Have a Rewarding Career Comforting the

Dying and Their Loved Ones

FabJob Guide to

Become a
Death
Doula

Rachel Gurevich

Visit www.FabJob.com
 FABJOB® GUIDE TO BECOME A DEATH DOULA

by Rachel Gurevich
ISBN: 978-1-926835-02-0

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FabJob Guide to Become a Death Doula

Contents
About the Author..............................................................................9
Book Dedication..............................................................................10
Acknowledgements........................................................................10

1. Introduction...........................................................................................12
1.1 A Career as a Death Doula...........................................................13
1.1.1 What an End-of-Life or Death Doula Is............................14
1.1.2 Why Death Doulas Matter..................................................17
1.1.3 How End-of-Life Doula’ing Differs From Other
End-of-Life Professionals...................................................19
1.1.4 Services Provided by an End-of-Life Doula....................23
1.2 The End-of-Life and Dying Industry..........................................24
1.3 Benefits of Being an End-of-Life Doula......................................27
1.4 Inside This Guide..........................................................................33

2. What an End-of-Life Doula Does......................................................36

2.1 Specializations...............................................................................37
2.1.1 Elder Care.............................................................................38
2.1.2 Providing Support and Comfort to the Terminally Ill....39
2.1.3 Respite Care for the Family................................................40
2.1.4 Facilitating Legacy and Life Review Projects..................41
2.1.5 Conducting Living Funerals..............................................41
2.1.6 Planning and Conducting Vigils.......................................42
2.1.7 Mourning and Post-Loss Support.....................................43
2.1.8 Facilitating with Post-Death Home Organization..........44
2.1.9 Pet Death Doula Services....................................................44
2.2 Tools of the Trade—And How to Use Them.............................48

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 FabJob Guide to Become a Death Doula

2.3 How to “Hold the Space” for Someone: Your Most

Vital Service....................................................................................58
2.4 How to Do a Client Consultation . .............................................64
2.4.1 Initial Consultations: Deep Listening +
Empowerment......................................................................65
2.4.2 Talking About Life and Dying ..........................................68
2.4.3 Discussing Advanced Care Directives . ...........................72
2.4.4 Discussing After-Death Body Care, Burial,
and Funerals.........................................................................76
2.5 How to Support and Comfort the Dying...................................86
2.5.1 Understanding the Needs of the Dying...........................86
2.5.2 Facilitating Legacy and Life Review Projects..................95
2.5.3 More Comfort Skills and Techniques...............................98
2.5.4 Creating Sacred Space.......................................................101
2.5.5 Using Traditional and Newly Created Rituals..............104
2.5.6 Planning a Vigil..................................................................107
2.6 How to Support Family and Friends of the Dying.................110
2.6.1 Providing Respite Care.....................................................111
2.6.2 Educating the Family on the Dying Process..................115
2.6.3 Support for the Mourning Family...................................119
2.6.4 Handling Conflict and Heated Emotional Moments...124
2.7 Conducting Workshops and Seminars.....................................126
2.8 Working with Fellow Dying Professionals..............................129

3. Getting Ready......................................................................................131
3.1 Skills and Knowledge You Will Need......................................131
3.1.1 Skills Assessment...............................................................132
3.1.2 Getting Comfortable with Death and Dying.................133
3.1.3 Interpersonal Skills............................................................135
3.1.4 Business Skills....................................................................138

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FabJob Guide to Become a Death Doula

3.1.5 Ethical Awareness..............................................................139

3.1.6 Self-Care Skills...................................................................142
3.2 Learning by Doing .....................................................................146
3.2.1 Volunteer Experiences......................................................147
3.2.2 Making the Most of Your Volunteer Experiences ........151
3.3 Learn From Other Business Owners........................................153
3.3.1 Information Interviews.....................................................153
3.3.2 Mentoring...........................................................................156
3.3.3 Join Associations and Social Clubs.................................160
3.4 Educational Programs................................................................163
3.4.1 Do You Need Certification as a Death/
End-of-Life Doula?............................................................164
3.4.2 What to Consider When Choosing a Program..............167
3.4.3 10 End-of-Life Doula/Midwife Training
Programs to Consider.......................................................172
3.4.4 College and University-Style Courses............................185
3.4.5 Additional Educational Options to Build Your Skills...187
3.4.6 Business Courses ..............................................................191
3.5 Resources for Self-Study ...........................................................192
3.5.1 Books...................................................................................192
3.5.2 Websites..............................................................................193
3.5.3 Documentaries...................................................................195

4. Starting Your Own Business............................................................197

4.1 Getting Started.............................................................................200
4.1.1 Creating a Business Plan.................................................200
4.1.2 Choosing a Business Legal Structure..............................209
4.1.3 Choosing a Business Name .............................................215
4.1.4 Choosing Your Location...................................................218

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 FabJob Guide to Become a Death Doula

4.2 Financial Matters.........................................................................221

4.2.1 Start-up and Operating Expenses...................................221
4.2.2 Start-up Financing ............................................................226
4.2.3 Taxes....................................................................................231
4.2.4 Insurance.............................................................................232
4.2.5 Setting Your Fees ..............................................................236
4.2.6 Getting Paid........................................................................245
4.2.7 Keeping Track of Your Finances......................................251
4.3 Working with Support Staff.......................................................255
4.3.1 Employees versus Contractors........................................256
4.3.2 Before You Hire..................................................................257
4.3.3 Finding Support Staff........................................................260
4.3.4 The Interview Process.......................................................261
4.3.5 References...........................................................................262

5. Getting Clients....................................................................................264
5.1 Choose Your Target Market.......................................................265
5.2 Marketing Tools...........................................................................267
5.2.1 Printed Materials...............................................................267
5.2.2 Your Portfolio.....................................................................274
5.2.3 Your Website.......................................................................278
5.2.4 Social Media ......................................................................284
5.3 Marketing Techniques................................................................287
5.3.1 Advertising.........................................................................288
5.3.2 Free Media Publicity.........................................................293
5.3.3 Networking........................................................................297
5.3.4 Your Elevator Pitch............................................................302
5.3.5 Promotional Events...........................................................306
5.4 Selling Your Services...................................................................310

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FabJob Guide to Become a Death Doula

5.4.1 Responding to Inquiries...................................................310

5.4.2 Contacting Corporate Clients..........................................313
5.4.3 Meeting with a Prospective Client..................................318
5.4.4 Preparing a Proposal.........................................................323
5.5 Client Contracts...........................................................................328

6. Conclusion ..........................................................................................334

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 FabJob Guide to Become a Death Doula

About the Author

Rachel Gurevich specializes in empowering
men and women to make informed choices
regarding their health and wellbeing. She is the
author of The Doula Advantage: Your Complete
Guide to Having an Empowered and Positive Birth
with the Help of a Professional Childbirth Assistant
(Three Rivers Press, 2003) and the FabJob Guide
to Become a Doula (FabJob, 2018.) Along with
Sharon Perkins, Rachel is also the co-author of
Birth Plans for Dummies (For Dummies, 2012). The Doula Advantage
received endorsements from Dr. William Sears, America’s
pediatrician and author of over 30 books; from Dr. Mayer Eisenstein,
author of The Home Birth Advantage; and Ann Douglas, author of
The Mother of All Pregnancy Books. The book also received endorsements
from doula professionals, including Tracy Peters of CAPPA and
Paullina Perez. The Doula Advantage is on the required reading list for
CAPPA labor doula certification and many others.

A professional member of the Association for Health Care Journalists,

Rachel has written hundreds of articles on all aspects of health and
wellness, but most especially on the subjects of family building
and reproductive health. She is the fertility expert (https://www.
verywellfamily.com/rachel-gurevich-1959833) for Verywell Family
(verywellfamily.com). In 2014, RESOLVE: The National Infertility
Association awarded Rachel the Hope Award for Achievement for
her writing on fertility. Rachel is also a freelance journalist for Reuters
Health.

You may visit Rachel’s website, www.rachelgurevich.com, or contact

her at [email protected].

Rachel Gurevich photo courtesy of:

Pamela Nicole
https://www.pamelanicole.com/

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FabJob Guide to Become a Death Doula

Book Dedication
Dedicated in loving memory to Serena Dawn Todd. After a six month
battle with liver cancer, Serena died peacefully at home surrounded by
love.
Acknowledgements
This book would not be possible if not for the generous contributions
of the experts and individuals interviewed for this book. I have much
gratitude for the time, stories, and wisdom they shared with me and
with my readers.

Alua Arthur, JD, Death Doula and Instructor for Death Doula
Training Courses, Going with Grace End-of-Life Planning, Training,
and Support; www.goingwithgrace.com

Rev. Angie Buchanan, Celebrant - Officiant, Certified Death

Midwife and Home Funeral Guide, International Speaker,
Developer and Instructor of,; The Death Midwife Training
Program; www.DeathMidwife.org

Rev. Arlene Radasky, Death Midwife, Home Funeral Guide,

Celebrant

Beth Mosley, Death Midwife

Carlos A.

Cassandra Yonder, Community, Deathcare Activist and Educator;

www.deathcaring.ca

Carol Neustadt, Certified End-of-Life Specialist (CEOLS);

[email protected]

Deanna Cochran RN, Founder, Quality of Life Care, author of

Amazon #1 Bestseller: Accompanying the Dying: Practical, Heart-
centered Wisdom for End-of-Life Doulas and Healthcare Advocates;
www.qualityoflifecare.com

Deb Holtz, End-of-Life Doula

Emily Pinzur, Death Doula, MSW, End-of-Life Doula, Mourning

Doula, Home Funeral Doula, Organizing Doula; Silver Wheel End-
of-Life Doula Care: www.silverwheelhealing.com

Emily Cross, End-of-Life Doula; www.steadywaveseol.com

Jason Olson, RDH

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 FabJob Guide to Become a Death Doula

Jess Kilbourn, Certified End-of-Life Doula, Licensed Massage

Therapist; https://jessicakilbourn.amtamembers.com

Jessica Headley Ternes, Certified Death Midwife & Ancestral

Lineage Healing Practitioner; https://sacredthresholds.org

Kelly Roman, End-of-Life Doula. Become a doula volunteer

through Ascend Hospice; www.ascendhospice.com

Merilynne Rush, MS Hospice and Palliative Studies, BSN, Lifespan

Doula Association, Ann Arbor, Michigan, President, National End-
of-Life Doula Alliance (NEDA); https://www.lifespandoulas.com

Nada Frazier, Certified End-of-Life Doula, Mentor & Trainer and

Founder of The Sacred Servant www.thesacredservant.com

Nathalie Bonafé, PhD, Certified End-of-Life Doula (CEOLD);

A Gentler Parting, LLC; www.agentlerparting.com

Patty Brennan, BA, Doula Trainer, Co-Owner of Lifespan Doula

Association, Ann Arbor, Michigan; author of The Doula Business
Guide: How to Succeed as a Birth, Postpartum or End-of-Life Doula,
3rd Edition and The Doula Business Guide Workbook: Tools to Create a
Thriving Practice, 3rd Edition; www.LifespanDoulas.com

Patty Burgess, End-of-Life Educator/Trainer for End-of-Life Doulas,

Hospice Volunteers; Teaching Transitions - Doing Death Differently,
President of Possibility; https://go.doingdeathdifferently.com/
doula-video

Patricia Ballentine, Ordained Minister and Priestess, Death

Midwife; www.thecreativeflame.com

Rev. Olivia Bareham, Death Midwife, Home Funeral Guide,

Celebrant, Conscious Dying Educator, Founder and Facilitator of
the Art of Death Midwifery certificate training program; http://
sacredcrossings.com/artofdeathmidwifery/

Sam Sanford

Tarron Estes, Founder, Conscious Dying Institute, Designer/

Developer of “Conscious Dying Education and Care” Curriculum
for Community Death Education, Facilitator, of Sacred
Passage: End-of-Life Doula Certificate Courses; https://www.
consciousdyinginstitute.com/sacred-passage-doula-certification

Toula Saratsis, End-of-Life Doula/Palliative Care Advocate

Ute Luppertz, MA, Pet Death Doula; www.pets-point-of-view.com

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FabJob Guide to Become a Death Doula

1. Introduction
“We must practice the art of dying so that when our death is upon us we
will not be afraid but recognize it as the most loving thing there is—and
fall into it completely.”
Rev. Olivia Bareham,
Death Midwife, Home Funeral Guide,
Celebrant, Conscious Dying Educator
SacredCrossings.com

Welcome to the world of death doula’ing!

Some may accuse you of being morbid for wanting to work with people
at the end of life. Strange. Weird. The topic of death is something the
majority of people today try to avoid, refuse to discuss, and attempt not
to think about. Yet, here you are, aspiring to walk alongside the dying.
Is something wrong with you?

Absolutely not! There is nothing wrong with you at all.

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 FabJob Guide to Become a Death Doula

Better words to describe someone like you: Brave. Gifted. Intuitive.

Compassionate. Comfortable with your own mortality. You likely feel
called to this work. Passionate. Inspired.

Death doulas are not “obsessed with death.” They are in love with life.
End-of-life doulas are so in love with life that they hope to bring comfort
and peace to the very last seconds of every person’s time in this world.

The transition from this world to the next—or the transition from a
state of being alive to being dead, however you personally choose to
describe it—can be as beautiful and meaningful as the time of birth.
Certainly, it is sad to say goodbye. But it doesn’t need to be frightening.

“People will often say to me, ‘Isn’t [working as an end-of-life doula]

depressing?’ And like, actually no, because it’s not my death. Just like it
wasn’t painful for me to be a [childbirth] midwife, I wasn’t the one going
through labor. When someone dies, it’s actually a wonderful thing to be
able to make that a better experience. To empower people find meaning
and make meaning and navigate and be fully present with that. You see
such amazing things.”
Merilynne Rush,
MS in Hospice & Palliative Studies, RN, BSN
Lifespan Doula Association
https://www.lifespandoulas.com

As a death doula, you will help individuals—as well as their friends

and families—face death with a little less fear and a little more love.

This guide will give you everything you know to get started on this
unique and important career path.

1.1 A Career as a Death Doula

If you’re reading this guide, you already have a general idea of what
a death doula is. But it’s very possible you have never actually met a
death doula. You may have only discovered this as a career path after
reading a news article, or after researching the world of death and
dying. It’s possible your local area doesn’t have even a handful of end-
of-life doula professionals. It’s also likely you have a limited definition
of what being a death doula could mean.

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FabJob Guide to Become a Death Doula

This is all great news. You may soon be surprised to learn about all
the possibilities and directions open to end-of-life doulas. You are also
very likely to be one of the first death doulas in your area. You’ll be a
trailblazer in a new profession that desperately needs people.

Did You Know? There are many possible ways to title your work in
this field, some which refer to specific specialties and others that can
be more general. You may call yourself a death doula, an end-of-life
doula, dying guide, a death coach, a deathwalker, a mourning doula, a
death care or end-of-life specialist, a community death care advocate, a
death midwife (sometimes specific to those who conduct home funerals
or specifically offer vigil work), a soul midwife, a thanadoula (from
the word thanatology, the scientific study of death), an elderly care
doula, or a pet death doula. Throughout this book, you’ll notice that
the experts quoted are referred to in a variety of ways and titles. This
is because the choice of title is very personal. Eventually, you’ll need to
decide how you’d like to refer to yourself in this work.

TIP: Be aware that there have been some legal challenges in

Canada to those wishing to use the term “midwife” outside
of the context of a licensed childbirth midwife. If you decide
to use the phrase midwife in your title or business name,
there’s a theoretical possibility that you will be pressured or
forced to legally change it.

1.1.1 What an End-of-Life or Death Doula Is

An end-of-life doula is a support person—man or woman—who
provides nonjudgmental, non-medical holistic support to those nearing
the end of life. An end-of-life doula also typically offers support to the
friends and family of the elderly, dying, or recently dead. An end-of-life
doula educates and empowers individuals to make decisions on their
own end-of-life care and final burial or funeral.

Note that end-of-life doulas are all genders—despite the word “doula”
grammatically referring to a female in the Greek origin of the word—
and end-of-life doulas serve people of all genders.

End-of-life doulas also aim to provide information to the dying and

their family, to help them become familiar with the normal and natural

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 FabJob Guide to Become a Death Doula

stages of dying. In demystifying the dying process, they help to reduce

fear and anxiety.

End-of-life doulas are nonjudgmental. They support the dying without

any preconceived notions of what dying should look like. Their job is
not to inject their own meaning of death to a family but to help a dying
person and their loved ones come to their own conclusions. A death
doula is not there to tell a dying individual the “right” or “best” way to
die, but to help the dying make their own decisions after learning about
their options.

An end-of-life doula is also not there to impart a specific spiritual

agenda, to “save” a person’s soul, or in any other way impose their
personal beliefs onto the dying.

An end-of-life doula may explore spiritual beliefs with the dying—

through active listening and conversation—or may provide support
that respects the dying’s religious desires. They may serve as an active
listener so the dying and their family can reevaluate their spiritual or
religious thoughts on death and burial.

But the death doula does not push or try to “sell” any specific
philosophy of death. They are only a mediator, supporter, or
compassionate listener, while the dying considers their life legacy and
what it means to die.

“Doulas support clients non-judgmentally, according to their needs,

values and priorities, and are not agenda-driven. A certain humility
is required to be truly effective and empowering in this work. [End-of-
Life Doula]s can support families many months before active dying, and
many months afterward. Training should include an awareness of this,
even if particular doulas then choose to go on and only focus their work
on the active dying phase or after death care. End-of-life doula really
encompasses it all—the whole “dying year” or years.”
Merilynne Rush,
MS in Hospice & Palliative Studies, RN, BSN
Lifespan Doula Association
https://www.lifespandoulas.com

End-of-life doulas are non-medical. While many death doulas are

inspired to enter the field after working on a medical team in hospice or

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FabJob Guide to Become a Death Doula

palliative care, the role of a death doula is non-medical. A death doula

does not provide medical care, though they may help advocate for the
dying and help ensure they get the medical care they need from the
healthcare support team.

A death doula may provide physical support. For example, a death

doula may offer healing touch (like holding a person’s hand), gentle
massage, and physical care needs that are often left for families to
provide (like keeping the dying individual clean, dry, and comfortable.)

Death doula support is holistic. Holistic care is support that goes

beyond the physical needs of a person but also considers their
emotional, social, and (possibly) spiritual needs.

End-of-life doulas educate and empower the dying and their families
on their end-of-life care, funeral, and burial options. They may
introduce or help a dying individual walk through the steps of creating
a living will or advanced care directives. After those documents are
completed, the doula may help advocate for the dying’s end-of-life
decisions, especially when they are no longer able to voice those wishes
themselves.

The death doula may provide information on various funeral options,

including the possibilities of having a living funeral—a ceremony
that occurs while the dying are still alive and able to participate—or
the option of a home funeral. They may help a dying person or the
mourning family consider traditional funeral options as well. A death
doula may also introduce them to options like green burial, or help the
family find ways to reduce the cost of dying.

End-of-life doulas may serve...

• the elderly (possibly for years before their death is due for arrival)

• the terminally ill, at any age

• the grieving, those who have lost or are about to say goodbye to a
loved one

• those facing the loss of a pet or beloved animal

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 FabJob Guide to Become a Death Doula

• those not near death but who want to wrestle with and confront
their mortality now

• those looking to practically plan for end-of-life, at any age,

regardless of health status

1.1.2 Why Death Doulas Matter

We are doing death and dying wrong.

Just consider the following:

• Most people near death are unable to express their end-of-life

∆medical care desires. But few people take the time to put down
on paper what they would want while they are alert and well.

• A 2014 Kaiser Health study (https://www.kff.org/health-costs/

poll-finding/kaiser-health-tracking-poll-september-2015/) found
that 9 in 10 felt doctors should discuss end-of-life care decisions,
and 8 in 10 said they would feel “very comfortable” talking about
end-of-life care with their family.

• However, that same study found that only 17 percent—barely 2 in

10—have actually had conversations on end-of-life care with their
doctor or health care provider.

• Until very recently, discussions surrounding end-of-life care

planning were not covered by health insurance. Talking about
advanced care directives was referred to as “death panel”
discussions in some political circles (https://khn.org/news/docs-
bill-medicare-for-end-of-life-advice-as-death-panel-fears-
reemerge/): an inaccurate and fear-based reference.

• Even when patients have advanced care directives available, their

doctors may not be aware they exist. One study found that only 1
in 4 doctors knew if their patient had advanced care directives in
place (https://www.pbs.org/wgbh/pages/frontline/facing-death/
facts-and-figures/).

• Studies have found that around 80 percent say they would prefer
to die at home (https://palliative.stanford.edu/home-hospice-
home-care-of-the-dying-patient/where-do-americans-die/).

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FabJob Guide to Become a Death Doula

• But less than 20 percent actually do die at home. Sixty percent die
in the hospital and another 20 percent in nursing homes.

This gap between what people want and what they get is partially
because the medical model of care is designed to keep people alive at
all costs—sometimes at the expense of their quality of life. The medical
model of care often leads to taking “extreme measures” to keep a
person breathing and their heart beating long after there is hope for
them to survive in the long term.

Of course, it’s a good and wonderful thing that doctors and nurses aim
to keep people alive and well when prognosis is good and hopes for a
decent quality of life is available.

Also, if a person wants so-called “extreme measures” to be taken, or

wants to die in a hospital or hospice and not at home, those wishes
should be respected.

But, dying with dignity—and having time to consider what that means
to an individual—is important. “Staying alive” isn’t and shouldn’t
always be the assumed goal.

Death doulas can help close these gaps between what people really
want and what occurs.

More so than any other service provider, death doulas stand in a

position to empower people to make decisions while they still can,
to consider what a “good death” looks like to them, and then help
advocate for those wishes at the end.

Note! There have been misconceptions that death doulas are there to
assist in or push an “aid in dying” agenda (also known as euthanasia.)
This is absolutely not true. While a death doula may be there to support
a person who has chosen aid-in-dying, may help a person explore their
local legal options, and may sit by the bedside of a person who has
chosen this path, a death doula does not specifically encourage aid-in-
dying and never assists in the medical tasks involved.

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1.1.3 How End-of-Life Doula’ing Differs From

Other End-of-Life Professionals
Every member of the end-of-life team is needed, and this is also true of
death doulas. Your role and your services are unique from others who
may offer care or provide services to the terminally ill, the dying, and
the elderly. The profession of end-of-life doula may be new—but the
need for this profession has always been there.

Hospice nurse
A hospice nurse’s primary role is to attend to the medical needs of the
patient. Remember that death doulas do not provide medical care. They
do not take vitals, give medications, do patient assessments, or work
with the attending
physician to care for
a client’s medical
needs.

Hospice nurses also

provide emotional
support to their pa-
tients and families.
Compassionate care
is a big part of hos-
p i c e n u r s e wo r k .
However, the time
they have to offer support beyond medical needs is scarce. Both home
and hospice center nurses have many other patients to care for, and
many responsibilities, that make sitting by the bedside of a dying
patient difficult to impossible.

Nurses rely on volunteers and people like death doulas to provide

patients that extra time and personal touch that they wish they could
provide, but just can’t.

Hospice nurses may look into becoming death doulas—professionally

or in a volunteer role—because they want to have the flexibility and
freedom to offer more holistic care. Expect to sit alongside hospice
nurses if you attend a death or end-of-life doula training. You yourself
may be a hospice nurse!

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FabJob Guide to Become a Death Doula

Hospice volunteer
Hospice volunteers may provide support to both patients and staff.
Their role may include sitting by the bedside as a patient is dying (No
One Dies Alone projects), visiting patients at any stage of illness to
provide company and companionship, or providing practical or office
support to the hospice staff.

However, as a hospice volunteer, your role will be limited by the

organization or hospice providing care. You will need to abide by
regulations set by the hospice, which are of course vitally important
but can limit how much and what kind of support you offer. You may
want to provide services that goes beyond the hospice bedside, but that
would be outside of the scope of your volunteer position.

There are many services that end-of-life doulas can offer that just don’t
fit inside the role of a hospice volunteer. (You’ll learn much more about
this in Chapter 2.)

Also, practically speaking, volunteer work is wonderful—but we all

need to make a living. You likely have a limited amount of time you
can dedicate free of charge. Death doula work enables you to make this
work your passion and (possibly) your living.

Many death doulas get their start as hospice volunteers. In your work
as a death doula, you will likely work alongside hospice volunteer
staff. Sometimes, there is a lack of volunteers. Volunteers may only be
assigned to those without friends and family. Your presence is needed
by those alone and those sitting with loved ones.

Nursing home staff

If you’re looking into elder care doula work, you may find yourself with
clients in nursing homes. Hospice care may also occur in the nursing
home setting, in some cases. This means you will be working alongside
nursing home staff.

Nursing homes are notoriously understaffed. Reports have estimated

that up to 90 percent of nursing homes do not have the staff required
to care for their residents (https://www.nytimes.com/2002/02/18/us/9-

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of-10-nursing-homes-in-us-lack-adequate-staff-a-government-study-
finds.html).

Whether you find yourself delivering workshops on end-of-life

decision-making, working with clients as an elder care doula, or
offering vigil or hospice work specifically, your presence is desperately
needed. The nurses, certified nursing assistants, and volunteers will all
be grateful for your help.

Housekeepers and food delivery

If you decide to offer services as an elder care doula, you may offer
light housekeeping and shopping assistance to your clients. As a death
doula, you may or may not offer the same to help support the dying
and their family. Couldn’t the family just hire a housekeeper or use a
food delivery service? Yes…. and no.

While those services may be helpful—and as a doula you might refer

and work alongside housekeeping and food delivery—your work is not
comparable.

A housekeeper will clean things up… but he is unlikely to consult with

the family about how to arrange the room to best support the dying
and their loved ones. He is unlikely to help create sacred space for the
dying, or, for the elderly, create rooms that offer encouragement to
continue with beloved hobbies or social activities.

After death, a housekeeper won’t be there to consider how to organize

the home or personal belongings of the dying, to help decide what to
keep, what to give away, and offer the emotional support as family
makes these decisions. Housekeepers are unlikely to assist in creating
sacred rituals to make this process healing and cleansing.

Food delivery is helpful… but the delivery service won’t sit with your
client and discuss what they want to eat (or what the family wants to
eat), how to best nourish everyone’s physical and emotional needs, or
to reduce time and effort put towards meal preparation.

As an elder care doula, you may sit with your client and help create a
meal plan, and even cook some of those meals. Or cook or bake together
with your client, in an act of companionship and practical help.

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FabJob Guide to Become a Death Doula

You are much more than a housekeeper or food delivery service.

Therapists and counselors

Therapists, psychologists, and psychiatrists diagnose and treat mental
health issues. End-of-life doulas may refer clients to psychological
professionals and may help individuals and families recognize signs of
depression or anxiety. However, doulas do not diagnose or treat mental
illness.

As an end-of-life doula, you will likely find yourself having emotionally

intense conversations about death and dying. You will use many skills
that mental health professionals have, like active listening and offering
compassionate support. But that’s not psychological therapy.

Some therapists do decide to add death doula work to their toolbox, and
you may find yourself training alongside mental health professionals.

“I’m a social worker, too. I was volunteering with a senior aging in

place, getting to know her and others like her who also needed services,
through my organization, I started seeing how many gaps there are in
services for sick people, and elders. Eventually, I was inspired to work
for change in home health and hospice. But, even these programs were
missing something. Families’ emotional needs weren’t being met. The
missing piece was time, and unconditional support; emotional, practical,
informational. I knew there was a way to bridge the gap. When a hospice
nurse friend mentioned a Death Doula certification course, I knew I was
starting down my true path.”
Emily Pinzur,
End-of-Life Doula
www.silverwheelhealing.com

Funeral directors
Death doulas are not funeral directors. While some death doulas also
offer home funeral guidance and support, that’s an accessory service
and not the essence of death doula work.

As a death doula, you may help your clients consider their options
before they die—or you may help a grieving family navigate the post-
death arrangements. You may or may not help educate clients on all

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their funeral and burial options, including things like green burial,
home funerals, and of course more traditional funerals.

You should get to know the local options for funeral services and
burial, and be at least somewhat familiar with local laws, so you can
offer consultation and referrals. If you don’t know what’s available, you
can’t discuss it with your client.

But you don’t take the place of a funeral director.

1.1.4 Services Provided by an End-of-Life Doula

One of the most
exciting things
about becoming an
end-of-life doula is
the flexibility and
openness of your job
description. This is
a new career with
almost limitless
possibilities. What
does death doula
work look like?

A day-in-the-life of a death doula may include…

• Meeting with a healthy client and their family in the dining room
of their home, going over advanced care directives, helping them
understand their options for the future, facilitating conversation
between the client and his or her family, and helping them get
their wishes understood and documented.

• Standing vigil by the hospital bedside of dying client. Creating

sacred space for the dying and their loved ones by “lighting”
electric candles, playing soft classical music, reading poetry, or
using hospital-approved aromatherapy.

• Visiting an elderly client at their home who has no immediate

family living nearby, making sure their basic needs are being met,
creating a plan to meet those needs, offering conversation and
companionship, helping with meals or light housework, planning

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FabJob Guide to Become a Death Doula

your next visit, and reporting back to the elderly client’s family on
their father/mother/sister/brother’s well-being.

• Giving a workshop on what a “good death” can mean at a local

library to a diverse crowd, of all ages and backgrounds. Educating
the group on what they can do now—while they are well and
active—to ensure they die with dignity and peace.

• Conducting a “living funeral” for a cancer patient at their hospice

bedside. Helping plan the event and, on the day of, helping direct
the ceremony, and possibly documenting the “funeral” through
pictures or video or keeping a detailed written record.

• Meeting with the friends and family of a recently passed loved

one, who left this world suddenly and tragically. Helping them
navigate their burial and funeral options, putting them in touch
with appropriate resources, educating them on the natural and
normal stages of grieving, and creating a plan together on how
you can best support them in the coming days and weeks.

• Holding the hand of a terminally ill client, and listening to their

fears, life stories, and wishes for their end of life. Possibly offering
guidance for taking those stories and creating a legacy project,
something to help them process and admire the amazing life they
have lived, and create a physical remembrance of that life.

All this freedom to create your career is also a possible disadvantage

to death doula work—there are so many options that you may feel
tempted to offer everything to everyone. Don’t do this!

Instead, consider all your current skills and talents. Consider what
has brought you into this field of work and how you can best serve.
Start there. Offer just a few services very well instead of offering lots of
services just okay. Begin to seek out additional training and education
in the field. With time, you may expand, shift, or re-define what end-of-
life doula work means to you.

1.2 The End-of-Life and Dying Industry

“I absolutely think we can have any career we want, including as full
time doulas. My approach, and the approach of MourningDoula.Com
where I studied, is to offer a continuum of services, and roll out our

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method across the country. The idea is that people and families start
having better conversations about death and dying earlier through
talking with End-of-Life Doulas. Then, later on, those same individuals
and families work with me as a Death Doula. Then, that family might
want a Mourning Doula. Then they might want to have a home funeral,
and later hire me as an organizer. For me, I get to help people in lots
of different ways. I offer creative problem solving, energy healing,
emotional support; all the things that work for me in my own life. It’s
organic, it makes sense.”
Emily Pinzur,
End-of-Life Doula
www.silverwheelhealing.com

“I would encourage students to be suspicious or at least curious about

any programs claiming that they will be professionals or have a career
or job afterward. Not many people are making a reasonable living in this
field and websites can be misleading.”
Cassandra Yonder,
Death Care Specialist
http://www.deathmidwifery.ca
http://www.deathcaring.ca

Can you make death doula work a career? Yes. Can you make a full-
time living working as an end-of-life doula? Yes. Is this common and
do most doulas make a full-time living with this work? No, not yet. But
the potential is there for those who hustle, work hard at educating the
public at what they do, and think outside the box.

The truth is that many of those looking to become end-of-life doulas

aren’t interested in making a full-time income. They may want to
supplement their income, or this may be a source of additional cash
during retirement. Many end-of-life doulas intend to primarily do the
work on a volunteer basis, or might hope to volunteer for the majority
of their clients while getting paid from a few others to support the
volunteer work.

When we asked working death doulas if you can make a living at this
work, we received a variety of answers—everything from “it’s very
unlikely” to “absolutely yes, and I am one of those doulas making a
full-time income.”

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FabJob Guide to Become a Death Doula

What are your prospects of making a living at this work? That’s up to

you. Don’t let anyone tell you that you can’t do it, if this is your dream.
At the same time, if making a full-time income from this work isn’t
your goal, don’t let anyone dissuade you from pursuing your passion.
No one says everything we do in life has to be all about money.

Regardless of your personal goals—whether to earn a living at this or

simply make some extra cash on the side—the market and potential for
end-of-life doula support is there.

Consider the following...

• In a Time Magazine article, on “7 New Jobs That Are So 2017”

(http://time.com/money/4631366/new-jobs-2017/), profiling
unique and exciting job possibilities, death doulas are on the list.
The possible annual salary for a death doula is listed in the article
as “$40,000 to $70,000 (private practice).” It’s unclear what their
source is for this salary quote, but there are end-of-life doulas
making full-time incomes.

• The growing popularity and demand for death doulas has

made news internationally. All published in 2018, a Home Health
Care News article (https://homehealthcarenews.com/2018/05/
death-doulas-gain-buzz-start-making-hospice-connections/)
discusses the up and coming profession of death doulas, the
Star Tribune (http://www.startribune.com/death-doulas-help-
normalize-the-experience-for-life-s-final-journey/479570193/)
covered death doulas, CBC Radio Canada did a story on the
death doulas and home funeral movement (https://www.cbc.
ca/radio/thecurrent/the-current-for-march-28-2018-1.4595735/
how-death-doulas-and-home-funerals-are-changing-the-way-
we-grieve-1.4595770), and The New York Times covered the death
positive movement (along with discussing death doulas.) Read
this article at https://www.nytimes.com/2018/06/22/nyregion/the-
positive-death-movement-comes-to-life.html.

• Remember that not too long ago, hospice care was a new concept.
The first hospices to open in the USA and Canada only occurred
in 1974 (http://www.chpca.net/about-us/history.aspx). Only in
the 1980s and 90s were laws passed requiring health insurance
companies to cover hospice care. Once considered unusual,
hospice care is now considered the standard of care for those at the

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end of life, with research showing many benefits (https://www.

nhpco.org/history-hospice-care). In 2016, 1.43 million Medicare
beneficiaries spent at least one day in hospice care (https://www.
nhpco.org/sites/default/files/public/Statistics_Research/2017_
Facts_Figures.pdf). The emergence and increasing popularity of
the death doula movement fits right in line with the increasing
popularity of hospice.

• The Baby Boomer Generation—those born between 1946 and

1964—have long been considered cultural changers and take-
chargers of life transitions. They are frequently cited as being
responsible for getting the homebirth and homeschooling
movements off the ground. Now, as they move into retirement
and near end-of-life, “taking charge” of death and dying is the
next natural frontier. The U.S. Census Bureau estimated that there
are 77 million baby boomers in the United States of America.

• The National Funeral Directors Association lists “Advanced

Funeral Planning,” “Green Burial,” and “The Popularity of
Personalization,” in an article (http://www.nfda.org/news/trends-
in-funeral-service) on trends seen in the funeral industry. These
concepts all tie into the same umbrella as the death positive
movement and end-of-life doula support services.

As you can see, interest in the death positive movement and the need
for end-of-life doula care is rising. This guide will give you all the
information you need to begin working in this field and plan for long-
term success.

1.3 Benefits of Being an End-of-Life Doula

“I am drawn to work with dying and ill patients because it’s the song of
my soul. It’s my passion. It is important to recognize the importance of
who I am and to add that liveliness to what I do. This is the way my soul
chooses to grow, and in return, I help those I meet along the way. We are
in this together. We are all one.”

Carol Neustadt,
Certified End-of-Life Specialist (CEOLS)

Being an end-of-life doula will enable you to be a part of one of the

most important, transformational moments of people’s lives. The

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positive impact you will have on those at the end of life and their loved
ones is immeasurable. As a career, end-of-life doula’ing enables you
to choose your clients, be your own boss, and be a pioneer in death
positive movement. Here are some of the many benefits of becoming
an end-of-life doula or death midwife.

Be Inspired and Awed by Your Work

You could say that the most awe-inspiring moments in life are at the
start—at the moment of birth, when the child takes his or her first
breath—and at the end, when a woman or man takes their last breath.

As a death midwife, you will have the honor of attending and being
present at this moment.

“There is no greater honor or privilege than to attend someone’s final rite

of passage; to be present as they commit their last act as a human being.
It is a profound, awe-inspiring event that leaves you forever changed.
Each instance is different. Some are a whisper or a sigh – others more
active. Sometimes I feel the presence of Others in varying degrees of
strength. Other times, there’s nothing – just a slipping away, a peaceful
absence of humanness, an empty vessel. Each time it leaves me with this
awe-junkie sense of being grounded in my own mortality, the macro and
microcosm aspects of my place in the world, and the vastness of energy
in the universe as it cycles and constantly gives birth to itself.”
Rev. Angie Buchanan,
Death Midwife
www.DeathMidwife.org

Empower People to Live Life Fully to the End

Death doulas act as a kind of life coach for those at the end of life. They
empower their clients to consider their last years, months, weeks, and
even days carefully and thoughtfully. Whether you start working with
an individual just after the diagnosis of a life limiting illness, or you
start working with them towards the very end, your role in reducing
fear and regret at the end of life will help them face their last days with
increased inner strength, peace, and resolve. In other words, you will
help them live life to the fullest potential—whatever that means for
them at this moment.

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When you actively listen to your clients, you help them process and
accept the many emotions that come on our last days. When you
work with clients on legacy projects, you enable them to celebrate the
amazing life they have lived. For those that are harboring regrets, your
support and encouragement may help them resolve those regrets,
sometimes by helping them directly reach out and make amends, and
sometimes by compassionately listening to their story and life history.

When you guide people as they write advanced care directives and set
their end-of-life wishes on paper, you enable them to make decisions
for themselves long after the point when they would otherwise be
capable of voicing those wishes.

The cycle of life and death can make some feel powerless—but you
return some of that power to the men and women you work with.

Help People Have Better Deaths

As you already read in section 1.1.2, people are not dying the way they
hope to die. Many people hope to die at home, but instead are dying in
hospitals. We don’t always have a choice over where we die, or what
our last moments look like—but sometimes, we do. Death doulas show
people how they can make these choices and die the way they want.

Death can be sad. It’s never easy to say goodbye. But death and dying
can also be beautiful and spiritual. Whether you help plan an active
vigil, create sacred space or introduce rituals, or sit by the bedside of the
dying, you are making a tremendous impact on the death experience.

Most people are afraid to die, afraid of the transition that every single
living thing must make on this planet. But, when you come as an end-
of-life doula to your client, and tell them you are there to help reduce
some of the fears surrounding this inevitable part of life? That alone
enables them to have a better death.

“[It is a] gift to be a source of comfort and ease for the dying and their
families. Helping people wrap up loose ends and settle into the embrace
of their death instead of succumbing to the fear of it.”
Rev. Angie Buchanan,
Death Midwife
www.DeathMidwife.org

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Don’t forget also the physical and emotional comfort you provide by
sitting by the bedside, holding their hand, wiping a cool cloth on the
forehead, playing soft comforting music, encouraging their loved ones
to lie next to them, or talking to them softly in their last moments.

Be Involved in Work That Is Completely Engrossing

There are no “boring” days at work when working with individuals at
the end of life. Being completely present with people, serving them and
offering comfort in their last days, and walking alongside them as they
consider the meaning and legacies of their lives—these are not actions
you can make half-heartedly.

“Working with people at the end of life is incredibly empowering and

humbling at the same time. It requires you to be totally present.”
Nathalie Bonafé, PhD,
CEOLD (Certified End-of-Life Doula)
https://www.agentlerparting.com

Be a Source of Comfort for the Grieving

Let’s not forget that death midwives and end-of-life doulas are not
only serving the dying—they also serve the loved ones of the dying.
Sometimes, it’s a friend or family member that hires the services of an
end-of-life doula. You also provide comfort to the mourning.

Having a loved one die—whether over an extended period of time from

illness, or suddenly in an unforeseen accident—can be traumatizing
and overwhelming. There are so many practical issues to be dealt with,
on top of the emotional experience itself.

As an end-of-life doula, you can take some of the burden away, be there
to hold their hand as well, and guide them towards the path of healing.

Witness the Miracle and Mystery of Life and Death

Who truly understands the mystery of life and death? Probably no one.
But, as an end-of-life doula, you will witness the living making their
final transition… making this wonderment especially strong.

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“The biggest gift I have received is the profound understanding that I

will never understand, that we are not meant to understand, that this
miracle we call Life is a mystery and so is whatever comes next. My
‘work’ is to bow to the mystery and surrender to the divine.”
Rev. Olivia Bareham,
Death Midwife, Home Funeral Guide,
Celebrant, Conscious Dying Educator
SacredCrossings.com

Be Your Own Boss and Define Your Own Career Path

As an end-of-life doula, you work for yourself. Yes, you work for your
clients, but you decide what services to provide, you decide what you
want your services to look like, and you decide how to deliver those
services.

Many end-of-life doulas were once hospice volunteers, hospice nurses

or healthcare workers, or otherwise working with people at the end
of life, but in a different role or under the supervision of another
organization. You may have felt frustrated that you couldn’t do certain
things, or you didn’t have the time you wanted to fully support your
patients.

When you start a business as an end-of-life doula, you now can decide
how much time you spend by the bedside and can provide a wider
range of care and support (within the scope and practice of the death
doula role) than you possibly could have previously.

Be Constantly Reminded to Live Your Own Life Well

What better way to remember that every day is precious than to work
with those who are near the end of life? People often ask the question,
“If you knew you were going to die next week, or next month, or
tomorrow... what would you do?” Those who work with death have
this idea at the top of their minds on a continual basis. Not in a fearful
or morbid way—but in an empowering, positive way. In a way that
reminds them to live every day to its fullest!

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“Working in the death positive community is incredibly gratifying.

Death positive people are the most life-affirming people I know. We know
life is fragile, and we spend our time well and wisely!”
Emily Pinzur,
End-of-Life Doula
www.silverwheelhealing.com

Be Greatly Respected in Your Community

“I could never do what you do.”Be prepared to hear these words
frequently when you introduce yourself to people. Not everyone is
meant to work with people at the end of life, and not everyone has the
emotional and spiritual wherewithal to sit by the bedside of the dying.

Death midwives and end-of-life doulas are well respected for their
work. People know how vital the service is, they know what kind of
impact you can have on the dying and their loved ones, and they know
it’s not a role or job that just anyone can do.

Be Energized by Your Work and Filled With Gratitude

People may assume this work can be exhausting and overwhelming.
But for those that love working with the dying, it is anything but that.
Yes, of course, you will need to take time for yourself. It is soul-intense
work. Self-care is a must. However, that’s not because the work depletes
your soul. For many in this profession, working with the dying fills up
their cup—it doesn’t empty it.

“I do not experience this work as emotionally draining; on the contrary,

I feel fed and upheld and filled with gratitude.”
Rev. Olivia Bareham,
Death Midwife, Home Funeral Guide,
Celebrant, Conscious Dying Educator
SacredCrossings.com

Be a Part of a Cultural Revolution

The death positive movement is about embracing death and dying,
talking about death and not ignoring it, respecting people’s wishes
at the end of life, not viewing the dead body as “dangerous” or

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untouchable, and the belief that by personally being open about death
and choices at the end of life, every individual can change the overall
culture and attitude towards death.

End-of-Life doulas and death midwives are a huge part of the death
positive movement. They aren’t just talking about what it means to
have a “good death”—but helping people have one. When you as an
individual become an end-of-life doula, you take a vital step towards
changing the world’s attitudes around death and dying.

Receive Financial Rewards While Working Your

Passion
Most end-of-life doulas get their start either by working with a family
member or by volunteering in a hospice. In other words, they do this
work for free. When you start an end-of-life doula business, you take
your previous hobby and turn it into a career.

Whether you decide to go full speed and aim to do the work full-time,
or you’re just looking to do death doula work on the side in addition
to whatever you do full-time, either way, you will make money doing
something you love. You will be providing a valuable service to others
and making a difference in people’s lives (and deaths!), while earning
an income that will allow you to continue to dedicate your time to this
important work.

1.4 Inside This Guide

By purchasing this guide, you have already taken the first step towards
starting a successful career as an end-of-life doula or death midwife.
Are you ready to learn what you need to know to get started? The
following pages will give you all the information, resources, and
tools you need. You will learn about what end-of-life doulas do, how
to gain and improve upon the skills you already have, how to start
your business, and how to let your future clients know you’re here and
you’re ready to serve them.

Chapter 2 (What an End-of-Life Doula Does) will teach you the essentials
of death doula work. You will learn about the variety of specializations
open to you, and why you may want to consider focusing on one or

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FabJob Guide to Become a Death Doula

a few of them. You will learn what kinds of tools and items you need
to serve clients and offer physical, spiritual, and emotional comfort.
You will learn how to be a better listener, how to “hold the space” for
someone, and how to be fully present. (Skills, by the way, that you
can use in all areas of your life.) You will learn how to do an initial
client consultation and learn how you can be best of service to those
that want to work with you. You’ll learn about the physical, emotional,
practical, and spiritual needs of the dying, how to help your clients get
those needs met, and how to provide support to the dying’s friends
and family members. You’ll get ideas on how to start educating the
public about death doula work and how to work alongside other dying
professionals.

