and drinking and did not have anything by mouth for about nine or ten days before he passed but he was conscious most of that time. And we could not figure out why it was taking so long. And so we tried everything. And, you know, all of his children came to see him.

39:34Dr. Rebecca Dekker: All of his grandchildren came to see him or talk to him. And he talked to his twin brother on the phone. And we could not figure out what it was that was keeping him here. And at the very end, I felt like, you know maybe it was he was hanging on to the connection to my mom and that she needed to start spending less time in the room somebody also suggested that there was like a like a nanny cam in the room to turn the camera off because some people don't want to be watched while they die just like they wouldn't want to watch be watched being birthed on camera yeah and or huh or being watched while you're falling asleep or while you're yeah and I I had never thought of that.

40:19Dr. Rebecca Dekker: But somebody was like, did you turn the nanny cam off? And I was like, oh, we need to do that. You know, but that didn't solve it. And so I think, you know, what my mom and I agree finally helped was her spending on the last day, spending less time in the room to kind of help distance themselves. And then also I called his twin and had his twin talk to him on speaker, even when my dad was on responses. and just tell him it was okay to go. Yeah. Yeah. Because that twin connection, I think, might have been what was like keeping him here. Yeah.

40:59Wow.

41:01Dr. Rebecca Dekker: And just, it's so mysterious and there's so many unknowns and every family seems so unique. It's just like with birth, sometimes you think at the end, like, you know, we can't do this anymore. This is so hard, you know? Yeah. yeah it's um it's the human connection we are connected to each other right so intricately but how wonderful that you were troubleshooting and really you did keep him at the center of like his whole person his not just his body you know his right um what he might be feeling and thinking and you used your knowledge of death to problem solve in the situation. It sounds like you figured it out, the twin connection.

41:58Dr. Rebecca Dekker: Yeah, I think that was a big part of it at least. And it did make me think though, again, like if I was someone without that experience, would I have known to? I don't think so. Yeah, that's where I feel like a death doula. And even the hospice nurses were trying to help us troubleshoot it. And it was just, you know, every birth is unique and every death process is unique and the atmosphere really matters. You know, like you talked about creating almost like your little nest to give birth in, like the atmosphere, you know, with a death, does somebody want to die surrounded by lots of boisterous family or not?

42:39Dr. Rebecca Dekker: And they might not know until they're in the situation, but I did feel like in the beginning there was just too much. There's too many of us, you know, when you had six kids and in-laws and grandchildren and everybody wanting to be there, it, it created too heightened of an energy for him to be able to let go. Yeah. But you can't know until you assess the situation so i don't think that you could have done it any other way i mean you had to all these people wanted to say goodbye and that was a beautiful thing and then you know you go from there and you treated him as you know with dignity and respect and that's that's actually a beautiful thing that he had that you were exhausted but a lot of people at the end of life are completely isolated and long deaths are hard to take care of because people have to go, they have to work and they have kids and, you know, people are maybe taking turns going to the hospital.

43:49And then there are times when that person is all alone and then we feel guilty. And so it's, it's good to have a death doula there just to, to be there and to help the family navigate, to help the family, make sure everybody's eating and drinking healthy and, and, um, helping the family to really focus on the relationship with that person, because that, that's what matters. There's a lot of bureaucracy that's around death and there are, there are forms and there are plans. There's so many plans and phone calls and the prescriptions and yeah. Yes. And so a death doula can kind of like a postpartum doula does everything else so that mom can bond with their baby.

44:33A deaf doula does everything else so that the family can soak up those last minutes or days with their loved one and say things sometimes that need to be said, I love you, I'm sorry. Because you can't, if you're busy doing other things, it's hard to make time to have those important conversations.

44:53Dr. Rebecca Dekker: Can you talk a little bit about how cultural, religious, or spiritual beliefs might shape the way people experience and understand the death transition? Different cultures have different ways of coming together and celebrating that life or mourning that life. so it could be in Mexico there's the day of the dead in the Jewish tradition there's sitting Shiva after the person dies and people are coming together so it looks different there's traditional western funerals with the casket, there are religions that of course it will be a cremation because we have to put the ashes in this river to honor this God.

45:48And we all, we have these different rituals, but what the rituals have in common, even though they look different on the outside, they are helping us come together and have something to do together that in some way helps to explain this big mystery. And that's why it's so important to have the ritual because it brings us together. In cultures where the ritual is missing, we don't have a reason to come together and we need each other.