In Chapter 3 (Getting Ready), you’ll do a quick assessment of the skills

you already have and start thinking about the skills you need to gain or
improve upon. You will learn how to “learn by doing,” one of the best
ways to gain skills as an end-of-life doula, and how to learn from others
who are already in the end-of-life doula community. You will learn
about the many educational opportunities for end-of-life doula and
death midwifery training, learn what you need to know about gaining
certification, and get an insider overview of some of the top end-of-
life doula training programs. You’ll also get ideas on how to further
expand your skills, and find resources for studying on your own.

In Chapter 4 (Starting Your Own Business), you’ll get the nitty-gritty

details of what it takes to start a business, including how to create a
business plan for success from the very start, what you need to know
about legal structures, and how to handle the basics of making smart
financial business decisions. You’ll learn how to set up your fees for
your doula work, and what the average going rates are for death doula
work. You’ll also learn about hiring support staff, something you may
not be thinking about now, but in the future, as you gain more clients,
this information will be invaluable.

In Chapter 5 (Getting Clients), you’ll learn about the essentials of

marketing, and how to let the world know you are open and ready for
business. You’ll learn how to get publicity for your death doula business
both for free and for a fee. You’ll learn how to sell your services through
networking and how to handle calls from interested clients. You’ll also
learn about writing a contract for your death doula work.

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Finally, in Chapter 6, you’ll get some last words of inspiration and

encouragement, to get started in your new career.

After completing this guide, you will soon find yourself ready to start
working as an end-of-life doula or death midwife. Let’s get started!

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FabJob Guide to Become a Death Doula

2. What an End-of-Life Doula Does

“Preparing to die actually prepares people to live. I work in death—it
enriches everything!”
Alua Arthur,
Going with Grace
www.goingwithgrace.com

You know that end-of-life doulas provide holistic, nonjudgmental, non-

medical support to those nearing the end of life. They empower men
and women to consider what a “good death” means to them and then
support them as they seek that “good death.” They encourage those
with life-ending illness to make the most of their last years, months,
weeks, or days, so they can pass in peace. They also support the friends
and family of the dying.

But what does that look like, day by day? What does an end-of-life
doula actually do?

This chapter looks at the broad range of areas where death doulas and
midwives put their skills to work.

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You won’t apply or use every one of these techniques or services with
every client. In fact, you shouldn’t! Your number one job is to listen to
your client’s needs and start there. (See Sections 2.3 and 2.4.) However,
after reading this chapter, you will be well prepared to meet those
needs in a variety of ways. Your end-of-life “doula toolbox” will be
well stocked.

2.1 Specializations
“Being a Death Midwife covers a wider range of opportunities than
most folks think. They often visualize sitting by the bedside of the dying.
Most likely, no one is an expert on all of the aspects. Find the piece that
is your passion and anchor there. Much work is done with those who are
very actively alive, and not even experiencing a health crisis. We need
people to open doors, introduce concepts, be way showers as well as end
of life companions, ministers, and ritualists.”
~ Patricia Ballentine,
Ordained Minister and Priestess,
Certified Death Midwife

End-of-life doula work has so many potential paths. The services that
one death doula offers can look completely different from what another
does, and neither is “doing” it wrong. As long as the basis of the work
is nonjudgmental, nonmedical, empowering support for the terminally
ill (at any age), elderly, or dying, it’s death doula work.

What are your options? Check them out below.

TIP: Don’t feel overwhelmed by all the potential specializations!

If you’re unsure what you should be offering or what your
area of specialty should be, go back to your why. Why are
you interested in death doula work? What has peaked your
interest? Your path is hidden inside the answer to that
question.

Also, be open to the fact that the more experience you gain, the more
training, and the more education you receive, your specialty may shift,
change, widen, or deepen. That’s okay. It’s good, in fact.

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2.1.1 Elder Care

Elder care doula work could be considered a separate kind of doula
work than death support. And yet, it also naturally fits alongside
midwifery for the dying. Quite a few death doulas offer elder care
doula services.

Elder care doula work involves practical, emotional, and (sometimes)

physical (but not medical) support of elderly clients. This is also
sometimes called companion care.

Your client may be healthy, well, and living at home. They may be
living with a family member. Or, they may be a resident in a nursing
home. With elder care work, the person you are serving may hire you,
or you may be hired by a family member.

Elder care can look very different, depending on the needs of the client.

With one person, you may visit the client in their home weekly for a
few hours, helping with light housework, providing companionship,
and maybe running some simple errands for them or with them.

With another client, you may visit them in a nursing home setting,
offering primarily social and emotional support, ensuring their basic
needs are being met, and reporting back to the family that possibly
lives far away and can’t visit regularly.

In either case, you are also hopefully offering more than just practical
support, but also holding the space for them to talk about their lives,
their legacy, and encouraging them to make the most of their final
years. You are more than just a housekeeper. You are also a sort of life
coach.

Unlike your terminally ill clients, planning for death isn’t the key focus.
Yet, empowering your elderly clients to consider death planning may
be a part of your job description.

In these ways, death doula work and elder care work fit together nicely.

Note that your elder care clients may one day become death doula
clients. This may be a seamless transition, or there may be a gap in

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years of service. When there is a gap in service, they may come back
to you during their final months because they remember your support
fondly.

2.1.2 Providing Support and Comfort to the

Terminally Ill
“While traveling, I met this woman from Germany on a bus, and we
got to talking on this long ride. I found out she had uterine cancer, and
she wanted to travel to her favorite places before she died. We spent
time making meaning out of her life, and I realized then that I wanted
to support people in preparing for their death. I never had seriously
considered my mortality, and here I was having a conversation with
this woman about hers. A year after getting clear that this was my
life’s work, my brother-in-law became ill, and I supported him and his
family through the last few months of his life. It was then I discovered
the incongruency of the medical support team, the hospice team, and the
funeral staff of how to really support families in this time.”
Alua Arthur,
End-of-Life Doula
Going with Grace
http://www.goingwithgrace.com/

Supporting those diagnosed with a life-limiting disease is possibly the

essence of death doula work. However, this isn’t true for every death
doula. Some choose to focus on just the very end, providing primarily
vigil planning and support, and possibly home funeral guidance. (See
Section 2.1.7 and 2.11.) For this reason, focusing on supporting those in
the final years (as opposed to only the final weeks or days) could still be
considered a “specialty” of death doula work.

As you can see from death doula Alua Arthur’s story, supporting
a terminally ill patient may look more like life coaching, with an
awareness of death planning—as it was with the woman on the bus,
traveling after a diagnosis of uterine cancer—or it may be a much more
intense, immediate support situation, like it was with Alua’s brother-
in-law.

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FabJob Guide to Become a Death Doula

The terminally ill or their family members may seek out your services
early in the diagnosis period—possibly when they still have years to
live—or they may not find you until the end is very near.

The kind of support and services you provide will vary based on the
needs and health status of your client. But the essence is the same:
empowerment, education, emotional support, and advocacy.

2.1.3 Respite Care for the Family

Respite care is short-term relief for primary caregivers. When someone
is seriously ill, the ill or their family members may require or want
someone present at all times. This can be difficult for the caregiver. Also,
if someone is in the process of dying, leaving the dying person’s side
can feel impossible.
And yet, the dying
process can take days
(or weeks.) It’s simply
not healthy for one
or even two primary
caregivers to be there
every moment until
the end.

An end-of-life doula
may offer services
to sit with an ill or
dying family member so the caregivers can get a break. Sometimes,
this respite care doubles as death doula care for the dying as well. In
other words, the doula may be offering non-medical comfort measures,
a compassionate ear, or helping them plan for their death; while also
giving the caregivers time to themselves.

In other situations, the ill or dying person is not conscious, or they may
be mentally unable to engage with the doula. The death doula will still
use their knowledge and skills to provide a calming, peaceful presence
for the ill or dying, but it’s a slightly different kind of support.

Not every death doula does respite care specifically. They may refer
clients to respite care service providers or work alongside respite care
professionals.

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2.1.4 Facilitating Legacy and Life Review Projects

“No person dies without a reason. And no person lives without a reason.
Life has to have purpose and meaning in terms of value and fulfillment.
Without that, it is empty. In whatever work I chose to do, the purpose of
my life is not to be something else or someone else, but to become more
of myself.”
Carol Neustadt,
Certified End-of-Life Specialist (CEOLS)

In the context of doula work, legacy projects are a way for someone—
anyone, they don’t have to be dying—to create a physical remembrance
of their life story or values. They are usually intended to be passed onto
the next generation or be left as a memorial, a gift to those left behind.

Life review projects are similar to legacy projects, though there may not
be an intention to share with others what’s created. They might remain
private to the individual.

Both legacy and life review projects enable the terminally ill to consider
the whole of their lived experience so far. Life review is a natural part
of the dying process. Creating a project can take what’s typically an
internal “project” and make it something tangible. This can be healing
for not only the dying person but also their loved ones.

Some doulas specialize in facilitating legacy or life review projects. Not

every doula offers this as a service, though even those that don’t make
it an official part of their business may get clients who would like to
work on a legacy project.

Section 2.5.2 will give you more guidance on how to facilitate legacy or
life review projects.

2.1.5 Conducting Living Funerals

A living funeral gives your client the chance to be there when their
family and friends are actively remembering and reminiscing about the
client’s life.

Sometimes also known as a pre-funeral or living wake, it moves the

celebration of a person’s life from after death to before death, so the

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FabJob Guide to Become a Death Doula

celebrated person can be there to cry, laugh, and enjoy the memorial
held in their honor. Living funerals can also help families and the
terminally ill come to terms with the upcoming death and recognize a
good life lived.

Living funerals may also be held for those who are healthy and well.
They are not exclusively for the terminally ill. In this context, they can
help people consider their own mortality and the kind of legacy they
want to leave behind before they leave this world.

Death doula Emily Cross offers a living funeral ceremony intended for
healthy participants.

Living Funeral attendee Sam Sanford had this to say about the
experience:

“It can be hard for me to immerse myself in an experience, as I tend to

maintain a detached, analytical stance and sort of view what’s happening
to me from a distance rather than experiencing it. But Emily’s ceremony
really opened my heart, both in making me think about my life and what
I will leave behind when I die, and in hearing the other participants’
thoughts about their own lives. Hearing everyone’s reflections on their
lives, messages to their loved ones, regrets and wishes read aloud was
deeply moving and connected all the participants intimately. This heart-
opening experience was the perfect preparation for the visualization of
dying that followed, and when we were subsequently guided back to life,
we felt real joy at being alive and having a second chance to create the
lives we really wanted. It can be hard to market a ceremony like Emily’s -
people see the word ‘funeral’ and assume it’s not for them. Our culture
does not like to talk about death. But nearly everyone has the feeling that
they are not living their best life, and a ceremony like this is a powerful
way to make big changes toward living the life you dream of.”

2.1.6 Planning and Conducting Vigils

Planning a vigil is a common service offered by most end-of-life doulas.
However, the degree to which the doula is actively involved can vary
significantly.

For many death doulas, they are primarily a consultant with the family
and the dying individual. They assist the dying and their loved ones

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to come up with a plan, but they don’t carry out the plan. The dying
person’s caregivers do.

However, there are doulas that focus almost exclusively on “vigiling”—

not just planning the vigil but also being there alongside the dying in
the last days.

Just like a birth doula sits with an actively laboring woman and
provides comfort, support, and advocacy, a death doula who offers
active vigil care does the same—but for the active dying phase.

Frequently, because the active dying phase can take place over a
number of days, doulas that offer these services will work as a team or
with a partner.

Doulas who offer active vigil service are “on call.” That is to say, they
must be prepared to go whenever the family or hospice professionals
say the time is near. This could be in the middle of the night or on a
weekend or holiday. While other aspects of death doula work can be
scheduled, this kind of doula’ing can’t be planned in advance.

Sometimes, death workers who focus on vigiling prefer to call

themselves death midwives. A childbirth midwife is there for the birth
and transition into life; a death midwife is there for the transition into
death. Others object to the title of midwife for death vigiling because
the root of the word midwife means with woman—and of course, death
doulas/midwives sit with the dying no matter what their gender. What
you decide to call yourself, if you offer this service, is a personal choice.

2.1.7 Mourning and Post-Loss Support

Mourning doulas provide support for those who have recently lost a
loved one. They may offer practical and emotional support. They may
also help them with post-death arrangements, especially when death
was sudden or there were no pre-existing plans.

There are some that confuse this kind of support with taking the
place of a funeral director, but that’s not so. A mourning doula is not
a funeral director. That said, the doula might refer clients to local
funeral directors or help inform their clients of alternative options for

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disposition of the body. They may also discuss options like green burial
and home funeral arrangements.

2.1.8 Facilitating with Post-Death Home

Organization
Also known as material artifact support, some death doulas specialize
in offering post-death home organization. Going through the
belongings of a friend or family member who has recently passed can
be emotional and overwhelming.

Death doulas that offer material artifact support may work with
the family after the death, or they may work directly with a person
diagnosed with a life limiting illness. For a dying individual, making
decisions on what to give to their loved ones, what to dispose of, and
what to display (possibly as part of a legacy project) can be comforting.

Dying individuals often worry about “being a burden” to their family.

Taking care of this typically post-death activity can relieve some of that
anxiety.

Material artifact support may involve primarily consultations, or it may

include hands-on support. This will depend on the desires of the client.

2.1.9 Pet Death Doula Services

Some death doulas specialize in helping people cope with the loss of
their pets. They may create rituals or ceremonies for when a pet owner
has to euthanize their beloved companion. They can offer practical and
emotional support to both the pet and the owner before, during, and
after the loss of a pet.

Pet death doula work is much needed. “It’s underestimated,” explaind

Ute Luppertz, a pet death doula in Portland, Oregon. “Most of our
animals will die sooner than we do. The veterinarians are really
compassionate, and they have to [put animals to sleep] every day, and
other than that, people are on their own.”

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As pet deat h
doula, both
the pet and the
people will be
your clients. “I
also take the
animal into
consideration,”
explains Ute.
“Because I do
a lot of healing
work and
intuitive work.
The animal is
my client, and I support the person too. They are both my clients. I have
done a lot of active support. People have hired me to be there during
euthanasia. We prep the family; we prep the children. And when I
say prepping, I mean, ‘How can we make this as inclusive as possible
and as dignified as possible, and not run with a panic?’ when trying to
figure out when is the right time to put an animal to sleep.”

Ute continues: “There are all these things that veterinarians say, and
bless their heart, I understand why, but they will say, “You know
when it’s time.’ And I cannot tell you how many people tell me that
they didn’t know. And I say, I understand. It depends on the illness.
Sometimes, it’s very clear. Very often, it’s a roller-coaster ride, and you
don’t quite know when it’s time. It’s not easy to gauge. There are so
many things that people think they should anticipate, and sometimes
that’s the case, but you know, where you see a predictable outcome,
usually with a terminal illness, it is predictable, but also, I tell people
that animals only show anything when the stress is insurmountable
because their DNA dictates to them, not just to show it. Because in the
wild, they will not survive if they complain like you and I.”

Check out Ute Luppertz’s beautiful website:

Pets Point of View: Death Doula Service for Pets
https://www.pets-point-of-view.com

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What Does Pet Death Doula Work Look Like?

Ute Luppertz’s shares two stories of what it may look like to
support a pet and the family during death:

“I was working with one family for many years. And one of their dogs
died, and he was also the special needs child of the family, so in his
younger years, I did a lot of behavioral work with him when he was
younger. They had us over the day before the dog was euthanized.
We just talked about the what, if, and when. Because she [one of the
dog’s owners] wanted it a certain way, with only her veterinarian, on
a certain day, etcetera. And I said, “Look, I understand... but what do
you need to look at if he takes a turn for the worse that night?” And the
dog actually did.

“She ended up having to use someone she didn’t know. I know the
company, it’s a group of veterinarians, they are absolutely fantastic.

“Next, the practical… and so I said, okay, you know how to do this
yourself but… if you want me to, I make the phone call to the vet.
I have the credit card. I will meet them at the door. I have someone come
over to take care of the other dogs. I ask, “Do you need someone to bring
food?”

“Simple things, but when you’re in the thick of things, very practical
things. What I did the entire time is I gave them space, husband and
wife, to be with their dog. Everything else was taken care of, and it
looked like a very practical measure. However, I also made sure that the
energy field was harmonious for him by the time the vet came… I would
check and ask, Are there Kleenex? Do we need to do this, do we need to
do that? Do you want to bring him to the cremation place today? Do
they know you are coming? What else do you want me to do?

“In essence, it’s something that anybody could do, but because I
understand the nature of the situation, I do it in a very calm way.
I make sure everybody is supported. I make sure if they need their
favorite junk food or a glass of water, whatever it is, I make sure they
have it. Do they have blankets for the dogs because they might urinate
or defecate after they take their last breath? Simple things, but they are
so massively important.”

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“I had another situation with a dog… they called me for the

euthanasia, and the dog was very far gone even prior to the arrival of
the veterinarian. He probably would have died within an hour. Totally
gone. And I arrive at the scene, and the whole group of girlfriends are
gathered around the dog, and that was good. And then the dog started
very labored breathing, and there is the same thing when you go into
labor with giving birth, it is the same thing with death. It’s called the
death rattle… and it doesn’t look pretty when you don’t expect it from
a pet. The women were just getting really emotional, they clustered
around him, and I could feel he was in distress. And I said, ladies, you
need take one step back. This is very natural. He is preparing to die.
And the breath gets very erratic, and it’s not pretty. But this is what
he has to do to separate from his body. This is a very natural process.
One of the girls asked, “Is he in pain?!” And I said, no. He was not
mentally there, he was far far gone. But he could sense when they got
really emotional, I said please, just take it a notch down. It will not help
him. I have seen animals pull themselves back in when someone says,
‘Oh no Fluffy, please don’t go, don’t go, don’t go.’ And I completely
understand it. But if someone hires me for that occasion, I say, “What
can we do to keep it calm and peaceful for your dog?”

“Different situations call for different interventions. What it comes

down to it for me is… how can I create the most peaceful environment
possible for the animal to do what they need to do? And it’s also super
super intense for the person.

“If people work with me ahead of time, we can usually achieve a better
situation. We know we need to pay attention when is the right time for
euthanasia and how… but also, how can you all prepare one another?
Tell each other stories, write letters, do whatever it takes. I like rituals,
any kind of traditions, every culture has something ritualistic around
death, and I encourage people to think about what works for them. I
don’t care what it is. It’s not that you have to do something religious.
But something that gives you a feeling of significance, that the death is
not less because it’s not a person.”

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2.2 Tools of the Trade—And How to Use

Them
The primary tools of death doula’ing are your own heart and soul.
There are, of course, also physical tools—practical items—you may
want to have on hand or easily available to you.

What you bring with you will depend on if you’re meeting a client for
an initial consultation, reviewing advanced care directives, working on
a legacy project, or sitting by the bedside. What you bring for a vigil
will be different from what you bring for a mourning doula visit, post-
death, or what you might bring for a living funeral ceremony. You
also may not always know what awaits you when you’re called in to
support someone.

The following list isn’t broken up into specific categories of service

because many of the items can be used in multiple settings.

Your use of items also depends on your style. For example, some may
approach working on advanced care directives in a formal, meeting
style way. Others may approach it with a spiritual, more ritualized
style. In one case, writing devices will be your primary tools. In the
other case, having lit candles or even relaxing music playing while you
work on the paperwork together may not be unusual.

Here are items you may want to have available or on-hand as you work
as a death doula or midwife.

Candles
Make sure you have both unscented traditional candles as well as
electric, “flameless” candles. You can’t use real candles where an
oxygen tank is in use or in the hospital environment. This is where
electric candles can really come in handy.

Also, for your real-flame candles, have something to place the candle in
or on, both for safety’s sake and for beauty.

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Aromatherapy Tools
Appealing to the sense of smell can calm the dying and the well. You
may want to use aromatherapy tools during consultations, visits with
your client, or during vigiling.
Some people
have allergies or
sensitivities to
aromatherapy
oils, so always
make sure to
discuss this
with your
clients and their
visiting friends
and family
before you use
them. If you’re
working inside
a hospitial, hospice, or nursing home, check with staff before using any
aromatherapy tools that will diffuse the scent beyond the bedside of
your client.

Also, be cautious with using oils on the skin, especially on the

terminally ill or elderly. Aromatherapy oils can cause irritation and
even serious burns. They can also interact with medications. Those
who are not well are at higher risk for these negative side effects. Those
who are not fully conscious may not be able to tell you if something is
causing pain or physical damage.

If you bring a diffuser for the oils, make sure it is flameless. Choose and
use the oils lightly. Don’t overdo it. Just a hint of scent can be best.

Note: Aromatherapy oils can be dangerous if used improperly. They

can cause damage to a person’s health, skin, or lungs. Make sure you
are well educated in their safe use before you add them to your toolbox.

• National Association for Holistic Aromatherapy: Exploring

Aromatherapy Safety
https://naha.org/explore-aromatherapy/safety

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• Aromatherapy Safety: Alliance of International Aromatherapists

https://www.alliance-aromatherapists.org/aromatherapy-safety

Softer Scented Items

Using scent to calm and comfort doesn’t have to be limited to essential
oils. You might also consider having other sources of pleasant scents,
like…

• Dried herbs

• Sage sticks

• Twig of rosemary

• Mint leaves

• Cinnamon sticks

• Fresh or dried flowers

You may consider just having these items nearby for a quick whiff or on
a table by the bedside. As with aromatherapy oils, always talk to your
clients first about possible allergies or sensitivities before you bring
anything like this into their environment.

Gentle Moisturizing Creams, Lotions, or Massage Oil

Lotions, creams, and massage oils can be used to offer physical,
non-medical comfort. Having a variety of options—including
hypoallergenic non-scented oils, and perhaps some with soothing or
relaxing scents—is a good idea.

As with aromatherapy use, always ask your client and their family first
about allergies or sensitivities to chemicals or scents.

Music Player and Auditory Tools

The sense of hearing is one of the last to go in the dying phase. Having
relaxing or beloved music softly playing can be a source of comfort.

If you meet the client while they are able to communicate their wishes,
you can ask what music they prefer or would enjoy. If not, talk to family

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members about what they think their relative would have wanted if
they could tell you.

You could play music from your smart phone, but having a Bluetooth
speaker (preferably battery operated or cordless) can be better. You will
still likely want to play the music softly, but the quality will be higher.

You may also want to have headphones with disposable ear bud tips.
Another option is over-the-ear headphones and an alcohol-based spray
cleaner to sanitize them after client use.

Besides music, you may also want to have available:

• Books on tape—especially sacred texts

• Guided imagery recordings—ones you’ve created yourself or

purchased recordings

Visual and Audio Recording Devices

You could use your personal phone to take photos or video, but there
are several reasons why this may be less than ideal. For one, you’ll want
to protect the privacy of your clients. Having your personal pictures
and video along with client images on your phone could make that
difficult. Also, you may want or need to use your phone for something
else.

Whether you decide to use your personal phone, an older smart

phone you’re not using personally, a camera, a video camera, a laptop
with video or audio recording functions, or an old fashioned audio
recording, having these available in your death doula work can be
helpful.

You might use these recording devices to...

• Takepictures for the family—like to capture a touching moment

when a family pet lies on the bed near their master

• Video tape or audio record life stories, so the family and friends
can watch and remember these tales

• Help create a legacy project

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Charging Cords and Backup Batteries—For Everything

For your personal phone, a smart phone you might be using to play
music with or record video with, for the Bluetooth speaker, for the
flameless candles, (possibly) for the aromatherapy diffuser.

Art Supplies and Journaling Paper

Art supplies may come in handy for legacy work, especially if your
client wants to go this direction when creating one.

Art supplies can also be nice to have simply for comfort or distraction,
for clients or family members. Adult and even children coloring books
may come in handy.

Blank journals or fancy journaling paper can be used for legacy projects,
letter writing, or simply self-reflection.

They may also be used to keep a diary, especially if individuals holding

vigil changes over the hours and days. This way, there is continuity in
the narrative for the living.

A Notebook or Legal Pad

You always will want to have a notebook, legal pad, or computer to
take notes. You want to keep track of the needs of your clients, work on
paperwork or consultation paperwork, mark down changes in plans,
and so on.

A big part of your role is helping plan. Writing these plans down is
essential. Plus, you’ll want to mark down questions you need to
research for your client.

Even if you’re not specifically working on formal paperwork, you will

still want to have notes. Right now, when you’re starting off, you might
figure you can remember the details of each client’s situation, their likes
and dislikes, their fears and desires, etc. However, as you gain clients,
it will naturally be harder to keep track. Better to develop a habit of
taking notes.

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Official Forms, Documents, and Guides

Especially if you’re helping people with advanced care directives,
or helping to create vigil plans, you might have forms—ones you’ve
created yourself, purchased, or found for free online—that you use to
guide clients.

You’ll want to have at least a few copies of your primary documents

and forms.

Sacred Texts
You might want to keep on hand at least the most popular sacred texts
from various religions.

That might include having a copy or excerpts from…

• The Bible

• The Koran

• The Torah

• The Book of Mormon

• A hymn book or two

• A Jewish prayer book (known as a siddur in Hebrew)

You can have all these in electronic format. Don’t picture carrying
around a huge stack of books!

As a doula, you are not there to convert or pressure any client into any
particular belief. That would be unethical.

However, you will likely serve people who gain comfort from religion.
Sometimes, even someone who has not been actively involved in
religion in decades will suddenly wish for someone to read Biblical or
other sacred texts to him or her.

The family may have these texts available. Many hospitals and hospices
have some texts available to borrow.

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But, just in case, it can be nice for you to be prepared.

Books of Poetry or Classic Tales

Besides sacred texts, having a variety of secular literature to read
out loud can be nice. Look at poetry and even classic children’s story
collections.

It’s also possible that your client will request a specific book or books to
be read to them. You should accommodate this as best you can. If they
don’t have the reading material available for you, remember that most
libraries offer electronic book borrowing.

Non-Latex Gloves
You won’t be providing medical care, but you still will want to have
non-latex gloves available. You can use them when applying physical
comfort measures, like helping to apply Vaseline on dried out lips, or
use them if you are gently applying massage oil or lotion to the arms,
hands, or feet of your client.

Any activities of daily living that a family member may be expected to

do, you might find yourself also providing or assisting with. This can
include helping shift the position of the terminally ill client, helping
with bathing, or assisting with keeping them clean and dry after
urination or bowel movements.

How involved you’ll be with this kind of care will depend on your
comfort level, the client’s, and their family. It will also depend on the
environment. For example, in a hospital, hospice, or nursing home,
there are certified staff who take care of these issues.

If the family has decided to personally wash the body of their loved
one after death, you will want gloves to assist or stand by during this
process.

Hand Sanitizer
You’ll want this for both before you walk into a client’s room or home—
you don’t want to be responsible for passing on illnesses—and after
working with clients.

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In a hospital, hospice, or nursing home, there will likely be plenty of

places to wash and sanitize hands. Still, it’s good to have your own just
in case.

(Inexpensive) Washcloths
When possible, it’s best to use the washcloths available in the person’s
home, or those provided by the hospice or hospital. However, in the
event nothing is easily accessible, having some cheap washcloths on
hand can be useful. If they are cheap, you won’t feel bad throwing them
away after use.

They can be used to carefully dab the forehead with cool water or be
used to clean up spills or accidents.

Chapstick and/or Vasoline

In the last week or days of a person’s life, dry lips and mouth can be a
problem and a major source of discomfort. Having something to relieve
that discomfort can be helpful.

If you use something like Chapstick, use a gloved finger to apply it.
Don’t directly apply the stick to the lips, unless you will then leave it
with the client.

Oral Swabs
The mouth can feel dry and become uncomfortable at the end of life.
Dental oral swaps can be used to apply moisture. These are sometimes
known by the brand name “Toothettes.”

The swabs can be simply dipped in water or a saline solution.

Sometimes, a dying person doesn’t want to drink, but gentle sucking on

fluid through a dental swap can be comforting. They can be dipped into
a favorite drink for flavor.

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CloSYS Alcohol Free Mouthwash

Oral swabs may used to apply mouthwash, to help give a clean, fresher
oral experience, but many mouthwashes are too strong for those near
the end of life or in the active dying phase.

Jason Olson, a dental hygienist and former certified nurses aid,

recommends using CloSYS Alcohol Free Mouthwash. This is a non-
prescription mouthwash that is gentler than more common dental
rinses.

Library of Books on Death and Dying

You might not be carrying around a library of books of death and
dying—but having books available for clients to borrow might be
something you consider. These might be books you read while training
for your role as a death doula.

You might have a laminate sheet that lists your books open for
borrowing.

TIP: Look into purchasing Barbara Karnes booklets on

death and dying. They are easy to read, inexpensive
(especially when bought in bulk), and can be a source
of comfort and reassurance to your clients and their
families. Karnes books on death and dying are considered
classics. If you have not read them yet, you should.
https://bkbooks.com

Extra Change of Clothes for Yourself

Always have an extra set of clothes with you, either in your bag or in
the car. You never know when you may get soiled with body fluids,
especially when you’re working with the ill.

Also, if you’ll be sitting vigil for hours, you may want a fresh change of
clothes available—even if you’re not necessarily “dirty.”

Should you wear scrubs? It’s your choice. There are advantages and
disadvantages.

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Advantages include easier washing and care, you don’t have to worry as
much about them getting dirty or stained (it’s not your favorite blouse),
ease of movement, and it can indicate to healthcare professionals that
you, too, are working in a professional role.

A disadvantage is they may make it look like you are part of the
healthcare staff (which you aren’t.) They can also trigger negative
feelings in clients who have had a bad or traumatizing experience with
medical care.

TIP: What you wear can have an effect on those you are
caring for. According to this fascinating article on death
doula and hospice clothing choices (https://www.racked.
com/2017/10/18/16469252/death-doula-clothing-hospice),
wearing all white flowing clothes, all black, or reds can be
problematic.

Care Items for Yourself

Especially if you’re sitting vigil, you will want basic care items with
you, for yourself: toothbrush and toothpaste, mouthwash and/or breath
freshener gum, a water bottle, snacks, or protein bars.

You might want to have items that you use for comfort after being
with a patient as well. Don’t forget about your own emotional and
physical care! For example, you might keep a private journal. You may
have items you use after meeting with someone for ritual or spiritual
comfort. You may have your own private music and headphones.

A Bag, Box, or Carry-On Suitcase

You will need something to carry all this in! Depending on what you’re
carrying and when, you might have a simple backpack, a more formal
briefcase, or even a small carry-on suitcase with rollers.

Your Pet—If They Are a Trained Therapy Animal

Yes, your pet may be a “tool” you include in your “doula bag.” This
will only be true, however, if your animal is a trained therapy animal
(https://www.akc.org/canine-partners/which-is-which-therapy-dog-

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or-service-dog/). You would not want to bring along your pet if you
and they have not formally studied how to provide therapy through
animal service.

As always, be sure to confirm with your client and their support team
if a therapy animal is welcome and if there are any allergies (or animal
fears) you should know about. Also, if the client has their own pet or
animals present, bringing a therapy animal may not be appropriate.

2.3 How to “Hold the Space” for Someone:

Your Most Vital Service
“Self reflection is key to cultivating an ability to hold space for others.
In my opinion, too many enter this work because they feel enlightened
by their own version of ‘death acceptance’ and wish to peddle that for
others. We need to learn how to get our own agendas out of the way to
meet folks where they are at.”
Cassandra Yonder,
Community Deathcare Activist and Educator
www.deathcaring.ca

One of the most important services you offer is “holding the space.” If
you are to succeed as a death doula, holding space for the dying and
their loved ones will be the skill you must practice and perfect (as much
as possible.)

You will likely find yourself holding space…

• During initial and subsequent consultations

• When sitting with your client, for any reason

• When facilitating advanced care directive planning

• When facilitating funeral and/or burial planning

• When vigiling

• In the moments just after death

• In sitting with a mourning family

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• Any time you are interacting with anyone as a doula

What does it mean to “hold the space” for someone? There’s no agreed
upon definition, but it might be defined simply as…

• Being with a person without judgment

• Accepting their emotions as they are, without trying to fix them

or take them away

• Truly listening to what they are saying, without spending time in

your head trying to “figure them out” or come up with a solution
or response

• Allowing your emotions to be present too, without having them

overtake you. (It’s okay to tear up or laugh—but don’t lose your
composure. Don’t make this about you.)

You likely know what it feels like personally when someone “holds the
space” for you. Getting in touch with how it feels when someone holds
the space for you can help you learn how to hold space for others.

When someone holds the space for you, it can be an amazing, healing
experience. Calming. Comforting. Like everything is going to be okay,
even if things are not “okay.”

It is the difference between being vulnerable with someone and finding

yourself feeling defensive or shutdown—versus being vulnerable and
feeling understood and accepted just as you are.

When someone tries to “fix” things too quickly or jumps in too fast
with their own stories, you walk away feeling as bad or maybe even
worse than when you shared your struggle.

When someone “holds the space” for you, you feel lighter, more at ease,
and loved. You feel this way even if you’re actually more in touch with
the depth of your sadness or difficult emotion.

A person holding space for you gives you permission to be with your
intense emotions, and this allows your pain to flow. Flow is how
emotions move through us. Trying to stop the flow doesn’t make it
better. It creates flooding. Overwhelm. Going with the flow is how we

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process what we’re experiencing and (eventually, in our own time)

move past into the next phase or emotion.

Whether you’re meeting with a client for the first or tenth time, or
you’re sitting vigil by the bedside, here is how to get better at “holding
space” for someone.

TIP: Practice these techniques and skills with your friends and
loved ones. It’ll help you be a better doula and a better
person. Ask a trusted friend to actively practice and provide
feedback. In other words, let them know you’ll be holding
space for each other for five minutes each. Then, after, agree
to share with each other what helped and what could be
worked on to improve your skills.

Get comfortable with silence.

“It’s not about you! Stop overlaying your own interpretations, belief
structures, world view… Be present and attentive, but not overbearing.
Get comfortable with silence. Words are not always necessary.”
Rev. Angie Buchanan
http://deathmidwife.org

We are uncomfortable with quiet in conversation. This is why we

sometimes feel the need to quickly jump in with a solution or personal
story. Resist sharing a personal story or experience.

Learning to get comfortable with silence is essential. Giving someone

time and space to sit with what they just shared can help them process
their own feelings and allow them time to think of what they want to
share or say next.

Sometimes, an understanding nod, sound of affirmation (“mmm… “) or

encouragement to share more (“Tell me more.”) can help. Sometimes,
silence is what’s needed most.

Let go of having the “perfect response.”

When you make friends with silence, it’s easier to let go of having that
perfect response. We can get so busy with trying to think of what to say
that we’re not even listening to what the person in front of us is saying.

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When you’re comfortable with not having the “perfect” response, you
can sit and listen.

You’ll spend less time trying to think of what you’ll say, more time
“holding the space” for your client.

Let go of thinking you know “exactly” what this person needs or

should do.

Being a doula is not about making decisions for others or telling them
what a “good death” looks like. That’s not the doula’s role.

Here’s some wonderful advice from death doula Carol Neustadt:

“It’s not my story, so don’t get caught up with what’s going on with that
patient and their family. Especially when I have to work with children,
and I think, god, I would never do that. One of my managers, best advice
I ever received, said, ‘Carol, it’s not your story.’ I thought, God, you’re
so right, and I just need to be the greatest observer that I can be and just
allow their story to unfold. Not to judge, to know this is exactly what
needs to be, at this exact time for this person, and that on some greater
level, there is more going on than I can understand. I tell myself all the
time; this is not your story. It can be fun too, because then you’re just
letting whatever is going to happen in the moment, and it writes its own
story. And it can be magical.”
Carol Neustadt,
Certified End-of-Life Specialist (CEOLS)

Be okay with “not fixing” things.

You can’t take away painful feelings, and you really shouldn’t even
aim to do so. People don’t want someone to “fix” their problems—they
want someone to witness their pain and feel understood.

This can be a tricky space to be in since one of your roles is providing

informational support. However, there is a fine line between offering
guidance and empowerment, and “fixing” things and offering unasked
for solutions. There is also a difference between offering options,
compared to suggesting that you know “the best” option for them.

This is another skill you will learn with practice and time.

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Be okay with death not being “beautiful.”

In the end-of-life doula world, there is a focus on helping people have
a “good death” and make choices. This is noble, and throughout this
guide, helping people consider what a good death means to them is
discussed in great detail.

However, death is not always beautiful or peaceful. Even with planning

and support, death can be painful, messy, and heartbreaking. The
last thing anyone wants is to make a dying person feel like they are
“failing” at having a “good death.”

You can’t “hold the space” for someone if you’re concerned they are not
getting the “good death” that they envisioned or that you hoped for
them. Holding the space requires letting go of all expectations and just
being present with what is.

TIP: Read this beautiful blog post on “The Dangerous Myth

of a Good Death,” by Kathleen Clohessy (http://blog.
sevenponds.com/so-you-got-the-news/the-dangerous-
myth-of-a-good-death).

Be comfortable (or at least work on getting comfortable) with your own

mortality. Get clear on your personal thoughts on death, dying, and
even the afterlife.

You cannot “hold the space” for a person who is dying if you haven’t
yet confronted your own thoughts on your mortality and what a “good
death” means to you.

Taking time to consider what a “good death” means to you isn’t so you
can “figure out” what a good death means generally. That will differ
from person to person. This is so you can know what a “good death”
means to you personally, so you can support another person as they
consider what a “good death” means to them personally.

It’s also vital to consider what it would mean for you if death didn’t go
as planned for you personally. (For example, if it came on suddenly, or
if your last days were terribly painful.)

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If you have not confronted these questions and thoughts yourself, you
will automatically find yourself ruminating on them as you meet and
work with clients. That means you won’t be able to be fully present as
you sit with them. You’ll be in your own head, trying to figure things
out for yourself.

See 3.1.2 for more on how to get comfortable with death and dying.

Be aware that anger—even if it seems to be directed at you—it’s likely

not about you at all.

Emotions may run high for the dying and their loved ones. For that
matter, friends and family of the dying may have more difficulty
with their emotions than the dying person. Anger is just one possible
emotion that may arise when you’re working with a family.

Of course, you should never accept or tolerate abuse. That said, if and
when a family member lashes out at you, or loses their composure; try
to remember that the anger is not about you personally.

Anger can mask fear and sadness. The person may be angry at the
illness, at god, at circumstance, or at the situation. They may even be
angry at the dying person—for past wrongs or even for “dying on
them.”

However, you (or anyone) may become the target of these intense
emotions. The best thing you can do is remind yourself that this isn’t
about you. Breath deeply. Try not to go into defensive mode. And, as
long as you’re not in danger of physical harm, continue to “hold the
space.” That may mean standing there and listening quietly until the
person calms themselves down. That may mean stepping out of the
room.

Whatever you do, don’t fight back or respond with anger. More about
handling difficult family emotions in section 2.6.4.

Carefully consider the time to offer options or provide

education.
One of your vital roles is to empower your client to make decisions
for themselves. This often means providing them with information and

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options. Death is less scary when you know what to expect, and few
people know what to expect.

People frequently don’t know all their options, either. They may only
be familiar with what has been offered to them by their medical team,
or with what they’ve seen themselves when friends or relatives have
been ill. For example, they may not know that home hospice care is a
possibility. They may not know about green burial or home funeral.

You will want to help your client understand their options—but

you don’t want to offer that information at the wrong time. This can
interfere with your role as a compassionate listener.

You’ll learn with practice when is the time to “hold the space,” and
when is the time to share your thoughts and suggestions.

TIP: Ask your client if it’s okay if you jot down notes as you talk
together. Ensure them that this will help you listen to them
better. This way, you can “hold the space” while they talk
and share their wishes, fears, and questions. Then, after,
offer suggestions or information. It’s better to ask your client
to give you a moment to jot down a note, than to interject
with information or education too soon or at the wrong
moment.

2.4 How to Do a Client Consultation

“It is ok to embrace this work from a mystical and also a very practical
nuts and bolts side. Death is an extremely personal experience that every
single person on the planet goes through, and often happens in a very
public way. As Death Midwives, we must have a pretty diverse toolbox
and be willing to put it all aside. If we think we have a bucket full of
answers... we’d best check our motivation for the work.”
Patricia Ballentine,
Ordained Minister and Priestess,
Certified Death Midwife

Client consultation is how you will discover what this individual or

family needs most right now. Or, at least, what they believe they need
right now. Needs and perceptions can change with time and education.

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Sometimes, in death doula work, the majority of your work will be

consultation. A better phrase may actually be life coaching. (And death
coaching!) In fact, studying the art of life coaching may help you in
your death doula work. Your work with clients may primarily involve
sitting together, holding the space, talking about their experiences, and
providing emotional and informational support as they consider what
a “good death” (and a good life!) means to them.

You might be hired to vigil or act as a “midwife” during the death

transition—or you might be hired to offer advice and guidance on the
vigil, to help create a plan, and not be asked to be present for those
moments personally.

What an individual wants and needs will vary. Of course, this will also
all depend on the services you offer.

Depending on their current situation, topics you may discuss in depth

with a client and/or their family include...

• How they want to live their life right now

• How to start saying their goodbyes (and possibly deal with

regrets)

• How to “not be a burden” to their family (a common fear of the

dying)

• What “putting their affairs in order” means and how to do so

• What a “good death” means to them and how to have one

• What the dying experience looks like

• What their funeral and burial options are

• What support and guidance they are looking to receive from your
services

2.4.1 Initial Consultations: Deep Listening +

Empowerment
“Listen. Let go of everything you think you already know and listen to
the silence and allow yourself to fall in love.”

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Rev. Olivia Bareham,

Death Midwife, Home Funeral Guide,
End-of-Life Educator
SacredCrossings.com

Initial consultations as a death doula are typically free of charge, time

limited (15 to 30 minutes), and so important. This is the first contact
the client may have with you in your role as doula or midwife. First
impressions are vital and can’t be done-over.

At your initial consultation with a client, there are three (maybe four)
primary goals:

• Listen to their situation/story (in brief form)

• Find out what they are looking for in terms of service

• Assess whether you can provide those services and what that
plan may look like

• Ifyou are not the right person, help refer them to someone who
can help

Since that first consultation is short, you may feel tempted to jump in
quickly and sell your knowledge and your services. Or tell a personal
story.

Don’t do it. Breathe. Listen. Deeply listen.

If it helps, you can decide at the beginning of the call or meeting that
you will share only in the last 5 to 10 minutes of your time together.
This way, you feel less pulled to quickly offer fixes or responses.

If the potential client feels heard, they are much more likely to hire you.
It’s worth getting comfortable with silence and allowing them to share.
(Remember everything from section 2.3.)

TIP: Remember that you also get to choose whether you want
to work with a particular client. Sometimes, it may not feel
right to get into a contract with an individual or family.
Listen to your gut. Don’t be afraid to (politely) decline or
refer to someone else. There are plenty of future potential
clients waiting for you

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Because your first session is likely time limited, don’t hesitate to set
up expectations and boundaries right away. Your client may be eager
to share (and share a lot), but if your offer is 20 minutes for free, and
they want to go for 45 minutes, it’s better if you’ve already established
(gently, in a compassionate way) what the plan will be if you reach the
set-end time of your free initial consultation.

You might say, for example...

“I’m so excited to have this time to get to know you and see how I
might be of service. Our no-cost call today is 20 minutes, and it’s 4:30
PM right now. Let’s spend the first 10 minutes hearing what your needs
are and what you’re looking for, and the last 10 we’ll discuss whether
and how I might help. If you decide you want to speak for longer, we
can discuss how we can work together.”

Something else to keep in mind is you may find yourself educating

your client on what services and options they have available to them.
They may not really know what they need, just that they need someone
or something.

Empowerment happens when we listen and help people understand

what their options are—without putting judgments on which options
they decide to pursue.

TIP: As with any service, your client will want to ask you
questions, assess whether you’re the right person for them,
and whether you are qualified to offer those services. The
End of Life Doula Directory (Australia) website (https://
www.endoflifedouladirectory.com.au/resources/7-
questions-to-ask-when-hiring-an-end-of-life-death-
doula/) has a list of questions they recommend people ask a
potential doula. Check it out and consider… what are your
answers? You might want to have some of this information
written out and prepared in an easy to read, concise “Service
Information” handout.

Balancing time to hear a client’s (initial) story, finding out what they
think they need (or know they need), and explaining how you might
meet those needs—all within a set timeframe— takes practice. So much
practice!

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Many doula-training programs will give you advice on how to do

consultations effectively and compassionately, but at the end of the day,
the best way to get good at this is to do it.

You may not feel ready, but you may never feel ready. You’ve got to just
learn from experience.

TIP: Especially when working with someone you know

personally, it’s extremely important to be clear when
you’re offering to volunteer to help or offering services
as a professional. When you’re just starting out, working
“for free” can help you gain experience and confidence.
However, if you’re giving your time to someone—especially
if you have trained or studied to provide these services—
you should be paid. Even if it’s a small, honorary fee. If they
can’t pay you in money, perhaps they can offer a letter of
recommendation to use in the future.

2.4.2 Talking About Life and Dying

“People don’t die as fast as they used to, we’re living longer with life
limiting illness. But you still die. People who are choosing to work
with doulas are the people who are like, ‘This is happening. I want to
be prepared. I want to live fully into dying, and do some work around
it. Have things ready. Say my goodbyes. Have things lined up for my
care.’”
Merilynne Rush,
MS in Hospice & Palliative Studies, RN, BSN
Lifespan Doula Association
https://www.lifespandoulas.com/

People are going to come to you at all stages of the “dying” process.
Some will come to you when they are bedridden and the end is months
(or weeks) away. Some will come just after they receive a diagnosis,
with possibly a year or even years of life left. Others will look to hire
you when their loved one is non-responsive and the active dying phase
is about to begin or has already begun.

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There will even be people who hire you who are nowhere near death’s
door (as far as they know.) They just want to be ready, whenever that
time comes, however that time comes.

Here are some topics you may find yourself discussing with clients as
you work together.

How They Want to Live Today

Your clients may come to you looking for encouragement and guidance
on how to approach their last days, weeks, months, or even years. This
is where reading up on life coaching can be very helpful.

Sometimes, your clients will need encouragement from you to start

living (or re-living) their life. Especially when illness or treatments
from illness have overtaken their focus, it can be difficult to remember
they are more than their disease.

People like to ask the question, “If you knew you only have X months
to live…” Except it ignores a big part of the reality: that when you really
only have X months left, your fear of death, your current physical state,
or your previous focus on preventing death can keep you from living.

You can remind clients they still have time. For some, that can mean
traveling. For others, that can mean pursing dreams from a hospice
bed. Or just being present in the moment.

Being the outside observer who is not consumed by illness—or frozen

in fear or grief, as a relative may be—gives you an advantage. You can
see potential and possibility, something that they or their loved ones
may struggle to envision.

TIP: Check out Soul Pancake’s series My Last Days. You

can watch many of the episodes on Facebook (https://
w w w. f a c e b o o k . c o m / m y l a s t d a y s s o u l p a n c a k e / ) ,
and some on YouTube (https://www.youtube.com/
watch?v=9NjKgV65fpo&list=PLzvRx_johoA_k3ZX_
TATji0k_mxCxlrao). My Last Days features people who
are diagnosed with terminal illness and how they and their
loved ones prepare and live out those last months (or years).
The program is heartwarming and inspiring.

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Saying Goodbyes, Facing Regrets

Providing emotional support as a client thinks about what it means to
“say their goodbyes” and deal with regrets may be part of your work
as a death doula.

“Saying goodbyes” may look like any of the following...

• Calling an old friend to just say hello after years of being

disconnected

• Contacting people unaware of the situation to let them know the

client would like to see or talk to them (You, the client, or a family
member may do this.)

• Writingletters to family or friends—which could be meant to be

read now or after they are gone (or both)

• Creating video messages for loved ones—for now or for watching

after death

• Writing a letter that is never sent, to relieve guilt or ask

forgiveness, from those alive or passed

• Actually sending a letter asking for forgiveness—or offering

forgiveness

• Working on a legacy project, where they consider the life they

have lived, their values, and their family history—with a goal of
passing the project on as a remembrance

Putting “Ones Affairs” in Order

People talk about “putting your affairs in order” but… what does that
mean? As a death doula, that may be something you discuss with a
client.

It can mean…

• Having all important legal documents in a secure known place

• Ensuring the spouse or significant other has a way to access

important accounts

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• Puttingtogether advanced care directives and discussing them

with medical care providers and family members

• Having a plan for what should happen to property—having this

all legally documented in a will

• Having plans on what should happen to personal belongings (the

little things that a will doesn’t cover)

• Having funeral, burial, or cremation plans considered and

planned ahead of time

• Arranging a health care proxy according to local law and

regulation, even if one isn’t needed right now

• Having a plan for social media, email, or other electronic

accountants after death—Facebook allows you to have what they
call a Legacy Contact

A lawyer isn’t needed for all of these activities. However, in some cases,
a lawyer’s services may be required or preferred. This is when having
business connections with local lawyers can help. You can refer clients
to people you trust. If you develop a good business relationship, they
may in turn refer new clients to you.

Remember: It’s not necessarily your job to carry out these “putting of
affairs in order” activities, but only to guide your client as they explore
these issues, help them come up with a plan that feels right to them,
and offer local resources and information.

Fears Around Death and Dying

As a death doula, you are there to bring a sense of normalcy and calm
surrounding the death experience. Dying is sad, but it doesn’t have to
be frightening.

Your client may have intense fears around death that are rooted in fire-
and-brimstone religious teachings, from watching friends or family die
“horrible” deaths, or just from fear of the unknown.

As the doula, you can...

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• “Hold space” for them as they find meaning in what it means to

live and die

• Inform them on what natural death and the stages of dying look
like, so the process is less mysterious

• Empower them to make choices (when possible) about how they

want to die—and how they want their body to be handled after
death

• Remind them that it’s their choice whether to continue with

treatments (which may be decreasing their quality of life without
truly improving their prognosis or length of life)

• Offer support as they consider their beliefs on spirituality and

death (without pushing your particular beliefs onto them)

Home, Hospital, or Hospice?

A client who is currently in a hospital may or may not know that they
can choose to go home, and continue to receive pain medications at
home (if needed.) They don’t have to die in a hospital bed, if they don’t
want to.

Some clients may not be aware they qualify for hospice care. They may
think they aren’t “sick enough.”

Others may want to be at home but are worried about the burden this
may put on their family. Helping them explore home hospice care—
hospice or nursing home care that is home-like—can help.

Remember: There will be clients who actually want to stay at the

hospital, even if being at home is possible. Your job isn’t to judge or
push a particular “good way to die.” Your role is to help inform your
clients of their options and support them in their choices.

2.4.3 Discussing Advanced Care Directives

“Advanced care planning is more than just filling out your out your
advanced directives. It’s really about how to have conversations with
your loved one about what your values are, so that when it comes time
for them to make decisions for you, you will have already talked about

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it. So they aren’t just trying to read a piece of paper. It does not work to
just write things down somewhere and tuck it away somewhere; you’ve
got to talk to people.”

Merilynne Rush,
MS in Hospice & Palliative Studies, RN, BSN
Lifespan Doula Association

One of your services as a death doula may be encouraging and assisting

your client in preparing advanced care directives. This is formal
paperwork that establishes the kind of medical care they want at the
end of life.

Putting together those directives isn’t enough, however. You will also
want to facilitate or encourage conversation between your client and
their family members.

Research has shown that simply writing the directives and putting
them into a folder doesn’t work. Those who are most likely to be asked
to make these end-of-life decisions for your client need to not only
know the advanced care directives exist, but also have discussed what
they mean to your client. Conversations need to occur.

Some things to know about advanced care directives...

• You do not need to talk to a lawyer to write up advanced care

directives. However, some clients may want t∆o consult legal
advice. Also, you have to make clear when assisting a client that
your help isn’t legal counsel.
• The laws and regulations vary from location to location. You’ll
want to be sure to check the laws for advanced care directives in
your state or province. Your state or province may have its own
forms or requirements for the directives to be considered binding.
• You should encourage both time to write the advanced care
directive and time to discuss the wishes with close family members.
You may all meet together, the client and family members or health
care proxy, to discuss what the client wants, or those might be
separate consultations. However it’s done, it is essential that the
documents aren’t just written. They must also be discussed.

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• Be sure your client shares their advanced care directives with

their doctor. They should also leave a copy of their directives with
any physician under their care. Your client’s doctor may also be
a good source for getting the appropriate forms for their state or
province. Health insurance may also cover time to discuss their
care plans, so they can ask medical advice as they consider their
end-of-life options.
• Advanced care directives are not written in stone. They can be
adjusted or discarded. If your client changes their mind, they can
throw away the directives they previously wrote and write up
new ones.

You don’t necessarily need training to assist someone in writing his

or her advanced care directives—you could be self-taught (as long as
you are not offering legal or medical advice in that context.) However,
getting education and training is highly recommended. You must be at
least familiar with the laws and regulations in your local area.

One possible certification course to look at is Respecting

Choices. The course is available online:
Respecting Choices ACP Facilitator Certification
https://respectingchoices.org/types-of-curriculum-and-
certification/facilitator-certification

Here are more resources.

• National Hospice and Palliative Care Organization: State-by-
State Guidelines
This is an amazing resource where you’ll find specific information
and guidelines for each state in the USA. You’ll find free forms
you can use and download, plus instructions, and what is needed
for the individual location. Remember that laws vary by state.
If you are consulting with someone in another location, use the
client’s location’s guide.
http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3289

• Dying with Dignity Canada: Province-by-Province Guide

Another must have resource, you’ll find advanced care directive
guides for use in (almost) every province in Canada. The guides
contain helpful, general information on advanced care planning
that applies outside of Canada, so even if you’re not Canadian or

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not working with Canadian clients, be sure to check out these free
resources as well.
http://www.dyingwithdignity.ca/download_your_advance_
care_planning_kit

• Five Wishes
Created by the non-profit organization Aging with Dignity, this
inexpensive and easy to use advanced care directive guide can be
used with your clients and is legally binding in 42 states. (Outside
of those states, additional steps may be needed in order to make
the document binding. For example, you may need witnesses,
have the forms formally notarized, or have additional signed
paperwork to complete.)
https://fivewishes.org/shop/order/product/five-wishes

• Conversation Project: Starter Guides

The Conversation Project “is an initiative of the Institute for
Healthcare Improvement, a not-for-profit organization that is a
leader in health and health care improvement worldwide.” Their
goal is to help people have conversations about the end of life.
They have an amazing free resource, The Conversation Starter
Kits, in a variety of languages and for a variety of situations
(including talking to terminally ill children.)
https://theconversationproject.org/starter-kits

• National Institute on Aging: Advanced Care Planning

Clear, concise explanations on the kinds of decisions and
steps
that go into writing advanced care directives.
https://www.nia.nih.gov/health/advance-care-planning-
healthcare-directives

TIP: As you work as a death doula and gain experience, you

may feel called to create your own Advanced Care Directive
forms or guidebook. Rev. Olivia Bareham, death midwife
and founder of SacredCrossings.com, has created her own
Advanced Care Directive booklet.

Be sure if and when you do this that you hire a lawyer to review
your document and confirm it would be legally binding in your state,
province, or country.

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TIP: Have you written up your personal advanced care

directives? If not, do this before you start consulting with
others. Not only is this a valuable learning experience, but
you should practice what you preach—empowered end-of-
life planning.

2.4.4 Discussing After-Death Body Care, Burial,

and Funerals
As a death doula, your primary focus will likely be on support and care
for the person as they are dying and at the time of transition from life
to death. However, you may also find yourself consulting or offering
guidance on post-death burial and funeral options.

You may discuss options with a client months (or years) before their
actual death. Sometimes, you’ll be discussing what steps to take next
with a mourning family, after their loved one passes.

Dealing with the aftermath of death (especially when it comes

suddenly) can be overwhelming (and extremely expensive.) Having
someone who can stand alongside the grieving as they consider their
options—and make sure they know what those options are—can help.
Mourning families need an advocate, and as a death doula, you may be
that advocate.

Here are some of the issues and options you may discuss with clients.

Donating the Body or Organs to Science/Medicine

If your client wants to be an organ donor, or wants to donate their body
to scientific research, dying at home may be problematic. Most organs
cannot be donated unless the person dies in the hospital, and typically
was on a ventilator and brain dead. Eyes and tissue can sometimes be
donated if a person dies at home.

Depending on the cause of death, and presence of illness, donation is

not always possible. If your client wants to die at home, but also wants
to donate, encourage them to talk to their doctor. It’s possible that
donation isn’t even a possibility for completely different reasons, which

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in turn may mean there’s no reason to forgo an at-home death. Or, there
may be an option to remain home as long as possible.

After-Death Body Care: Just After Passing

In the hour just after death, the body should be washed, dressed,
positioned, and cared for. This should occur within the first couple
hours before rigor mortis sets in and the body becomes stiff. Usually,
three to four people are needed to help with moving and dressing the
body.

Washing and positioning the body may be done by the hospital or

hospice staff, or the funeral home when they arrive, but it’s also possible
for the individual’s loved ones to participate alongside staff, or even
complete the preparations alone.

What is there to do?

• Gentle washing of the face and mouth

• Closing of the eyes (Sometimes, vasoline is used to close and set

the eyes closed.)

• Gentle closing of the jaw (Sometimes, a ribbon or cloth is wrapped

around to hold the jaw shut until rigor mortis sets in. The ribbon
can then be removed.)

• Washing and brushing of the hair

• Shaving, if the person would typically be shaven

• Cleaning of the teeth and mouth

• Cleaning the entire body, while ensuring modesty and respect

• Changing the clothing

• Position the body so the arms and legs are straight and the body is
lying flat or in whatever position is desired for burial/disposition

Some religions and cultures discourage contact with the dead body,
while others encourage it. Caring for the dead can be a healing and last
loving act for some families… but it can be traumatizing for others.

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The decision of who will care for the body just after death is sensitive
and should be discussed well in advance (both with the client and
any medical staff, so they are aware of their role and what the family
wants).

Also, remind the family that they can change their mind about after-
death care.

In other words, if they at first thought washing, positioning, and

dressing of the body would be something they wanted to do—but then
after the death, it’s too emotionally difficult, and they would rather
hospice staff take over, they can do that.

TIP: An amazing resource on post death care, including video

and photo, guidance on how to wash the body, can be found
at the Canadian Integrative Network for Death Education
and Alternatives website (http://www.cindea.ca/home-
funerals.html). The entire website is worth reading, but
their section on post death care and home funeral can be
very helpful (even if you’re not planning a home funeral.)

Another resource is the Canadian Virtual Hospice (http://www.

virtualhospice.ca/en_US/Main+Site+Navigation/Home/Topics/
Topics/Final+Days/Care+of+the+Body+After+Death.aspx), which has
instructions and guidance on after-death body care.

Care of the Dead Body Between Death and Disposition

of the Body
Once the body is washed and dressed, what now? If the body is being
picked up by a funeral home, they will take care of things from this
point. However, your client still has choices about that, even if the
family may not be directly involved anymore.

Some things to think about include…

– Does the family want the embalming of the body? This is

not required, and there are many arguments made against
embalming. However, some people prefer it. This is an option
your client has, but they may not be aware they have a choice.

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– Does the client want a showing or for the body to remain

covered after death? By the way, if a family doesn’t want
embalming, that doesn’t mean they can’t have a showing of
the body. The body can be preserved with ice between death,
showing, and the burial.

– Does family want to remain with the body just after death until
disposition is complete? If yes, who will be with the body? Will
they take shifts with someone else? Some religious groups have
designated volunteers who will sit with the dead until burial.
When should they be called?

– What if family members want to visit the body once its been
moved to the funeral home? How can they arrange this? Who is
the contact?

TIP: Many of these options will be discussed with a funeral

home (if they are using a funeral home’s services.) Knowing
the laws that govern funeral homes will help you advocate
for your client. Check out the Federal Trade Commissions’
Funeral Rule explanations (https://www.consumer.ftc.gov/
articles/0300-ftc-funeral-rule).

If a home funeral has been chosen, then preserving the body at home
will be essential. A home funeral guide can help with arrangements,
but some things to consider are using dry ice, specialized cooling plates
or blankets, and even multiple gel ice packs.

TIP: If your client wants to keep the body at home for a few days
before moving handing things over to a home funeral—but
they don’t want to have a home funeral, so to speak—that’s
also a possibility. Cooling devices keep the body fresh until
the time comes to switch the body to a funeral home.

Traditional and Alternative Options for Disposition of

the Body
As discussed earlier, your client may opt to donate their body to
medicine. This isn’t a common choice.

The two most popular choices for body disposition are…

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• Burial

• Cremation

But these are not the only options... !

Here are just some of the possibilities you should know about, as you
help your client navigate their options.

Dissolving the body (resomation or alkaline hydrolysis): This

is an alternative to cremation, turning the body into liquid with a
specialized machine and chemicals. Alkaline hydrolysis takes the
normal decomposition process and speeds it up, getting there in a
couple hours. Some consider resomation to be a more green alternative
to cremation.

Turning the body (or a lock of hair) into a diamond: The company
LifeGem (http://www.lifegem.com) will transform cremated remains
into colorful diamonds. They can also create a diamond using a lock of
hair. So, if the person doesn’t want to be cremated, but they still like this
gem option, they can still become a diamond!

Becoming part of a barrier reef: The company Eternal Reef (https://

www.eternalreefs.com/) will take cremated remains and incorporate
those remains into an environmentally friendly cement mixture. This
is formed into an artificial reef structure and placed in the ocean,
where fish and other sea creatures can live. They also offer dedication
ceremonies before the reef is brought to its spot in the ocean, if the
family wants.

Launching remains into space: The company Celestis (https://

www.celestis.com/about/) will launch DNA or a symbolic amount
of cremated remains into space. The client has the option of being
launched into space and then directly returning, being launched into
space and orbiting the Earth, being launched and orbiting the moon, or
being launched into deep space.

Becoming a tree or plant: There are several companies, all offering

variation on a theme here, which is simply this—have the body or
cremated remains nurture a tree or plant.

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• The Living Urn

https://www.thelivingurn.com/

• Capsula Mundi
https://www.capsulamundi.it/en/

• Bios Urn
https://urnabios.com/incube/

• EterniTrees
http://eternitrees.com/

Scattering ashes in a special place: One option for those that choose
to be cremated is scattering the ashes. There will be a lot of ashes,
typically: between 3 to 7 lbs. worth, depending on the size of the person.
It’s completely possible to keep some ashes in an urn or piece of jewelry
(more on that below), while placing other bits of ashes elsewhere.

Be aware that there are laws surrounding ash scattering. When

talking through options with clients, you want them to also know and
understand the regulations.

Some things to keep in mind include...

• Each state or province will have its own laws. Check local law in
addition to paying attention to federal regulations.

• For scattering ashes at sea, the Clean Water Act requires ashes
be scattered at least three nautical miles from land. You can’t just
go onto the beach or at a shoreline and scatter ashes there. You
can read the EPA’s frequently asked questions guide on scattering
ashes at sea here - https://www.epa.gov/ocean-dumping/burial-
sea.

• Iftraveling will be involved, suggest that the ashes be placed in

carry-on luggage.

• Ifyou don’t want to directly touch the ashes with your hands,
consider using a specialized scattering urn, carefully turning
over a bag of ashes, using gloves, or some sort of scooping device
(could even be a spoon.) Bring something to wash and dry your
hands after.

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• Take note of which way the wind is blowing. Probably don’t want
to get ashes in your face or mouth by accident.

• If your client is considering scattering the ashes on private

property, even their own, you may want to point out that one day,
that land may be sold or become inaccessible. This isn’t a reason
to not do so, but they may want to keep some additional ashes
besides the ones they scatter.

• Suggest that family may want to take photos or video of the ash
scattering, for memories.

Placing the ashes into jewelry: Another option for storing cremated
remains is to have some placed in jewelry. Your client can have the
funeral home place the remains directly into the jewelry for them, so
they don’t have to handle it themselves. There should be more than
enough ash to go around, if multiple family members and friends want
this option.

Backyard burial: It is possible! Those interested in home funerals may

consider backyard burial (https://science.howstuffworks.com/science-
vs-myth/afterlife/can-you-bury-someone-your-backyard.htm).
Knowing the local laws and regulations is important to be sure it’s not
done improperly (which could lead to needing to move the body, a
possibly traumatic experience.)

Something to mention to your client is that if they are buried in the

backyard, what would the plan (or feelings) be if the house later was
sold? This is something to discuss.

A local home funeral guide is likely to be knowledgeable about the

local regulations, if this is something your client wants.

Caskets, Urns, and Shrouds

As already somewhat discussed above, one of the decisions your client
can make before death is how they want their remains to be stored or
buried after death.

The casket can be an extremely expensive aspect body disposition.

Your client may want a fancy, expensive casket—or they may want to

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go simple. It’s possible to pay as little as several hundred dollars or as

much as tens of thousands of dollars (at the extreme).

One interesting option is to create your own casket. There are many
companies that will sell you kits to create your own, though if you’re
good with carpentry, you or a client could actually make it without a
kit. Your client can also purchase a do-it-yourself casket kit and add
embellishments or decorations.

Some find the act of making and designing their own casket healing.

The North Woods Casket Company has instructions on their website:

https://www.northwoodscasket.com/build-your-own-casket/

Urns are typically less

expensive than caskets,
but they can also cost
up into the thousands.

Some things for your

client to consider when
purchasing an urn
include…

• Where will it sit?

Will it be buried?
Kept at home? Places outdoors?

• Would a specialized scattering urn make sense, if some or all of

the ashes will be scattered?

• Does your client prefer a biodegradable urn, for a green burial

option?

• Do they want just one urn or multiple urns, for the ashes to be
divided up between loved ones?

Yet another option for body disposition is using a shroud. You actually
don’t need a casket for burial—a shroud is legally enough to be used
to bury a body. Shroud burial is a possible green burial option, and for
some, religious practice prefers burial in a shroud rather than a casket.
Some cultures will bury the dead in a shroud and a casket.

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Shrouds may come with handles (just like a casket would have) for ease
of moving the body. The costs can range from a couple hundred dollars
to a little over a thousand.

Green Burial
Many people who seek out the services of a death doula or
midwife are also going to be interested in green burial.

What is a green burial? Everyone has slightly different

definitions. That said, some possible descriptions of green burial
may include options that…

• use as little resources as possible

• are Earth-friendly (or friendlier)

• return the body back to nature

• protect the living from harmful chemical exposure

Is your client interested in green burial options? You’ll want to

read and review the information on the Green Burial Council’s
website at http://greenburialcouncil.org/.

Also, read this:

Four Ways to Ensure an Eco-Friendly Burial
The Order of the Good Death website also has helpful
information on green and natural burial options:
http://www.orderofthegooddeath.com/resources/natural-burial

Home Funerals
Some of your clients may be interested in having a home funeral. Not
too long ago, all funerals occurred at home. The idea may seem strange
today, but at one time, funerals outside the home was unusual. The
more you know about this option, the better you can help them decide
if it’s the right choice. Your clients will likely be grateful if you can refer
them to a local home funeral guide. (This is one of many reasons to

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network with death and dying professionals in your area! See 5.3.3 for
more on networking.)

An excellent resource is the National Home Funeral Alliance (NHFA)

website (https://www.homefuneralalliance.org/). You’ll find practical
information and educational opportunities.

Some death doulas or midwives also work as home funeral guides. A

home funeral guide is someone who helps a family care for his or her
dead at home. Some death doulas are also celebrants. A celebrant is
someone who conducts a ceremony that takes into account the beliefs
and values of the family. That said, home funeral guides and celebrants
are not necessarily death doulas. They are unique professions and carry
different roles and responsibilities.

Note: Some death midwife and doula courses offer home funeral and/
or celebrant training as part of their death doula course. If this interests
you, be sure to look for that option in your training.

Funeral, Burials, and Caring for the Dead: Not an All or

Nothing Situation
Your client’s options after death do not have to be black or white. For
example, it’s possible to…

• Have family care and wash the body just after death, but then
give over the rest to a funeral director

• Choose to use a funeral home but forgo embalming

• Conduct a home funeral but have a more formal burial plan

A funeral director, who wants to sell as many services as possible, may

not make all the options clear. A home funeral guide may push his or
her own agendas as well. Helping your client know they have options
that can “blur the lines” between traditional and alternative is part of
your role.

TIP: Take time to meet with local funeral directors, celebrants,

and home funeral guides. This is how you can learn the
options available to your clients. You’ll also network in

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the process, and might one day gain clients from these
connections.

If you do have financial connections with specific funeral homes

or directors (like you get referral fees or percentages), make sure to
disclose that information up front to your clients. There is nothing
wrong with earning referral fees, as long as the client knows your
financial benefit.

2.5 How to Support and Comfort the Dying

“We’re all dying; every moment is precious.”
Beth Mosley,
Certified Death Midwife

As a death doula or midwife, this truly is your number one goal: to

offer comfort and support to the dying. That’s your aim whether you’re
helping during the last months and weeks of life or whether you’re
sitting by a client’s bedside.

As mentioned earlier in this book, clients will come to you at all stages
of the dying process—it could be years before their death. Much of the
information in this section applies to those last months, weeks, days,
and hours.

2.5.1 Understanding the Needs of the Dying

“We are really super big on the doula model of care. The doula model
of care is you don’t give meaning to somebody; they make their own
meaning. You meet people where they’re at, and let them figure out what
they need. Don’t come in and say ‘Here’s how to do it.’”
Merilynne Rush,
MS in Hospice & Palliative Studies, RN, BSN
Lifespan Doula Association
https://www.lifespandoulas.com/

How do you know what your client needs? Ask and observe.

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Don’t assume you know, even if you’ve already sat by the besides
of dozens of dying clients. Even if you have sat by this particular
client’s bedside… needs change. Desires for care and comfort change.
Remaining alert and aware of these changes is part of your role.

That said, knowing what the most common needs are (listed below)
will help. You can also use this knowledge to empower family members
or the health care proxy to advocate for their loved one’s needs.

TIP: It is not your job to meet all the needs listed below. You
can’t. For example, only your client can take time to consider
their life. Only the medical care team can prescribe pain
relief. You are a guide and supporter and maybe even a
delegator—not the do-all-er.

Help Transitioning from Treatment to Comfort

Mindset
You may come into the client’s life just after this transition, or you may
have been a part of their support team before. Either way, switching
from a “cure” mindset to a “comfort and live” mindset can be difficult.

Depending on the disease, treatment can involve frantic, busy days,

traveling to and from appointments, and more. When a family decides
to move on from that state of being, the busyness is replaced with
stillness.

This may also be the first time they have had time and space to be with
the reality of dying.

As a death doula, you can ideally give your clients ways to cope with
the emotional transition, provide support, and offer encouragement on
how to live out those last weeks (and maybe months.) This will look
very different depending on how sick the person is.

Adequate Pain Control

Death doulas and midwives do not prescribe medications, provide
medical care, or give medical advice. Therefore, you won’t be directly
involved in pain control.

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That said, your role as a death doula may involve advocating for your
client. Making sure the client or family members speak up if the client is
experiencing pain. Pain control can change when medical professionals
are aware that death is near. There is usually less concern of pain
medication addictions forming.

Friends and family members of the dying may be afraid that pain
medications—especially the stronger ones—may shorten their
loved ones life. This is generally untrue, but a common fear. You can
encourage them to discuss these fears with the doctor.

You may offer natural pain relief suggestions, including guided

imagery, light massage, or aromatherapy. You may also help with
position changes, encouraging rest, music therapy, and helping ensure
the room is comfortable.

Note: Dying itself is not painful. Some diseases that lead to death are
painful. Another role you have is to reassure the family of the dying that
death doesn’t hurt. A person doesn’t necessarily need pain medications
just because they are dying.

To Maintain Dignity and Comfort

The very ill and dying person may be unable to care for themselves.
They may possibly not be conscious much of the day or time.
Regardless, they need someone guarding their basic dignity and
comfort.

This can mean a variety of things, including…

• Ensuring they are clean and dry

• Good oral and mouth care

• Modesty when bathing and dressing

• Position changes to avoid the formation of bed sores (The hospice

nurse should provide this education.)

• Respectwhen people enter and talk in their room (even if they

appear to be asleep, they may be able to hear – it would be

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disrespectful to talk about the dying while in the room with them.
They should be spoken to… not spoken about.)

• Treating them like an adult (assuming they are an adult), and not
talking or treating them like they are a child

• Respecting the advanced care directives they put in place—

hopefully they assigned a health care proxy who understands
and is ready to respect their wishes, even if it goes against what
they personally (the health care proxy) would have chosen for
themselves

Time to Reflect on the Life They Have Lived

Much of this occurs silently, but some reflection may take place with
others or in a more visible fashion. Giving them time to be alone (if
that’s what they wish) is important. You can advocate for that time to
reflect as a doula.

Also, allowing them to share stories, talk about their life, and process
what their life has looked like may be a part of life reflection. A death
doula can help provide space for this to occur. This can occur by deep
listening, or may involve asking leading questions.

TIP: Legacy and Life Review projects (discussed later in this

chapter) are one possible way for the dying to reflect on
their lives. There are some doula trainings that put a great
deal of focus on legacy review projects, facilitating and
encouraging them. However, remember that not everyone
will want to (or be able to) work on such a project. Legacy
and life review projects are simply a possible method—not
the key method—to reflecting on life.

Forgiveness
The end-of-life often brings up memories and thoughts about how
we could have done better. The dying may desire forgiveness, either
directly from those they feel they have hurt, or they may want to offer
their own forgiveness to those who have hurt them.

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If there have been difficult family relationships, the dying may want to
reach out and try to repair (at least somewhat) those broken links.

As a death doula, you may simply listen to their regrets and hold the
space for them to share. This may be healing enough.

Others may want to write letters, make phone calls, or arrange an in-
person visit with those they are seeking forgiveness or understanding
from. In your role as a death doula, you may support and empower
your client as they attempt to make reconciliations. You may also be
there to support them if the reconciliations don’t go smoothly or end
positively (which can occur.)

TIP: Watch Matthew O’Reilly’s TED talk on “Am I Dying? The

Honest Answer” (https://www.ted.com/talks/matthew_o_
reilly_am_i_dying_the_honest_answer). He discusses the
need for forgiveness at the end of life.

Being Seen as More Than a “Dying” Person

Imagine if every time people visited you, they looked at you with fear
and grief in their eyes. This can be a tremendous emotional burden.

As a death doula, however, just by talking and looking at your client

in a natural, everything-is-okay way, you provide healing. By talking
with (or to) them, and interacting with them, and by remembering not
to talk about them if they are lying in a bed nearby, you help the dying
remember that they are not “just” a “person who is dying.” They are a
person.

Depending on how active the person can be in their last months or

weeks, something else you help with is reminding your client that they
still have life to live and time to experience or do things. Fear of death
can freeze a person and a family. You can help them “unfreeze” with
gentle encouragement.

(Maybe) Physical Touch

People can be afraid to be physically affectionate or even come close to
someone who appears frail. This means the dying may lack physical
touch, a basic human need.

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As a death doula, you may help with this need in two ways...

• Encouraging friends and family to be physically affectionate: all,

of course, only within the consent and boundaries of the dying.
But this can look like encouraging them to hold the person’s hand,
lying next to them in bed, or light stroking of the arm or head.

• Providing physical attention to the client yourself: again, only

with consent, but this may look like holding the client’s hand,
light and gentle massage or stroking of the arm or head, or maybe
foot massage.

Ideally, the kind of physical affection and support the client would
like should be discussed before they are so sick that they are unable to
express their wishes. This may be part of vigil planning.

If the dying are too sick, however, talking with family can provide
insight into what they believe they would have preferred. (Not all
people are touchy-feely or enjoy physical affection.)

Most of the time, holding a person’s hand is a safe and available option,
if the dying can’t be asked directly what they want.

TIP: Basic care for the dying often involves physical touch.
Things like bathing, keeping them clean and dry, good oral
care, position changes, applying lotion to dry skin, etc. The
attitude of the person offering that care can make all the
difference.

To Be Seen and Heard

This can mean so many different things.

The need to share stories and thoughts on life may be more intense.
They may want or need to repeat the same stories over and over.

There may also be a need to simply be “witnessed” in their illness or

dying. In other words, silently being with a person during a time of
transition may be exactly what they need.

Giving your wholehearted attention to the dying is a gift.

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Another aspect of being seen and heard is that friends and family
should talk and behave as if the person is there in the room. This
can be difficult if the dying person is sleeping or goes in and out of
consciousness frequently.

As a death doula, you can gently remind them that though the dying
may appear to not be aware, they may actually be quite aware of what’s
happening around them. They may hear their voices and conversations,
even if they are not responding to them.

To Have a Sense of Control

We can’t stop death or the dying process. But there are choices that can
be made that can give a client a sense of control over the process, or at
least how they will be cared for during the transition.

Coming up with a vigil plan can give the dying a sense of control, as can
planning their own funeral and post-death care. Creating or decorating
a coffin or urn can even part of “taking control” of death.

When it comes to basic care, when there is a choice, assuming they can
voice it, the dying should be asked for their opinion. For example, for
bathing, if turning their body onto their side is necessary, they can be
asked which side they’d like to be turned to first.

The simplest yes or no question can offer a sense of control.

At the same time, you don’t want to overwhelm the dying with asking
too many questions.

A difficult one for families can be allowing the dying to be able to

choose when, whether, and how they eat, drink, and sleep. It’s natural
for people to sleep more, and eat and drink much less, towards the end
of life. The body is slowing down and simply doesn’t need as much
nourishment. The loved ones of the dying may be fearful of this natural
decreased interest in eating and drinking.

Respecting the dying’s desires (or lack of desires) is part of allowing

them control.

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To Have an Idea of What to Expect

Fear of the unknown is part of what makes death so scary for people.
What will dying look like? Feel like? What happens to the body as a
person dies? And after death?

It’s impossible to completely predict how someone’s death is going to

proceed, and of course, there are a lot of things we don’t know about
death, dying, and (especially) the afterlife.

However, as a death doula, your knowledge of the dying process is

going to be better than average. Sharing what you do know can comfort
not only the dying, but also their loved ones.

To Not Be Alone
No one should die alone. In fact, there is an entire volunteer program
named after this concept (NODA, which stands for No One Dies
Alone.) Hospice volunteers will often be sent to those who don’t have
friends or family available, so they will not be alone as they die.

As a death doula, you can help set up a vigil plan so the dying will not
be alone, but also, the caregiver won’t feel overwhelmed.

Some death doulas only plan and delegate the role of sitting with the
dying. Others will try to be present throughout the process, usually as
a team effort (since dying can take place over many days.)

But Also—To Have Time Alone

As important as it is to not be alone, the dying may also have a need
to have some time to themselves. It can be extremely difficult for loved
ones to walk away from the bedside of someone they love, especially if
they know the last days or weeks are here.

And yet, it can be suffocating and overwhelming to have people

visiting all the time.

As a death doula, you can help plan for alone time for the dying, while
offering reassurance and possibly rituals for the caregivers so they can
feel comfortable walking away from time to time.

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Time to Consider Spiritual or Religious Ideas on Death

“I’m very intuitive, so I come at my work very differently. A lot of death
doulas won’t even talk about the other side with their patients, the other
side, seeing spirits.”
Carol Neustadt,
Certified End-of-Life Specialist (CEOLS)

End of life is a time when many people re-consider or contemplate

religious and spiritual beliefs. Part of this is because of the emphasis
on the afterlife. Some are brought up fearing life after death, with
vivid and frightening imagery of eternal torture. These clients may
experience intense fear of death.

Others are taught that the afterlife is a place of beauty and peace. Those
with secular beliefs may have ideas about their body returning to Earth
and the cycle of life. Or, they may not believe in any afterlife at all.
Some have no definitive thoughts on the afterlife, but start thinking
about it intensely when death is on the horizon.

This is a good spot to mention that the common folk saying, “There are
no atheists in a foxhole,” is untrue. Death does not create believers.

However, that said, thinking about spirituality, religion, or philosophy

is a common need of the dying.

As a death doula, to help meet this need, you may serve as an active
listener. Listening with your ears and your heart, in a non-judgmental
way, is a genuine act of service.

You may also be asked to help arrange for important religious rituals
for just before or after death, like calling for a priest to deliver last rites
(or delegating this task to a family member), or helping a Jewish client
say the sh’ma (or having the sh’ma prayer said for them.)

The desire for religious rituals at the end of life and just after death
should be discussed during early consultations. Don’t assume you
know what they want based on what their stated religion is. They
may or may not want a traditional path, and they may choose to add,
subtract, or modify customs.

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TIP: Study the traditions of death and dying from all spiritual
and religious paths. Be familiar with them. Remember that
a death doula provides non-judgmental support. Your
personal belief system should not come into play when
supporting your client.

Also, be aware that not everyone will have a spiritual experience with
death. At the same time, be aware those who identify themselves as
agnostic or atheist may still embrace spirituality, possibly without the
idea of a “god” behind it.

2.5.2 Facilitating Legacy and Life Review Projects

Self-reflection and mentally reviewing one’s lived life is common when
a person is nearing the end. Much of this process occurs silently—inside
the quiet moments, possibly when there’s time to be alone and just be
with one’s thoughts. Some of it occurs out loud, through conversations
with others.

Also, when people know they are approaching the end of their life,
they start to consider what they want to pass on or leave behind for
those still living. This can be a material object—like great grandma’s
piano—but it can also be intangible items, like family anecdotes.

Benefits to creating a legacy project include...

• Preserve family history and information

• Pass on family stories, recipes, jokes, life lessons, and other

intangible heirlooms

• Remember a good-life-lived

• Process what your life has meant to others (and yourself)

• Leavethose who are still living with something to remember (or

know you) you by

• Gives terminally ill “something to do”, provides a sense of

purpose

What does a legacy project look like? It can be so many things!

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Here are some possible ideas and examples:

• Creating a collection of recipes, especially the ones that are not

written down, or the ones that are most loved by the family.
This can be as complicated or simple as the family wants. It can
involve actually making the recipes and taking photos, or can just
be writing the recipes down into a booklet.

• Creating a scrapbook—again, this can be very basic, or it can be

very artsy in style.

• Creating multiple scrapbooks—one per special person, with

unique messages and memories shared for each individual. For
example, a dying parent may create a scrapbook for each of their
children, with pictures and stories specific to that child.

• Arranging
”
objects (photographs, ribbons or awards, meaningful
mementos, etc.) on a shelf or series of shelves

• Writing letters to each family member to be read after the dying

person passes.

• Writing letters to be opened and read at specific dates in the

future that the dying person is going to miss. For example, at their
grandchild’s graduation from college.

• Video taping interviews or conversations that take place between

the dying and a family member (or the doula, if they are helping
create the video project.)

• Creatinga video message aimed at specific friends or family

members with a personal message just for them.

• Written,video, or auditory recordings of family stories the dying

wishes to pass on.

• Written,video, or auditory recordings of life lessons, values, or

other non-monetary family traditions the dying wants to pass
down.

• Creating a family tree with names, photos (if available), and

important dates.

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TIP: Make sure your client knows it’s okay to not finish what
they start. The dying can feel like their “time is running
out,” and for some this makes them want to do things faster,
and for others, they lose motivation. Let them know that
just starting is enough.

TIP: Legacy projects don’t have to be the exclusive work of the

dying. They can be family or group projects. When done
together or by the side of the dying—for example, friends
or family share their stories, and they or you record those
stories, while sitting with the dying—it can be just as healing
and powerful as when carried out by the dying individual
themselves.

There are so many options, and there is no wrong way to go about

legacy and life review projects. Some death doula trainings have
guidance on legacy project.

Not every client will want (or have the ability) to start a legacy project.
Legacy work is not required. You should never pressure someone or
make them feel like “this is how you die” well.

However, if you list “legacy project facilitation” on your website or

print materials as a service, clients may ask about it. You may also bring
up the idea if it feels appropriate to what they are looking for during
a consultation, or if it fits naturally into conversation. For example, if
the topic of family stories comes up during a visit, you might suggest
recording those stories.

Resources to check out: The Alabama Research Institute on Aging

(http://aria.ua.edu/) offers a free Legacy Participant Notebook on
their website (http://aria.ua.edu/files/2013/11/legacynotebook.pdf),
free to download and use. Another amazing resource comes from Dr.
Ernest H. Rosenbaum of Stanford Medical School, The Legacy Project: A
Guideline Booklet for Leaving a Legacy (http://med.stanford.edu/content/
dam/sm/survivingcancer/documents/legacyproject.pdf).

TIP: If you have not watched it, you must see Randy Pausch’s
Last Lecture: “Achieving Your Childhood Dreams” (https://
www.youtube.com/watch?v=ji5_MqicxSo). This might be
one of the most famous “legacy projects” gone viral.

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2.5.3 More Comfort Skills and Techniques

Truly, the vast majority of this chapter covers comfort skills and
techniques. You can also get many ideas for comforting your clients
from section 2.2 Tools of the Trade.

With that said, here are additional comfort skills to consider adding to
your doula practice.

Guided Imagery
“[We must be cautious about] projecting our own beliefs onto someone
else’s death. We have to know, if at all possible, what their beliefs or
practices are before we sit by their deathbed. Don’t tell an atheist that
they are surrounded by angels.”
Patricia Ballentine,
Ordained Minister and Priestess,
Certified Death Midwife
http://www.TheCreativeFlame.com

If you’re not familiar with guided imagery, it usually involves

combining words and music together to illicit for the listener an intense
imagined experience to bring about positive feelings of calm, safety, or
comfort. While audio recordings of guided imagery usually have music
accompaniment, music is not required. The most important key is the
vivid imagery created with words.

Guided imagery can be very powerful, even bringing about pain relief.
Guided imagery can also be used to prepare someone to face a future
experience with less fear and anxiety. For example, guided imagery
may be used to help someone approach a job interview with less
anxiety, by imagining things going smoothly. Guided imagery can also
be used to prepare someone for childbirth or—yes, death.

If you want to offer guided imagery for your clients, the first step
is to start trying it out yourself. There are so many guided imagery
audios, marketed for everything from getting better sleep to increasing
confidence. By listening and trying guided imagery yourself, especially
if you try a variety of sources and styles, you’ll learn how to create your
own.

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You may also offer guided imagery for clients by suggesting or selling
audio recordings.

TIP: Health Journey’s from Belleruth Naparstek (https://www.

healthjourneys.com/) is an excellent source for a wide
variety of guided imagery resources and examples.

Reading to Your Client Out Loud

This is a rather simple technique—and if you can read (you can!), you
can offer this—and yet, the comfort can be powerful.

How does reading out loud provide comfort?

The sound of someone reading provides company without the

requirement to respond. Someone who is ill may not have the energy to
entertain, have conversations, or even listen to someone talk about their
day (because they may still feel like they need to respond in some way.)

But listening to a story doesn’t require any back and forth interaction.
At the same time, you feel taken care of. Someone is giving his or her
attention to you. You hear their voice, and sense their presence in the
room, without the need to exert energy towards that presence.

It occupies the mind. Listening to a book means considering the words,

their meaning, and maybe imagining what’s being read. This means
there is less time to focus on internal worrying or simply being sucked
into a painful boredom.

At the same time, it’s not a painful, exhausting occupation of the mind.
There’s no test afterwards. So, the person can just listen, and drift in and
out, as they please.

What should you read? Anything. It depends on the client, but poetry
can be a good choice because it doesn’t require extended listening to
appreciate fully. But other options include children’s stories, short
stories, novels, essays, and sacred texts (like the Bible.)

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Creating an Environment of Comfort

Creating a space that is comfortable is a simple but powerful method to
support the dying. Is the temperature of the room okay? Has there been
any access to fresh air recently? Do they need a blanket? Do they need
to be cooled off? Are they being repositioned often enough? Are there
too many people in the room? Is the person alone too much?

In the home environment, you might even consider cooking or baking

to provide a comforting aroma. Even if the dying client isn’t interested
or wanting to eat, just having the scents of familiar foods can be
relaxing.

“I met with one lady, and the family was like ‘She doesn’t know she is
dying.’ I’m thinking, She is in a hospital bed in your living room. She
knows. I walk in there and ask her how she is, and what can I do for
you, and the first thing she wants to do is pray. And I find out she’s
Catholic. I thought, my god, why are they not getting a priest in here
for her last rites? Why do they not have her rosary in her hands? I also
had an insight that she was a baker, and I asked them, and they said yes,
that was her hobby, that was what she did. I said, ‘Then, let’s be baking
cookies in the kitchen for her so she can smell them, even if it’s just
one cookie.’ I passed on that information to their mother. That started a
dialogue between them. They weren’t afraid anymore to admit that she
was dying. They weren’t afraid anymore to talk to her about dying.”
Carol Neustadt,
Certified End-of-Life Specialist (CEOLS)
https://doingdeathdifferently.com/doulas/carol-neustadt/

You might want to consider baking or cooking...

• Cookies, bread, or other comfort foods

• A flavorful soup (This can simmer all day long.)

• Simply boiling or simmering water with herbs or spices in the

kitchen

• A traditional or family recipe that has personal meaning to your

client

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These foods can both offer a comforting aroma for the dying (who may
not want to eat), while providing nourishment for the caregiving team,
friends, and family.

Speaking of creating an environment of comfort, creating sacred space

can be one way to elicit a sense of safety for the dying.

2.5.4 Creating Sacred Space

Sacred means dedicated or set apart for a special purpose. It can also
mean entitled to respect or intended to invoke a sense of awe. Living is
a sacred act. Dying, even more so, is a sacred act. The transition from
life to death may be sad, but it can also be powerful, beautiful, and
holy. Creating a sacred space can help reduce the fear around death
and bring calm and comfort to the dying and their loved ones.

Sacred space can be used during active vigiling but it may also be used
during consultations or visits of any sort.

TIP: Don’t confuse sacred with religious. While religious acts

can be considered sacred, and creating a sacred space may
sometimes involve religious items or acts if that appeals to
a client, approaching death with a sense of awe and wonder
is not exclusive to the religious.