46:33Dr. Rebecca Dekker: I feel like we saw that in COVID when so many funeral processes were, you know, basically not allowed to take place. I felt like there were elderly people I knew who died during those years, whether it was COVID related or not. And we weren't able to come together as a, like a large community to really celebrate them, to go through those rituals. And I still feel like there's a piece missing from those people who did not have that. Yeah. COVID was a hyper focus on the physical and we completely forgot that we are humans who need each other. And then that manifests in physical problems. So mental health and yeah, we are whole people with all of these pieces.

47:27We're not just a heart and lungs with legs.

47:32Dr. Rebecca Dekker: Yeah, I think a lot of people experience the dying alone, as you mentioned, during COVID as well or not having people there who should have been there for sure. Are there any other similarities between death and birth you want to share? Yes. When we become parents, we have a huge identity shift and there is a lot of neuroplasticity because of the oxytocin flowing through our veins and we are becoming in tune to our baby and our priorities are shifting and our brain is sort of rewiring. So grief is actually similar. What is grief but love? And that's oxytocin and that is our brain shifting and learning how to live this life without this person physically here.

48:34And it's just another reason why we need so much support because not only have we gone through this intense change of, you know, physical change, logistics, we're either caring for a new person or we are figuring out life without a person that we love, there is a period when we are very susceptible to outside noise and stress and literally our brains are being rewired. So that's why we really need the support of people who are not going to add to the noise, but people who are going to support us and shelter us and keep us safe.

49:20Dr. Rebecca Dekker: So you mean like the bereavement that people go through after they lose a loved one is an actual kind of rewiring of the brain and transformative process? Yes, absolutely. And like what is the end result then? What are you on the other side of losing someone? You're a different person. Everyone's different, I guess, but in our brains sort of compensate for the new life but it is a new life and it's a new way to have a relationship with that person I don't know what you believe but um I still have a relationship with my dad I talk to him and I ask him for advice and it's a it's a different and I feel him and he sends me signs and that's it's this whole other way of communicating that I didn't know how to do before.

50:18It's beautiful.

50:21Dr. Rebecca Dekker: And Catherine, like going back to your dad and his legacy and like you being able to start the Global Doula Project, can you talk a little bit about like what you do and how you work? Yeah. So my dad was a psychiatrist and he focused, you know, he spent his life helping people climb out of the darkness. And my goal is to help people stay in the light. And doula support is absolutely this. It is in the times of birth and the times of death when we are most vulnerable, yet these are powerful growth moments. When we have compassionate support, we can thrive. So how do we help transform these experiences for people?

51:14Doula support means to be accessible. It needs to be affordable. So we have three branches to the Global Doula Project. We support organizations with grants so that they can offer their doula services to families who could not otherwise afford those services. We offer scholarships to aspiring doulas and we have our storytelling and raising awareness where we just shout from the mountaintops about the importance of social support during life's greatest transitions.

51:49Dr. Rebecca Dekker: And how does someone go about becoming a death doula? Like if we have any listeners who are like intrigued by that as a path? Yes, there are lots of different death doula trainings around the world. There are hybrid options in person, also online. The Global Doula Project is actually creating a global doula training directory because we have a lot of inquiries about our scholarship program. And a lot of people say, I want to become a death doula. Where do you recommend I study? And it's such a, it's such a personal choice. And as we know, doula support with matching culture is so important and, you know, values and budget and where you are.

52:42So we're creating this tool so that people can browse and find a culturally appropriate training for them. But there are hundreds and they don't always pop up right on Google, but just keep searching. And then next year, hopefully we'll have our, our, our training directory up. So people can browse.

53:01Dr. Rebecca Dekker: That's amazing. I would definitely recommend checking out, you know, your beautiful website, globaldoulaproject.org. And it lists all of the, the grants and funding they provide. And, you know, they have the holding space for the directory that you're building for people who want to train as a deaf doula. So Anne-Katherine, thank you so much for coming on the top, on the podcast. I know I said in the beginning, it's a difficult, challenging subject, but I think it's also, like you mentioned, beautiful and a part of life and something we shouldn't be afraid to talk about. So thank you for spreading the word and spreading that message.

53:38Thank you for having me. And thank you for spreading the word about all of the evidence around birth. You're welcome. Thank you.

53:47Dr. Rebecca Dekker: Today's podcast was brought to you by the Evidence-Based Birth Professional Membership. The free articles and podcasts we provide to the public are supported by our professional membership program at Evidence-Based Birth. Our members are professionals in the childbirth field who are committed to being change agents in their community. Professional members at EBB get access to continuing education courses with up to 23 contact hours, live monthly training sessions, an exclusive library of printer-friendly PDFs to share with your clients, and a supportive community for asking questions and sharing challenges, struggles, and success stories.

54:23Dr. Rebecca Dekker: We offer monthly and annual plans, as well as scholarships for students and for people of color. To learn more, visit ebbirth.com slash membership.