How can you help create a sacred space for your client? Of course, as
with everything, you should discuss what sacred means to them, what
might bring them peace or comfort, and how they want their “dying
room” to look like. This is part of planning the vigil. (See Section 2.5.6.)

All that said, here are some ideas:

Hide or at least limit medical items in the line of site. Some things
may need to be nearby, especially if they are required for comfort, but
anything that can be in a drawer or put away, have those things put
away. Sometimes, if the transition from treatment to dying has only
recently taken place, there may be medical items out that don’t need
to be there anymore. Getting all that cleared out can help those present
mentally transition.

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Clear and organize the space. The less clutter and mess, the better.
People usually feel more at ease in a neat environment.

Light candles—real or flameless. If you’re in a medical environment

with oxygen, you can’t use real candles. The same restrictions would
be if you’re in a home environment and an oxygen tank is present.
However, there are flameless candles intended for just this purpose.

Candles and flame are used in so many religions, because of the sense
of magic they bring. Have a few in the room, by the bedside, and maybe
even one right outside the door to remind those entering that they are
walking into a sacred space.

Place a sign on the door. Just like setting a candle outside the door,
placing a sign on the door to indicate that this is a sacred area and
should be entered with that in mind, can be helpful. The sign may be
very simple. It might just say “Vigil In Progress.”

Or, the sign may have instructions, like to use soft voices, to take a
moment before entering to meditate or pray, or to take one’s shoes off.
Whatever the client and their family feel is comforting and appropriate
to their beliefs and traditions.

TIP: If the vigil is taking place in a hospice, hospital, or nursing

home, ask the staff if they have a traditional way of
indicating a room has an active vigil in progress. They may
put a ribbon on the door or have some other way to alert
residents and staff of what’s happening.

Burn incense or essential oils. The incense may be traditional or

religious, like frankincense and myrrh, or they may be other gentle
scents that bring peace of mind and calm.

As always, check first for allergies and sensitivities. If you’re working

in a hospital, hospice, or nursing home, check with staff if they have
rules regarding aromatherapy use. Also, know that there are essential
oil diffusers that are electric and flameless.

Keep the room peaceful. This may mean requesting that soft voices be
used. When children enter the room, they shouldn’t run around but

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walk in quietly and leave when they feel the need to bounce around (as
children naturally do.)

This can also mean respectfully asking that people walk out if they
are too overwhelmed by their emotions. There is a line between quiet
or calm crying, and becoming completely overcome by crying. Out of
respect for the dying, to encourage calm, and to maintain the sacred
space, a person who has fallen apart can walk outside the room for
awhile and then return when feeling more settled.

Sometimes, anger can arise between family members, especially in

moments of grief. Arguments should be taken outside of the sacred
space.

Also, as the doula, you may want to gently remind family and friends
that the dying can often hear until the very end. They may look
nonresponsive, but that doesn’t mean they aren’t aware of what’s
happening around them.

Set religious symbols or objects nearby. This may be include items like
rosary beads, a prayer book, a cross or other religious symbol, crystals,
holy water, or photographs of holy people. This is something to discuss
with the dying and/or their family. Even families that are not usually
religious may want cultural or spiritual symbols nearby at the time of
death

Have a clergy member or spiritual leader visit during the vigil. They
may come and just sit by the beside of the dying person. They may
offer a prayer or blessing. For Catholics, a priest may give the person
their last rites. See http://www.beliefnet.com/faiths/catholic/2005/04/
what-are-the-last-rites.aspx.

Play calming sounds or music. This is different for everyone, but may
be anything from music that is personally meaningful for the dying
individual, classical or new age music, shamanic beats, or nature
recordings like a thunderstorm, rain shower, or whale calls. Someone
may want you to play rock music as they die. It’s a personal preference.

If you or a client’s family member is a musician or plays any instrument,

especially something with a ritual or sacred meaning, this can also help.
For example, gentle drumming or flute music.

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Decorate the room and make it home like. If the dying are not at home,
making the room more like home and less like an institution can bring
a sense of comfort. This may mean having pillows or blankets from
home. This may mean placing knick-knacks or pictures at the bedside.

TIP: Watch My Last Day’s episode “Meet Claire, Finding Beauty

in the Sadness” (https://www.youtube.com/watch?v=kD_
Fr3VAsYM&t=4s). Claire Wineland spent many days in
the hospital due to her terminal illness of cystic fibrosis.
In the video, Claire talks about how she made her hospital
room her own space. This is one example of what creating
sacred space can mean. Sacred space doesn’t have to mean
solemn and serious. It can also be lighthearted. You may
also enjoy watching Claire Wineland’s short inspirational
speech, “Make Your Life Beautiful” (https://www.youtube.
com/watch?v=865nKudhLfM).

2.5.5 Using Traditional and Newly Created Rituals

Rituals can be used to create sacred space, but that’s not all. Rituals
may be part of how you begin or end every consultation. You may
use rituals by yourself before or after meeting with clients, to center
yourself or “cleanse your energy.” Religious rituals may be used during
illness, before death, and after death.

Ritual is an important tool for offering comfort to your client, their

loved ones, and even yourself. Miriam-Webster dictionary defines ritual
as “an act or series of acts regularly repeated in a set precise manner.”

While people often associate ritual with religion, ritual applies to

any series of acts (https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC4327323/). For example, CPR can be considered a medical ritual.
(One that your client may ask not to be performed at the end of life.)

Some examples of rituals may include...

• Reading a prayer, poem, or set of affirmations

• Singing or vocalizations (like an “ommmm” after yoga)

• Breathing exercises

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• Doing a solo or group guided meditation

• Or, doing a mediation on your own

• Changing clothing in a ritualistic way—for example, you may

have a ritual of how you undress from your death doula scrubs or
“outfit” and put on fresh new clothing

• Lighting a candle… or blowing out a lit candle

• Using a sage smudge stick or some other incense lightning

(https://www.mindbodygreen.com/0-17875/a-sage-smudging-
ritual-to-cleanse-your-aura-clear-your-space.html)

• A ritual dance or set of physical movements (like yoga salutations)

• Playing specific music for specific activities or transitions—could

be a recording or life music. May even include playing drums or
using rattles.

• Starting or ending with a question every consultation session

(Examples include, “What is the key take away from today’s
session?” or “What is the most important thing we should address
today?”)

• Expression of gratitude or love (Saying “I love you” to someone

every time you say goodbye is an every day ritual people may not
even think about.)

• Having a moment of silence—possibly marked as starting and

ending with a chime, singing bowl, or cellphone recording of a
meditation chime.

• Washing, bathing, or showering—can be ritualistic with intention

When might you use rituals in death doula work?

• At the beginning or end of a visit with a client

• As comfort suggestions for caregivers

• For entering the room of an actively dying person

• For when you get on or off the phone with a client

• Before, during, or after working on advanced care directives

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• Before, during, or after a workshop on any topic

• For leaving and rejoining the bedside during a vigil

• For the last hours of death

• For the first moments after death

• For use during any transition

Of course, there are religious rituals that arise in death and dying. For
Jews, this may be saying the sh’ma prayer before death. For Catholics,
this may mean having a priest deliver last rites.

You don’t need to be familiar with every religion’s rituals surrounding

death and dying, but studying popular and not-so-well-known
religious rituals will enrich your doula practice. Not only will you feel
more comfortable supporting a variety of clients but your study may
help you design your own rituals.

Here are some helpful resources.

• Transition Rituals: A Faith-by-Faith Guide to Rites for the

Deceased (lots of links to additional information)
http://www.beliefnet.com/wellness/health/health-support/
grief-and-loss/2001/05/transition-rituals.aspx

• A Memory Tree: Customs and Religious Protocols

http://www.amemorytree.co.nz/customs.php

• A Wiccan Guide to Ritual Creation

https://wiccanspells.info/wiccan-pagan-articles/create-spells-
and-rituals/

TIP: Consider meeting with local ministers, rabbis, priests,

imams, and other religious leaders. Introduce yourself,
what you do (or what you’re studying to do), and ask if you
could meet with them to better understand their specific
religious approach to dying and death. Tell them you want
to support clients who ascribe to their beliefs with as much
sensitivity and knowledge as possible. Not only will you
learn a great deal, but you will also be networking and
making connections. They may refer families in need of
extra support to you.

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2.5.6 Planning a Vigil

“Death is not an emergency. Sloooooow down. Make your movements
and your speech slow and deliberate. Be fully present in the moment;
thoughtful. Too often we get caught up in being efficient and hyper
focused on the goal and not the process. Dying—the Final Rite of
Passage, which includes the dying person and the act of death itself,
as well as the family and friends around them, and the caring of the
body once death has occurred—is a process. Slowing down, treating it
as something sacred; with respect and compassion, can result in better
healing, and cherished memories.”
Rev. Angie Buchanan
http://deathmidwife.org/

Birth doulas help a pregnant mother consider and plan for labor and
birth. Death doulas help a dying client consider and plan for dying.
While an expectant mother will always take an active part in creating
a birth plan, a dying client may or may not be directly involved in
planning the vigil. This depends on what stage you’re hired and if the
terminally ill person is able to voice their desires.

Depending on your doula practice, the planning may include you

as part of the vigiling. Some death doulas and midwives sit with the
family during the vigil process. They may work in shifts with other
doulas (working together as a team), or they may only be present for a
set, limited period of time each day.

Other death doulas are not actively present for the vigil. They act more
like planners and educators before the vigil time arrives, so family and
friends can carry out the plan.

Planning for the vigil has two separate but related steps: discussing and
preparing for the vigil, and writing out a plan itself.

For discussing the vigil, this involves talking to the client(s) about...

• What the active dying process looks like

• Possible options they have for comfort, ritual, and creating sacred
space

• How to actually provide and put into action their options

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• The reality that things may not go as planned—and that’s okay

• That the death may occur when a loved one is alone or when a
caregiver is taking a break, or allowing the dying time to be by
themselves—and that is okay

• What support you will offer (whether by phone or in person or

both)

• When vigiling starts—the signs of active dying—plus how it

will be decided to start putting the vigil plan into action (often
includes discussion with the hospice doctor or nurse)

• What happens after the vigil—especially in those first moments

and then hours

The written vigil plan should be written and presented in an easy to

read format. This is something that the family will be reviewing and
looking at during a time of stress and emotional intensity. It shouldn’t
be wordy or crowded. Simplicity is best.

TIP: You may want to write up two plans for your client—one
that is more detailed with instructions and guidance, to
act as a kind of reference “book,” and a second plan that is
brief, just one or two pages that have just the most essential
information for quick review and sharing with hospice or
hospital staff (if appropriate.)

Here are some questions to help you work with a client on a vigil plan.
Remember that a “good death” does not look the same to every person.
It’s very individual. Not all of these questions will fit every client. There
may be different topics to discuss, depending on the situation. This is
only a guideline.

• How will it be decided when the vigil starts?

• Who will be sitting vigil?

• Ifmore than one person will take turns sitting vigil (ideally, this
should be the case), who are those people? How will they be
contacted? How will their shifts be decided?

• How will the room be arranged (or what will be present in the
room) to create a sense of sacred space?

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• What type of physical support will be offered? (holding the

dying’s hand, gentle application of lotion, lying on the bedside,
etc.)

• Will there be music? What kind, for how long will it be played?

• How will moments of silence be determined?

• What is the ritual or transition for leaving the dying person’s side
for short periods of time? How would this best meet the needs of
the dying and the caregiver?

• What is the doula’s role? When will they be called? What is the
contact information and back up person to call if the doula isn’t
available?

• Who will alert the family and friends that the active dying process
has begun? Does that person have all the needed names and
phone numbers?

• Who may want to come visit to say their last goodbyes and when
might that take place? Will Facetime or Skype be used for loved
ones who can’t be there in person? How will that be arranged and
who will take care of it?

• What will be done if the dying see their loved ones or seem to
be reacting to “someone else” in the room? (Nothing needs to
be done at all... but some families may want to acknowledge the
presence of ancestral spirits.)

• What will the lighting be like? During the day? Will the windows
be opened or will it be kept dim? What about during the night?

• What does the dying person want the person sitting vigil to do
while they sit nearby? Options may include prayer, holding their
hand, reading something outloud, talking to them (even though
they may not be responding), reminiscing about life stories, etc.?

• Are there any religious rituals to do or clergy who should be

called? At what point?

• What will happen the moments after death? Will there be a

moment of silence? Prayer? Will those present take turns saying a
final farewell?

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• After death, will family or friends help with washing or changing

the clothing? Will there be a written guide to help them complete
this task, if they are alone?

• Who will take charge of the ritual of changing the sheets and
rearranging the room after the dead have been removed from the
place they passed away? In a hospice or hospital, staff will take
care of this. But if someone dies at home, having a designated
person to clean up, change the sheets, and even place a flower on
the bed is a good idea. This person may be the doula, if present.

• After death, how long do they want to sit with the dead before
calling the funeral director or home funeral guide? What needs to
be ready and prepared for that?

TIP: Talking about the moments just before and after death with
your client is important. Sometimes, people panic and call
911. They forget that this person is dying, or that there is
a DNR (do not resuscitate.) There is no need to call 911.
Everything is as it should be. Discussing this common initial
panic, and better ways to handle the moment if it arises, can
prevent last minute panic.

Watch this wonderful video from Sarah Kerr (https://www.facebook.

com/SoulPassages/videos/610729049323633/) on what to do in the
moments just after death.

2.6 How to Support Family and Friends of the

Dying
As a death doula, you will be supporting both the dying individual and
their loved ones. Sometimes, your direct interactions will all be through
friends and family. This is especially true if the dying individual is
unable to communicate, or if you are hired after death occurs (as a
“mourning doula.”)

Truly, everything you’ve already learned in this chapter can aid you in
supporting the friends and family of the dying.

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When you…

• provide comfort to the terminally ill individual

• show the family how to support their loved one

• help preserve and remember memories through legacy projects

• help to create a sacred space

• suggest and introduce ritual

• design and put into action a vigil plan

…you are supporting everyone.

You’ve learned how to do all this already.

That said, there are more ways to directly support the loved ones—
through respite care and encouraging good self-care, educating the
family on what the stages of dying looks like, and supporting a family
during the time of mourning.

Also, understanding and being prepared to handle heated moments

and difficult emotions is vital to death doula work. This is another way
you will support not only the friends and family, but also the dying
individual, as your calming presence can reduce tension overall.

2.6.1 Providing Respite Care

Taking care of someone at the end of life can be more than a full-time
job. It often falls on just one or two family members—a spouse, a lover,
a son or daughter, a parent, or a sibling. Sometimes, a very close friend.

There are families that manage to delegate care between each other,
but this is rare. Families may be spread across the state, province, or
country. There may be only one or two family members who can take a
pause from full-time work to care for the ill family member.

And, let’s be honest, some family members may be afraid or unwilling

to step up.

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By the time you come into a caregiver’s life, they have likely been
working around the clock for months, possibly years. They may be in
desperate need of respite care.

Respite care is temporary relief for a primary caregiver. This may look
like giving a caregiver a couple hours each week for themselves, or it
can be days of time so the caregiver can travel.

Respite care allows the primary caregiver to know that their loved one
will have someone there to watch over and care for them while they get
time to reset and refresh.

Fears of Taking Time Away From Caregiving

Even though the caregiver is likely exhausted and possibly burnt
out, you may need to convince or reassure them that taking time for
themselves isn’t only okay—it’s needed.

The caregiver may be afraid to take a break even if they hired you
specifically for this purpose.

Here are some common worries, and ways you can address or support
the caregiver during consultations. For the sake of the examples, let’s
say the name of the terminally ill person is Joann.

The Worry: No one else will care for my loved one the way I will. If
something bad happens, it will be my fault because I wasn’t there doing
my job.

Reassurance You Can Offer: “Your love for Joann is strong, and you are an
amazing caregiver. You need time for yourself so you can continue to
offer loving, strong support. By taking a break, you are actually making
it more likely you’ll be able to be present with Joann. Taking care of
Joann will be more difficult if you’re exhausted and burnt out.”

The Worry: What if my loved one dies while I am not by their side?

Reassurance You Can Offer: “Death is unpredictable. It is true that we

can’t predict the exact moment a person will pass. Perhaps we can
create a ritual together for you to carry out before taking your weekly
caregiving breaks, that will allow you to feel at peace with your ‘last

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goodbye’ to Joann, if she does happen to pass before you return to her
side.”

The Worry: My family will judge me for leaving my loved ones’ side.
Taking time for myself is selfish.

Reassurance You Can Offer: “As they tell us on the airplane, you must put
your oxygen mask on first. If you don’t, you won’t be well enough to
care for Joann. Taking time for yourself isn’t selfish.”

The Worry: These are my last days or weeks with my loved one. How
can I do anything else but be with them?

Reassurance You Can Offer: “Every memory you have made with Joann
is precious. The quality—not the quantity—of those memories is what’s
most precious. The additional memories you have to create together
will be so much more pleasant if you are well rested.”

The Worry: I feel guilty wanting a break. I feel guilty for the feelings of
resentment and exhaustion.

Reassurance You Can Offer: “These are all very normal feelings, both
wanting a break and feeling guilty. Resentment and even anger is
common as well. Taking a break will help you let go of the resentment
and be fully present with Joann. Your time away is a gift to her.”

Find Out What They Need

Before you can offer respite services or refer to local resources, you
need to evaluate what the needs of the client are exactly.

Some questions to consider or ask include...

• How much time would you like? What day? What hours?

• What tasks for caregiving are required while you are away?

• What do you want most help with? Cleaning? Cooking? Offering

companionship time to your loved one so you can get self-care
time to yourself?

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TIP: Together with the caregiver, it can be helpful to create a

caregiving “help sheet” that lists important information
like emergency contacts, doctor or hospice phone numbers,
current medications and times and doses, basic needs
and times for those needs to be provided, basic likes and
dislikes, their daily routine, and so on.

This can be used not only for respite care helpers, but also could come
in handy if the primary caregiver has an emergency and doesn’t have
time or the opportunity to explain what’s needed.

Providing Respite Care

Helping a caregiver with respite care can look like many things,
including…

Death doula work with the dying, while the caregiver takes time
alone—you may be sitting with the dying and doing “death doula
work” with them, while family gets their time to relax. So, this could
look like life coaching, consultation, working on a legacy project,
providing emotional or (non-medical) physical comfort, or simply
“holding space.”

More practical support for specific time periods—respite care may

look more like very hands on, practical (non-medical) support while
your client takes time for himself or herself. Depending on how much
supervision the ill person needs, you may spend some time doing light
housework or cooking.

Delegating respite care—you can get a list of names of friends and

family who have said they “want to help” from your client. With
this list, you can then reach out to these friends and family members,
let them know exactly what your client needs for support, and start
assigning tasks, household chores, errands, or visitation times.

In essence, you are a manager. People often want to help, but have
no idea how to put that help into action. Caregivers desire help from
people, but may not know how to delegate tasks, not have time or the
mental room to manage other people (it can feel easier to just do it
themselves), or they may feel guilty or ashamed asking for assistance.

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But, you can do all these things as a death doula. You not only help
your clients, but also those that love them and want to help.

Call in professionals or refer to local respite care resources—in some

cases, health insurance or government programs may have a limited
amount of paid (or discounted) respite care available. You can put your
client in contact with these agencies.

You may also put your client in touch with housecleaning or meal
services. You might be able to earn referral fees for making these
connections as well. (Always be open about any financial benefit you
may receive for referring to another service provider.)

2.6.2 Educating the Family on the Dying Process

What does dying look like? What can someone expect during those last
days and hours?

Just like childbirth can look frightening if you’re unsure of what’s

happening, the same is with death. You can’t predict the exact moment
of death (just like you can’t exactly predict childbirth), but there are
common signs and occurrences to watch for.

When people are prepared and knowledgeable about what dying looks
like, the experience can be less frightening. Witnessing some stages of
death can be traumatic if you are caught by surprise or don’t realize
something is a normal part of transitioning. On the other hand, when
you are prepared, some of these same signs of dying can be comforting.

Carlos A. was present when a family member started hospice

care, and also present at the moment when a different family
member passed away. Hearing a hospice nurse’s explanation
of what to expect in the last days and moments helped him
cope at the moment of his grandfather’s death. Also, with the
second family member’s death, those relatives did not have the
information on what to expect in the last days. Carlos talks about
how this made the situation more frightening and traumatic for
them.

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Here’s his story:

“When my wife’s uncle was terminally ill, and he decided to go to

hospice, at the time he looked healthy, he had all his wits to him, he could
walk around, and he was in good spirits. I was there at his home when
he went home from the hospital and the nurse arrived from the hospice
facility and gave the family the introduction. There were probably 12 or
15 of us there, and she was basically giving the speech to him because
he was still very much alert. For me, it was my very first contact with
hospice. I had never heard the explanation of that way of passing away.
And the nurse just did a really great job of explaining the purpose of it
and that they would do everything possible to make sure he wouldn’t
suffer in his last days or weeks...

It was really illuminating to hear her talk about what the last days
would look like. ‘Like four days before someone passes away, these are
the things that will happen…’ I remember her talking about the burst
of energy, and talking about the death rattle. She also told us not to
call 911, but to call the hospice nurse first if we were worried about
anything. I wasn’t there when [my wife’s uncle] passed away, but I
was there when my grandpa passed away, who was also in hospice…
but that time, my family had not gotten a similar introduction like my
wife’s family had with her uncle.

So, at the end, when my grandpa passed away, and he was having that
death rattle, I knew what that was. I remember my wife’s uncle’s nurse
explaining the noises, and what the liquid someone would have, and it
would be black. So when it happened with my grandpa, I just remember
seeing it, and being like, oh, I was told this would happen. And I
remember, not so much being at peace with it, but expecting it. But
my family [who never heard the hospice nurse explanations like I did]
was like… shocked, and saying, ‘He’s dying!’ And I was like, ‘Yes, I
know, I know. This is what happens…’ One of my aunts was so shocked
seeing her father spit out black liquid that she called 911, which brought
our family additional stress that night having a team of firefighters and
paramedics enter the house at such a difficult time.”

Of course, every death is different and unique. The cause of death will
also strongly impact what the last hours or days look like. Sudden
death is also very different from death from old age or illness.

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With that said, here are some possible signs and symptoms of dying
in the last days and hours. You may share this with your clients when
discussing vigil planning or during a more general consultation.

Providing your client with a written explanation, in addition to a

discussion, is ideal. This will allow them time to process and review
what you share.

Labored or “gurgling” breathing: it may sound like the person has

congestion or mucus pooling in the back of their throat.

Changes in breathing pattern: they may gasp loudly for breath and then
return to quiet, shallow and slow breaths. They take a breath, not
breath for many seconds, and then breath again. It can appear like they
have stopped breathing, but death has actually not yet occurred.

Yawning and snoring: because of a lack of oxygen, yawning may occur.

They may sleep with their mouth slightly ajar, leading to raspy snoring.

Limbs become cold or blue-colored: as circulation and blood pressure drop,

their hands may feel very cool. There may be a blue tinge to their limbs.

Bruising: also from poorer circulation and lower blood pressure, blood
may pool and lead to deep blue looking bruises, especially on the lower
back and near the spine.

Odor: a dying person may give off an odor similar to nail polish
remover.

No longer responding, difficult to wake up, or sleeping for extended times

periods: they may seem to constantly sleep or be difficult to wake up.

Detached or withdrawn: when they are awake, they may seem to be lost
in thought, withdrawn, and detached.

Seeing or talking to people in the room (who have died): they may see and talk
to people in the room who are not actually visible in the room, frequently
those who have already passed away. They may be frightened by these
visions or comforted by them. (Caregivers present should not tell the
dying that the visions are not real or argue about them, but instead, offer
comfort and reassurance to the dying that they are safe.)

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Reaching out towards something or someone: they may reach out with a
hand or both arms, as if something or someone is there.

TIP: Watch “I See Dead People: Dreams and Visions of the Dying”
by Dr. Christopher Kerr (https://www.youtube.com/
watch?v=rbnBe-vXGQM), and “More to Dying Than Meets
the Eye” by Martha Atkins (https://www.youtube.com/
watch?v=vg8WAv0YT9c).

Decreased desire to eat or drink: because the body is slowing down, the
need for food and liquid is diminished.

Incontinence and loss of control of bowel movements: there is less urine

and bowel movements because they are taking less food and liquid in.
However, they may experience incontinence or be unable to control
their bowel movements.

Confusion: they may become confused, disoriented, or even frightening.

They may be confused where they are and who is with them. They may
misinterpret sounds and objects in the room. Flowing curtains may
appear like a ghost, for example.

Restlessness: they may shift around and pull at medical equipment or

bed sheets.

What Does the Actual Moment of Death Look Like?

When death actually occurs, the person will...

• Have no pulse

• Cease breathing (though there may be sudden exhalations or

intakes of air after minutes of no breathing, from the lungs
naturally emptying)

• Eyes lose focus and pupils are non-reactive, eye lids may be
partially open

• Jaw may hang loose and open

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2.6.3 Support for the Mourning Family

Mourning begins before death actually arrives. As soon as a terminal
illness is diagnosed, the grieving process may begin. This is sometimes
called anticipatory grief.

Whether you support a family while a loved one is dying, or they hire
you only after death has occurred, part of your role as a death doula
will involve supporting the mourning family.

Holding space is a big part of supporting a mourning family, as well

as providing practical support as they plan for post-death rituals and
organization—much like what was discussed in Section 2.4 How to Do
a Client Consultation.

Here are more things you should know about supporting a mourning
family.

Possible Emotional States of Grief—and How There

Are No Ordered Stages
You’ve likely heard of the five stages of grief, a concept invented by
Dr. Elizabeth Kubler-Ross. These stages have been widely
misinterpreted and misunderstood, and used in a way that Dr. Kubler-
Ross never intended. The five stages of grief weren’t meant to be a
blueprint on “how people should grieve” or a set of “goals” for proper
grieving.

In fact, originally, Dr. Kubler-Ross was talking about those diagnosed

with a terminal illness—and not talking about those mourning the
death of a loved one.

With all that said, one thing we can take away from the five stages of
grief is that it’s natural to experience a variety of emotions (and denial
of emotions) when mourning a loss.

Some of the emotions your clients may experience (in any order)
include:

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Denial: “This is not happening.” Numbness as a way of coping

with unbearable thoughts. They may have difficulty thinking or
concentrating on life.

Denial is not a “bad” emotion. The brain uses denial to protect a person
from emotions they are not yet able to handle. With time, in titrated
doses, they will eventually come to accept reality. Do not attempt to
speed up that process.

Anger: They may be angry at the illness, angry at God, angry at fate,
even angry with the dying person. They may be angry with themselves.

Beneath anger is sadness. Anger tends to seek a target, so a grieving

person who experiences anger may lash out at people around them.

Bargaining: This can look like making deals with God or the Universe.
“If you make this not be true, I will never do ….. again.”

This may include guilt. Thoughts like:

• “If only I spent more time with them…”

• “If only I picked up my phone when they called…”

• “If only I intervened more when they started drinking…”

• “I should have made them see the doctor sooner…”

• “Ishou l d h ave en courag ed th e m to g e t th e ir ye a rly

mammogram… “

• “I should have been a better caregiver… they’d have had more

time with us then…”

This is a stage that involves trying to make what’s happening be within

the mourner’s control, whether through making deals with god, with
fate, or trying to make what happened the mourner’s “fault.”

Of course, the death is not their fault. But if it can be blamed on their
action or inaction, that means they have control. That’s a comforting
idea.

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Depression: This is deep sadness and possibly a feeling of emptiness.

They may lose interest in life, work, relationships, and the world
around them. They may isolate themselves or walk around as if they
are in a fog.

Acceptance: Not “It’s okay my mom died,” but, “My mom died, but I am
going to be okay.” There may still be a deep sadness and feeling of loss.
But hopelessness is dissipating. They may start interacting with life and
the world again.

As a death doula, holding the space for a mourning client is an

important service. It’s difficult to hold space for someone if you are
judging the way they are handling their emotions.

Some thoughts to keep in mind…

• Denial is normal. A mourner does not need to be convinced of the

reality of the situation. It’s a healthy, natural coping mechanism.

• Anger is normal. This doesn’t give a pass to hurting others

with anger, but anger does often look for a target. If you
become a target, knowing pain lurks underneath is a valuable
understanding. Don’t accept abuse. But if someone lashes out at
you, take a deep breath and remember this isn’t about you.

• Ifthe mourner has guilt over the death, know this is a coping
mechanism. Sit with them as they experience this guilt. Reassure
them without denying their feelings. (“You did the very best you
could.”)

• There is no “order” to grief.

• There is no requirement to experience each emotion. Not everyone

will have a denial or anger stage.

• There is no timeline.

• Beneath all the emotions of grief is pain.

• There is no wrong or right way to grieve.

TIP: Providing information to your clients not only on the many

emotions that can arise, as well as the fact that grieving
can start before the death has occurred, that they don’t

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necessarily “go in order,” and that there is no set limit on

how long you should be in mourning—could be days, could
last years— can help them face these difficult days with
more confidence and strength

Reprocessing the Death

After the death, some doulas offer a time to sit with the clients and talk
about the experience and feelings over what has occurred.

This is a time of active listening, “holding the space,” and just being
really present with your clients.

The goal of this meeting is to emotionally and mentally process what

has occurred. To be heard, to seek for meaning in the experience, and
consider both what was beautiful and what was painful during the
transition.

This may be a time to look over a legacy project that was created, to
look at photos taken during the last days or weeks, to read letters that
the dying prepared or wrote for this moment before they died, or to
conduct a ritual (or rituals) that are personal and meaningful to your
clients.

Traditionally, funerals are a ritualistic way to face and cope with death.
But they occur so soon after the person passes. There hasn’t been time
to be with the reality of the loss. Also, the time between death and the
funeral can be busy and stressful, more like “putting on a performance”
and less like a self-care experience.

This is why you may want to have your post-death meeting with your
client a month after the death, after the funeral, and after family and
friends have gone back to their regular life. Just when the reality of the
loss is settling in, this is the time to have that meeting with you, the
death doula.

Using Ritual During Mourning

There are a variety of religious and cultural rituals intended to help
people cope with the death of a loved one. These are important, vital,
and can be comforting. As part of your study to become a death doula,

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you should educate yourself on these traditional rituals. See http://

www.beliefnet.com/wellness/health/health-support/grief-and-
loss/2001/05/transition-rituals.aspx.

However, research has found it’s not these rituals that make the biggest
difference. Studies have found that those who cope better after death
create their own personal rituals (https://www.ncbi.nlm.nih.gov/
pubmed/23398180).

As a death doula, you can encourage your clients to consider what a

personal ritual may look like for them.

Some examples may include...

• Writing the deceased a letter of goodbye. The letter may be kept

and re-read or added to each year on the memorial of their death.
Or, the letter may be burned, shredded, or even buried with or
next to the deceased.

• Lighting a candle, saying a prayer or talking to the deceased

directly, and then blowing the candle out.

• Going to the deceased person’s favorite restaurant to have a meal

and talk about them. This can become a yearly, memorial event.
This can be adjusted to be going to the deceased favorite park, or
hiking spot, or biking trail, or whatever. Something personal and
specific, though, to the person who died.

• Creating a box of memories.

• Playing their favorite song and singing or dancing or just enjoying

it together with loved ones.

TIP: Read this wonderful article from Counseling Today entitled

“Grief: Going Beyond Death and Stages” (https://ct.counseling.
org/2016/10/grief-going-beyond-death-stages/). Rituals,
among other things, are discussed, along with specific
examples.

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2.6.4 Handling Conflict and Heated Emotional

Moments
Emotions run high under stress, and facing terminal illness and the
death of a loved one are highly stressful situations. As a death doula,
you will occasionally be confronted with “the worst” of people. When
people are in pain or afraid, they may say things that they later regret.

You may also find yourself “in the middle” of family conflicts. For
example, disagreements over how the funeral or burial should be
conducted, disagreements about end-of-life care decisions (especially
if there were no advanced care directives discussed before the decisions
had to be made), and anger or resentful feelings family members have
towards each other.

When facing heated moments as a death doula, here are some things to
keep in mind.

Look for the good in people. There will be family members or friends of
your clients who you simply do not like. You do not have to like every
person, but working with your clients will be difficult if you harbor
strong negative feelings towards their annoying aunt or nosy brother.

Try to look for the good in the person you can’t stand. There is
something good in every person. The bossy person may be a natural
leader, for example. When you try to find the good, and remember their
humanness, you’ll have an easier time dealing with their less-than-
pleasant personality traits.

Be an observer—not a decider—in the midst of family disputes. Not

everyone will always agree with each other. In the best of situations,
advanced care directives will be discussed and written out together
so everyone is on the same page with the dying (even if they might
have chosen differently), and funeral arrangements will have also been
planned and discussed ahead of time.

But this won’t always be the case. Especially when death is imminent or
just occurred, needing to make decisions can be highly emotional. Your
client may attempt to pull you into their disputes with family members
and ask you to declare “who is right.” Don’t do it. This is a legal (and
emotional) minefield.

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Support individuals without “taking sides.” The best course of action is

to hear your client’s complaint or arguments, be an active listener, hold
the space for their emotions on the sensitive topic, and acknowledge
that their reaction is understandable and legitimate.

Use your best judgement but it can also help sometimes to acknowledge
the opposing view’s legitimacy as well. In other words, you’re not
saying who is right or wrong… but saying both sides has their point.

Remember that this time is challenging and exhausting for them. It’s
extremely challenging to keep your own emotions in check when facing
a stressful situation. Just remembering that this is a difficult time in
their lives can help you have more patience and compassion for others.

Encourage (gently) an atmosphere of peace and respect in the room

with the dying. This may come up during basic consultations, when
planning a vigil, or just discussing the best ways to comfort the
terminally ill.

But at some point (ideally before a emotionally charged event takes

place), talk to your clients about keeping the space where the dying
lay calm and peaceful. Remind them that even if the person looks
unresponsive or unaware of their surrounding, we know that people
often are still somewhat in tune to what’s happening around them.

You may even consider suggesting posting a note or reminder on the

door to the room, to keep this place loving and calm.

If things get heated in the vigil room, you may be able to gently remind
visitors that this space is sacred, and out of respect for the dying, it
would be better to take their conflict elsewhere and return when they
are feeling centered again.

Do not accept abuse. But do not respond to anger with anger. There is a
difference between understanding anger and it’s source, and accepting
abuse from a client or a family or friend of a client. If you need to walk
away or leave the room, do it.

Just don’t start yelling back or getting defensive. It’s better to

acknowledge their anger and walk away. (“I see that you’re angry right

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now. I am going to walk away and give you some space. We can discuss
this when you’re feeling calmer.”)

2.7 Conducting Workshops and Seminars

“The public doesn’t know about end-of-life doulas, so many people
are getting training and then they have to go out there and their first
job is educating the public about what it is they do. We tell people in
our trainings, don’t think you’re going to go home and start working
fulltime. You gotta get out there and talk to people and do presentations
and education and tell everyone you know and talk to everyone you
know and go to your local hospice. Get the word about what you do. But,
then, when people find out about it, they think it’s a really great idea.”
Merilynne Rush,
MS in Hospice & Palliative Studies, RN, BSN
Lifespan Doula Association
https://www.lifespandoulas.com/

If you want to be successful as a death doula, your business must be

more than about working with individuals. This is true even if your
primary desire is to work one-on-one with clients and families.

The first role of a death doula is to help educate the public on who you
are. The good news is that there are many people looking for guidance
and information on how to handle end-of-life decisions and care. There
is an audience out there.

What can your workshops and seminars be about? There are so many
topics! Here are some ideas. (Feel free to use them!):

• Understanding Advanced Care Directive Basics

• Death Doulas: What Is a Death Doula and How Might One Help
You?

• Self-Care for Full-Time Caregivers

• Coping with the Terminal Illness

• Coping with the Recent Loss of a Loved One

• Living Funerals: What Is It, Is It Right for You?

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• Creatinga Legacy Project (could be a seminar, could be a multi-

week workshop)

• Post-DeathReorganization: Compassionate, Practical Help in

Going Through a Loved Ones Possessions

• Home Funerals: What Is It, Is It Right for You?

• Green Burial Options: Reducing Your Carbon Footprint After

Death

• How to Plan for Your Funeral and Burial Before You Go

These are just a few possible ideas to get you started. There is so much
more you could discuss!

“When [green burial] was going to be the topic of discussion for a brown
bag lunch at the senior center, people would flock to it. And always the
conversation would turn to death. People need to talk about people they
know who have died or their own grief or questions about how somebody
died or how a funeral happened that they weren’t happy with.”
Merilynne Rush,
MS in Hospice & Palliative Studies, RN, BSN
Lifespan Doula Association
https://www.lifespandoulas.com/

Where might you give a workshop? Again, there are so many options:

• Local libraries or bookstores

• Churches, synagogues, mosques, etc.

• Community college or art center

• City recreational centers

• Nursing homes

• Senior living centers

• Cancer research or support centers

• Lion’s Clubs

• Rotary Clubs

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• Yoga, gyms (that offer healthy living workshops), or even natural

health stores

Again, this is only a beginning. Look at your local newspaper or city

magazine, and see where people are offering and attending workshops.
Those are all possible locations.

“Get out in the community as much as possible. A lot of the work for now
is in public education about the services we (death doulas) offer. I benefit
from word of mouth, podcast and magazine interviews and videos with
Refinery 29. I am actively engaged on my Facebook and Instagram.”
Alua Arthur,
Going with Grace
www.goingwithgrace.com

Also, don’t forget about online options! You can conduct seminars or
workshops that can be accessed remotely. These can also often be saved
and shared later.

Online possibilities include…

• Using Facebook Live

• Conducting an online webinar

• Starting a YouTube Channel

• Starting a podcast

Should you charge for your workshops? Eventually, yes. You might
want to give some free, especially in the beginning. That said, giving a
workshop is a lot of work. The goal should be to get paid for your work.

TIP: Consider joining a local Toastmasters International club

(https://www.toastmasters.org/) to gain experience with
public speaking.

In Chapter 5.3, you will learn more skills and ways to educate the
public about your work and spread the word about end-of-life doulas.

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2.8 Working with Fellow Dying Professionals

“Part to my vision for death doulas everywhere is that we work in
conjunction with hospice agencies, hospitals, funeral homes, grief
counselors, basically any industry that has anything to do with death.
Death has traditionally been done in one way, and we are hoping to shift
the paradigm which requires all arms and facets of this work to collaborate.
Death doulas are the bow that tie all these industries together.”
Alua Arthur,
Going with Grace
www.goingwithgrace.com

Remember that all those that work in death are a community—even if

you disagree with some of the community member’s approach to death
and dying—are playing vital roles in the lives of people facing and
coping with death.

There can be an instinctive reaction to create “us” vs. “them”

paradigms. Home funeral advocates against traditional funeral home,
for example. This can create aggression and negative competition
between businesses who could be working together to bring the best
experience to each individual.

Instead of seeing a home funeral guide as competition, see them as a

potential partner. Instead of seeing a hospital ICU nurse as a “medical
establishment” member, see them as a caregiver providing support and
medical care in the way best known to them.

Also remember that you all play different roles and are not truly in
competition. Death doulas, for example, do not provide medical care.
Your client needs nurses and doctors and therapists.

The more connections you form within the death community—and the
more you remember that you’re job isn’t to define what a “good death”
looks like, but to help your clients discover and define what that means
to them—the more successful you will be, and the more happy you will
be in your career.

Ways to form positive connections and meaningful business

partnerships include...

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• Visit and tour your local hospice options. If you have not
volunteered there, at least go introduce yourself and find out
what they can offer to your future clients.

• Seek out, tour, and interview local funeral homes. Talk to funeral
directors. Find out how you can work together and refer clients to
each other.

• Seek out local home funeral guides. Meet over coffee or lunch. Let
them know what you’re looking to do in the death community,
while finding out what their vision and mission looks like. Look
for ways to work together, when appropriate.

• When working with a client in a hospice or hospital environment,

introduce yourself to the staff. Let them know your role and that
you are there to help them as well as your client. Be an ally.

• Talk with local grief counselors and group therapy leaders that
relate to the death and dying community (like cancer support
groups.)

You may encounter resistance from those in the death community, and
it can be discouraging. But don’t give up. Remember that these are the
pioneering days of death doula work. Your work will help create a path
not only for your own business, but also for those who come after you.

“It is not easy to break into our tightly closed ideas of how to handle a
body; usually they call the mortuary, and let them do it. Look for people
you will be able to work with, maybe a direct crematorium company or
mortuary who is open to these ideas to work with in the beginning….
I am even finding that I threaten social workers in hospices who feel it
is their jobs to handle the end of life plans for patients. I would love to
complement, not compete; however, I am not there yet. I see many closed
doors in front of me right now; I am going to knock on all of them to
see what happens. I really want to make this sacred time available for
all those who want and need it in our community. It is not here right
now, and I know that if I can just break through a little, more and more
changes will happen.”
Rev. Arlene Radasky,
Death Midwife

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3. Getting Ready
Now that you know what the job involves, this chapter will give you
information on how to further develop the skills you will need to
succeed in this career.

Before you start an end-of-life doula business, there are several steps
that may make it easier for you to transition to this career. In this
chapter, you will discover how to develop your skills, knowledge and
experience. By following this advice, you could make yourself much
more attractive to prospective employers and clients.

3.1 Skills and Knowledge You Will Need

End-of-life doula’s need to use a variety of skills to do their job well.
As you will read in this chapter, the skills you need to succeed as an
end-of-life doula can be learned. However, if you already have relevant
experience or an aptitude for end-of-life doula’ing, entering this career
will be even easier for you. So let’s take a look at the specific skills and
knowledge that can help you succeed in death doula work. Later in this
chapter you’ll find plenty of resources to develop these skills through
education and self-study.

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3.1.1 Skills Assessment

Here are some questions that reflect traits shared by many death
doulas. Make a mental note or put a checkmark next to all that are a
“yes” for you.

Signs of Death Doula Talent

If you are a born “death worker” you likely have already demonstrated
your ability in a number of ways. See how many of the following are
true for you:

___ You easily connect with people. And others seem to connect
right back with you just as easily.

___ You can read people’s emotional states without them saying
a word. You may be able to read them better than they know
themselves.

___ Cemeteries don’t scare you. In fact, taking a walk through a

cemetery sounds like a beautiful, peaceful way to spend a
weekend afternoon.

___ You enjoy reading, watching, and thinking about death, dying,
and the afterlife. You are fascinated and perhaps even awed by
the transition.

___ People often comment on how easy it is to be with you.

___ You’re naturally intuitive. You may wonder (or know) that you
have a connection with unseen spirits or energies.

___ When situations arise that would cause many people fall apart
or become extremely stressed out, you are a voice of calm and
reason.

___ People often talk to you about deep topics, like the meaning of
life and why we’re here in this world. Friends might joke that
you’re their “therapist.”

___ When a friend or family member is sick in the hospital, you’re

the first to go visit.

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___ When a friend or family member has a baby, is in distress, or

for any reason is in need of additional support, you’re the first
to offer practical help. You’re there bringing them a meal, or
calling up friends and family so you can all pitch in together.

___ Being around people who are very ill, dying, or elderly doesn’t
bother you. You feel as comfortable visiting the sick as you do
sitting with a healthy person.

___ When you look at people, you see their humanity—not their
religion, race, sexuality, age, gender, societal status, disability,
or illness. Physical appearance and lifestyle orientations don’t
affect how you interact with people.

___ You are trustworthy and maintain people’s privacy. Friends

know that if they confide in you, what they share will not be
shared with anyone else.

___ People say your presence is naturally calming to them. They

might say you have “good energy.”

___ There is a common theme running through the above list. The
most important traits for a death doula are excellent people
skills, especially in situations of stress and illness, along with a
deep desire to help.

This comes naturally to some people, while others have to work to

develop it. In this guide, you will learn how to develop and improve
these vital traits.

3.1.2 Getting Comfortable with Death and Dying

“It is vitally important to build your own relationship with death. That
doesn’t mean you have no fear of it, rather, it means you take the time
to figure out what you are drawn to or interested in when it comes to
death.”
Alua Arthur,
Going with Grace
www.goingwithgrace.com

How do you come to terms with mortality and death? Of course, as

you study death doula work and add to your skills, you will naturally

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become more comfortable with death and dying. The rest of this
chapter will provide many ways to develop those skills.

With that said, here are some more possibilities to get more comfortable
with your own mortality:

• Write your own advanced care directives, and talk to your family
about your decisions and desires. This is a given. You can’t help
someone else with this task until you have done it yourself.

• Have a will. A legal will that indicates what should be done with
your belongings and finances.

• Consider what your beliefs may be in afterlife. The more you

understand your own beliefs and feel comfortable with them, the
better you will be able to support someone else in their personal
beliefs. You don’t have to come to any conclusion—just consider
your beliefs thoughtfully.

• Journal. Write down your thoughts and feelings about your own
death, dying, and afterlife. What you imagine it to be, what would
be the “best” death, what your worst fears are, what you would
want if your family were holding a vigil for you.

• Go to therapy. Talking about mortality with a therapist is a

wonderful way to get your thoughts out in a safe and supportive
environment.

• Talk about death. Talk to friends and to family about death. Talk
to your spiritual mentor. Talk about death and dying with anyone
who is interested in discussing these ideas. You might consider
joining or starting a death café. (More on this in section 3.3.3 Join
Associations and Social Clubs.)

• Read, watch, and listen to stories and information on death and

dying. There is so much written on the topic. Documentaries you
can watch. Podcasts to listen to. Seek it all out and take it all in.
Then, ideally, discuss your thoughts with a trusted friend on what
you read and listen to afterwards.

TIP: Know that you don’t have to come to a solid answer or

conclusion on what it means to die. For example, you don’t
have to know for sure what “the afterlife” may or may not
mean to you. You don’t have to be 100 percent certain how

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you want to be buried. What you do want to do is wrestle

with these questions and feel somewhat comfortable with
your uncertainty, if that’s where you find yourself.

“I have been a Hospice of Santa Barbara volunteer for over fifteen years.
I have worked with people who have died while I was with them at the
end of life. I also have done extensive research and soul-searching to
establish my after-life beliefs. I feel that is very important—not what I
believe, but that I know I am not afraid to be with a person who is dying
or to die myself.”
Rev. Arlene Radasky,
Death Midwife

3.1.3 Interpersonal Skills

As a death doula, you will need to work effectively with many people
including your clients, hospice and hospital staff, friends and family
member’s of your clients, employees and partners (if you have them),
fellow death professionals, and everyone else you do business with. Your
interpersonal skills (i.e. your skills in dealing with other people) will be
one of the key factors in ensuring that you are successful in this business.

Following are some key interpersonal skills and why they can be so
helpful to you in the end-of-life doula profession.

Developing Relationships
To have a successful death doula business, you first must have clients
who will hire you to perform the work and feel comfortable referring
you to their social network. When prospective clients find out about
your services, chances are they will want to meet with you to determine
whether there is a “fit” between their needs and your services. If people
have a choice between two different end-of-life doulas who both have
similar experience and capability, they are more likely to select the
death doula that they “liked” the most and felt the most comfortable
with. Think about the individuals who you choose to do business with,
for example when you need a haircut. As a general rule, people prefer
to do business with people who they like. Chances are, if you don’t like
someone or how they treat you, you will take your business somewhere
else if you have that option.

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If you are able to develop a rapport with people and build their trust in
you, they are more likely to want to hire you to do the job. One of the
best ways to develop that relationship is to show genuine interest in
them and their needs. A common mistake many new business owners
make is to talk too much about themselves while trying to sell their
services. Instead, you should focus on asking others about themselves.
Then listen attentively to the responses, using the listening tips
provided below. If you show interest in prospective clients and their
needs, they are more likely going to show interest in you and want to
hire you as their death doula.

Besides developing relationships with clients, you will also need

to develop relationships with other business people. For example, if
you have a good relationship with other death professionals, they are
more likely to come through or help you get what you want when
you need something in a rush or when you need something that
is difficult to track down. For example, a funeral director who has a
good relationship with you is much more likely to go the extra mile
for you, which will in turn make you look good to your clients. Just as
importantly, other death professionals can recommend your services to
prospective clients.

If this is an area you want to improve, pick up a copy of Dale Carnegie’s

book, How to Win Friends and Influence People.

Listening
Being an excellent listener is the key to providing your clients with the
service they want. While listening seems like an easy skill to master,
most of us experience challenges in at least one of the following
areas involved in listening: paying attention, understanding, and
remembering.

The importance of active listening in your role as a death doula was

discussed in detail in Chapter 2, sections 2.3 and 2.4. However, listening
will also be an important skill when you interact with hospice and
hospital personnel, friends and family of your clients, and fellow death
workers. You can become a better listener by focusing fully on someone
when they are speaking. Here are some ways to do that:

• Don’t interrupt the other person. Hear them out.

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• Keep listening to the other person, even if you think you know
what they will say next. If you make assumptions, you may miss
the point they’re making.

• Ask questions in order to clarify what the other person has said.
Take notes if necessary.

• Don’t be distracted by outside interference. Loud noises, the other

person mispronouncing a word, or even an uncomfortable room
temperature can break your concentration and distract you from
the conversation.

• Give feedback to the other person. Nod occasionally; say things

like “I see,” and smile, if appropriate. Let them know you’re
listening.

• Use paraphrasing. In other words, repeat back in your own words

your understanding of what the other person has said. It can help
alleviate misunderstandings later on.

If this is a skill you want to improve, there are numerous books on the
subject of honing your listening skills and one of the best is Listening:
The Forgotten Skill: A Self-Teaching Guide, by Madelyn Burley-Allen.
Helpful free advice is available online at www.businesslistening.
com. Another good resource is The Seven Challenges Workbook, a short
workbook on improving communication, including listening skills.
Visit www.newconversations.net/#pdf-table.

Verbal Communication Skills

Good verbal skills are helpful when you are selling yourself to potential
clients or when you need to communicate with employees, suppliers,
or other business people, such as your banker. Many people prefer
to work with somebody they can understand who “speaks their
language.” To improve your verbal communication skills, ask friends
or a vocal coach for feedback on any areas that could be improved,
such as clarity of speech, use of slang, proper grammar, or altering your
tone of voice to eliminate any harshness. An inexpensive digital voice
recorder (available from any office supply store; for example see www.
staples.com/Voice-Recorders/cat_CL140515) will allow you to find out
how you sound to others.

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Reading Non-Verbal Messages

In addition to hearing what people say, a skilled end-of-life doula also
notices non-verbal communication (tone of voice, facial expression,
body language, etc.). These signals can give you valuable clues about
what the other person is thinking. Being able to “read” people may
not only help you get the job, it can help ensure you keep your clients
satisfied. For example, did a prospective client fold their arms when
you made a particular suggestion? If so, they may be communicating
that they disagree, even if they don’t actually say so.

Although body language can’t tell you precisely what someone is

thinking, it can give you clues so you can ask follow-up questions,
even as basic as “How do you feel about that?” If you want to improve
this skill, you can find some excellent advice in books such as Reading
People, by Jo-Ellan Dimitrius, Ph.D. and Wendy Patrick Mazzarella, and
How to Read a Person Like a Book, by Gerard I. Nierenberg and Henry H.
Calero.

3.1.4 Business Skills

“I wish I had started working with my business coach and consultant,
Lisa, right away. Before I started working with her, I was passionate,
but I lacked confidence and clarity. I knew where I wanted to go, but I
could not see a clear path. Lisa helped me get super clear on my vision,
my services, my perfect clients. If new doulas do the same, their passion
and personality will shine through. I knew I wanted to do this work,
but I didn’t know anything about starting a business. Specifically, the
marketing challenges that come along with a business that few people
have heard of, and most are scared of! I keep learning one lesson over and
over: we don’t have to be perfect.”
Emily Pinzur,
End-of-Life Doula
www.silverwheelhealing.com

You can be excellent at relating to people, be comfortable with illness

and death, have wonderful energy, and tremendous compassion—but
if you can’t keep track of scheduled appointments, billing and expenses,
marketing, and contracts—you’re going to struggle as a death doula.

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Staying organized is essential to death doula work. Some end-of-

life doulas rely on organizers or datebooks such as the Day-Timer
(www.daytimer.com) or the more upscale Franklin-Covey (https://
franklinplanner.fcorgp.com); you may find you prefer these to an
electronic version. If this is your only support system, though, you’re at
risk of losing your entire business if you lose your ‘book’!

A PDA with basic features can be considerably less of a financial

investment than a smartphone. At press time, the PalmPilot is poised
to make a comeback per http://fortune.com/2017/08/31/palm-pda-
comeback-tcl, and BlackBerry is causing a stir with its Motion release
(www.cnet.com/news/all-screen-blackberry-motion-is-here-sort-of).
Even if you already have a smartphone, you might have an interest in
the PDA. Offerings in the marketplace change rapidly; look for recent
articles such as the following for advice:

• www.quora.com/Whats-the-difference-between-a-PDA-and-a-
smartphone

• www.lifewire.com/pda-vs-smartphone-2583232

• www.recode.net/2017/5/17/15655458/digital-assistants-voice-
activated-operating-systems-alexa-siri-cortana-ios

You will also need a simple filing system for paperwork, bills and
invoices. For files, check out your local office supplies retailer. You can
also find some excellent tips on getting organized at:

• www.score.org/blog/6-organizing-tips-entrepreneurs

• www.lifehack.org/articles/productivity/how-organize-your-life-
10-habits-really-organized-people.html

• w w w. t h e b a l a n c e . c o m / h o w - t o - o r g a n i z e - a - s m a l l -
business-4126115

3.1.5 Ethical Awareness

An end-of-life doula must have a strong sense of ethics. You will be
working with people when they are most vulnerable, and be privy to
information that is personal and sensitive. It is an honor to be able to
work with people as they transition, and the work demands respect.

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Privacy and Confidentiality

Privacy is a big part of death doula work. You have likely heard of
Health Insurance Portability and Accountability Act (HIPAA), a law
in the United States of America that protects personal healthcare
information. You’ve probably signed HIPAA papers for your primary
care doctor’s office.

You can learn more about HIPAA at https://www.hhs.gov/hipaa/for-

individuals/guidance-materials-for-consumers/index.html.

Does HIPAA apply to end-of-life doulas? While you should always

consult with a lawyer (and ensure you have liability insurance), as of
right now, it does not appear that HIPAA applies to doula work.

However, that doesn’t mean you shouldn’t respect the privacy of your
clients. What they share with you should remain confidential. You
should do your best to protect their information (including photos,
video, or audios created during legacy work.) Also, of course, you
should not talk about your client’s personal information with others.

You also must be careful with what information you post to social
media. When talking about your work online, never use any identifying
information. Even if you hide personal details, always ask clients if you
can share their stories online before you post anything.

Reliability and Responsibility

As an end-of-life doula, your clients are relying on you to be there
when you say you will be there. This is true for every profession, but
even more so when you’re helping people at a time of vulnerability and
sensitivity.

The degree to which you must be available and responsive to your

clients will vary, depending on what services you offer. If you are
primarily a consultant-style death doula, this will be very different
from doula work that includes active vigiling or companionship. If
you intend to be there for the last days/hours, you will be on-call. This
means being ready to drop whatever you’re doing when your client
needs you.

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Being firm but compassionate with boundaries is also vital to your

success as a death doula. Only by maintaining clear, professional
boundaries will you remain strong enough to care for your clients,
provide a sense of safety for them, and avoid burn out.

As you work with clients, it’s essential that you, your clients, and your
contract make clear...

• When can clients contact you? Are there particular days or times?
Under what conditions can they attempt to reach out off regular
hours?

• How can they contact you? Do you have a paging system or

service? Text messages? Email?

• If/when they contact you, how is this time billed? Are there a set
number of hours already included in a flat fee? Is it per hour past
a particular limit?

• What is your policy regarding connecting on social media with

clients?

• Ifyou are not available due to illness or another unforeseen

emergency, who is your back up? How can your client reach
them? Will they get a chance to meet your back up?

• If you work with a team, how will hours/shifts be determined?

Scope of Practice
Something else to keep in mind is the scope of practice as an end-of-life
doula.

To start, death doulas do not...

• Provide medical care

• Give legal advice or guidance

• Directly assist with aid in dying (also known as euthanasia)

• Push their personal religious or spiritual beliefs onto clients

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The Lifespan Doula Association (https://www.lifespandoulas.com/

doula-model-of-care/) has clear, excellent materials on the role and
scope of practice for death doulas. This is their association’s personal
opinion—there’s no official resource for these ideas (yet)—but their
guidelines are common sense and smart. Well worth reading and
reviewing.

3.1.6 Self-Care Skills

“The self-care practices that apply to living definitely apply to this work.
However, it is doubly important to exercise them regularly. I run, I
practice meditation, eat whatever I want, and I allow my emotions to
release.”
Alua Arthur
Going with Grace
www.goingwithgrace.com

You cannot take care of others if you are not taking good care of
yourself. Self-care skills are essential to death doula work. If you don’t
have good self-care skills, truly, you need to develop these skills before
you even think about attending a certification or training program.

As they say, you cannot pour from an empty cup.

You should consider your self-care time as important as any other

aspect of your business. If you were running a transportation business
(like being an Uber driver), you’d be sure your car was clean and in
working order. If you were a chef, you’d ensure your ingredients,
knives, and cookware was top quality. As a death doula, your heart and
soul are your equipment. Take care of them.

Here are some thoughts on self-care from working death doulas and
midwives:

“Know your own boundaries. Especially if we are doing end of life

companionship and facilitation.... We have to know what our own limits
are before we put ourselves and those we are serving in an inappropriate
position. This is BIG work on all levels: physically, mentally,
emotionally, and spiritually. If you go through a certification, training,

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or class, allow time for personal integration. Be sure the enthusiasm has
the time and space to evolve into a passion for the work.”’
~ Patricia Ballentine,
Ordained Minister and Priestess,
Certified Death Midwife
http://www.TheCreativeFlame.com

“Because we act as buffers, witnessing conflicts with family or

healthcare providers can be tough. But I find that it’s not too difficult
to protect yourself. I personally find that beautiful meaningful
exchanges and moments, laughs, smiles, affect me a lot deeply than I had
anticipated at first. I need time to process such emotions; they can be of
an overwhelming beauty. Like witnessing a very moving painting! A
Michelangelo, Da Vinci, Botticelli or Cezanne! Time alone helps me best
during the processing. It’s also a reason I have diversified my business
so much. One can’t be doing this work every day. I work one client at the
time, in parallel to my Cottage rental.”
Nathalie Bonafé,
PhD, CEOLD (Certified End-of-Life Doula)
https://www.agentlerparting.com/

“I practice radical self-acceptance which really means I do what I want

and I do not do what I don’t want, and I love and accept every part
of myself, even when it’s hard. So, I’m pretty in tune with what my
body, my brain, and my heart want and need at any given moment. I
know what feels good, where and to whom to turn for support, what
to do to restore. I love being in ritual to restore. The familiarity, the
concentration required; it’s really grounding. I create a lot of containers.
I think of it as a bowl. I do a lot of pouring, literally and figuratively, in
and out.”
Emily Pinzur,
End-of-Life Doula
www.silverwheelhealing.com

What does good self-care look like? This is personal. But, some things
to consider include...

• Meditation (Headspace is an excellent app for learning mediation.

Visit https://www.headspace.com.)

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• Exercise (possibilities include early or evening walks, yoga, lifting

weights, dance aerobics, martial arts, kickboxing... so many
options)

• Time alone

• Eating nourishing food

• Remaining well hydrated—and be sure you’re taking time to eat

and drink even when working with clients (of course, always in a
respectful way)

• Having your own therapist or counselor—even if you only see

them once a month

• Develop good sleep habits

• Making time for art, music, or any creative activity you enjoy

• Create personal rituals (for before and after working with clients,
for everyday morning or evenings, etc.)

• Keep a list of close friends and family who you can call when you
need to talk

• Find time to connect with friends in person (not just texting or on

social media)

Here are some resources to improve your self-care skills. (Yes, it’s a
skill! One you will improve on with practice.)

• https://www.developgoodhabits.com/self-care-ideas/

• https://tinybuddha.com/blog/45-simple-self-care-practices-for-
a-healthy-mind-body-and-soul/

• https://www.stress.org/military/for-practitionersleaders/
compassion-fatigue/

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Taking Breaks Between Clients

“We have to plan for our own bounce back/recovery time as part
of each death experience. Otherwise, we may burnout.”
Patricia Ballentine
Ordained Minister and Priestess,
Certified Death Midwife
http://www.TheCreativeFlame.com

Do you need to take breaks or time between clients, especially

after a death? And how long should that break be? This depends
on the individual. You may find that you need a few days after
a client dies to process the death and renew your spirit, or you
may find you need a few weeks.

If you have one client at a time—or one client near death at a

time (since you may have clients who are theoretically years
or months away from the end)—then taking a pause between
clients will be easier.

The practicalities of taking breaks, however, may be tricky,

especially if you are doing this work full-time. Death is not
always predictable. You may have three or four clients at once,
and even if they are at various stages of end-of-life, they still may
all reach the “very end” around the same time. As their death
doula, you will need to have a self-care plan in place so you can
support them, while still taking care of yourself.

A few ways to cope include...

• Have a back-up doula: If you live an area where you are

the only doula available, then this may be impossible. But,
if you are lucky enough to have fellow death workers in the
area, talk to them. Agree to support each other.

• Use rituals: Just like you encourage your clients to use

rituals for comfort and grieving, you too can use rituals.
Create your own that you use to transition from your
doula or midwife role, to your non-doula role. You may
have a ritual you do in your car after meeting with a client,

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a ritual you perform at home or in nature after the passing

of a client. You may do this ritual alone, with fellow death
workers, or with a friend.

• Don’t over book yourself: It’s hard to know how much time
you will need and how many clients you can take at once
until you start. That said, be careful about taking too much
work before you know you can handle it. It’s okay to turn a
client away and refer them to a colleague. This is better for
you, better for them, better for your colleague, and another
client will come to you when the time is right.

3.2 Learning by Doing

One of the best ways to learn end-of-life doula work is to jump in and
start doula’ing. When clients are looking at your resume compared to a
competitor, having some hands-on experience could give you the edge.
This section provides a variety of ideas and resources to help you build
your experience, develop your knowledge, and add to your credentials.

End-of-life doula work is primarily a freelance, contract position. In

other words, you can’t get a full-time job with health insurance and
benefits working as a death doula. There are no internships.

How can you get experience before stepping out completely on your
own? You can volunteer.

“Volunteer. Volunteer. Volunteer. Spend as much time as you can

with people and families in that final sacred space. Every death is as
different as the individual experiencing it. That sacred space is filled
with meaning, and it can surprise or even blindside you. Be prepared
for anything. Protect your own heart, but keep it open—to the dying,
the grieving, and the rest of the world. We’re all dying; every moment
is precious.”
Beth Mosley,
End-of-Life Midwife

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3.2.1 Volunteer Experiences

One of the best ways to prepare for a career in end-of-life doula work is
by volunteering. Although you won’t be paid, you will build credentials
that can help you get hired in the future. You will gain practical
experience, develop your knowledge, and possibly make valuable
contacts that could lead to future paid work. Many end-of-life doulas
gain their first clients from connections they made while volunteering.
Volunteer work also looks great on a resume. If you can get a letter
of reference from your place of volunteering for your portfolio from a
volunteer supervisor, even better!

Another plus for volunteer work: most organizations will provide free
training. This may include full day—or even multiple day training—all
for free.

The training you’ll receive is not enough to start working as an end-of-

life doula on your own. (You should still seek out further educational
opportunities, more in section 3.4.) But, you will absolutely gain
valuable skills and increased confidence in working with people at the
end of life or living with terminal illness.

Hospice work is probably the most obvious place to look for volunteer
opportunities. But don’t stop there.

To prepare yourself for end-of-life doula work, you may also want to
look for volunteer opportunities that enable you to work with...

• the elderly

• those living with cancer (at all ages)

• seriously ill adults and children

• those living with Alzheimer’s or dementia

Here are some organizations and resources to consider as you seek out
volunteer opportunities.

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Hospice Volunteering
“There will be ancillary experiences that lend how to do it. It would
be wrong to say you can be a hospice volunteer and then know how to
be a end-of-life doula, but you can become a hospice volunteer and get
some valuable experience that will help you become an end-of-life doula.
That’s a great way to ‘get with death’ see if that’s what you want to do.”
Merilynne Rush,
MS in Hospice & Palliative Studies, RN, BSN
Lifespan Doula Association
https://www.lifespandoulas.com/

Many end-of-life doulas first gain interest in this work after

volunteering at a hospice. Hospice volunteer work is not the same
as death doula work—the degree of responsibility and scope of your
role is much wider when you’re working on your own. That said, you
can gain valuable skills and experience, and hospice work is just one
volunteer possibility.

Even though you’re volunteering, you will still likely need to apply for
the volunteer position as if you were applying for a job. Depending
on the program and hospice, you may be asked for a resume, letters
of reference, and answers to questions to why you are interested in
hospice volunteer work. You may also be interviewed one-on-one
before being offered a volunteer position.

Then, there is likely to be training. Training might be a webinar you can

do from home, it may mean a few hours on a weekday evening, or it
might be a full day or multiple day training on a weekend.

How can you find volunteer opportunities? Look for your local
hospices and reach out. If you don’t find information on their websites
for potential volunteers, pick up your phone and ask.

• National Hospice and Palliative Care Organization

https://www.nhpco.org/find-hospice

• Medicare.gov: Hospice Compare

https://www.medicare.gov/hospicecompare/

• Hospice Foundation of America

https://hospicefoundation.org/Hospice-Directory

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• Canadian Directory of Hospice Palliative Care Services

http://www.chpca.net/family-caregivers/directory-of-services.
aspx

No One Dies Alone (NODA) Programs

No One Dies Alone (https://www.peacehealth.org/sacred-heart-
riverbend/no-one-dies-alone) is a national program in the United
States, intended to ensure those without friends and family to sit with
them don’t die alone. It was first invented at Sacred Heart Medical
Center in Eugene, Oregen, but the concept has spread widely.

The best way to find No One Dies Alone programs in your area is to
type into a search engine “no one dies alone” along with your city or
state. You can also try calling local hospitals and hospices to see if they
have a No One Dies Alone program and how you can volunteer.

Hospital Volunteering
Hospital volunteer work may focus on those with terminal illness and
those near the end of life—especially if you volunteer on a hospice
wing of a hospital—but more often than not, you will be interacting
with those who have good hopes of getting better and going home.

Still, hospital volunteer work is a place you can gain work experiences
that will aid you in your pursuit of death doula work. Volunteering
in the ICU may give you valuable experience working with severely
ill individuals and/or their family members. Working in a children’s
hospital may give you experience working with very sick kids and their
families.

Look up your local hospitals, and call to find out what volunteer
opportunities are available.

Nursing Homes and Senior Living Centers

Volunteering in nursing homes and senior living centers can give you
experience working with those towards the end of life, as well as men
and women experiencing mental confusion. Especially if you volunteer
to work with dementia or Alzheimer patients, and their families, the

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training and exposure you receive when volunteering can be a valuable

learning experience.

• Medicare.gov: Nursing Home Compare

https://www.medicare.gov/nursinghomecompare/search.html?

• Guide to Seniors Housing in Canada

https://www.aplaceformom.com/planning-and-advice/articles/
canada-seniors-housing-guide

There may also be opportunities for networking if you volunteer in

assisted living or senior independent living communities. The residents
here may be generally healthy now, but end-of-life planning should be
on their radar. They may also have friends and family that are not-so-
well and could use the services of an end-of-life doula. This can be a
place to make connections that might help you land future clients.

Volunteer Match
Opportunities to work with those with terminal illness and end-of-life
can be found beyond hospitals, hospices, and nursing home facilities.
There are a variety of local and national organizations that aim to serve
the terminally ill, the elderly, and those at the end of life.

How can you find these organizations? You can always go to a search
engine and look for “volunteer” along with whatever population you’re
hoping to serve. But there is an excellent website you should check out
first: Volunteer Match (https://www.volunteermatch.org/). Input your
location, who you’re looking to volunteer with, and you’ll find local
opportunities to consider.

Volunteering for Friends and Family

“I had a mystical experience when my stepdad died in 2001. I saw
something that seemed unbelievable that I completely believed. It
anchored a belief that something happens when we die that isn’t about
the body; it is about the journey of a soul or spirit.”
Patricia Ballentine,
Ordained Minister and Priestess,
Certified Death Midwife
http://www.TheCreativeFlame.com

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Many death midwives and doulas get their first doula’ing experience
working with a family member or loved one. This may be what inspires
them to pursue training and attempt to create a business. Or, family
may be the first client after training.

Either way, friends and family can be both the best and most difficult
volunteer situations. Your love and care for them will be deeper than
with a “stranger.” This will change the dynamics of the experience
automatically.

On the other hand, friends and family will be “easy” first word-of-
mouth referrals, and they may be more willing to offer you feedback,
a testimonial for your website, or even allow you to take photos to use
in a portfolio.

TIP: When working with people you know personally, be

sure to establish right away whether you’re working in a
completely volunteer experience or if you’re expecting some
level of payment for your services. This will depend on
your relationship with the person as well as how long you
have been working as a death doula. The sooner you clarify
your intentions (pure volunteer work or for pay, even if at a
discounted rate), the better for both of you.

3.2.2 Making the Most of Your Volunteer

Experiences
“If people take my training and they aren’t sure, they realize how vague
it is, they don’t feel quite ready, and they want to be really more sure
before they really got out and start doing it, I kind of have to nudge
them and say, ‘Start doing something.’ Within their comfort zone.
Like pushing little birdies out of the nest. It’s okay to start slowly and
volunteer maybe at first, be very clear with people on what you’re
comfortable with and what you’re not, and you’ll learn together. That’s
how everybody starts.”
Merilynne Rush,
MS in Hospice & Palliative Studies, RN, BSN
Lifespan Doula Association
https://www.lifespandoulas.com/

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You will of course gain valuable exposure and experiences if you

simply volunteer and take no further steps. However, there are actions
you can take to gain even more from your volunteer work.

Take your volunteer training seriously. This is typically free training,

and it’s easy to take something free for granted. Don’t. Treat your
volunteer training the way you would if you were paying hundreds of
dollars for it. Ask questions of the volunteer trainer; if you get written
materials, read them cover to cover.

Journal or otherwise record and evaluate your volunteer interactions

and experiences. After every volunteering session or interaction,
take some time to reflect on what happened, how you felt about the
experience, what you did well, and what you could do better next time.

Put your volunteer experiences on your resume. This is another reason

to carefully track your volunteering. Volunteer work is just as worthy
to make it to your resume as a paid job. List it as such. Note the hours,
number of patients/clients, responsibilities, or any details that indicate
work experience.

When volunteering with an individual, take the same steps you

would if they were a paying client. This isn’t applicable when you’re
volunteering within an organization, like at a hospice or hospital. Then,
you need to follow their protocols. However, when you work with a
friend or family member, you have the opportunity to practice things
like first consultations, creating and agreeing to a contract, and so on.
Whatever you’d do with a “real” paying client, do those things in a
volunteer context.

Explain to your friend or family member that this is helping you

practice for when you have a paying client.

Request a letter of reference from staff, a volunteer supervisor, or an

individual. Once those supervising your volunteer work have gotten
the chance to know you, or after you have completed volunteer work
with an individual, reach out (at an appropriate time) to ask if they
would consider writing you a letter of reference that you can share with
future potential end-of-life doula clients.

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When you’re asking this from someone you worked with one-on-one,
be mindful of allowing them time after the death before you request a
letter. There’s no set time period, but you certainly would want to wait
a few weeks.

Get photographs of your work, when appropriate. If you’re already

going to take photos as part of your end-of-life doula work with a
client, ask if you can use some of those photos for your portfolio.

Network. After you’ve been volunteering at a particular location or for

an organization for several months, let people know you have an end-
of-life doula business and would be appreciative of referrals. Leave
them with a few business cards. Or, even better, have pamphlets that
offer information on what your services are, along with your contact
information.

TIP: Be mindful of asking for referrals and networking

connections too soon. If you started volunteering last week,
this is not the time to already start asking if people could
send you people for your business.

3.3 Learn From Other Business Owners

One of the best ways to learn about end-of-life doula work is by
speaking with people who are currently working in the industry. In
this section you will find a variety of ways to connect with people in
the industry.

3.3.1 Information Interviews

Information interviews are another effective way to learn about end-of-
life doula work. An information interview is defined as a brief meeting
with someone who is working in a career you are interested in learning
about.

If you’ve been connecting with the death community, you can try
asking people you know if they know anyone working as an end-of-life
midwife or doula. Your most likely link to connections will be through
community groups like death cafes (more on that in 3.3.3) or through
hospice staff. If possible, go beyond getting a name and telephone

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number. Instead, ask the individual who personally knows the death
doula to make the initial contact, explain that you are learning about
this pursuit, and see if you can call them to ask a few questions.

Chances are, however, that you won’t know anyone who knows a death
doula or midwife—just because the profession is so new. Your best bet
for finding people to talk to is by searching online and making a cold
contact yourself.

You can find death doulas and midwives by searching relevant terms
with city and state names. (You may want to look for people who are
not local. More on why in a bit.) Another option is to look through
death doula/midwife directories and on certification websites (that list
graduates.)

Some places to seek out connections:

• https://www.inelda.org/find-doula/

• http://www.doulagivers.com/find-a-doula/

• http://www.nedalliance.org/doula-directory.html

• http://deathmidwife.org/directory/

• https://www.homefuneralalliance.org/end-of-life-doulas.html

Although you are conducting an “information interview,” it’s usually

best to avoid using that term when you first call.

Instead, say that you are studying end-of-life midwifery and politely
ask if you can arrange to meet with them, speak on the phone, or
Skype with them for 20 minutes to learn about the career. People are
much more likely to agree to a meeting if they know it won’t take too
much time. Be prepared that the death doula may not be available for a
personal meeting but may be willing to answer questions on the phone
or by email. If they make such an offer, take them up on it! If you’re
sending an email, you’re more likely to get a response if it is limited to
only a few key questions.

It’s important to remember that while some people are generous with
their time and encouraging to newcomers, others may simply be too
busy to meet with everyone who wants career advice. This is especially

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true given that most death doulas can’t do the work full-time—so they
may already be balancing other full or part time work, in addition to
death work, and of course their personal life. If someone you contact
says they don’t have time for a meeting, politely ask if they know
anyone who might be available to talk with you.

If the doula agrees to a personal meeting, arrive on time, dressed

professionally, and come prepared with a list of questions. If you’re
talking on the phone, be prepared and professional.

The following are some questions you might ask:

• How did you get started in end-of-life care?

• What do you enjoy most about your work?

• What do you wish you had known when you were first getting
into death work?

• What are typical duties in your role as a death doula?

• Based on a quick review of my experience to date, what training

or experience do you think I should pursue next?

• How did you find your first clients?

• Do you have business relationships with other people in the death

and dying industry? How did you make those connections?

• What are some challenges you’ve experienced and how did you
handle them?

• What advice do you have for someone just getting started in death
work?

• Which professional associations, websites, or publications should

I look into?

TIP: While end-of-life doulas may be willing to speak with you,

be aware that they probably will not be eager to help if you
plan to start a competing business in the same city. However,
if you are going into a niche they do not serve, they might
be willing to answer questions about their business such as
which marketing techniques they have found most effective.

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Alternatively, you may wish to contact business owners in a

region adjoining your own.

If you want to make a good impression, it’s usually not a good idea to
stay or talk longer than agreed without permission. Let the end-of-life
doula know when the 20-minute time limit is up, say you know they
are busy, and offer to leave. They may be happy to extend the meeting.
Thank them for their time and any referrals they were able to provide.
After the meeting, send a thank you note to the person you met with
and, if someone referred you, thank that person as well. Making a
good impression in an information interview could lead to future
opportunities. They may refer clients to you when they can’t take
new people on, they may ask you to act as their back up (or you may
ask them to be your back up doula), or you may even one day work
together as a team.

3.3.2 Mentoring
Another way to learn about death doula work is to find someone who
is willing to be your mentor. Princeton University’s WordNet defines
the word mentor as “a wise and trusted guide and advisor.” A mentor
can provide you with personal training to help you launch your own
career.

TIP: Job shadowing involves spending a day, a week, or some

other limited period of time observing someone work. It
allows you to learn more about a career, ask questions, and
actually see what a job entails on a daily basis. When seeking
a mentor, you may want to ask if there is an opportunity to
observe your mentor while they work with a client. Some
certification programs encourage or require you to shadow
an end-of-life doula.

Once you have identified an end-of-life doula who you would like
to have as a mentor, approach them with a letter of introduction (see
sample below). In your letter:

• Explain why you selected this person as a potential mentor. It

may be their success in an industry you are interested in or that
you admire their skills. Whatever the reason, let the potential
mentor know why you chose them. You may or may not want to

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ask a local death doula that you’ll be competing with to mentor

you, or you might get a negative response. Looking to another
city or town, even just an hour or so drive away, may be better.

• Make a specific request. Don’t just say you want them to be your
mentor; explain what you are asking. Do you want to talk with
them on the telephone once a week for 20 minutes? Do you want
to meet with them once a month over lunch? Do you want to
communicate with them on a weekly basis via email? Also, be
open to their offer of an alternative method of contact, as you are
the one asking for a favor. Some people shy away from mentoring
because they fear it will take too much time or energy. Assure
your potential mentor this won’t be the case.

• Offer something back. While some doulas charge a fee for

mentoring (see below), others will provide the service at no
charge. However, there may be many demands on their time, so
you may have a skill that you can offer in return for mentoring
services. Maybe you are a computer whiz and can offer to set
up the mentor ’s new computer network. Or maybe you can
write great advertising copy, and offer to write the mentor’s next
brochure.

Sample Mentoring Request Letter

Gentle Goodnight Death Doula Service
Attn: Dianne Doula
123 Any Street
Lincoln City, ME

Dear Ms. Dianne Doula,

I have been watching your YouTube videos on death doula

work. I am very impressed with the information you share and
your overall positive, calming energy. I especially enjoyed the
video [specific example here], where you talked about [specific
example]. I also looked over your website and have been reading
the testimonials people have written about you. I admire the
success you have had as a death doula. I am looking to start
working as a death doula in Another City, about 150 miles from

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your city. I would like to ask if you would be willing to mentor

me in this new career.

I know that you are very busy and very involved with your
volunteer work at the Lincoln City Hospice, which is one more
reason that I wanted you to be my mentor. You have such a heart
for the community and manage to handle a successful death
doula business and still have time for volunteer work, which is
something I strive to achieve as well.

I want to ensure you that being my mentor will not require

an exhaustive effort on your part. I would like to be able to
communicate with you via email — this would be only when I
had specific questions or concerns about the business. I would
also like the opportunity to call on you once a month to discuss
business issues or, if your schedule allows, we could meet for
lunch once a month for these discussions.

I have experience as a specialist in social media marketing, and

would be happy to offer my services to boost up your social
media marketing efforts in return for your mentoring time.

Thank you and I appreciate your consideration of this proposal.

I will follow up with you next week.

Warm regards,
Polly Proper

Mentoring for a Fee

Some successful end-of-life doulas offer mentoring or personal
coaching services for a fee, including:

Quality of Life Care with Deanne Cochrane

Deanne Cochrane offers a mentoring program as an add-on program
for her online death doula training. As of press time, the training
program alone is $995, but if you add mentoring on, it’s $1,495 for the

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school plus mentorship. You can find out more here: https://www.
qualityoflifecare.com/mentoring-program.html.

Emily Cross
Death doula Emily Cross offers mentoring for those who want to
conduct living funerals (see section 2.1.5) for the healthy and well.
She offers a package that includes materials, her script, mentoring via
email and phone calls, a marketing guide, and a price guide. Emily
says, “My base fee for the living funeral package is $750, and they can
expect to pay an additional $1,000 or so on supplies (that is based on
a 15 person ceremony with all components.) The goal is for people to
make money while giving this amazing gift of the ceremony! I charge
$50 per participant for the two to three hour ceremony. If 15 people sign
up, that is $750, so I feel that with the right system in place, the initial
investment is quite easily paid back.” Emily’s website: steadywaveseol.
com.

Ute Luppertz
Pet death doula Ute Luppertz does one-on-one and group remote
trainings on working as a pet death doula. Pricing varies between $200
and $350, depending on the length of the training.

Here’s her explanation of her pet death doula mentoring and training
program:

“Wouldn’t it be wonderful if we could aid our pets to have a truly peaceful

transition at the end of their life? Wouldn’t it be amazing if we had a new way
of supporting our loved ones and clients when they experience the death of
their pet?

“This is why I created this one of a kind of work based on my many years of
experience working with dying pets and their humans. In the Death Doula
Training, you will get tools to have a more integrated experience during the
end of life process.”

Topics include:

• Creating a compassionate and inclusive culture for the end of life

• The partnership between humans and their pets

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• The different phases of dying

• Tools of discernment: our pain – our pet’s pain

• Holding Space

• Holistic end of life care

• Creating meaningful rituals

• Coping with pet loss

• Supporting pet guardians during pet hospice

• Supporting pet guardians during euthanasia

• Supporting pet guardians after the death of their pet

• Self Care

You can visit Ute’s website here: www.pets-point-of-view.com.

TIP: When looking at death doula training and certification

programs, consider what kind of support you will receive
after training. Some training programs offer a sort of
mentoring after, while others don’t offer any on-going
support. The lack of (or inclusion of) post-training support
doesn’t automatically make an educational program the
right one for you... but you should certainly take it into
consideration.

3.3.3 Join Associations and Social Clubs

Some death doula certification organizations also offer memberships
to their “associations” after you take or complete their training.
Depending on the organization, this can include online support, in-
person gatherings, and other support services. You’ll learn more about
your options for end-of-life doula training in section 3.4.

You may also discover that volunteer experiences provide social and
educational opportunities. Some organizations hold regular gatherings
to bring their volunteers together to learn and talk.

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Here are some more ways to connect with the death and dying
community:

Death Café
Death cafés are a social franchise where groups of people (usually
strangers) meet to discuss death and dying over tea and cake.
According to the death café website, the movement is international,
with café taking place in 60 countries.

You can’t advertise your death doula work at a death café, but you can
network, help spread awareness, and meet people who are interested
in wrestling with death and dying.

This is what end-of-life doula Merilynne Rush of the Lifespan Doula

Association has to say about death café:

“There’s no agenda, there’s no presentation, it’s open, accessible, confidential,

and you can’t sell anything or promote any one ideology. It’s just about the
good old fashioned café movement, which really started in Europe around
political topics. It gets people out of the cubical, out of their own little worlds,
and keeps the art of conversation alive. We regularly get over 30 people
attending every month. We get a real diverse group, really diverse ages.”

Get more information, find a local death café to join, or learn how to
start one here: https://deathcafe.com/.

The Death Over Dinner Movement

The Death Over Dinner movement is an initiative to get people talking
about end of life and care with their friends and family. According to
their website, there have been over 500 dinners held in 20 countries. The
website provides guidance and scripts to use. While Death Over Dinner
is usually with people you know (unlike death café, which is death and
dying discussions mostly with strangers), it still offers opportunities to
make connections and talk about end of life care choices. Visit https://
deathoverdinner.org/.

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National End-of-Life Doula Alliance

The mission statement of the NEDA, as per their website, is “to inspire
positive, creative change in American death practices by offering the
highest standard and ethical and practical guidelines, public education,
and rich networking opportunities for all end-of-life (EOL) doulas who
support the dying, their caregivers, and the agencies involved.”

One of the great things about the NEDA is the board is made up of
end-of-life doulas from a variety of doula training organizations. The
alliance is inclusive. More at http://www.nedalliance.org/.

National Home Funeral Alliance (NHFA)

The National Home Funeral Alliance (https://www.homefuneralalliance.
org/) is a non-profit, all volunteer run organization that helps to spread
information and support for at-home care after death. Membership to
the National Home Funeral Alliance is free. They organize a conference
on home funerals and at-home post-death care every two years.

Northwest Association for Death Education &

Bereavement Support
The Northwest Association for Death Education & Bereavement
Support (http://www.nwadebs.org/) is a non-profit organization whose
goal is to help educate people on death and mourning. This particular
organization is in Portland, Oregon and offers many workshops on a
variety of topics. For those of you who are not near Portland, it’s worth
looking around your area for similar themed organizations. (If such an
organization doesn’t exist in your city or town… perhaps you will start
one!)

IAPO International Association of Professional

Death Doula Business Owners
IAPO International Association of Professional Death Doula Business
Owners is a membership organization created to provide education
and business development services for people working as, or studying
to become, a professional death doula business owner.

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Benefits for Members

Numerous benefits for paid members including: discounts on the Death
Doula Business Owner Certificate Courses offered by the International
Association of Professions Career College; quarterly newsletter with
practical advice to help you achieve greater success in your career;
additional discounts on hundreds of products and services for both
business and pleasure including: restaurants, hotels, computers, movie
tickets, books, flowers, cell phones, gifts and much more from popular
companies such as Dell, Target, Sears, Disney, FabJob, Toyota, Sprint,
and many more in the U.S., with some discounts available in other
countries. Plus, you may display the seal of membership of the IAPO
International Association of Professional Death Doula Business Owners
on your own website and marketing materials.

Join the growing IAPO Professional Death Doula community today and
start accessing all of the benefits membership offers.

Visit IAPO International Association of Professional Death Doulas

for more information about benefits and membership fees, and to join.

Business Organizations
You can also join a number of excellent organizations designed for
business owners to learn and network in an organized setting. One
excellent resource is your local Chamber of Commerce. Chambers
usually have an annual fee and are set up to aid the local businessperson
with a variety of business-related issues. Members attend local
meetings and can also take part in events designed to help them be
more successful. Through these connections you may even find out
about part-time or full-time job openings.

To find the Chamber near you, visit www.uschamber.com/members/

chambers; in Canada, visit www.chamber.ca.

3.4 Educational Programs

“Seek a training program. While you’ve likely got most of the skills
necessary to do this work like compassion, deep listening, and patience,
it is also useful to learn practical tools, like how to dress a dead body and
some of the logistics around preparing people for death… .”

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Alua Arthur,
Going with Grace
www.goingwithgrace.com

Much of death doula work is intuitive. Having compassion and

sensitivity towards people at the end of life, showing respect for their
desires and needs, and treating the transition from life to death as
natural and sacred are not activities you need to be taught. With the
information you received in Chapter 2 of this book, you already know
most of what you need to know to start working as an end-of-life doula.
If you have already been volunteering, you have also likely gained
many skills you can use in your work with people with life limiting
illnesses.

That said, gaining further education is highly recommended. There

are a variety of end-of-life doula and midwifery programs available,
all with a slightly different flavor or emphasis. Whether you prefer an
exclusively online program or in-person training, whether you’d prefer
a more spiritual angle or a more practical nuts-and-bolts training, you
can find it.

Plus, having attended death doula training will look good to clients
when they are considering whom to hire.

Here’s what you need to know while you consider your options!

3.4.1 Do You Need Certification as a

Death/End-of-Life Doula?
“There’s always going to be people that want to hire somebody that has
as many initials behind their name as possible, and has passed some
sort of test or whatnot, and [then] there’s going to be people who are
like, ‘I’m going to hire that woman because she goes to my church, I
know her, she’s been doing this for 20 years, and she has never been
formally trained but I trust her, know her, and share her values.’ That
has to be the way it remains. Because this profession, you don’t have
to have training to do it. It’s kind of a no-brainer. How do you be with
someone who’s dying? You care about people and you have compassion
and patience. It’s a non-medical position. It’s not like you have to have
any clinical skills at all. But at the same time, I think it’s going to be

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really important to have that available for people who want to go into
it, who are saying, ‘Hey, guide me, I haven’t had any experience with
death, but my heart is calling me to do this, and I really do want to learn
in a textbook fashion.’ And that has to be available too.”
Merilynne Rush,
MS in Hospice & Palliative Studies, RN, BSN
Lifespan Doula Association
https://www.lifespandoulas.com/

A big question of those looking to enter the end-of-life doula or midwife

profession is… do you need an official certification or license?

The answer is no. You do not need any particular certification or license.
The end-of-life doula and midwife profession is currently unregulated.

This could change over time, but as it stands now, anyone can call
themselves an end-of-life doula. There is no special required training,
no degree, and no certificate you need to obtain.

However, many end-of-life doula and midwifery programs promise

to give you certification. An overseeing body doesn’t regulate this
“certification”, so what certification means varies greatly. Each program
is different in what they teach.

For example, you could have three different death doulas, all with
a “formal” certification, and they might have different skills and
approaches. There is nothing wrong with this per se—but it’s something
to be aware of.

If you don’t need it, why get certified?

One thing, certification may allow you to have specific initials after your
name. You can also list on your resume that you are a “certified” death
doula or midwife or whatever you call yourself (or your certification
allows you to call yourself.) This can look impressive to those looking
to hire you.

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International Association of Professions

Career College
The International Association of Professions Career College, also
known as IAP Career College, was established by the founders
of FabJob (publishers of the guide you are reading) and a team of
respected academics with the aim of offering the finest certificate
programs for non-traditional careers. IAP Career College offers a
Death Doula Business Owner Certificate Course which uses the
guide you are now reading as a textbook.

This part-time 6-week course is open to students anywhere in the

world and is offered online, allowing you to earn a Death Doula
Certificate from the comfort of your own home.

Registration gives you an all-inclusive package consisting of:

access to the comprehensive, self-directed online Death Doula
Certificate Course, help from a Faculty Member who can provide
you with personal teaching assistance and career advice, and a
beautiful professional Death Doula Certificate upon successful
completion of the course. When you register for the course, you
will also have the option of becoming a member of the IAPO
International Association of Professional Death Doulas and
enjoy its many benefits.

Visit the Death Doula Certificate Course page on the IAP Career
College website for more information about benefits and fees,
and to register.

On the other hand, if you attend training that doesn’t have a

“certification” option but grants you a “certificate of completion,” you
can also list that on your resume or website.

You can also list that you have studied with so-and-so experienced
death midwife, or say you have formally studied death and dying for
X many hours, or mention the locations and time spent volunteering
with the dying.

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There are many ways to show clients that you have dedicated time to
your passion and are knowledgeable and skilled in your work.

When you look at programs, you might naturally favor those that offer
certification. Try not to put all your focus on certification. Instead, look
at the big picture and whether the educational program meets your
needs and aligns with your values.

Also, remember, you can always take more than one training. Maybe
one of those will have a certification option, if that is personally
important to you.

TIP: When the birth doula movement started, there were no

formal certification programs. Now, most birth doulas get
certified, and many families looking to hire a birth doula
want someone with a formal certification. You still don’t
legally need certification to be a birth doula—it’s just
something that has become generally accepted. This isn’t
yet true for the end-of-life doula movement, but it may
change with time. When birth doula certification became
more common, many doula programs had alternative ways
to gain certification, offered to those who had already been
working for years without formal training. This might
happen in the death doula movement as well.

3.4.2 What to Consider When Choosing a Program

“Given the current state of things for end-of-life doulas, where there
is no overseeing accrediting body, each of the programs out there are
reflective of the experience, and viewpoint of the trainer—which is a
good thing. I know for many it feels like it can get expensive to get all
of those viewpoints, but I like that we all have a place within the doula
movement. Those who are drawn to each of us, will find themselves at
the exact right place!”
Patty Burgess,
President of Possibility Teaching Transitions -
Doing Death Differently
https://doingdeathdifferently.com/

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How do you decide which training is the best one for you? You may
find that a particular training is the best one for you right now, while
another would be wonderful in the future. You may find two or three
trainings that sound great. Or, you might discover a training that looks
like your best option “for now and always.”

Take your time to evaluate your options. There’s no rush, and new
death and dying doula and midwifery training programs are being
developed all the time.

Here are some questions to ask yourself as you look through your
options:

What is the organization’s definition of what it means to be a death

doula or midwife? Not everyone defines the role the same. Does this
training define the role in a way that appeals to you or meets your
vision of what it means to be an end-of-life doula? (Or death midwife,
or deathcare advocate, or dying guide, or… so many possible view
points!)

Is the training online, in person, or combination? The best option for

you will depend on your lifestyle, your location, and how you learn
best.

Ideally, learning in person or at least a combination of online plus in-

person learning is better for learning about death and dying support.
This way, you can have real hands-on training for what is a very hands-
on profession. If the training teaches you how to prepare a body after
death, you will actually get to go through the physical motions of that
kind of preparation (as opposed to watching a video of someone else
do it.)

That said, exclusive online learning can be a great option for some.
Maybe in-person trainings would require traveling on your part, and
that’s not possible for you right now. Maybe there will be an in-person
training in your area in the future, but you want to start studying right
now… so you sign up for an online experience with the goal of taking
an in-person training when it comes closer to your location.

A couple important caveats to online learning: if you’re not a self-

motivated person, online learning may not be for you. For some people,

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staying on task is more difficult, especially if it’s self-paced or there isn’t

a place you need to be. Some online programs match you with a buddy,
or you work with a “group” online, which can help with motivation.
Still, it’s not for everyone.

Secondly, studying death and dying can bring up strong emotional

reactions—even if you’re certain this work is for you and you already
have relevant volunteer experience. Being with other people can be
helpful, as they can offer support.

Who is teaching the course? Is it one instructor? Two? Or a team?

Who are they? What’s their experience? What makes them qualified
to be an instructor? A doula trainer with years of experience doing the
work doesn’t necessarily make them the best teacher—but you should
consider their work experiences.

Look them up online, beyond the primary website that you found
the training on. Do a little “stalking.” (Not really stalking but… you
know you’ve stalked people online before!) You might find interviews
in newspapers or on blog posts. Do you generally agree with their
viewpoints on end-of-life doula work?

If possible, try to watch a video or two where they are speaking. Do you
feel connected? Do they seem like someone you can learn from?

What topics are covered? Does it meet your interests or fill in your
educational gaps? There are some basics that all death doula trainings
cover, and then there are topics that may be more unique or emphasized
more in specific trainings.

For example, one training may put a lot of emphasis on post-death care
and maybe give you a little bit of home funeral training. Another may
focus primarily on vigiling—or supporting clients in their last days—
while another may cover a wider range of end-of-life care. Some doula
trainings spend a great deal of time on doing legacy projects with
clients, while others may focus more on creating rituals and spiritual
comfort measures.

There really are no wrong or rights here; what you should look for
is a training that will fill in your educational or experience gaps. Or,

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consider the aspects of death doula work that appeal to you most, and
ensure the training covers those topics well.

What kind of spiritual viewpoint does the training offer? Some end-of-
life doula and midwifery courses offer spiritual instruction or guidance.
This can arise naturally based on the instructor (if they are a spiritual
leader themselves.) Other death and dying trainings leave spirituality
out of the equation almost completely.

Again, there is no right or wrong here. This is more about what fits
your personality and approach to the work. If you approach this end-
of-life care with a deep sense of spirituality, you will likely feel more
fulfilled by a training that covers spirituality.

TIP: Remember that your job as a doula is not to push a particular

agenda or set of beliefs onto your clients. Having the topic
of spirituality covered in a doula training doesn’t mean
it pushes one specific viewpoint, only that you will learn
how to support the spiritual needs of clients and yourself—
regardless of the client’s or your personal religion (or lack
there of)—which is an important skill.

Is the business of death doula work covered? This can be the most
difficult aspect of the work for many people. If this is an area of
weakness for you, look to see what aspects of building an end-of-life
doula business are covered.

How many hours of instruction are provided? More time doesn’t

always mean “better,” but you should consider the total number of
hours (or days) of instruction.

How will the material be presented? It is going to mostly be reading?

Watching videos? In-person discussion? Physical hands-on exercises?
Are there opportunities for discussion? Will the discussions be online,
via phone or video conferencing, or in person?

What happens after training? Is there any on-going support? Is there

any sort of on-going mentorship or continuing education? If there is
post-training support, what are the options and costs? Do the follow-up
topics appeal to you?

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Is there any attempt to build or offer community with fellow students

or graduates? If you have an in-person training, you will likely connect
with students while you are there, but maintaining those connections
post-training may or may not be part of the program.

Some doula trainings have online communities that you join before,
during, or after completing training. Others have on-going in-person
events you can attend (more likely if you take a local course.)

Where is the training? How frequently is it offered? Practicalities

matter! If the training you want requires significant travel expenses,
you may or may not be able to attend. That said, traveling could be
completely worth your time, for the right environment and educational
experience.

What is the cost? And how does this fit within the realistic expectations
of making back the investment? Most trainings cost between $500 and
$2,000. That’s the average.

TIP: Don’t assume online training will always be less expensive

than in person trainings. Some online programs cost
significantly more than face-to-face workshops, sometimes
even after you factor travel expenses.

When looking at end-of-life doula training, be realistic about your

earning potential. If you are serious about pursuing this as a business,
putting your heart and soul completely into it, knowing that you’re
likely a pioneer and a trailblazer, and ready to offer workshops and
seminars to spread the word (and earn cash), then you will likely make
back your training costs with time.

On the other hand, if you’re mostly going to volunteer, or plan to

primarily work with friends or family members—or you’re interested
in doing this professionally but not about to go all-in—that’s okay.
Paying for your own self-development and investing even into mostly
volunteer work is worth your time and money, if those are your
passions. Just be mindful of the decision you are making.

TIP: In addition to death doula training programs, there are also

a number of college courses on end-of-life care and death

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and dying issues. There’s usually not as much interaction

and mentorship between students and the instructor, but the
cost (per course) is significantly less—on average between
$200 and $500.

TIP: Are you a professional healthcare provider or therapist?

Some end-of-life training programs are approved for
continuing education credits. This means you can meet
your continuing education requirements and also indicate
the course cost as a tax deduction. Depending on your
employer, they may even be willing to pay for part or all
of your death midwifery training. If this education could
apply to your day job, it’s worth asking about!

3.4.3 10 End-of-Life Doula/Midwife Training

Programs to Consider
There are so many possible training programs available for those
that want to work in end-of-life doula care. How can you choose?
This section will attempt to give you a little more information and
perspective so you can make the decision that works best for you.

Look through our list below, check out the training websites for more
detailed information, and consider carefully which programs meet
your needs best.

After you determine your top three choices, dig a little deeper before
you make a decision. Contact the instructor or organization with
questions. If the school has a directory of doulas on their site, reach
out to those doulas or midwives and ask what they thought about the
course. If there are no listings, ask the instructor or organization for
some names and email addresses, former students, you can contact as
references.

TIP: When looking at the various websites, you may notice

some declare themselves the “only” or “first” to offer
whatever their kind of death doula training they offer.
Take declarations like this with a grain of salt. Being first
or unique doesn’t always mean better or best. On the other
hand, experience in the profession does matter.

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Note: A listing here should not be considered an endorsement. The

programs are listed in alphabetical order. Also, note that not every
possible death/end-of-life doula or midwifery program is listed here.
While we believe the programs listed here are worth considering and
have unique offerings, you should certainly do a little Googling, if none
of these programs feel right for you.

The Art of Death Midwifery

http://sacredcrossings.com/artofdeathmidwifery/

The 75-hour certificate program has both in-person and online learning.
There are three weekend workshops, as well as online group sessions.
The Art of Death Midwifery has a strong spiritual component, and
teaches students how to work with people of all faiths and cultural
backgrounds.

Rev. Olivia Bareham, founder and facilitator of the Art of Death

Midwifery certificate training program, says, “The Art of Death
Midwifery is offered in-person in a private in-home setting. Class
size is limited to 20 students to ensure the intimacy of the group and
provide the necessary time for each student to feel heard and held. This
work evokes deep emotions and requires time and space to process.
While on-line classes can certainly transmit the information required,
we believe that the essence of the death doula work is spiritual and best
imparted and shared in-person.”

Rev Olivia also shares, “The Art of Death Midwifery is designed to be

a transformative program and an invitation not only to doula’s, but
anyone wishing to delve more deeply into what it means to die and
learn tools so that they can better assist their loved-ones.”

What some students had to say when FabJob asked them about the
program:

“I would highly recommend this program. Olivia Bareham, with over

twenty years of experience, is an accomplished teacher. Her patience
and extensive knowledge gives her students confidence and a full
understanding of what a Death Midwife does. The seventy-five hours
are filled with facts and hands-on training.

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“[For example,] I learned how to be able to allow a family to wash a body

of a loved one after death and, if they would like, keep it at home to be
able to say goodbye. Too often the end of a life, the disposition of the loved
one’s body is handled by taking the body away and not seeing it again
until days later. It is so much better to be with the loved one and be able
to say goodbye in our own time. It is a tradition that our grandparents
and great grandparents had. I would like to be able to bring it back into
our community.
“I left knowing I was a Death Midwife and could do this work. I also
knew, I could use Olivia as a resource when needed.”
~ Rev. Arlene Radasky

“I had heard the instructor, Olivia Bareham, come and speak at a

community I was a part of at that time. She seemed profoundly kind.
Also, the content of the class was comprehensive and covered everything
an aspiring Death Midwife would need to know. I loved how it
encouraged us to begin cultivating a relationship with death. In my
work, I find that this is the single most important thing I can do in order
to help support others through death and dying. A surprise learning
experience was that the closer I got to building a meaningful relationship
with death, the less space terror around death took up.”
~ Jessica Headley Ternes,
Certified Death Midwife & Ancestral Lineage
Healing Practitioner
https://sacredthresholds.org/

BEyond Yonder Virtual School for Community

Deathcaring
http://www.deathcaring.ca/virtual%20school%20-%20core%20
program.html

BEyond Yonder Virtual School for Community Deathcaring is an online

Canadian based 14-week program for those wanting to work in end-of-
life care. As the name implies, this training puts a strong emphasis on
the community aspects of deathcaring. Because they value community,
the training itself requires working with other online students.

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“[The BEyond Yonder Virtual School for Community Deathcaring] is

different from other ‘online’ programs because students don’t work in
isolation. Rather, the program is a shared ‘virtual’ learning experience
that is always surprisingly intimate between a class of 9 -14 students,”
Cassandra Yonder,
Co-founder and co-owner,
BEyond Yonder Virtual School for
Community Deathcaring

Some other thoughts from Cassandra on their program:

• “Our focus is very much about creating community around

deathcaring and recognizing it as a grassroots practice.”

• “We recognize that the most important learning comes not from
the materials we provide, but from the connectivity students
develop with one another and within their own region. Our
program facilitates these connections via buddy calls, community
based assignments, and other requirements.”

• “We use a secure educational website for readings / forum

discussions. We use Zoom as a platform for twice weekly live
classroom discussions with teachers and facilitators. We match
students with each other in a rotational buddy system so they
can connect in whatever way is convenient for them. We assign
projects which offer an opportunity for students to connect with
other practitioners and systems in their own region / communities
so they are not in isolation at the end of the program.”

• “Students say that they wish they had known that our program is
very intense and requires lots of work every day.”

The Death Midwife Certification Program

(Earth Traditions)
http://deathmidwife.org/

The Death Midwife Certification program from Earth Traditions is a

three-day in person workshop taught and developed by Rev. Angie
Buchanan. The training is made up of 10-hour days, packed with
information and hands on learning experiences. The workshops are
offered in a variety of cities around the United States.

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Participants that attend all three full days, participate fully in the
course, and take the exam at the end will receive a certification as a
death midwife.

“We do not believe that working with the dying, or dead is something
that requires weeks and weeks of study and costs thousands of dollars.
We have taken over 25 years of experience and information gathering,
and packaged it into a 3-day intensive that provides anyone with more
information than they will ever need to do this work. This includes
helpful tips about navigating the dying threshold, partnering with the
medical profession, self-care, recognizing different aspects of grief and
how they might show up, creating sacred space, and making sure people
know their options for body disposition, which may or may not include
the services of a funeral home. Our training has a combination of lecture,
audio-visual, role-playing, and hands-on components that have each
been carefully developed to have the most impact, and in ways that are
memorable so, easily retained. Students feel supported, and are given
access to groups where we provide updated information in state laws,
recommended publications, pertinent websites and articles, a place to
ask questions, share experiences, and network with one another. We also
offer continuing eduction, one-day workshops on a specific, related topic.
It is not our intention to professionalize so much as to reclaim family
directed choice at end of life; to provide information about options which
allow families to care for their own Beloveds, the way we used to, in
our own homes, or in partnerships with the medical profession, and the
funeral industry.”
Rev. Angie Buchanan

The Death Midwife (Earth Traditions) course is an in-person experience,

and Rev. Angie Buchanan strongly believes in-person training is a must
for death midwifery work.

Rev. Buchanan explains, “Students need to have the experience of

sitting next to their classmate as the classmate shares the story of their
loss, of their Beloved Dead. Students need to understand the difference
between the sacredfeel what it’s like to enter sacred space—the dying
threshold or to help support a family in the ceremonial aspects of
bathing, and blessing, and speaking of and to, their Beloved Dead.
A student needs to take the hand of another student, and learn what
it feels like to provide comfort through human touch, to run energy
into someone else, and to receive it. Students leave my class with a

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profound sense of the reverence of death. An online program cannot

begin to touch that. (No pun intended.)”

What a student has to say to FabJob about this program:

“Angie has an excellent reputation, and I was referred to the program by

another doula who had taken it. I loved how much ground she covered
and how many different perspectives on the material there were from
the other people taking the course. I think the only thing that surprised
me, really, were various bits of information about the options available
to individuals and families after someone passes. There’s a lot the
mainstream funeral industry would prefer you didn’t know, because that
innocence translates into profit for them. And I guess I wasn’t surprised,
exactly, but freshly struck at how beautiful the dying experience can
be, for the person going through it and those around them. Angie is
an amazing teacher - piercingly intelligent, profoundly insightful, very
down-to-earth. She has a rooted presence that inspires confidence, and a
kind of tough compassion that makes you feel supported, but insists that
you use that support to stand on your own.”
~ Beth Mosley,
End-of-Life Midwife

Doing Death Differently

https://doingdeathdifferently.com/training/
https://doingdeathdifferently.com/purchase-training

Doing Death Differently is an interactive, online training program,

with a strong focus on hospice work. In fact, this training may also be
enough to provide the education you need to start volunteering at your
local hospice. (If this is your plan, be sure to talk to your local hospice
first.)

“We have been working with hospices across the US for over six years
now and can ‘dually certify’ End-of-Life doulas, which means that
doulas who wish to volunteer can do that as a result of taking our
training. Most hospices accept our training, and we will provide a letter
of reference, plus curriculum information to the hospice if required.”

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“We offer a lot of info on culture, philosophy, interdisciplinary team, role

within a hospice or healthcare organization, so that doulas are prepared
to work in that environment.”
“We have a Business and Marketing Track for EOL Doulas that is filled
with step-by-step assistance on starting a practice, including phone and
email scripts for approaching hospices and other healthcare entities,
discussing fears regarding charging for services, and ‘done for you’
templates.”
“Our program is online only, but offers a phone consultation with me
personally, as well as monthly video chat meetings and a Facebook group
for on-going support.”
Patty Burgess
President,
Doing Death Differently

TIP: If you want to get a feel for their teaching style, they have a
four-part video mini-course available on their website. Visit
https://go.doingdeathdifferently.com/living-as-a-doula.

Final Passages
https://finalpassages.org/level-1-2-description/
https://finalpassages.org/level-3-description/

Final Passages offers in person workshops in California, with a strong

focus on home funerals and green burial. If you’re interested in death
doula work and home funeral guidance, this is a course to seriously
consider.

To receive certification in death midwifery and home funeral guidance,

you must complete all three levels of training. Level 1 and 2 are offered
at least twice a year, and are offered back-to-back over four days. Level
3 is offered once a year over a period of five days.

Jerrigrace Lyons—one of the pioneers in the death awareness and home

funeral movement—teaches the workshops. Lyons was featured in the
2003 documentary A Family Undertaking, a documentary about the
home funeral movement.

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Going with Grace Training Program

http://www.goingwithgrace.com/training/

The Going with Grace Training Program is an online, self-paced course,

taught by death doula and end-of-life planner Alua Arthur. Arthur is
also an attorney, adjunct professor, and ordained minister. Refinery29’s
Last Look did a short video (I Plan People’s Death For A Living:
https://www.youtube.com/watch?v=jVjkeUUxke8&t=304s) on Alua
and the death doula movement.

“The Going with Grace End-of-Life Training offers an in-depth view into
holistic death support, covering the practical, legal, emotional and spiritual
elements of death care,” explains Arthur.

The training program is 12 modules and includes monthly webinars

so you can ask questions. Alua Arthur is a working, successful death
doula and has practical working experience to share with her students.

International End-of-Life Doula Association

https://www.inelda.org/

The International End-of-Life Doula Association (INELDA) offers a

death doula certification training that takes place partially in person
and partially online. The in-person part is three days long and offered
frequently in various cities throughout the United States.

International End-of-Life Doula Association (INELDA) was co-founded

by Henry Fersko-Weiss, Meredith Lawida, and Janie Rakow. Henry
Fersko-Weiss has appeared in many media articles and news stories
on death doula work, and he is the author of “Caring for the Dying: The
Doula Approach to a Meaningful Death.” Henry Fersko-Weiss—a licensed
social worker— also developed one of the very first death doula hospice
training programs.

INEDLA puts a good deal of emphasis on legacy and meaning work

with the dying, so if this is an aspect of death doula work that interests
you, this may be a training to consider.

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In addition to the training, they offer a certification option that is

similar in style to birth doula certifications. (In other words, requiring
contact hours, having evaluation forms filled out, and so on.) Those
who received certification will no doubt be ready to serve as death
doulas. For more, go to https://www.inelda.org/certifications/.

Lifespan Doula Association: End-of-Life Doula

Training
https://www.lifespandoulas.com/

The Lifespan Doula Association End-of-Life Doula Training is a three-

day workshop offered in Ann Arbor, Michigan, with a limit of 24
attendees at any given training. After training, participants have access
to remote mentoring and online support. There is a post-workshop
certification process available, for those interested in pursuing it.

If you’re looking for a training organization with on-going educational

support, on a variety of end-of-life challenges and topics, this is one to
consider. Also, if you’re familiar with the training birth doulas receive,
Lifespan Doula Association trains and certifies in a similar style.

The Lifespan Doula Association is co-owned by Merilynne Rush and

Patty Brennan, and they co-teach the workshops.

“We believe very strongly that an on-site, in person training portion is crucial
to learning [end-of-life] doula skills and gaining knowledge,” they explained.
“We offer a mentored certification component that takes place after the
intensive three-day training. In addition, we offer online mentoring in the form
of post-training webinars to folks who become members of the organization. A
portion of the training will become available on-line in 2019.”

Merilynne and Patty have extensive experience, education, and

associations in both the childbirth field and the death and dying field,
and are more than qualified to teach future end-of-life doulas. You can
read about them here: https://www.lifespandoulas.com/our-team/.

Lifespan Doula Association offers a number of continuing education

one-day long, in-person workshops. Topics include advance care
planning facilitator training and certification, how to start a death café

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in your community, doula business development, and a home funeral

and green burial workshop. In addition to the in person workshops,
they offer webinars on a variety of topics, from using essential oils to
taking the next steps after training.

You can get many more details on their end-of-life doula-training

program here: https://www.lifespandoulas.com/end-of-life-doula-
training/.

What students have to say to FabJob about this program:

“The LDA training has a multidimensional approach that helps give

an overview while presenting details. The combination of lecture,
individual reflection, group/partner activities and discussion appealed
to me. I am a teacher myself and was impressed with the scope and
flow of the curriculum. It was also a very supportive and professional
environment that nurtured a sense of community. I was surprised by
how quickly our training group bonded by this desire to bring awareness
of the EOLD mission. We came from different backgrounds and shared
a common vision that the LDA training was able to capitalize on for the
successful training. As a result, we are an instant network.”
~ Toula Saratsis,
End-of-Life Doula/Palliative Care Advocate

“My mom and I had taken many classes with Merilynne on home funerals
and green burials in particular. We ended up taking the pilot end-of-life
doula training offered by LDA! I didn’t compare any other programs. I
knew this was the one. Loved it all and all of it was a suprising learning
experience! This field is new to me, so learning and hearing stories from
folks in the field (hospice and such) was really eye opening. I especially
loved talking about what a good death is for each of us, imagining our
own death and what elements we want etc. I appreciated the material and
discussion on working with families. They have given a lot of thought
and share their own personal experiences in the field which really makes
the foundation of the material strong and stick. They are great mentors
and teachers. They care. They set training participants up to be ready to
go out into the world and begin their journey as an [end-of-life doula].”
~ Jess Kilbourn,
Certified End-of-Life Doula and Licensed Massage Therapist
https://mkt.com/jessica-kilbourn

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Sacred Passage
https://www.consciousdyinginstitute.com/sacred-passage-guide-
certification/
https://www.consciousdyinginstitute.com/sacred-passage-guide-
certification-2/

The Sacred Passage End-of-Life Doula Certificate training combines in

person training, self-paced study, and twelve weeks of virtual online
coaching. The workshops are offered in various locations throughout
the United States and Canada.

“We deliver a program with eight days of intensive on-site training, which
includes more than 66 contact hours, and twelve weeks of coaching at about
the same hourly rate of other programs. Our program is expensive, but it also
value-packed,” explains Tarron Estes.

Tarron Estes is the founder the Conscious Dying Institute, the

designer and developer of the “Conscious Dying Education and Care”
curriculum, and facilitator of the Sacred Passage: End-of-Life Doula
Certificate courses.

They have two end-of-life doula programs, Sacred Passage End-of-

Life Doula Certificate and Conscious Dying Coach and Educator. The
Conscious Dying Coach and Education is for graduates of the End-of-
Life Doula Certificate program.

Their approach to the work is interesting.

“What makes our program unique is that we offer our participants to begin
their training in Phase 1 with a personal exploration of death,” explains
Tarron. “They spend 12 weeks working with their Doula partners and
Conscious Dying Educators on a coaching tool we have developed called the
Best Three Months Vision Map, which creates explorations and discoveries
on End of Life Wishes. When our participants come in to Phase 2, they have
an experiential foundation to learn how to support others. The results are
transformational.”

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School of Accompanying the Dying

https://school.accompanyingthedying.com

The School of Accompanying the Dying is an End-of-Life Doula

Certificate program that can be completed at your own pace. You have
one year of support within the School environment and may finish in 16
weeks (Fast Track). “We know exactly what an end of life doula needs to be
excellent as a private practitioner. We offer a comprehensive end-of-life doula
curriculum, complete with extensive personal journey, and a blueprint for
creating your own practice,” says Deanna Cochran, RN and creator of the
program. Deanna has been serving the dying since 2000 as a Hospice
RN and since 2005 as a private End of Life Doula herself, giving her
years of practical work experience in death care.

While it’s an online course, there is a built-in community and support

structure. You can request to be matched with a buddy, and you can ask
questions as you work through the material. The learning environment
and community include an online portal, a Facebook study group,
Answers Hub for weekly questions answered directly by Deanna,
access to School Faculty and monthly video conference mentoring
sessions for students who desire more personal engagement.

There are also opportunities to meet fellow students in person. “We do

have local gatherings throughout the year,” says Deanna.

You can watch free educational videos on her Facebook page and get
a feel for whether she is the right teacher for you. See https://www.
facebook.com/journeywithDeanna/.

You can also listen to podcast episodes she has recorded at https://
www.qualityoflifecare.com/podcast.

Here’s what some of students had to say to FabJob about the Quality of
Life Care training:

“I chose Deanna’s program, Accompanying the Dying for a number

of reasons. Deanna was very responsive to my questions when I was
searching for an end-of-life doula program. Her program looked like it had
practical, realistic, idealistic, spiritual, and healing components. I was
not disappointed. I loved the personal attention that Deanna provided. I

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always had my questions answered. Deanna’s experiences as a palliative

nurse helped me learn about pain management and expectations at the
end-of-life. I loved that the pace of instruction was individualized for
what I needed. I absolutely loved the group conference calls and the on-
line sharing of experiences. I learned so much, and continue to learn
from others who have a variety of background experiences.”
~ Deb Holtz,
End-of-Life Doula
[email protected]

“One of the greatest benefits to me personally was coming into

community with other end-of-life doulas from around the United States
and beyond, and the benefits gained from being in the company of like-
minded practitioners that serve as colleagues, references, support and
conscious community. I had been doing this work for a long time but
from a relatively isolated, behind the scenes way. Being in the company
of and in community with other end-of-life doulas makes me an even
better end-of-life doula.
“Many universities and educational institutions are moving to the
virtual classroom environments and QLC is technologically advanced
in this respect. What I like about the QLC program is that the written
training materials are excellent, comprehensive and include practical
applications. The program also includes what I’ll call virtual video
classroom office hours and community discussions, as well as virtual
library resources and mentoring. If for some reason one misses the in-
person video class time, it is recorded and can be viewed later.
“Also, typically once a year QLC EOL Doulas have the opportunity
to come together in what are called Soul Sessions, and I’ll be attending
the October 2018 QLC Soul Sessions Retreat. Also, Deanna hosts
QLC local gatherings around the country throughout the year with her
students. And, in my local community, I’ve been in personal contact
with other QLC doulas in my area to come together in community and
offer mentoring as appropriate.”
~ Nada Frazier,
Certified End-of-Life Doula,
Mentor & Trainer and Founder of The Sacred Servant
https://www.thesacredservant.com/

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“I began my vigil work when my brother was dying. After his funeral,
I returned to work in long-term care and found myself sitting vigil for
patients who were dying. It came naturally and was a way to channel
the grief from losing my brother. After sitting vigil with patients for
three years, I discovered what it was I was doing. It was during a psychic
reading that I was introduced to the term “end-of-life doula.” Yes, a
reading. I was shown a catalog with an end-of-life doula class listed. It
validated everything I had been doing and felt called to do.
“That was in March of 2014. By December, I had searched numerous
times on the Internet, and Deanna’s website always popped up first. So
I reached out to her. I began taking her course, and during that time she
would tell me that I will take this program and introduce it to a company
willing to pay for the training. Fast forward to 2016, and I was hired
by Ascend Hospice who did such a thing. They listened and said yes to
building the program.
“I was able to bring her into the company I work for now and allow her
to build a program personalized specifically for them, for their program
and for the patients. Deanna and I met for the first time this January
after talking online for four years. I value her work, I value her ideas
and what she has to offer as a teacher. She has an inviting presence to
her training that engages the student. I email my volunteers the 30-day
video guide that Deanna has created. Many of my volunteers taking the
training with me now feel connected to Deanna and enjoy the program
very much.”
~ Kelly Roman,
End-of-Life Doula

3.4.4 College and University-Style Courses

If you’re looking for a more academic approach to death study, there are
a number of colleges and universities offering courses and sometimes
even certificates on end-of-life care or the culture of dying. Some
companies that offer continuing education courses for professionals
(like nurses and therapists) also offer educational tracts on end-of-life
care. You don’t necessarily have to be in one of those professions to take
the course.

First, look into your local options. You never know, your community
college or a local university may be offering courses on end-of-life care
or death and dying.

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Here are some education programs to consider.

Allegra Learning Solutions

https://allegralearning.com/courses/certificate-in-end-of-life-care/

Allegra Learning Solutions continuing education courses on a number

of subjects. They have a course that will get you a Certificate in End of
Life Care.

Centennial College: Thanatology Certificate

https://db2.centennialcollege.ca/ce/certdetail.php?CertificateCode=7982

Centennial College in Canada offers a distance-learning certificate on

thanatology (the study of death and dying.) The certificate requires you
to take five courses before applying for the certificate course.

Douglas College
https://www.douglascollege.ca/programs-courses/continuing-
education/health/end-of-life-doula

Douglas College in British Columbia, Canada offers an End-of-Life

Doula Certificate. The non-credited college course is offered over five
days. Depending on the location of the course, it may be offered on five
consecutive days or the class may meet once a week.

The University of Vermont: Larner College of Medicine

https://learn.uvm.edu/program/end-of-life-doula-certificate/

The University of Vermont’s Larner College of Medicine offers an

End-of-Life Doula Professional Certificate that you can get online. The
course is eight weeks long.

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3.4.5 Additional Educational Options to Build

Your Skills
“There is no doubt that one immerses themselves in additional training,
that it is enriching personally and professionally. I would also encourage
people to attend symposiums, conferences, and anything in their area of
interest or specialization. For example, a doula may be drawn to, and
specialize in advance directives, or healing touch or ritual, etc. Anything
an end-of-life doula can do to set apart their services and niche them
down will serve them greatly.”
Patty Burgess,
President of PossibilityTeaching Transitions—
Doing Death Differently

As you learned in Section 2.1, when you read about the variety of death
doula specialties, there are so many additional and complementary
services you can offer. In fact, it can feel overwhelming at times when
you look at all the possibilities.

However, seeking out additional education doesn’t mean you have

to offer a new service. Your continuing education studies can help
you understand the options your clients have for end-of-life care and
support. You can also use what you learn to simply better support your
client’s needs (without necessarily offering a “new service.”)

Here are some possible areas to study, either formally or informally.

Studying Advanced Care Directives

If there is one topic to explore deeply, it’s the world of advanced care
directives. Most end-of-life doula work involves either discussing
advance care directives, encouraging their clients to create them,
actually guiding them through the process, or (at the very least)
advocating for their clients that their decisions are respected.

Studying advanced care directions doesn’t just stop at reading forms

and knowing how to fill them out. It can also be helpful to read about
end-of-life care options. For example, what does tube feeding mean
exactly? What are the benefits and risks? What kinds of pain relief
options do people have at the end of life?

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To be clear, you won’t be giving anyone medical advice in your role as

a death doula. However, having information on the options and what
they mean can be helpful to your clients.

Here are some resources for studying advanced care directives:

• https://respectingchoices.org/types-of-curriculum-and-
certification/facilitator-certification/

• https://www.cdc.gov/aging/advancecareplanning/care-
planning-course.htm

• https://theconversationproject.org/

Religious and Spiritual Study

“I would not have become a death doula had I not initially studied yoga,
which led me to the study of Reiki, and later Integrative Energy Healing
at Langara College in Vancouver BC. They taught me both how to listen
in a new and different way, and how to talk to bodies without using
words, which comes in really handy in my work.”
Emily Pinzur,
End-of-Life Doula
www.silverwheelhealing.com

Religion and spirituality can be extremely important aspects to

supporting the dying. As a death doula or midwife, your role will not
be to push any particular religious agenda. You will, however, be there
to advocate for the spiritual needs of your client. It’s difficult to be a
good advocate if you don’t know what to advocate for.

For example, a devote Catholic may want to have a plan for how they
will receive their last rites. A Jewish family may want help preparing
the house for mourning, which according to Jewish custom includes
things like covering all mirrors in the home and sitting low stools or
cushions on the floor.

Spirituality is not only for the religious, however. Supporting the

human spirit or soul can come from non-religious sources like
meditation, physical touch, and ritual.

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You can learn about religion and spirituality from a variety of sources,
including…

• Attending workshops (Check out your local yoga studios,

health food store, and book stores—these can be great learning
resources.)

• Taking community college courses, look for courses covering

“world religions”

• Reading everything you can on religion and spirituality, of all

kinds

• Listening to podcasts or watching YouTube videos on religion

and spirituality (Check out this list: https://www.refinery29.com/
en-us/best-spirituality-podcasts)

• Looking at what the local houses of worship offer in terms of

education

• Conducting information interviews (see section 3.3.1) with local

clergy

Train Your Pet to Be a Therapy Animal

Do you have a pet that just loves people? You might want to consider
training your pet to be a therapy animal.

Don’t confuse therapy animal with service animal, a very common

mistake. Service animals perform tasks for those with a disability. For
example, they may be training to listen for certain sounds if a person
has difficulty with hearing. Service animals are not there for “comfort”
but are working animals. The general rule is that you don’t pet a service
dog when they are at work.

A therapy animal, on the other hand, is there to provide love and

psychological comfort. Therapy animals are for petting and touch.
Therapy animals and their handlers need to go through training before
they can enter hospitals, hospices, and other places where their services
could benefit others.

Talk to your veterinarian about whether your pet might make a good
therapy animal and ask what local training program they recommend.

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You can read more about the benefits of therapy animals in hospice
care: https://crhcf.org/Blog/what-is-hospice-pet-therapy/.

Home Funeral Guide

https://www.homefuneralalliance.org/

Some clients who choose to work with a death doula will also be
interested in holding a home funeral. It’s important to note that death
doulas are not home funeral guides. These are two separate professions.

That said, studying the options for home funerals can help you provide
guidance to your clients. You might even decide to also become a home
funeral guide, in addition to your death doula work.

One way to both learn more about home funerals and network with
local death care workers is to interview local home funeral guides in
your area. Let them know that you are a death doula (or studying to
become one), and you want to learn about what they do and how they
help your future clients.

Another excellent resource for learning about home funerals is the

National Home Funeral Alliance (NHFA.)

Death Celebrant
A death celebrant is a professional who performs and offers funeral
services without a specific religious agenda or specific belief in the
afterlife. Death celebrants can be a better choice for those who are not
religious, who feel uncomfortable with religion, or who just simply
want a different approach to a funeral than you might get with a
traditional minister, priest, imam, or rabbi. Some celebrants are in fact
also ordained in a more “traditional” religious study, but also offer
the more neutral “celebrant” services to those looking for a different
approach.

Celebrants may specialize in a particular area—like death—or they

may offer services to celebrate various life cycle events, like weddings
or even divorces.

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You can study celebrant work and even attend training, if this is an
area you’d like to explore deeply. Learning more about how people can
celebrate, recognize, and remember the dying and the dead can help
you with your death midwifery work.

Here are some resources to learn more about celebrants:

• http://www.celebrantinstitute.org/

• https://iccfa.com/celebrant-training/

• https://www.homefuneralalliance.org/funeral-celebrants.html

• http://www.nfda.org/education/certification-training-programs/
about-certified-celebrant-training

3.4.6 Business Courses

Earning a degree, diploma, or certificate in business can be helpful in
running your own business. However, a formal business education
is not necessary to run an end-of-life doula business. There are many
successful business owners who are self-taught and have never studied
business. Others have taken a course here and there but do not possess
a degree. However, the skills you learn in business classes can come in
handy. Depending on which of your skills you would like to develop,
consider taking courses on topics such as:

• Advertising

• Basic Accounting

• Business Communications

• Business Management

• Entrepreneurship

Your local college or university may offer these and other business
courses. If you are not interested in attending courses at a school, or you
don’t have the time, another option that can easily fit into your schedule
is distance learning. Traditionally these were called correspondence
courses and the lessons were mailed back and forth between student
and instructor. Today, with the help of the Internet, there are many
online courses available.

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Before you decide to invest an interesting amount of money, be sure

to check degree-offering schools’ accreditation status with reputable
accreditors such as the Distance Education Accrediting Commission
(DEAC; formerly Distance Education and Training Council) at
www.deac.org. Avoid diploma mills and bogus accreditation agencies;
see https://en.wikipedia.org/wiki/List_of_unrecognized_higher_
education_accreditation_organizations for helpful information.

Your local Chamber of Commerce may also offer training courses and
seminars for new business owners. Many also offer consultations with
retired executives and business owners who are well-qualified to offer
advice.

3.5 Resources for Self-Study

“Feed the calling! Personally, I found that I couldn’t read about the topic
or watch enough documentaries to satisfy the urge to do this work.”
Kelly Roman,
End-of-Life Doula

This section provides information about books, documentaries, and

websites that can help you get an education on death and dying.

3.5.1 Books
Amazon.com lists more than 10,000 books on the subject of death and
dying, but of course you do not have the time to read them all! So here
is a selection of excellent books you may want to start with. Look for
them at your local library, browse through them at a local bookstore, or
order them online.

• Aging Families and Caregiving, by Sara Honn Qualls (Editor),

Steven H. Zarit

• American Cancer Society Complete Guide to Family Caregiving: The

Essential Guide to Cancer Caregiving at Home, by Julia A. Bucher RN
PhD, Peter S. Houts PhD

• BeingMortal: Medicine and What Matters in the End, by Atul

Gawande

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• Dying at Home: A Family Guide for Caregiving (Johns Hopkins Press

Health Book), by Andrea Sankar

• The Green Burial Guidebook: Everything You Need to Plan an

Affordable, Environmentally Friendly Burial, by Elizabeth Fournier

• Extreme Measures: Finding a Better Path to the End of Life, by Dr.

Jessica Nutik Zitter M.D.

Gifts: Understanding the Special Awareness, Needs, and

• Final
Communications of the Dying, by Maggie Callanan

• TheFour Things That Matter Most: A Book About Living, by Ira

Byock M.D.

• How to Care for Aging Parents, 3rd Edition: A One-Stop Resource

for All Your Medical, Financial, Housing, and Emotional Issues, by
Virginia Morris

• Knocking on Heaven’s Door: The Path to a Better Way of Death, by

Katy Butler

• Modern Death: How Medicine Changed the End of Life, by Haider

Warraich

• Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and

Killing Ourselves to Live Longer, by Barbara Ehrenreich

• On Death and Dying: What the Dying Have to Teach Doctors, Nurses,
Clergy and Their Own Families, by Elisabeth Kübler-Ross and Ira
Byock M.D.

Dying: Creating Rituals for Embracing the End of Life, by

• Sacred
Megory Anderson

• Smoke Gets in Your Eyes: And Other Lessons from the Crematory, by
Caitlin Doughty

3.5.2 Websites
Throughout this guide you will find numerous websites that can assist
you in various aspects of starting and running an end-of-life doula
business. In this section, we focus on several key resources that can
help you quickly increase your knowledge. Each of these websites is a

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wealth of information that you can refer to throughout the process of

starting your business.

Starting a Business Sites

• SBA
The Small Business Administration (SBA) is a leading U.S.
government resource for information about licensing, taxes,
and starting a small business. You can find a range of resources
including information on financing your new business, business
plans and much more at www.sba.gov.

• SCORE
The Service Corps of Retired Executives (SCORE) is an
organization of U.S. volunteers who donate their time and
expertise to new business owners. You can find information on
taxes, tips for starting your business, or even find a mentor who
will coach you and help you maximize your chances of succeeding
as a new business owner. Visit them at www.score.org.

• Canada Business Services for Entrepreneurs

This Canadian government website offers information on
legislation, taxes, incorporation, and other issues of interest to
Canadian business owners or those who do business in Canada.
For more information and a list of services they offer visit their
website at http://canadabusiness.ca.

Industry Sites
If you type “death and dying” into a search engine, you will have
literally thousands of websites to choose from. So here’s a short list of
the best websites for getting started learning about the death positive
movement.

• The Conversation Project

A rich resource on talking about advanced care directives and end
of life planning.
https://theconversationproject.org/

• Death Café
The official website for the death café movement. (See 3.3.3 for
more on death café.)
https://deathcafe.com/

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• Green Burial Council

For your clients interested in green burial, this could be a vital
resource to find local providers.
http://greenburialcouncil.org/

• National End-of-Life Doula Alliance (NEDA)

Official website of the National End-of-Life Doula Alliance, an
organization that brings together end-of-life doulas and death
midwives from a variety of backgrounds.
http://www.nedalliance.org/

• National Home Funeral Alliance (NHFA)

Website of the National Home Funeral Alliance, has a list of home
funeral guides, plus useful information on home funeral.
https://www.homefuneralalliance.org/

• National Hospice and Palliative Care Organization

Numerous resources for learning about hospice and palliative
care. You could spend hours and hours on this site learning.
https://www.nhpco.org/

3.5.3 Documentaries
Here are some videos to watch on the subjects of death and dying.
• End Game
A Netflix documentary on end-of-life, what it means to die, and
hospice care.
https://www.netflix.com/title/80210691

• Soul Pancake’s Series: My Last Days

A truly touching and inspiring series that features people at the
end of life, and how they choose to live their last days.
h t t p s : / / w w w. y o u t u b e . c o m / p l a y l i s t ? l i s t = P L z v R x _
johoA8ITQgxBpeJTaDUhhIB7bfX

• Ram Das: Going Home

In this documentary, spiritual teacher Ram Das approaches end
of life in an awe-inspiring way. This documentary is currently
available streaming on Netflix.
https://ramdassgoinghome.com/

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• A Family Undertaking
A documentary on the home funeral movement. Not currently
available online via streaming, tracking down a DVD may take
some extra effort. Check out your library. Netflix DVD rental does
carry it.
https://www.pbs.org/pov/afamilyundertaking/

• How to Die in Oregon

A moving documentary on aid-in-dying (also known as
physician-assisted suicide.)
http://www.howtodieinoregon.com/index.html

• TED Talks: New Ways to Think About Death

A playlist of TED talks on death and dying. This is just a start;
there are many excellent TED talks on the subject of death and
dying.
https://www.ted.com/playlists/241/new_ways_to_think_about_
death

• A Will for the Woods

The story of musician,psychiatrist, and folk dancer Clark Wang,
who after being diagnosed with lymphoma, begins to consider
and plan for his own green burial.
http://www.awillforthewoods.com/

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4. Starting Your Own Business

If you dream of having your own end-of-life doula business, the
information in this chapter will help you get started. Few end-of-life
doulas make a full-time income with their work, so you might be
thinking you don’t need to plan and set up your business formally.
However, it is in your best interest to treat your end-of-life midwifery
work like a business. Legally, in some areas may be required (if you are
being paid for your work), but also, even if death doula’ing is going to
be a side venture for you, giving your death doula work the attention,
planning, and respect it deserves will help you be more successful and
hopefully protect you from making costly mistakes.

Plus, you never know—your death work may be more of a hobby

today, but it could bloom into a full-time business later. Having solid
ground to start on will give you a great advantage.

Starting Full-Time or Part-Time

If you are currently employed, some of the questions you may need to
consider are:

• Should I quit my job and start my end-of-life doula business on a

full-time basis?

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• Should I remain at my current job and start an end-of-life doula

business on the side?

• Would my employer let me keep my job on a part-time basis so I

could be available to meet with clients during business hours and
have a secure source of income while I’m getting my business off
the ground?

• IfI leave my job to start my own end-of-life doula business can I

rely on my current employer to become one of my clients? (Like if
you work for a hospice)

While some of your choices will depend on external factors such as

whether or not your employer allows employees to moonlight, other
choices will be yours to make.

Note that leaving your job to become a full-time death doula right from
the start is not a great idea…

“I do not recommend any of my students or colleagues to leave their

day job and become a Doula full time. I personally have other sources
of income.... But I have made money: as a consultant for elder care
(dementia cases mostly) and end-of-life doula, and now as a [death doula]
trainer, enough to cover fees to continue my community workshops,
promotions, memberships to associations, meetings, insurance, etc., and
keep investing…”
Nathalie Bonafé,
PhD, CEOLD (Certified End of Life Doula)
https://www.agentlerparting.com/

… However, with that said, making a full-time income in this work is

possible. There are doulas out there who live off their income as end-of-
life doulas. But they didn’t start off by quitting their full-time job. They
built up their business thoughtfully and intelligently.

First, start your business, and get things going. Then, only when the
time is right, consider leaving your job. (If that’s what you want! There’s
nothing wrong with doing doula work on the side.)

The following chapter will give you the information you need to plan
for success in your end-of-life doula career.

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Other Start-Up Decisions

Whether or not you are currently employed, there are many other
decisions you will face when starting your end-of-life doula business.
For example:

• Should I have a specialization?

• Should I incorporate?

• Should I work with one or more partners?

• Where should I set up my office? (Most death doulas work out of

their homes)

• What should I name my company?

• What systems do I need to set up (e.g. for invoicing)?

• How much should I invest in start-up costs? (Start up costs are

typically low)

• Should I hire support staff?

• What types of insurance should I get?

• What fees should I charge?

This chapter is designed to help you make these and other decisions
you will face in starting your business. (The next chapter will help you
decide how to market your business to attract clients.) We’ll start with
creating a business plan and continue with an overview of other factors
you’ll need to consider in starting your own business. Chapters 4 and
5 also offer strategies, tips, and advice for increasing your chances of
success in the early stages, and insight into how to make your business
successful in the long term.

Throughout the chapter you will also find many helpful resources
for further information. If you could use more help with all areas of
starting a business, the following are excellent sources of information:

• Small Business Administration

The SBA offers help with businessstart-ups and has a variety of
programs and services for the small business owner. There is at

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least one SBA office in every state in the United States. Visit www.
sba.gov.

• SCORE
A non-profit organization, SCORE has over 10,000 volunteers
who provide counseling and mentoring to new business start-
ups. They also offer business tips on their website. Visit www.
score.org.

• Canada Business Network

You will find a wide range of information at this site, including
step-by-step instructions to guide you through starting your new
business. Visit http://canadabusiness.ca.

• Nolo.com
Nolo is a publisher of plain English legal information. They also
offer free advice on a variety of other small business matters. Visit
their website at www.nolo.com.

4.1 Getting Started

4.1.1 Creating a Business Plan
Business planning involves putting in writing all the plans you have
for your business. If you will be seeking financing for your business,
the lender will expect to see a business plan that shows you have a
viable business idea with an excellent chance for success. Now, few
death doula businesses require financing. However, putting ideas on
paper will give you the “road map” of where you want to go with your
business and how you are going to get there.

A business plan can also help you avoid costly surprises. If you are
considering whether to leave a secure job to start your own end-of-life
doula business, a business plan can help you determine the resources
you will need to start your business and decide when the timing is best
to get started. It will help you determine if you have enough funds set
aside to support yourself while you get the business up and running.
Leaving a full-time job to be a death doula is not a good idea when
you’re just starting out. However, as you get more into the field and
gain more success, it may eventually be a possibility.

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If you make the effort to draw up a good plan now, you can be
confident that it will pay off in the future. You may find over the course
of your research that your thoughts change about how you will set up
your business. For example, you may have been considering focusing
exclusively on vigiling doula services. But, your research might show
that the need for elder care is high, and the potential profits are more in
line with your budget needs. With this knowledge in mind, if your goal
is to make enough money to leave your current place of employment,
you may decide to offer vigiling and elder-care services.

After reading this chapter, and the next one on finding clients, you will
be able to start creating your own business plan. It is a document you
will probably read repeatedly as you start to operate your business. In
the meantime, this section will give you an introduction to business
planning, walk you through key components of a business plan, and
conclude with a variety of resources to help you create your own
business plan, including links to further information, business planning
software, and business plan templates.

TIP: If your business plan is going to be shown to anyone, such

as potential investors, make sure you proofread it carefully.

While the format of a business plan can vary, one good approach is to
divide the body of your business plan into the following sections:

• A description of your business

• Your marketing plan

• Your financial plan

• Your management plan

In addition, your plan should include the following items:

• A cover sheet

• A table of contents

• An executive summary

• Financial projections

• Supporting documents

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Description of Your Business

A description of your business is just that—a description of the business
you plan to start and operate. The key is to include information about
your business so that everyone who reads your business plan will know
you’re on to something viable.

You’ll need to state in this section that, as a death midwife, you’ll be

operating a service business. Get specific about the services you’ll
provide. If you will have a specialization, state that in your description.

Should You Specialize?

Most professionals market themselves as specialists. For
example, unless a doctor is a general practitioner, he or she
will specialize as a pediatrician, cardiologist, plastic surgeon,
etc. Similarly, lawyers specialize in criminal law, intellectual
property, immigration, etc. Likewise, most end-of-life doulas
choose to specialize.

Many feel it is easier to get started in the business as a specialist

rather than a generalist because you have narrowed down the
options of who your potential clients may be and these potential
clients will perceive you as an expert in that area.

However, depending on your particular business, it may be

better for you to be the equivalent of a general practitioner. For
example, if you live in a rural area, you may need to offer all types
of end-of-life doula services or offer your services to all types of
clients in order to attract enough business to be profitable.

You can find information about specializations in section 2.1.

When choosing a specialization, in addition to considering which
areas you have experience in and are most enthusiastic about,
you will need to consider which areas are most in demand.

Also watch for emerging trends which can help you recognize
opportunities for your death care business. The resources in
section 3.3 can help you keep on top of trends in the death and
dying industry.

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The description of your business should also explain the legal structure
of your business. Will you have a sole proprietorship, for instance, or
incorporate? You’ll find more information about legal structures in
section 4.1.2.

In this section you can also discuss the death and dying industry
generally, touch on points you will address in other parts of the business
plan, and include details about how your business will operate. For
example, you could describe your business hours. Do you plan to be
available during regular business hours? Most death midwives will
need to offer at least some services (like vigiling) off of regular hours,
while other services may fit into the more typical schedule. If you
are working at another full-time or part-time job, when will you be
available to meet with clients? You may find yourself primarily offering
consultations on weekends or in the evenings. You could also identify
the planned location of your business, and why it’s appropriate for
your business. The most likely place you’ll meet with clients is in their
own homes, or at a hospital or hospice bedside. But what about when
that’s not an option?

You can conclude the description of your business by clearly identifying

your goals and objectives such as sales targets. Support them with
information you’ve acquired about being a end-of-life support person.
It’s here that you’re explaining exactly why you’re starting this business
and what you hope to accomplish with it.

Your own company description will be unique to your end-of-life

care business. You’ll find business plan models you can follow in the
resources listed at the end of this section.

Your Marketing Plan

Following are key elements of a typical marketing plan. You will find
additional information to help you plan your marketing in chapter 6 of
this book.

Your Clients
The most important elements of a good marketing plan are defining
your market and knowing your customers. Knowing your customers is

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important because it allows you to tailor your services to accommodate

those clients.

You don’t want to limit yourself to a market that is too narrow—that

can limit the scope of your business once it’s underway. For example,
you’ll have many more prospective clients if you target “terminally
ill” rather than “cancer patients.” And targeting all “chronically ill
patients” will give you an even larger market. Quantify your market
and use your marketing plan to paint a picture of a wide and ready
market that needs your doula’ing services.

TIP: To find hard numbers to support your target market

calculations, consult the government census; for US
statistics, visit http://census.gov for USA statistics, and in
Canada, visit www12.statcan.gc.ca.

Competition
All businesses compete for customers, market share, and publicity. So
it’s smart to know who your competitors are and exactly what they’re
doing. To provide services that are different and better than those
of your rivals, you need to evaluate your competitors’ services, how
they’re promoting them, who is buying them, and other information.
This obviously means looking at other local death doula workers, but
also consider other businesses that may offer support services for the
terminally ill. (Respite care services, for example.)

Pricing
You’ll learn more about setting fees later in this chapter, but know that
you should address this issue, at least briefly, in your business plan.
This section should consider factors such as competitive pricing, costs
of labor and materials, and overhead. Don’t be quick to dismiss the
costs of materials in death doula work. Your time, training and on
going continuing education, and any support materials (advanced care
directive plans) or technologies (cell phone, pager, credit card or PayPal
fees, etc.) you use all come with a price.

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Your Market Strategy

You’ll need to think about how you’ll advertise and promote your
business. Have a budget in mind, or at least set percentages of your
income that you’ll invest back into marketing the business.

Your Financial Plan

Financial management is crucial to running a successful business.
Your business plan should describe both your startup costs and your
operating costs. The startup budget includes all the costs necessary
to get your business up and running. Operating costs are ongoing
expenses, such as advertising, fees to any professional associations,
liability insurance, and so forth.

Remember to include the following items in your budgets. Notice that

some expenses overlap on the startup and operating budgets. More
information about start-up expenses is provided in section 4.2.1.

Start-up Budget
Legal and professional fees, training and/or certification costs,
equipment (books, comfort tools), supplies (non-latex gloves, oral
care items, art supplies for legacy work, etc.), stationery, marketing
expenses.

Operating Budget
Make a budget for your first three to six months of operation, including
expenses such as: personnel (even if it’s only your own salary), rent
(though you’re likely working from home), liability insurance,
marketing expenses, legal and accounting fees, supplies, printing,
postage and courier, membership dues, subscriptions, pager or cell
phone fees (so clients can reach you), and taxes.

Your financial management plan also should address the accounting

system you plan to use. Many small business owners conduct their own
accounting, using software such as Quicken (www.quicken.com) or
Quickbooks (http://quickbooks.intuit.com), while others hire someone
to set up a system.

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Your Management Plan

No matter how large or small your business is, managing it requires
organization and leadership. Your management plan will therefore
address issues such as:

• Your background and business experience, and how they will be

beneficial to your end-of-life doula business

• The members of your management team (even if you’ll be the

only member)

• Assistance you expect to receive (financial help, advice, or other

forms of aid)

• Plans for hiring employees, either now or in the future (much

more likely you’ll work alongside fellow freelance contractors)

• The duties for which you and any employee or fellow contractors
will be responsible

• A general overview of how your business will be run

The Extras
In addition to these major areas, your business plan should include the
extras mentioned earlier:

A Cover Sheet
This identifies your business and explains the purpose of the business
plan. Be sure to include your name, the name of the business, and the
name of any partners, if applicable. Also include your address, phone
number, email address, and other relevant information.

Table of Contents
This goes just under your cover sheet and tells what’s included in your
business plan. Use major headings and subheadings to identify the
contents.

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Executive Summary
Basically, this is a summary of your business plan. It should summarize
everything you’ve included in the main body of the plan. This section
will be written last, and placed first.

Financial Projections
This is an estimate of how much money you’ll need to start your
business, and how much you expect to earn. Remember to support
your projections with explanations.

You’ll want to include cash flow forecasts, both monthly and annually,
to highlight your projected revenues and expenses. This will help you
to estimate more accurately your expenses and know how much you
will need to earn in order to pay your bills. This is an essential part of
planning your ongoing budgets.

Remember to account for time between clients (if you will need that),
and be realistic about how many clients you’ll get in your early months
and years. If the concept of death doula work is new in your area,
offering workshops and educational events may make up most of your
first income opportunities.

Supporting Documents
If you will be seeking start-up funding (unlikely, but maybe you have
big dreams!), you’ll be expected to include financial information. This
may include your personal (and business, if applicable) tax returns for
the past three years, a personal financial statement (get a form from
your bank) and a copy of a lease agreement if you will rent office space.

Resources
There are a number of excellent resources available to help you write
your business plan. The following are among the best:

• SBA
The SBA offers help with business start-ups and has a variety of
programs and services for the small business owner. The site also
has links to sample business plans, a business plan workshop, an

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interactive business planner and more. Visit https://www.sba.gov/

business-guide/plan-your-business/write-your-business-plan

• SCORE
A non-profit organization, SCORE has volunteers who provide
counseling and mentoring to new business start-ups. They
also offer an outstanding free business plan template, available
in Word or PDF formats, and an online workshop on how to
“Develop a Business Plan,” as well as many other tips and
resources. Visit https://www.score.org/resource/business-
planning-financial-statements-template-gallery.

• Canada Business Network

You will find a wide range of information at http://
canadabusiness.ca/business-planning, including a step-by-step
guide to walk you through starting your new business.

• Business Plan Pro Software

If you want help creating a professional business plan, another
option is to buy business planning software from PaloAlto
Software (www.paloalto.com). The standard version of Business
Plan Pro is available for $99.95; the premier version is $159.95.
Business Plan Pro offers a step-by-step guide to creating a
business plan, as well as 500 samples.

Sample Business Plan

Here are a couple of sample business plans, one for a personal shopping
service, and another for a concierge service. They aren’t business plans
for an end-of-life doula business, but they might at least give you an
idea of what to include in your business plan.

• https://www.bplans.com/personal_shopping_services_
business_plan/executive_summary_fc.php

• https://www.bplans.com/concierge_service_business_plan/
executive_summary_fc.php

At the pages above, you can see the executive summary; scroll to the
bottom of the page to find links to other areas of the business plan.

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Business Licensing
No matter what kind of company you own, you will need a
business license. There may also be other permits and licenses
you will need, so contact your local city hall or county clerk’s
office. Additional information and contact details can be found
through the website of your local city hall or county clerk, or
at sites such as sba.gov/business-guide/launch-your-business/
apply-licenses-permits.

In Canada, visit http://canadabusiness.ca/government/

registering-your-business.

Your city hall should also be able to tell you if you need a special
license to work from home (may be known as a home occupation
license) and, if so, where to get it. In many communities, to
obtain a license to work at home you will need to fill out a form,
provide your business name and phone number, and give some
details about the nature of your business. Most questions on
the form are designed to detect and deter people who will be a
nuisance or a risk to their neighbors, and may not apply to you.

For information about licensing and regulations for businesses

in Canada, check out the “Permits and Licenses” page at
the Canadian Government’s Canada Business Services for
Entrepreneurs site at https://canadabusiness.ca/government/
permits-and-licences.

If you are planning to sell wholesale items (could be essential

oils or some sort of comfort items), you will provide a
photocopy of your license upon entrance to wholesale shopping
establishments. You will also need a resale number for tax
purposes as described in section 4.2.3.

4.1.2 Choosing a Business Legal Structure

Like all entrepreneurs, death doulas or midwives are faced
with the decision of how to legally structure their business. You
may be familiar with the different forms of legal structures, sole

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proprietorship, partnership, corporation or limited liability company,

but it’s worthwhile to review them briefly so that you can consider
your options. In this section we will look at the advantages and
disadvantages of each for businesses.

Sole Proprietorship
A sole proprietorship is any business operated by one single individual
without any formal structure or registration requirements. A sole
proprietorship is the simplest and least expensive business legal
structure when you are starting out. It is also the easiest because it
requires less paperwork and you can report your business income on
your personal tax return. One drawback to this type of business is that
you are personally liable for any debts of the business. In the unlikely
(but possible) event a client sued you, this could be an issue.

Without going through any formal processes, you can begin your end-
of-life doula business simply by getting the word out that you’re in
business. With this said, however, there are usually business licenses
and permits required by local municipalities in order for you to conduct
business. The costs of these licenses are usually minimal, but be sure to
check with your local municipal licensing office.

Here are some of the advantages and disadvantages of starting your

end-of-life doula business under the sole proprietorship model.

Advantages

• Easy to start

• Low start-up costs

• Flexible and informal

• Business losses can often be deducted from personal income for

tax purposes

Disadvantages

• Unlimited personal liability: the sole proprietor can be held

personally responsible for debts and judgments placed against
the business. This means that all personal income and assets, not

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just those of the business, can be seized to recoup losses or pay

damages.

• All business income earned must be reported and is taxed as

personal income.

• More difficult to raise capital for the business

Incorporation
Incorporation of a business means that a separate, legal corporate
entity has been created for the purpose of conducting business. Like
an individual, corporations can be taxed, sued, can enter contractual
agreements and are liable for their debts. Corporations are characterized
by shareholders, a board of directors and various company officers. As
such, ownership interests can be freely transferred.

Creating a corporation requires filing of numerous documents to

legalize your end-of-life doula business, as well as formally naming
a president, shareholders, and director(s), all of whom can be a single
person as set out in the company charter. As the rules and forms
required for incorporation vary from state to state and province to
province, it’s best to consult your local business licensing office or a
local lawyer specializing in incorporation.

While it is probably best to seek legal expertise when incorporating,

if you have the expertise and knowledge, you can incorporate your
own business or use one of the many online resources that specialize in
these matters. Here are a few websites offering such services, often for
only a couple of hundred dollars:

• BizFilings
www.bizfilings.com

• The Company Corporation

www.incorporate.com

• MyCorporation
www.mycorporation.com

• Form-a-Corp, Inc.
www.form-a-corp.com

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Here is a list of some of the advantages and disadvantages to

incorporating your death midwifery business.

Advantages

• Protectpersonal assets and income from liability by separating

your business income and assets from your personal.

• Corporations get greater tax breaks and incentives

• Ownership can be sold or transferred if the owner wishes to retire

or leave the business

• Banks and other lending institutions tend to have more faith in

incorporated businesses so raising capital is easier

Disadvantages

• Increased start-up costs

• Substantial increase in paperwork

• Business losses cannot be offset against your personal income

• Corporations are more closely regulated

An S Corporation is similar to the corporation in most ways, but with

some tax advantages. The corporation can pass its earnings and profits
on as dividends to the shareholder(s). However, as an employee of
the corporation you do have to pay yourself a wage that meets the
government’s reasonable standards of compensation just as if you were
paying someone else to do your job.

Partnerships
Another business structure that some doulas choose over sole
proprietorship or incorporation is the partnership. A partnership is
precisely as its name implies, a business venture entered into by two
or more people with the intent to carry on business and earn profits.
Partnerships can be beneficial for death doulas as the workload and
finances can be shared, and partners with differing areas of expertise
can increase business opportunities.

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You must register your partnership with a corporate registry. This does
not mean that you must incorporate, only that you are making a formal
declaration of entering into business with another person or persons.
Be sure to consult your local business registry and a lawyer specializing
in business registry. The primary purpose for doing this is for each
partner to protect himself or herself concerning issues such as sharing
profits, liability and dissolving the partnership equitably. Below are
some of the potential advantages and disadvantages to partnerships:

Advantages

• More equity for start-up costs

• Broader areas of expertise can lead to increased opportunities

• Lower start-up costs than incorporation

• Some tax advantages

Disadvantages

• Allpartners are equally liable for the other’s mistakes with the
same liability as a sole proprietorship

• Profits and losses must be shared

• The business must be dissolved and reorganized when a partner

leaves

Beyond any legal issues, before going into business with a partner you
should spend many hours talking about how you will work together,
including:

• What each of you will be responsible for

• How you will make decisions on a day-to-day basis

• What percentage of the business each of you will own

• How you see the business developing in the future

• What you expect from each other

During your discussions you can learn if there are any areas where you
need to compromise. For example, one of you may want to start your

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business as a part-time job, while the other wants to work full-time

and eventually build a business that will employ more people. You can
avoid future misunderstandings by putting the points you have agreed
on into a written “partnership agreement” that covers any possibility
you can think of (including one of you leaving the business at some
point in the future).

Note: Even if you decide to work along with other death doulas—
which has many advantages, including working as a team and taking
shifts when doing vigil work—this doesn’t mean you have to legally
form your business as a partnership. Much more commonly, death
midwives work legally as individuals on a contract basis, but then
“work together” with clients. Or, they form an LLC owned by one
particular person, with each additional team member working as a
“freelance” for that company.

Limited Liability Company (LLC)

A Limited Liability Company is a newer type of business legal structure
in the U.S. It is a combination of a sole proprietorship (where there is
only one member of the LLC) or partnership and a corporation, and is
considered to have some of the best attributes of each, including limited
personal liability.

An LLC business structure gives you the benefits of a partnership

or S corporation while providing personal asset protection like
a corporation. Similar to incorporating, there will be substantial
paperwork involved in establishing this business structure. LLCs have
flexible tax options, but are usually taxed like a partnership. Here are
some of the advantages and disadvantages of LLCs:

Advantages

• Limited liability similar to a corporation

• Tax advantages similar to a corporation

• Canbe started with one (except in Massachusetts) or more

members like a sole proprietorship or partnership

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Disadvantages

• More costly to start than a sole proprietorship or partnership

• Consensus among members may become an issue

• LLC dissolves if any member leaves

In the end, choosing a business legal structure for your death doula
business is a personal choice, and the advantages and disadvantages
should be considered thoroughly. Many doulas begin their
independent venture as a sole proprietorship because of the low costs,
and incorporate as the business grows and the engagements become
larger and more complex.

For more information about business structures take a look at

the resources available at FindLaw.com. The direct link is http://
smallbusiness.findlaw.com/incorporation-and-legal-structures. For
some additional government resources to help you decide which
structure to choose in the U.S., try the Small Business Administration.
Visit https://www.sba.gov/business-guide/launch-your-business/
choose-business-structure.

In Canada, visit the Canada Business site https://canadabusiness.ca/

starting/before-starting-your-business/corporation-partnership-or-
sole-proprietorship.

4.1.3 Choosing a Business Name

There are a few things to consider when deciding how to name your
business. Your business name needs to:

• Describe what you do

• Be easy to pronounce

• Attract customers

• Be unique

• Be available

To choose a name for your end-of-life doula company, start by taking

a look on the Internet to see the names that other doulas have chosen.

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Notice which names stand out. When you’ve decided on a few names
that sound fabulous, let some friends and colleagues know what
you’re thinking of calling your business, and ask for their comments
and opinions. The decision is still up to you, of course, but the instant
reactions of “real people” can be a good indication of whether you are
on the right track or not. Here are name samples from end-of-life doula
business owners we surveyed.

Business name: Going with Grace

Why this name: “I choose the name Going with Grace because grace is an
integral component of how we can die if we choose.”
Alua Arthur
https://www.goingwithgrace.com/

Business name: Sacred Thresholds

Why this name: “The name best describes the various work I do from death
and dying, grief, ancestral lineage healing, weddings, radical embodied
compassion practices, etc. It’s all super threshold-ish.”
Jessica Headley Ternes,
Certified Death Midwife &
Ancestral Lineage Healing Practitioner
https://sacredthresholds.org/

Business name: A Gentler Parting, LLC.

Why this name: “I chose it so I can introduce the subject of separation/death
in a subtle, almost poetic way. Something so important needs to be approached
with tact, gentleness, kindness, and lightness too. But I also wanted to help
make such parting even gentler than it can be with the current systems in
place (i.e. palliative care and hospice care). Let’s take parting to a higher level of
understanding, with a certain empathy, yet without pretensions. Just wanting
to make it easier to say goodbye. And there are so many great tools doulas can
teach.”
Nathalie Bonafé,
PhD, CEOLD (Certified End-of-Life Doula)
http://www.agentlerparting.com

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Business name: Steady Waves

Why this name: “’Steady Waves’ is actually the title of one of the songs on
my last record, Wabi-Sabi. I liked it as a business name also, because life comes
in steady waves—and after death, the waves keep coming... Life goes on.”
Emily Cross,
Death Doula and Musician
https://steadywaveseol.com/

Ultimately you are the person who will need to live with your business
name. It should be one that you feel great about. It should feel like it fits
and it should make you happy.

It’s important that your business name not resemble the name of
another similar business offering similar services. For one thing,
prospective clients may confuse the other business with yours and go
with your competitor’s services instead of yours. In addition, if you
do use a name too similar to another business that was in business
first they will have grounds for legal action against you. The SBA has
an informative page at www.sba.gov/business-guide/launch-your-
business/choose-your-business-name and www.sba.gov/business-
guide/launch-your-business/register-your-business. In Canada, visit
https://canadabusiness.ca/government/registering-your-business
and www.canada.ca/en/services/business/start/choosing-a-business-
name-3.html.

Before officially registering your business name, you must conduct

formal fictitious names and trademark searches. (The fictitious names
database is where non-trademarked business names are listed.)
A trademark database lists all registered and trademarked business
names. In the U.S., the essential place to start is with the U.S. Patent and
Trademark Office. You can hire a company to do a name search for you,
or conduct a free search yourself at the PTO’s website at www.uspto.
gov/main/trademarks.htm.

In Canada, information on trademarks is found at www.ic.gc.ca and the

default database for name searches is the Newly Upgraded Automated
Name Search (NUANS) at https://canadabusiness.ca/programs/nuans-
corporate-name-search-1/.

There is a $21.47 (plus tax) charge for each NUANS search.

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You can also hire a company such as Arvic Search Services (www.arvic.
com) or www.biznamesearch.com to help you with name searches,
trademarks and incorporating your business for a fee. Check online for
“corporate registry services” to find other companies.

In most jurisdictions, once you have chosen your business name you
will also have to file a “Doing Business As” (DBA) application, to
register the fictitious name under which you will conduct your business
operations. The DBA allows you to operate under a name other than
your own legal name.

Filing a DBA usually takes place at the county level, although some
states require that you file at the state level, publish your intent to
operate under an assumed business name, and sign an affidavit stating
that you have done so. However, in most cases it’s usually just a short
form to fill out and a small filing fee that you pay to your state or
provincial government.

4.1.4 Choosing Your Location

Before you can decide where to locate your business, you have to
determine what functions you need your office to serve. Take into
consideration the services you provide and what tasks you will need
to do in your office. Consider whether you will meet with clients at
your office. Many death doulas don’t, and always travel to the client’s
home or place of business, or visit clients at their bedside in a hospice
or hospital setting. You will also need to consider if you have enough
space to store documents and other materials, and space for partners
to work.

Much like choosing a business name, your choice of office location may
depend on client perception. However, if you don’t intend to invite
clients to your office, then a home office is the most economical place
for you to establish your business. Many death doulas and midwives
choose to keep their office in their home for the long term.

Working from Home

Almost all end-of-life doulas keep their “office space” at home. For
many people, the biggest benefit of working from home is the end of
the commuter lifestyle, greater freedom, and the ability to spend time

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with family. Another benefit for eligible businesses is that you can
deduct from your income taxes a percent of your mortgage payment
and property taxes (or rent) and a share of utilities and maintenance
costs.

There are various methods to make those calculations, but by far the
easiest – and most acceptable to the IRS – is to use an entire room,
and to use it for no other purpose. In the U.S., IRS Publication 587 has
information on how to compute the calculation and file the deduction.
You can download this information by visiting the IRS website at www.
irs.gov/pub/irs-pdf/p587.pdf. In Canada, consult the Canada Revenue
Agency at https://www.canada.ca/en/revenue-agency/services/tax/
individuals/topics/about-your-tax-return/tax-return/completing-a-
tax-return/deductions-credits-expenses/line-229-other-employment-
expenses/commission-employees/work-space-home-expenses.html.

The other thing you should check before deciding on an office at home
is local zoning. Most places won’t have a problem with a home-based
business that adds only a few cars a day to the automobile load on your
street. Most will, however, prohibit you from posting a sign in your
front yard, which is okay anyway, as you will not get any clients from
drive-by traffic. To find out the rules in your area, check your municipal
website under “zoning” or “planning”.

In addition to any legalities, working from home requires some

planning with family members. Set regular office hours that you will
insist on, both for your own focus and to keep family members from
intruding when you need to work. It will be tempting for the family to
interrupt you. So make it clear you are at work unless it’s an emergency.
(The garage on fire is an emergency; needing to know where the cookies
are is not.)

Office Space
While a home office works well for many doulas, a few may prefer to
rent a separate space. If you find it challenging to stay motivated, or
tend to get easily distracted when you’re at home, an office may be just
what you need to help you focus on business. A separate space also
creates a better impression if you plan to have people visit you. If you
want a place to meet with clients, or work with employees, you might
want to consider getting an office outside your home.

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If you decide to rent space, start by determining what your requirements

are. Look for a place that is convenient to get to from your home, and
that gives you quick access to any services you may need. You can use
the checklist below as a starting point.

If you want the appearance of a professional office space, but cost is

an issue, consider shared office space in a business center or executive
suite. These facilities are typically furnished offices that provide you
with receptionist and mail services. They may also offer photocopiers,
Internet access, and conference rooms that you can use for client
meetings. Do a Google search for “office space”, “shared office space,”
“business center” or “executive suite” near you.

Access for People with Disabilities

As part of the Americans with Disabilities Act (you can read
about the requirements for Public Accommodations and
Commercial Facilities (Title III) at www.ada.gov/ada_title_III.
htm ) businesses are required to provide access for people with
disabilities. Similar laws exist in Canada (check with your local
municipality). Accessibility requirements may include:

• Floor aisles wide enough for wheelchairs

• Wheelchair ramps

• Wheelchair elevators if steps are present

• Rails in handicapped restrooms

Considering that you’ll be working with terminally ill clients,

accessibility isn’t “just” a legal issue—it’s a practical one too.
Make sure to discuss this with any landlord you are considering
renting space from!

Office Space Checklist

___ Will this be an easy commute for me? (You don’t want to
have to battle traffic to and from work every day if you can
avoid it.)

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___ Is the neighborhood or district safe? (You want to feel

comfortable in your office and you want this for your clients
as well.)
___ Is the parking area lit well? (Drive by at night and look at the
lighting. You don’t want to have to walk to your car in the
dark.)
___ Is the parking convenient for my clients, employees, and me?
(Even if you don’t mind a long hike, your clients will expect
convenience.)
___ Is there space for growth? (You don’t want to have to move to
a bigger office next year.)
___ Can I afford it? (You’ll want to read your lease agreement
carefully, and crunch some numbers in your budget before
you agree.)

4.2 Financial Matters

4.2.1 Start-up and Operating Expenses
Although your clients will reimburse you for expenses that can be
directly attributed to the projects you do for them (see section 4.2.6),
you will have a number of business expenses that you won’t be able to
bill to your clients. Fortunately, a death doula business is a relatively
inexpensive business to start.

Use the following to estimate your start-up expenses and your monthly
operating expenses. Note that even if an item is listed below, that
doesn’t mean you have to budget for it. You may not need it, or you
may already have it. You should also consider if there are expenses not
on this list that will apply to you.

Start-Up Expenses
___ Training and/or certification fees
___ Tools and supplies for comfort (See Section 2.2)
___ Office furniture (see checklist later in this section)
___ Computer

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___ Printer/copier/scanner (separate or all-in-one)

___ Office software
___ Business phone line installation fee (if using an office)
___ Telephone (might choose to use a cell phone exclusively for
your death doula work)
___ Office supplies
___ Stationery
___ Business cards
___ Printing (brochures or other marketing materials)
___ Website setup costs (design, domain name, etc.)
___ Business licenses/fees
___ Professional consulting (lawyer, accountant)
___ Other (list each item)
___ TOTAL

Monthly Operating Expenses

Your monthly operating expenses include both fixed and variable
costs. Fixed costs remain the same from month to month regardless of
the amount of work you do (examples include rent and membership
dues), while variable costs may vary from month to month (examples
include travel and taxes). To estimate monthly variable costs, start by
estimating a yearly total than divide that by 12 for a monthly average.

___ Salaries (this includes your own)

___ Consumable supplies (again, see 2.2 for a list of tools of the
trade)
___ Benefits (including your own)
___ Rent (or portion of mortgage)
___ Office supplies (see checklist later in this section)
___ Telephone
___ Internet service
___ Postage and courier
___ Travel expenses including mileage
___ Insurance costs
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___ Membership dues

___ Printing materials
___ Marketing expenses
___ Web hosting
___ Magazine subscriptions and professional literature
___ Training and conferences
___ Legal and accounting services
___ Banking expenses
___ Entertainment
___ Taxes
___ Other (list each item)
___ TOTAL

Creating a monthly budget will help you plan for your first year in
business. After the first year, you can then build a budget for year two
based on what you actually spent during your first year. Your monthly
budget will also help you determine what costs you need to cover
before you start making a profit.

Your own costs may vary widely from those of other doulas, depending
on what you currently have and what you plan to do with your
business. For example, your rent might range from $0 if you have a
home office to $1,000 per month for leased office space.

Following are checklists of typical office equipment and supplies

required for a doula business. For details about the specific tools and
supplies you’ll need to do doula work, and where to get them, see
section 2.2. Most of the large retail office supply chains can set you up
with everything you need for your office at a reasonable price.

• Staples
www.staples.com

• Office Depot
www.officedepot.com

• OfficeMax
www.officemax.com

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Office Furniture and Equipment Checklist

___ Bookcases for reference material
___ Chair(s)
___ Computer and software
___ Printer/copier/scanner
___ Desk (one or more)
___ Filing cabinet
___ Lamps and lighting
___ Storage shelves
___ Work table (for putting together packets of material for
advanced care directives or legacy project work)

Supplies and Small Equipment

___ Accordion files
___ Art supplies (for legacy project work)
___ Audio recorder (for legacy project work)
___ Binders
___ Brochures
___ Business cards
___ Business stationery
___ Calculator
___ Cell phone
___ Day planner or PDA
___ Envelopes (all sizes)
___ File folders
___ File labels
___ Index cards
___ L aser pointer and other supplies for making presen-
tations
___ Mailing labels
___ Mailing envelopes

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___ Paper
___ Paper clips
___ Paper cutter (for trimming brochures, postcards, etc.)
___ Pens, pencils, markers, and erasers
___ Post-it notes
___ Postage stamps
___ Rubber bands
___ Ruler
___ Stapler and staples
___ Tape

Keeping Track of Your Finances

Here are some tactics to use to keep track of your business income and
expenses. First, open a business account at a bank, trust company or
credit union, even if you are using only your own name to do business.
Use this only for paying the bills of the company and your own salary,
which you then deposit in your personal account.

Get a style of business check that requires you to record checks you’ve
written. You want to create a paper trail for your business account so
you are able to:

• Prove your deductions at tax time

• See at a glance where your money has gone

• Create balance sheets that your vendors or other financial

institutions may request from time to time

Also, keep track of your accounts receivable, accounts payable, and

so on in a ledger book, which you can get at any office supply store.
Or else use an electronic bookkeeping package. The most popular
bookkeeping software for small businesses is Quicken (www.quicken.
com). For under a hundred dollars, Quicken’s Home and Business
program will help you prepare invoices, manage your accounts, and
generate reports from your records.

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Finally, keep two additional ledgers – small enough to carry in

your purse or briefcase – so you can log (1) mileage (or other travel
expenses), and (2) everything you spend during the day (remember to
keep personal and business expenses separate).

Also carry an envelope so you can keep receipts for everything you buy.
The cup of coffee you buy for a prospective customer, the latest issue of
a business magazine, the mileage you travel to a client’s office, the pack
of paper you pick up at the office supply store, the admission charge
for a trade fair — these and many other expenses should be accounted
for so you can minimize your taxes. And, of course, knowing exactly
where your money is going will help you plan better and cut back on
any unnecessary expenses. So make it a habit to ask for a receipt for
every expense related to business.

Be sure to re-file these at night in the appropriate files in your file

cabinet. The business receipts should be stapled to the order form for
each purchase/service for a client. No matter how you design a system,
make sure it works for you and that you can find receipts for anything
at any time.

4.2.2 Start-up Financing

Although the start-up costs for end-of-life doula work are minimal,
you may want to secure a loan or investment to get through the early
months, purchase some office equipment, or lease office space.

In business, there are two basic kinds of financing: equity financing

and debt financing. The decision to choose debt or equity financing
usually will be based on your personal financial position and how
much additional money you need in order to get your business started.
Essentially, equity financing is when you agree to give someone a share
in your business in exchange for an agreed amount of investment
capital from that person.

Debt financing is any form of borrowing money, including a loan, lease,

line of credit or other debt on which you must pay interest in order to
finance the original principal amount. Sources for this kind of financing
include banks, credit unions, credit card companies, suppliers, and so
on. If you buy a computer system for your company and pay for it
in monthly installments over a couple of years, that is a form of debt

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financing since you will pay interest on the amount you finance.
Consider all your options carefully and, especially before you enter into
any kind of long-term debt arrangement, speak with an accountant and
a lawyer first.

Only you can decide which financing sources will be the best ones for
your business and your personal situation. The most important thing
is to make sure you agree to loan repayment terms that you can live
with and that are realistic for you. In the following sections we’ll look
at some of the sources of each type of financing and the advantages and
disadvantages to each. Additional advice on all aspects of financing
your business can be found at the SBA’s website at https://www.sba.
gov/business-guide/plan-your-business/fund-your-business and
https://www.sba.gov/business-guide/manage-your-business/manage-
your-finances. In Canada, visit http://canadabusiness.ca/starting/
financing-your-new-business.

TIP: Many financial consultants recommend having a nest egg

to live on while you are starting up your business. Some
suggest at least six months’ of living expense money — that
is, all the money you will need monthly to pay all your
personal living expenses, bills, and debts, so you can focus
on your new business without stress. This is apart from any
start-up capital you might need for the business itself.

Note: It’s very unlikely you’ll need to borrow much money to start your
death doula business. However, in the future, you may have a desire to
do so. For example, if you start giving regular trainings, or teach people
not interested in doula work how to care for their friends and family at
the end of life, and you want a set aside training center. Or, if you es-
tablish an office location where you will work with many death doula
partners. Death doula work is a relatively new business, and you never
know—your dreams may go beyond what’s currently the norm. Hav-
ing this information will hopefully serve you well if that time comes.

Commercial Loans
Commercial loans are loans that you can get from a financial institution.
These include traditional banks, credit unions, savings and loans and
commercial finance companies. The terms of your loan will depend
upon several things, including your credit score, your collateral, and

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your ability to pay back a loan. Be sure to compare interest rates and
terms of lending to see which institution offers the best deals.

When you are starting your business, financial institutions will likely
lend the money to you personally rather than to your business. As a
result, they are much more interested in your personal financial status
than your business plan. A business just starting up won’t count as
collateral, so you’ll probably need to guarantee the loan with personal
assets like your house or your car.

They will look at how much money you need every month to pay your
bills, what kind of resources or assets you have, what kind of debt you
are in, and how you will repay this debt.

Once your business is established, if you want a commercial loan in

order to expand – for example to open end-of-life doula care offices in
other cities – the financial institution may be willing to lend the money
to your business rather than to you personally.

In that case, the lending institution will insist on seeing a formal

business plan that demonstrates clearly-defined financial and business
goals. (If you haven’t read it already, see section 4.1.1 for advice on
creating a business plan.) You will also need to prepare a loan proposal,
which includes a credit application, and provide information about
your business including the following:

• The type of loan you’re applying for

• Amount you are requesting

• What you will use for collateral

• How the money will be used

• Information about your business, its name, legal structure, tax

numbers, existing loans, taxes owed, assets

• Details about the business owners or principals: name, mortgages,

source of other income

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Family and Friends

One of the greatest resources for your start-up money will always be
the people you know who believe in you and your ideas—your family
and friends. Very often they will help you with money when all other
resources fail you. They usually will agree to payback terms that aren’t
as strict as commercial lenders, and they are usually pulling for you,
too. As with any other kind of loan, it is important to make sure that
you and the other parties completely understand and agree to the terms
of the loan. Make sure you have a written document which states when
and how you will pay the loan back.

Another possibility is to ask a family member to co-sign a commercial

loan for you. Co-signing means that this person agrees to take on the
financial responsibility of the loan if you should fail. Family members
are often willing to help you out this way. Make sure, before friends or
family members help you out by co-signing a loan, that they are really
comfortable doing so.

Partners
One of the simplest forms of equity financing is taking on a partner.
Having a partner in your business brings additional skill sets, business
contacts and resources to the venture. Most importantly, a partner can
bring money to help pay for start-up costs and assist with ongoing
operations. You’ll need to decide whether your partner will be active
in the running of the company or just a silent partner who invests the
money, receives income from the business, but has no say in how things
are run. (You can read more about Partnerships as a form of business
legal structure in section 4.1.2.)

You as an Investor
Never forget that you might be your own best source of funding. One
nice thing about using your own money is that you aren’t obligated to
anyone else or any other organization—it is yours to invest. This can
be an excellent solution for individuals with some credit problems. To
raise your own capital, you can:

• Cash out stocks, bonds, life insurance, an IRA, RRSP, or other

retirement account

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• Increase your credit on charge cards (remember that you will pay
high interest rates on these)

• Use personal savings

• Take out a second mortgage or home equity loan on your house

or other property

• Sell something valuable, like a car, jewelry, real estate, or art

Government Programs

Small Business Administration Loans

The Small Business Administration (SBA) doesn’t actually lend
you money. However, they have a program called the “7(a) Loan
Program” in which they work with banks to provide loan services to
small business owners. The SBA guarantees a percentage of the loan
that a commercial lender will give you, so that if you default on your
payments, the bank will still get back the amount guaranteed by the
SBA. As the borrower, you are still responsible for the full amount of
the loan. When you apply for a small business loan, you will actually
apply at your local bank. The bank then decides whether they will
make the loan internally or use the SBA program.

The SBA also provides a pre-qualification program that assists business

start-ups in putting together a viable funding request package for
submission to lenders. They will work with you to help you apply for
a loan up to a maximum amount of $250,000. Once the loan package
has been submitted, studied, and approved by the SBA, they will issue
a commitment letter on your behalf that you can submit to lenders for
consideration. They provide the extra assurance that many lenders
need to get entrepreneurs the financing they need. You can read more
about the process at https://www.sba.gov/business-guide/plan-your-
business/write-your-business-plan.

Another program offered by the SBA is a “Micro-Loans” program,

which offers loans to start-up and newly established businesses
through non-profit entities at the local level up to a maximum of
$35,000. The average loan is about $13,000. Interest rates for these small
loans vary between about 8 to 13 percent. You can find out more about

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these loans at https://www.sba.gov/blogs/could-you-finance-your-

start-microloan.

Government Programs in Canada

If you are planning to open a retail business in Canada, you might
be interested in the Business Development Bank of Canada (BDC) or
the Canada Small Business Financing Program (CSBF). The BDC is
a financial institution owned by the federal government that offers
consulting and financing services to help get small businesses started.
They also have a financing program aimed specifically at women
entrepreneurs. You can learn more about the Business Development
Bank of Canada (BDC) and its financing resources at www.bdc.ca.

The Canada Small Business Financing Program is much like the SBA
7(a) Loan Program mentioned earlier in this section. The maximum
amount you can borrow is $1,000,000, and no more than $350,000 can
be used for purchasing leasehold improvements, improving leased
property or purchasing or improving new or used equipment. The
CSBFP works with lenders across the country to offer loans at 3% above
the lender’s prime lending rate. To find out more, visit www.ic.gc.ca/
eic/site/csbfp-pfpec.nsf/eng/h_la02855.html.

4.2.3 Taxes
If you are properly informed and prepared you won’t have to face
your tax responsibility with a feeling of dread. In fact, once you are
organized and you have enlisted the help of a good tax professional,
taxes become just another regular business task.

Get Informed First

The best thing you can do to be sure of your personal and business tax
obligations is to find the information you need before you start your
new business. The Internal Revenue Service (IRS) has a number of
informative documents online that you can look at today to learn the
basics about everything you need to prepare for your taxes as a small
business owner. If you read these documents and understand them,
you will have no surprises at tax time.

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One helpful document is the Tax Guide for Small Business that outlines
your rights and responsibilities as a small business owner. It tells you
how to file your taxes, and provides an overview of the tax system for
small businesses. You can find this document at www.irs.gov/pub/irs-
pdf/p334.pdf. For more general information for small business owners
from the IRS visit their website at https://www.irs.gov/businesses/
small-businesses-self-employed.

For Canadian residents, the Canada Revenue Agency also provides

basic tax information for new business owners. This includes
information about the GST, how to file your taxes, allowable expenses
and so on. You can find this information and more helpful documents
at: www.canada.ca/en/services/business/taxes.html.

It is also important to be informed about your tax obligations on a state

and local level. Tax laws and requirements vary on a state-by-state
basis and locally, too. Make sure that you find out exactly what you
are responsible for in your state and city. In addition, it is important
to find out about sales tax in your area. The Tax Foundation provides
information on a state-by-state basis for personal, sales and other taxes
at https://taxfoundation.org/. In Canada, consult the Canada Business
Network pages found at https://canadabusiness.ca/government/taxes-
gst-hst.

You will also need to understand payroll taxes if you plan on hiring
employees; see section 4.3 for more on this topic.

If you decide you would prefer a qualified tax professional to help you
handle your taxes, you will find you are in good company. Many small
business owners decide to have a professional handle their taxes. An
accountant can point out deductions you might otherwise miss and
save you a lot of money. See section 4.2.7 for advice on keeping track of
accounting.

4.2.4 Insurance
Insurance can help protect the investment you make in your company
from unforeseen circumstances or disaster. Types of insurance for the
small business owner are listed in this section. Contact your insurance
broker to determine whether these or other types of coverage are right
for you.

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Making sure you are properly insured is important, and in the case
of Workers’ Compensation insurance, it is the law. You must protect
your business if you damage something in a client’s home or office, you
should insure your office equipment, and if you hire them, you must
insure your employees.

Getting a Business Owner’s Policy (a BOP) is often a good place to start.

These policies are designed for small business owners with fewer than
100 employees and revenues of under $1 million, and combine liability
and property insurance together. Small business owners like these
policies because of their convenience and affordable premiums. You
can read more about this topic at the Insurance Information Institute
website at www.iii.org/publications/insuring-your-business-small-
business-owners-guide-to-insurance.

Liability Insurance
This insurance (also known as Errors and Omissions Insurance) protects
you against loss if you are sued for alleged negligence. It could pay
judgments against you (up to the policy limits) along with any legal fees
you incur defending yourself. Having liability insurance is a must in
end-of-life doula work. While you are not offering any medical services,
so you can’t really be sued for malpractice, you are working with people
who are very sick. Sometimes, when a loved one dies, hurting family
members may want to blame someone for the death—even when that
death was predictable and coming. You are also working with friends
and family members of the ill who may have disagreements between
each other and your client. Hopefully, you will never face legal charges,
but it’s possible. Be insured.

One company that provides malpractice liability insurance to end-

of-life doulas is Cotterell Mitchell and Fifer (CM&F.) They provide
insurance also for birth doulas and understand the profession and
needs for this kind of service worker. For more, go to https://www.
cmfgroup.com/professional-liability-insurance/end-of-life-doula-
insurance/.

TIP: Certain services that carry more liability risk, such as

driving your clients around, will increase your rates.
Consider whether or not the potential income from these
services is worth it. Some doulas will not drive clients

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anywhere because of this risk, while others consider helping

with transportation an important part of their work. Vehicle
insurance should have a rider on top of your regular auto
insurance to cover any valuables you might transport for a
client.

Property Insurance
This insurance covers losses to your personal property from damage or
theft. If your business will be located in your home, you’re most likely
already covered with homeowner’s insurance. However, it’s a good
idea to update your plan to provide coverage for office equipment and
other items that aren’t included in a standard plan.

If your business will be located in a building other than your home, you
may need an additional policy. If you rent space, you’ll need property
insurance only on the equipment you have in your office — the owner
of the building normally would pay for insurance on the property.
Depending on your location, you may also need flood, hurricane or
other natural disaster insurance.

Life and Disability Insurance

If you provide a portion of your family’s income, then you need to
carry life insurance and disability insurance to make certain they are
cared for if something happens to you. If you become sick or otherwise
disabled for an extended period, your business could be in jeopardy.
Disability insurance would provide at least a portion of your income
while you’re not able to work.

Business Interruption Insurance

This insurance covers your bills and lost profit while you are out of
operation for a covered loss, such as a fire. Just because the business is
shut down doesn’t mean the bills stop coming. This type of insurance
covers ongoing expenses such as rent or taxes until your business gets
up and running again. These policies may also have provisions for
loaned equipment until permanent replacements can be obtained.

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Car Insurance
Be sure to ask your broker about your auto insurance if you’ll be using
your personal vehicle on company business.

Health Insurance
If you live in the United States and aren’t covered under a spouse’s
health plan, you’ll need to consider your health insurance options.
The Patient Protection and Affordable Care Act (PPACA) of 2010
established (www.healthcare.gov) as your primary resource to obtain
affordable health insurance.

TIP: Some insurance companies offer discount pricing for

members of particular organizations. When you are looking
for organizations to join, whether your local Chamber
of Commerce or a national association, check to see if
discounted health insurance is one of the member benefits.

Canadians have most of their health care expenses covered by the

Canadian government. For expenses that are not covered (such
as dental care, eyeglasses, prescription drugs, etc.), self-employed
professionals may get tax benefits from setting up their own private
health care plan. Direct Reimbursement Associates (www.draltd.com)
is an example of the type of financial planning company that can help
you set up your own private health care plan.

Notice that FabJob does not recommend a specific vendor for your
insurance needs. As always, do your own research before making the
choice which is right for you.

Workers’ Compensation Insurance

Most states and all provinces require that small business owners who
hire others carry workers’ compensation insurance. For more about
these obligations in the U.S., visit the Office of Workers’ Compensation
Programs website at www.dol.gov/owcp. In Canada, visit the
Association of Workers’ Compensation Boards of Canada at http://
awcbc.org for more information.

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Bonding
Bonding is basically like insurance. A company bonds its employees
if there is any risk of illegal or fraudulent activity on the part of those
employees. If an employee acts dishonestly and the company loses
money as a result, bonding helps to protect against these losses.
Bonding is generally not necessary until you actually plan to hire
employees, in which case it will protect you from liability for their
actions (e.g., theft from your clients). If you do take on employees now
or in the future, ask your insurance professional to evaluate the pros
and cons of fidelity bonding for your business.

More Information
You may also want to check out the National Association for the Self-
Employed (www.nase.org) which offers reasonably priced insurance
plans for self-employed people. The Rocky Mountain Insurance
Information Association has an information page on home-based
business insurance at http://www.rmiia.org/business/home_business_
insurance.asp .

And the SBA offers a section on business insurance at https://www.sba.

gov/business-guide/launch-your-business/get-business-insurance.

In Canada, visit the Insurance Bureau of Canada at www.ibc.ca/on/

business.

4.2.5 Setting Your Fees

One of the biggest challenges for novice end-of-life doulas is
determining how much to charge clients and how to present the bill.
This section also offers insights on practical factors you may want
to consider in setting your own fees, plus addresses the emotional
difficulty some death doulas face when charging for work that they
may have once offered on a volunteer basis.

Factors affecting the fees you may charge include:

• Your income requirements (this includes how much you want to

be paid, your business expenses, and how much profit you want
your company to earn)

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• Your reputation, experience, and training

• Your specialization and services being offered

• Your client and their budget (many death doulas offer a sliding
scale fee)

• Your relationship with the client

• Your competitors’ fees if you will be competing for projects

(more on this below, but you can consider local birth and
postpartum doulas, life coaches, and other similar “caregivers”
as “competitors” when comparing fees if there are no local death
doulas in your area)

• Your geographic location

As you can see, some of these factors involve market conditions, while
others, such as your income requirements, are entirely under your
control.

How Should You Charge for Your Work?

Should you charge per hour? Per client/project/consultation? Should
you charge a retainer fee if you remain “on call” for a client? There’s
a lot of debate and controversy in the death doula community on
how to charge for services. Every one has a right to their opinion, but
you should be careful not to get too caught up into the politics of this
debate.

Knowing how to charge for the services you offer is something you
will learn and adjust as you work your business. While there are some
guidelines you can consider (which is covered below), you will likely
learn the most about what works best for you and your clients as you
gain experience. There really isn’t a right or wrong way to do this—it’s
personal, and will depend so much on what services you provide and
how you provide those services.

For example, let’s say Doula A offers vigil planning and on-call support
(but just support.) In other words, they sit with a client to come up with
a vigil plan, discuss options, perhaps teach their loved ones how to offer
care and comfort, and then offer to answers questions via text or email
or even phone calls in the last days. But, in our example, Doula A does

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not provide active vigiling services. In other words, they themselves

won’t be on-call to sit with the dying or the family.

Yes, You Should Charge for Your Death Doula Work

Some death doulas that are just starting out have conflicted
feelings on charging for their work. This can arise if they have
primarily served in a volunteer position. It may feel strange to
suddenly start charging for something they have done free of
charge until now.

Others feel guilty “asking for money” to offer comfort at the end
of life. How can you charge for the act of caring? But this is the
wrong way to look at doula work. You are not charging for your
comfort, your care, or your compassion. You are charging for
your time, your expertise, and your knowledge. The care and
compassion you offer are “free.” Your time and training are what
you request money for.

Think of all the other professions that charge people who are
sick, vulnerable, or struggling: psychologists, oncologist doctors
and nurses, respite care workers, teachers, day care providers,
certified nursing assistances, massage therapists, life coaches,
nursing home employees of all sorts.

Your services as an end-of-life doula are just as valuable and

just as worthy of being compensated as any other caregiving
profession.

Death doula and musician Emily Cross created this really

touching video on death doula work and why it is completely
ethical to charge for these services: https://www.youtube.com/
watch?v=6mL4BZg8DgM&t=19s.

Let’s say Doula B offers vigil planning but also does active vigiling.
They are on-call and show up to sit at the besides of a dying client.
Maybe they sit there a particular number of hours per day, or maybe
they even stay by the client around the clock when the very last
moments seem near. They may also have a back-up or partner who

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can take shifts with them, which means the doula may need to pay
something to that doula to retain their availability. Or the doulas may
split the fee in some way.

The way Doula A charges is going to be very different from Doula B.

Doula A—who is primarily offering planning and consultation

services—may decide to charge as a package or per hour. The doula
will be paid after a plan is completed, even if the vigil is months away.
It’s unlikely Doula A will charge a retainer fee for remaining on call via
text for support, and the original planning fee should cover any later
support via text and phone call.

When Doula B charges for his or her services, charging per hour may
not make any sense. No one can say how long the active vigiling stage
will take. Someone can be dying for hours or for days, and charging a
client per hour could be unpredictable and a cause of anxiety for that
client. Doula B would most likely charge for the “package” of services,
like the way a birth doula charges for services. (Birth doulas do not
charge per hour.) They will likely split payments up, with a payment
upfront for the planning stages, and then a portion of the fee after the
active vigil.

You can see how this can get complicated—but it’s really not too hard to
figure out as long as you think through your options before you begin,
consider what service you are offering, and remain open to changes as
you learn with experience.

Per Hour (or Per Day)

You may decide to charge per hour for services like...

• End-of-life planning

• Advance care directive support

• Vigil planning

• Respite or elder care services

• On going life coaching/bedside support on a weekly basis

• Legacy work

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• Post-death organization of the household

• Post-death mourning planning/consultation

• Any additional support beyond a given package (for example,

you may offer a package of services “up to” a number of hours,
and then charge extra for time that goes beyond those hours)

Charging per hour makes more sense when your service is primarily
of the consultant, practical support on a regular basis, or life coaching
kind of service.

Charging per hour may also make more sense if the work is reasonable
time limited and predictable. For example, you may know that working
through an advanced care directive with a client and their family takes
two to four hours. You can set a reasonable fee this way.

Per Service or Consultation

Some doulas charge a set fee for a particular service, without putting a
specific hourly rate or time limit to the service. (This doesn’t, however,
mean the time they offer is unlimited.) This can apply to any of the
services listed under per hour rates above.

An example might be legacy or life review work. Working with a client

on legacy or life review can be a short term project that takes just a few
hours, or—depending on how you work and the client—it could span
weeks, with meetings every so often between you and the client. This
kind of work can vary so much from doula to doula, and client to client,
that pricing is going to be unique to the individual.

Another example, some doulas prefer to charge a service fee for

advanced care directive planning without setting a specific number
of hours to the service. They may work with one client for two hours
and another client for six hours, if it requires acquiring documents and
more hands-on help. But the doula will receive and charge the same fee
to both. This way, the client doesn’t feel like they should “go quickly” to
save money, and you (the doula) don’t feel like you’re going to get paid
much less or much more based on how long the process takes.

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Per Package
Sometimes, it makes more sense to charge per package of services.

A good example is looking at how birth doulas work. They don’t charge
per hour. They charge for their birth doula service package, which
usually includes a couple pre-birth meetings to plan the birth, then
the actual birth support (which can range from two hours of support
to 20 hours of support, or even more), and then a follow-up meeting.
The package also usually includes some amount of text or phone call
support if the mother has questions along the way.

You can see how charging for a service like this per hour can be
complicated. If you’re going to offer active vigil support, charging a
package fee may make more sense, since this is a service that is hard to
predict or limit in an hourly way.

Other reasons to offer a package include…

• You can offer multiple services at once, giving your client a

discount compared to if they purchased them individually, but
still giving you more business and income from one client.

• You may offer one specific service in a package format—in other

words, you might offer Advance Care Directive planning, along
with a certain number of hours of support before or after the
planning is complete. Or you might include things like helping
gather documents, organizing them, etc., that is above and
beyond just writing the advanced care directive itself.

Setting Your Fees: How Much to Charge?

How much should you charge for doula services? There are general
averages, but you should also keep in mind this is a relatively new kind
of business. It’s difficult to say what’s “too low” or “too high.”

When setting your prices, besides everything mentioned at the start

of this chapter (like your experience and location), you should also
consider…

• The cost of “being on call” even when someone isn’t actively

calling you—which includes the fact that you can’t go away on

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vacation, must be available certain hours, need to pay for cell

phone services so you can be reached, etc.

• The research that may go into the work before or after you meet
with a client

• The costs of materials—this may include printing out forms for

plans, or comfort tools like lotions or chapstick, or art, audio,
or video supplies for legacy work. If you use software to create
documents or help create legacy work, that’s an expense you’ll be
covering

• The cost of training and education you have had in order to offer
these services

Average hourly rates

The average hourly rate for consultation-like death doula services—
legacy review projects, advanced care directive writing, vigil
planning—is around $100 to $200 per hour. Usually, doulas require a
minimum number of hours with that fee (typically two to four hours,
depending on the service.)

If the service is more like elder care support, respite care services, or
sitting at the bedside to offer a client comfort, the per hour charge is
typically between $25 and $50 per hour. This is also usually sold with a
required minimum hours (typically four hours per month, but there’s
no set rule.) You might charge a lower fee per hour if the client agrees
up front to more hours of service.

Average rates per service

When charging per service, end-of-life doula fees for advanced care
directive planning or vigil planning range from $250 to $500, on average.

For legacy work, the per service charge may range from $250 to $1,000,
depending on the time and complexity of the project and support being
offered.

For a living funeral, you might charge anywhere from $750 to $2,000,
depending on the planning involved and size of the event.

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Average rates for active vigil planning and support (meaning the doula
will be sitting at the bedside of the client either almost around the clock
or for a set number of hours per day or night) range from $1,000 to
$4,000.

Average rates per package

It’s difficult to put a specific price average for packages since they can
vary so much. That said, typical end-of-life doula packages can range
from $200 to $4,000. This very much depends on what’s being offered.

If you’re trying to figure out what to charge for a particular package of

services, use the hourly rates and per-service rates as a guide. Consider
what your package consists of, what that would cost if you charged per
hour and/or per service, and then set a price accordingly.

Offering a Sliding Scale

You may decide to offer sliding scale fees. This can be applied to hour,
per service, or per package charging structures.

A slide scale is when you give a client a range instead of a set fee. You
might have specific rules for your sliding scale—for example, if they
make $XX,XXX per year, they pay this much.

Or, you might leave it up to the client. You may say, “You can pay me
between $XXX or $XXXX, whatever you feel is best.” You can explain
that you offer this range so that people aren’t priced out of your
support, but “Those who can pay on the higher end of my scale help
support the work I do with those who must pay less.”

Many clients will choose a middle or upper range of the scale. Few
people will pay the least, unless that really is what they can afford.

What Happens if You Don’t/Can’t Provide the Service?

In the birth doula world, you have to account for the fact that
sometimes, calling the doula in time before the baby is here doesn’t or
can’t happen. Sometimes babies arrive super quickly.

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Specifically when it comes to vigil work, a similar situation can occur.

Death is unpredictable, perhaps even more so than birth. Someone who
seemed to have months left may suddenly pass in the night. Something
can happen that throws off the best vigil plans.

Comparing Your Fees to Local Businesses

The typical advice to service style business is to look at your
local competition, find out what they are charging, and charge
within that range. However, what if you don’t have local death
doulas? And how can you know what people are charging if they
won’t tell you? (Many doulas are unwilling to share their fees,
especially with local competition.)

One way to get around this is to look at what other businesses

are charging for similar services.

For example, if you’re offering post-death home organization,

what are the local home organization services charging?

If you’re offering elder care or bedside comfort doula care, what

are the local postpartum doulas charging?

If you’re offering active vigil planning and services, what are the
local birth doulas charging?

If you’re offering life coaching to the terminally ill, what are the
local life coaches charging?

Another tip: if the local death doula businesses won’t talk to

you, instead try calling death doulas working in a different city
but similar economic area. So, if you live in New York City, find
end-of-life doulas working in Los Angeles. If you live in a sleepy
town in Ohio, call up doulas working in sleepy town in Virginia
or Pennsylvania. Tell them where you are, what you’re doing,
and ask for help. Since you are in no way competing for the same
clients, they may be more willing to talk with you and share their
fee structure.

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You should have a specific fee and agreement up front for how this will
be handled before it happens. You should consider how much service
has been already provided, and how much of your fee applies to the
active vigiling that didn’t occur yet.

Just as an example, let’s say that you charge $1,250 for a vigil package.
Let’s say that includes an initial consultation, two planning meetings,
being on-call for support and to be called into sit during the vigil with
the client, the actual active support during the dying phase, and a
follow-up/processing meeting scheduled a few weeks after the death.

If for whatever reasons you never get to sit with the client during the
active vigil stage, remember that you still have provided all those other
services: the consultation and planning meetings, being available and
on-call, and will still offer the follow-up meeting. Maybe this means
you will charge half of the fee without active vigil, so $625.

There is no right or wrong in how to handle this—just be sure it’s

understood, planned, and agreed upon with your client when you sign
your business contract with them.

4.2.6 Getting Paid

Whatever type or combination of fees you decide is best for your
company to offer, make sure you and your client agree to it in writing.
A sample contract appears in the section 5.5, but you will need to revise
it according to the specifics of your arrangement with your client.

Invoicing
When you are working with corporate clients you may be expected to
submit invoices in order to be paid. This may be true if you offer your
services to a hospice or hospital. When you give the client an invoice,
detail the items you purchased, prices and taxes, and your commission,
if any. Make sure to provide the client with receipts, as some items may
be a tax write-off for them.

Your invoice should be on your letterhead and include the following.

• The client name and contact information

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• The date of the invoice

• A purchase order number (if the client gave you one)

• Services you provided

• Any taxes payable as required by law

• Any expenses you have paid (also known as disbursements)

• The total amount due

• Terms of payment (e.g. “Payable upon receipt” or “Payable within

30 days”)

TIP: Instead of preparing and sending invoices manually, you

can use FreshBooks at www.freshbooks.com. FreshBooks
is an online invoicing service that lets you quickly make
professional looking invoices, send them by email or mail,
and accept payments with PayPal or Authorize.net. You
can also use it for keeping track of other business matters
including tracking your expenses and time. At the time of
publication, the cost is $19 per month for managing up to 25
clients.

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Sample Invoice
(On YourLetterhead)
INVOICE
DATE: November 5, 20XX Invoice: #: 123
Federal Tax #: 54321
TO: Carla Client
Volunteer Department
XYZ Corporation
123 Main Street
Sunnyday, CA 12345

Re: End-of-Life Doula Training for Hospice Volunteers

Project Fee $2,000.00
(as per contract of Sept. 7, 20XX)
Tax on Project Fee $200.00
(insert your own tax rate)
Expenses (receipts enclosed) $195.23
Supplies for volunteer printouts/guide $46.44
Hospice Training Video License Fee $148.79
Total $2,590.46
Less: Deposit ($1,000.00)
Balance Due $1,590.46

Terms: Payable within 30 days.

Thank you for your business!

Accepting Payment
As soon as you establish your business you will need to open a business
checking account at a bank, trust company, or credit union. You can
shop around to find a financial institution that is supportive of small
business, or use the same one that you use for your personal banking.

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In addition to your checking account, a financial institution may

provide you with a corporate credit card used to make purchases for
your business, a line of credit to purchase items for your business,
and a merchant credit card account enabling you to accept credit card
payments from customers.

You have a variety of options for accepting payment from your

customers.

Accepting Debit Cards

With a debit purchase, the funds come directly out of the customer’s
account at the bank and are deposited directly into your business
bank account. There is no credit involved for customer or merchant. In
order to set up debit payment, you will need to ask your bank for an
application and you will need a debit machine. The equipment costs
about $200 to $500, but some companies offer leases.

There may be a short delay or small charge to you, initially or ongoing,

depending on the bank. And you will have to get the equipment to
process the payments and print receipts. (Federal law mandates receipts
be provided to customers for debit card purchases.) To find out more
about debit card services in the U.S., visit the Electronic Transactions
Association directory of member companies at www.electran.org
(click on “Information Resources” then “Links”), or in Canada, visit the
Interac Association at https://www.interac.ca/en/.

Accepting Credit Cards

American Express and Discover cards set up merchant accounts
nationally and internationally. MasterCard and Visa are local. To
become a merchant directly accepting MasterCard and Visa, you will
have to get accepted by a local acquirer (a financial institution like a
bank licensed by the credit card company). Because yours is a new
business, you may have to shop around to find one that gives you good
rates (you may be charged between 1.5 and 3 percent per transaction
for the service, and often an initial setup fee and perhaps ongoing fees
for phone calls, postage, statements, and so on).

You might also have to provide evidence of a good personal financial
record to set up an advantageous rate, at least until you’ve become

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established in your business and have a good track record for them
to look at. Remember, the bank is granting you credit in this instance,
“banking” on the fact that your customers will not want refunds or that
you won’t try to keep the money if they do.

These days, although the acquiring bank will be a local bank

somewhere, it need not be in your hometown. Numerous services are
available online to help you set up a merchant account. MasterCard
and Visa accounts, as well as American Express and Discover, can all
be set up through your local bank or by going to the websites of each of
these companies.

MasterCard Merchant
www.mastercard.us/merchants/index.html (USA)
www.mastercard.ca/en-ca/businesses.html (Canada)

Visa
https://usa.visa.com/run-your-business/accept-visa-payments.html
(USA)
www.visa.ca/en_CA/run-your-business/accept-visa-payments.html
(Canada)

American Express
https://merchant-channel.americanexpress.com/merchant/en_US/
accept-credit-cards (USA)
www.americanexpress.com/amex/ca/en/merchant/index.html
(Canada)

Discover
www.discovernetwork.com/merchants

Square provides ways to process credit card transactions anywhere

using their tools. One option is using their small card reader accessory
that plugs into your mobile device, enabling you to swipe cards and
receive payment through your phone or tablet. Customers will receive
copies of their receipts via email. A newer device allows you to read
chipped credit cards or accept payments with contact-free devices.
Read more about their services at https://squareup.com.

DirectPay is another way to get merchant account credit card services,

and offers a variety of other tools useful to the professional death

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doula business owner, including online shopping carts and the ability
to accept payments on-the-fly with a swipe reader accessory to your
smartphone. Read more about their services at www.directpayinc.com.

Accepting Payment Online

You may choose to accept payments online through services such as
PayPal (www.paypal.com) or Google Pay (https://pay.google.com).
Typically, these services charge a greater “discount rate,” which is
what the banks and credit card companies call the 1.5 to 3 percent they
withhold from your payments. And the purchase must usually be made
online. Still, there may be instances when you are doing business online
with some of your clients, and it may be useful then. Also, it provides a
safe route for conveying financial information over the Internet.

There are no monthly service or other account-related fees, but you will
surrender a small percentage of each transaction to a service like PayPal.
If you would like to accept credit card payments through PayPal, there
is an additional small charge per transaction (1.9%-2.9%) plus an
additional 30 cents per transaction. There is a small cross-border fee of
up to one percent applied to foreign payments, but this is waived for
funds coming from the U.S. to Canada. To find out more about PayPal’s
services visit their website and click on “Merchant Services.”

Accepting Checks
When you accept checks, especially for large amounts, you may want
to have a back-up system for getting paid if the client has insufficient
funds in their checking account. One option is to ask the client for a
credit card number which will be charged if the check does not clear.

It’s important to get a credit card number, driver’s license number, and
full phone number and address (you might even want to check it online
quickly to insure they are legitimate). If you have any doubts as to their
honesty, it might be a good idea not to accept the check and let the sale
go.

You can accept checks from customers with greater assurance by using
a check payment service such as TeleCheck. TeleCheck compares
checks you receive with a database of over 51 million bad check records,
allowing you to decide whether to accept a check from a particular

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client. The company also provides electronic payment services, from

telephone debit card processing to electronic checks. You can find out
more about TeleCheck at https://www.firstdata.com/en_us/products/
small-business/all-solutions/telecheck.html.

Following Up on an Invoice
If a client doesn’t pay within the time requested on the invoice, you can
send another invoice, noting that payment is expected within a shorter
time, perhaps five or ten days. This gives your client a reminder to
quickly make the overdue payment.

If a bill is not paid within a reasonable time frame, such as 60 days,

you will need to contact the client again. You can do this by phoning
or writing. If you send a letter, you can make arrangements with the
courier or post office to get confirmation that your client actually
received it. If you’re dealing with a corporate client that is slow to pay,
you may have to make more than one phone call. If you work with that
client again, you may want to consider requiring a larger deposit or
interim payments before proceeding with work.

4.2.7 Keeping Track of Your Finances

Being self-employed offers you the freedom to set your own schedule,
work from home and choose your clients. However, this also means
that you will be responsible for keeping track of your earnings and
any applicable deductions. The only way to really know where your
business stands is by having adequate financial records at your
fingertips.

Keep accurate track of all invoices, receipts, telephone bills (related to

your business), and other business paperwork. If you’re not used to
keeping receipts for everything you buy, you should quickly develop
this habit. Any supplies you buy for your office, right down to pens and
paperclips, are legitimate business expenses and deductible at tax time.
You don’t have to print hard copies of everything, but be certain that
the information is easily accessible if you need to look up or produce
something.

Knowing exactly where your money is going will help you plan better
and cut back on any unnecessary expenses. So, again, make it a habit to

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ask for a receipt for every expense related to business. At a glance, you
should be able to see how much money has been brought in, how much
money has been paid out, what amounts are waiting to be collected,
and what debt amounts are still owed.

Bookkeeping System
Your bookkeeping system is a record of your expenses and revenues.
Monitoring your expenses and revenues with a consistent bookkeeping
system will help you build a more profitable company. By making
this part of your daily activities, your financial position will be much
clearer, and you will have the records you will need at tax time.

The first step is to choose an accounting method for your business. The
two basic types are the accrual accounting method and the single-entry
cash accounting method. The accrual method is not generally used in
service businesses because it categorizes money that is still owed as
collected money, even if you haven’t received payment yet.

The single-entry cash method is much simpler, since all incoming

money is posted as a credit and any money spent is posted as a debit.
Your credits minus your debits will equal your ledger balance.

A good way to learn more about using a bookkeeping system is to take

a small business accounting course, as mentioned earlier. These usually
are fairly inexpensive, last a few weeks or a few months, and many are
offered online.

Bookkeeping Software
When in doubt, get some help with your bookkeeping efforts. One
solution is to invest in small business accounting software. Popular
software packages such as these have excellent training available and
can be purchased for a moderate price:

• Quicken
www.quicken.com

• Quickbooks
http://quickbooks.intuit.com

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• Sage (formerly Peachtree)

www.sage.com/us/size/small-business

These powerful, bundled software packages can help you manage the
following accounting functions:

• Accounts payable

• Accounts receivable and collections

• General ledger, balance sheet, and cash flow

• Invoicing and billing

• Payroll

• Report generation

• Stock and inventory

• Tax deductible expense tracking

In addition to these functions, a program like QuickBooks lets you

import all of your financial data into its QuickTax program, to make
your tax filing simple and painless.

Accounts Payable/Receivable
Accounts payable reports will tell you what bills you owe and when
they are due. You have to be able to pay all your incoming bills and still
have enough money for the other things you need to purchase for your
business. An accounts payable report will help you to schedule when
you will pay your bills, and will help you to make sure they are all paid
on time.

Accounts receivable reports are the monies that are owed to you. This
report will understandably be more complicated if you accept credit
cards or if you sell products over the Internet.

Balance Sheet
A balance sheet is the quickest way to see how your business is doing
at a glance. It shows you what you own and what you owe. In other
words, it is a “balance” of your assets and your liabilities. When your

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assets exceed your liabilities, you’ve got equity. Balance sheets are used
for a momentary snapshot, and the information compiled in them may
change daily.

Cash Flow Statement

With a cash flow statement you will be able to see where the cash is
in your business and how you are paying for things. They help you to
ensure that you are not putting out more than you can handle based
on what is coming in, and that you are spending money in appropriate
ratios.

Daily/Weekly Sales Report

Ideally you will make money every week, or at least every month. You
may get cash, take credit cards or debit cards, and you may accept
checks. A daily or weekly sales report logs all of this information into
the appropriate categories. Some professional organizers do their DSR
by hand using a form. Look for accounting software that allows you to
enter this information.

Income/Profit and Loss Statement

Your income statement, or profit and loss statement, will tell you how
much money you have in expenses and how much money you have in
revenue. It will help you keep tabs on your costs, your profit margin,
and your operating expenses. In the end, this statement will tell you
how much money your business is making or what is commonly
referred to as the “bottom line.”

Financial Experts
Just as people will hire you as an expert to help them solve some of their
personal and business problems, you may want to hire experts to assist
with your finances. An accountant or tax advisor can be expensive—
you might pay $100 per hour compared to the $20 per hour you might
pay a bookkeeper—but their advice could possibly save you hundreds
or even thousands of dollars at tax time.

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An accountant is someone who takes all your recorded transactions

and creates financial reports, such as those mentioned earlier, in order
to analyze your business. They can also provide valuable financial
guidance and help with filing tax returns. To lower your expenses
when hiring an accountant try to do some basic bookkeeping so the
professional accountant doesn’t have to sort through and organize your
paperwork. Remember, they charge by the hour.

If you find yourself so busy with providing your doula services that
you don’t have time to do your own bookkeeping, consider hiring a
part-time bookkeeper on a contract basis to do your bookkeeping for
you.

A bookkeeper can assist with your daily and weekly transactions with
respect to accounts payable and accounts receivable. They will record
all of your incoming money and process any money that you owe.
Depending on how busy you are, it may take the bookkeeper a few
hours per week to get your books up to date and balance them with
your bank statements.

Once you’ve determined what your accounting needs are you may be
able to find a professional accountant at the Accountant Finder website
(www.accountant-finder.com). This site offers a clickable map of the
United States with links to accountants in cities across the country.
Alternatively, an internet search is a good place to find listings for
accountants or bookkeepers in your area

TIP: Never neglect to back up your data on a regular basis. You

would find it more than embarrassing to tell the IRS at tax
time that you cannot file your taxes because your computer
died and your records were not backed up.

4.3 Working with Support Staff

You may be working on your own when you first start your business,
but at some point you could decide to hire people to work with you.
For example, you might hire an assistant or someone to help market
your company. You might hire these people as employees, or you might
sign them on as contractors.

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4.3.1 Employees versus Contractors

When you need help, you have to decide whether to hire a contractor,
or take on an employee as part of your staff. First, you need to know
what the difference is between a contractor and an employee. Secondly,
you need to know what your obligations are to both as the employer.
Here is some information to help you make the right decision for you.

Legally, if you hire an employee, you will have to pay payroll taxes
on that employee, and probably make unemployment and workers’
compensation contributions to the appropriate government agency. On
the other hand, you can train those employees the way you like, and
you can require them to do their work at certain hours and at places
you choose.

Contractors are different from employees in that you don’t invest

time in training them, nor do they work hours specified by you.
They are self-employed, and you pay them on an hourly or per-
task basis to complete specific tasks. You may be interested in hiring
contractors for specialized services, such as an accountant, business
consultant, or PR specialist. Be sure to read the IRS’s information and
advice on employees versus contractors at www.irs.gov/Businesses/
Small-Businesses-&-Self-Employed/Independent-Contractor-
Self-Employed-or-Employee. In Canada, read publication RC4110,
which you can find at https://www.canada.ca/en/revenue-agency/
services/forms-publications/publications/rc4110.html or visit http://
canadabusiness.ca/blog/looking-for-it-help-hiring-an-employee-vs-
an-independent-contractor-1.

If you hire contractors, those people will have learned their job skills
elsewhere. They can choose how and when to do the work. You
mutually agree on what product will be delivered or what services will
be performed, as well as where and when they will be performed. But
you cannot require them to be at your office or anywhere else for a
certain number of hours daily. It is often best to spell out what you
expect and what the contractor is to do or deliver in an agreement.
Other differences between an employee and a contractor, which also
apply to you as a provider of end-of-life doula services, are:

• Employees work only for you. Contractors may have other clients
as well as you, and can work for any and all of them.

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• Employees are paid on a regular basis. Contractors are paid per

project.

• Employees work for a certain number of hours. Contractors set

their own hours, as long as they get the job done. That can be
great for them if they are really fast, or not so great for them if
they are really slow. As long as the project is finished on time
to specs, it’s great for you. (On the other hand, if an employee is
slow, you may end up paying more salary to get the job done in
overtime, or even hiring temporary help to get things finished.)

• Employees can be fired or quit. Contractors can’t be fired in

the usual way while they are working under contract. You may
decide to have them stop working on a project, but you will be
obliged to pay them according to your contractual agreement
unless you are able to renegotiate the contract or successfully sue
them if you are unhappy with their work. (Of course that would
only be in extreme cases; it is best to avoid lawsuits altogether!)

Even if you are not writing paychecks to contractors, but rather

checks for contracting fees, there are still tax considerations. For more
information about employment taxes, contact the IRS or Canada
Revenue Agency.

4.3.2 Before You Hire

Have you decided that what you need is an employee? Before you get
ready to hire, employees, check with your local department of labor to
find out all the rules and regulations required as an employer. There
may be many state and federal rules and regulations that may apply to
you, including health and safety regulations, Workers’ Compensation,
minimum wage and unemployment insurance.

In addition to your local department of labor, visit these sites for more
information:

• U.S. Internal Revenue Service

www.irs.gov/businesses/small-businesses-self-employed/
businesses-with-employees

• U.S. Department of Labor

www.dol.gov/general/aboutdol/majorlaws

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• Canada Business Network

http://canadabusiness.ca/managing-your-business/employees/
hiring-employees

• NOLO
www.nolo.com/legal-encyclopedia/human-resources

In Canada, matters of employment law are covered at the government

websites www.canada.ca/en/services/business/hire.html.

Here are some issues you must consider:

Pay Scale
How much will you pay your new employee(s)? What is the minimum
wage in your area? Remember that making a pay rate too low may
cause employee turnover, which in turn costs you money, especially if
you have to hire often.

For minimum wage information in the US, visit www.dol.gov/general/

topic/wages/minimumwage. In Canada, visit the ESDC (Employment
and Social Development Canada) at www.canada.ca/en/employment-
social-development.html and http://srv116.services.gc.ca/dimt-wid/
sm-mw/rpt1.aspx.

Employer Contributions
When you determine payroll costs you must add in the matched
employer contributions for federal programs and worker ’s
compensation insurance costs. For example, in the United States
the current percentage of employer-matched contribution for social
security and Medicare is 7.65% of individual gross wages.

Overtime Wages
If your employees are considered nonexempt employees, they are
eligible to receive overtime wages. Take a good look at what overtime
wages will cost your business and if it makes sense to hire an extra
employee instead.

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Workers’ Compensation
The cost of Workers’ Compensation insurance is based on rates
determined by industry classification.

Other Costs
You will need to determine costs for unemployment insurance, paid
vacations, sick days, holidays or bonuses for employees, and medical
benefits. Also you must determine if you will set up an employee
commission structure or offer additional compensation for employees
on jury duty. Some of these are mandatory, and others will be based on
your personal decision about what will work best for your budget and
business.

Complying with Law

The U.S. and Canadian governments have many laws that protect
workers in the workplace. It is important to be aware of these laws
and to make sure that your business abides by them. Also, ensuring
compliance with all workplace laws will help you protect your business
from the occasional disgruntled employee.

Check with your state or province’s labor office to make sure you are
clear about all the forms employees must fill out in order to work
for you. The sites below give more information on legal paperwork,
including where to get blank copies of the forms your employees will
need to fill out.

• IRS – Employment Tax Forms

www.irs.gov/businesses/small-businesses-self-employed/
employment-tax-forms

• Canada Revenue Agency

www.canada.ca/en/revenue-agency/services/forms-
publications.html

Each new employee needs to fill out paperwork prior to their first
paycheck being issued. In the U.S. this will be a W-4 and an I-9 form. In
Canada, the employee will have to complete a T-4 and fill out a Canada
Pension form. Both the W-4 and the T-4 are legal documents verifying
the tax deductions a new employee has. The amount of tax you will

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withhold as an employer varies and is based on the required deductions

an employee has as specified by the federal government. Make sure you
retain the forms in a folder labeled with their name and store them in a
readily accessible place such as a filing cabinet in your office.

4.3.3 Finding Support Staff

So, how do you find staff when you need help? There are several routes
you can take, including running an ad in the classified section of your
area newspaper, working with an employment service, or seeking help
on an online job site.

However, the first place to start is by using word of mouth to get

the word out that you are looking to hire someone. Ask friends,
family, and acquaintances if they know anyone who might be a good
candidate to work with your business. You can also spread the word
through organizations that you belong to. You can find out more about
networking in section 5.3.3.

If you need help for just a limited time, you might consider contacting
a temporary employee service. These services provide employees
on a temporary basis. You pay the service, and the service pays the
employee. It also provides benefits to the employee and takes care of
payroll, taxes and so forth. You’ll likely need to pay more to the service
than you’d pay to a permanent employee, but if you only need help for
a limited amount of time, it may be worth it.

The selection process starts with the prospective employee filling

out an application. Here are some other things to look out for when
prospective employees come in to fill out an application or drop off a
resume:

• Are they dressed nicely? Well-groomed?

• Are they polite or do they say, “Gimme an application”?

• Arethey alone? Chances are that if the potential employee can’t

come to fill out an application without their best friend, they can’t
work without their friends either.

• What does your gut instinct tell you?

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4.3.4 The Interview Process

The purpose of an interview is to get to know potential applicants as
much as you can in a short period of time. It is therefore important
that most of that time be spent getting the applicants to talk about
themselves. Most employers with limited interviewing experience
spend too much time talking about the job or their business. And while
that is certainly important, it won’t help you learn about the applicant
or find out if that person is a good match for your party planning
service. A good rule of thumb to follow is that the applicant should do
80% of the talking.

To make the best use of your time, have a list of questions prepared in
advance. This will keep the process consistent between applicants. You
can always add questions that pop up based on their answers as you
go along.

To get a sense of how an employee will actually behave on the job, it is

also a good idea to ask “behavioral questions.” Behavioral questions
ask applicants to give answers based on their past behavior. An example
is “Tell me about a time you had to deal with a difficult customer.
What was the situation and how did you handle it?” Instead of giving
hypothetical answers of what someone would do in a particular
situation, the applicant must give examples of what they actually have
done. While people’s behavior can change, past performance is a better
indicator of someone’s future behavior than hypothetical answers.

By being clear on specifics and details in the interview, you can hash
out any potential problems right then and there or agree to go your
own ways because it is not going to work.

What You Can and Can’t Ask

You should be aware that there are some things you simply cannot ask
about during a job interview. Some are illegal and others are insulting
and open the door to charges of discrimination. They include questions
about:

• Age

• Race

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• Religion

• Marital status

• Family status or pregnancy

• Disability

• Workers Compensation claims

• Injury

• Medical condition

• Sexual orientation

4.3.5 References
Once you have found an applicant who appears to be a good fit, you
can learn more by checking their references. The best references are
former employers. (Former co-workers may be friends who will give
glowing references no matter how well the employee performed.)

Many companies will not give you detailed information about a past
employee. They are only required to give you employment dates and
sometimes they will confirm salary. But many times you will be able
to learn a lot about a potential applicant from a reference phone call. A
good employee is often remembered fondly and even asked about by a
former employer. An employer may not be able to tell you much about
a bad employee for liability reasons, but they can answer the question
“Is this employee eligible to be rehired?”

Here are some other questions from Tom Hennessy, author of the FabJob
Guide to Become a Coffee House Owner:

• How long did this person work for you? (This establishes the
accuracy of their application.)

• How well did they get along with everyone? (This will give you
information about team skills.)

• Did they take direction well? (This is another way of asking, “Did
they do their job ?”)

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• Could they work independently? (Or did they sit around waiting
to be told what to do next?)

• How did they handle stressful situations? (This is important,

especially if you are busy.)

If the references make you feel comfortable, call the employee to let
them know they have a job and to come in and fill out the paperwork.

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5. Getting Clients
“One of the greatest comforts when my mom was in hospice was
having Ally by our side. She’s an end-of-life doula, here’s her contact
information. Let me tell you all about her…”

“Have you taken the time to write your advanced care directives?
We attended a free workshop at the library with David, an end-of-life
doula, and learned so much. We actually hired him privately to help us
write our own. Worth every penny. Here’s his email address…”

“One of our volunteers here at the hospice offers additional support to

families like yours. She’s truly amazing, intuitive, caring. Let me give
you her brochure.”

This is an example of the way many end-of-life doulas find clients

— through word of mouth. As you probably know from personal
experience, a recommendation from a friend is perhaps the most
powerful form of advertising that exists.

But don’t despair if you are just starting out, or if you want to sell your
doula services to a market you have no previous experience with (for

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example, if you want to start offering elder-care, but have not done so
at all). In this chapter you will find a variety of ideas to help you attract
clients. And once you have done a great job for those first few clients,
you can start attracting more through word of mouth.

5.1 Choose Your Target Market

“You don’t sell doulas services like you sell cars or dog services or even
home health care. If there was one advice I wish I had received earlier is:
Get ready to be faced with the deepest and most intimate fears you can
find in people (the fear of death, dependence, vulnerability, the fear of
asking for help, the fear of paying for such help) and think about how
you are going market your services right from the start, while you are
still training. It’s an intimate business…. Despite all the benevolent,
charitable, compassionate reasons to train as a doula, you must
specifically develop some very solid business and marketing skills.”
Nathalie Bonafé,
PhD, CEOLD (Certified End-of-Life Doula)
https://www.agentlerparting.com/

Before you start trying to sell your services to prospective clients, you
should decide which types of clients you want to offer doulas services
to. These are your “target” markets.

It can be tempting for a new doula to say something like “I want to

doula for anyone who’ll pay me!” Avoid the temptation. It is costly
and time-consuming to try to market your business to “everyone” and
the truth is that some people will be more interested than others in the
services you have to offer. In fact, people are more likely to hire you if
they see you as an “expert” who specializes in what they need.

When you are just starting out, of course you might take whatever
business comes your way. However, you can focus your marketing
efforts on the target markets you most want to work with. Once you
start getting more business, you may be able to give up work you find
less rewarding, and spend your time on clients and projects you find
most rewarding.

Your target market will depend on any specialization you identified

in section 2.1, such as whether you want to offer elder care, respite

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care, living funerals, active vigiling, advanced care directive planning,

pet death doula’ing, etc. If you want to offer elder care, you might
target babyboomers looking for help themselves or looking for help
supporting their parents. If you want to offer pet death doula services,
you might target local dog and cat owners or even vet offices. If active
vigiling midwifery is your goal, you may target those on hospice or
looking for hospice care in the near future. Even if you plan to offer
many death doula services, beginning with a specific market in mind
can help you develop an effective marketing plan.

TIP: Census reports can help you with general information such
as the average age of a city or neighborhood’s residents
and the number of children in the area. You can locate
your area’s latest census data at the U.S. Census Bureau
site (www.census.gov) or Statistics Canada’s site (https://
www12.statcan.gc.ca/census-recensement/index-eng.
cfm?MM=1). Another good site is www.city-data.com.

Once you have decided who your target markets are, you can prepare
materials and plan marketing activities that will most appeal to those
groups. As you get more experience you may decide to go after new
target markets, or your business may naturally evolve to focus on
particular types of clients. However, starting with some specific target
markets in mind can help you focus your marketing efforts most
efficiently – saving you both time and money.

Here are some types of clients that typically hire end-of-life doulas,
which you might consider targeting:

• Cancer patients and their families, especially cancers with poorer

prognosis (multiple myeloma, gallbladder cancer, pancreatic
cancer, lung cancer, liver cancer, bile duct cancer, esophageal
cancer, mesothelioma, acute myelomonocytic (a kind of
leukemia), and metastatic cancers (or “stage 4” cancers)

• Parents of children with cancer or other chronic illnesses

• Individuals and their families facing a variety of terminal

illnesses (COPD, cystic fibrosis, stroke survivors, kidney disease,
Alzheimer patients, dementia patients, etc.)

• Caregivers looking for respite care services

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• Individuals starting to plan for end-of-life (possibly 50+)

• Men and women age 70+ looking for support themselves

• Men and women age 50+ looking for help supporting their
parents

• Long-term or experienced pet owners, with older pets (for pet

death doula work)

• Hospice residents or those on home hospice care

• Palliative care patients

• Readers of AARP (American Association of Retired Persons)

5.2 Marketing Tools

When you start a new business, you will have to invest in some business
promotional tools at the outset. These tools should be designed in a
way consistent way to promote both your business and the style of
your business; this includes the choice and use of a logo.

An attractive logo is an important part of branding your business; a

logo may be used to tie together all your printed materials as well as be
displayed on your website. There are companies such as DesignContest
(www.designcontest.com/logo-design) and Fiverr (www.fiverr.com/
categories/graphics-design/creative-logo-design) that help you find a
logo designer for a reasonable price. If you have a concept for a logo in
mind and you feel creative, you can design your own logo. Logo design
software such as Logo Design Studio (www.summitsoft.com/logo-
center.html) or LogoMaker (www.logomaker.com) can be obtained for
around $50.

5.2.1 Printed Materials

Your printed materials include business cards, stationery (such as
letterhead, envelopes, and mailing labels), and other marketing
materials such as brochures.

If you have a computer with a high quality printer, you may be able
to inexpensively print professional looking materials from your own

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computer. Free templates for the print materials you are likely to need
in your business can be found online.

An excellent resource is the Microsoft Office Online Templates

Homepage at https://templates.office.com. At this site you can search a
database to find templates for:

• Business stationery (envelopes, labels, letters, memos, etc.)

• Marketing materials (brochures, flyers, newsletters, postcards,

etc.)

• Other business documents (expense reports, invoices, receipts,

time sheets, etc.)

As an alternative to printing materials yourself, and for materials

that won’t fit through your printer (such as folders), consider using
a company that provides printing services. Beautiful stationery can
convey to prospective clients that you have a good eye and a high
standard of excellence. Your printed materials can be easily designed,
paid for and delivered without leaving the house. Here are links to
some companies that provide printing services for small businesses:

• FedEx Office
www.fedex.com/us/office/online-printing-services.html

• The Paper Mill Store

www.thepapermillstore.com

• Vistaprint
www.vistaprint.com

• MOO
www.moo.com/us

• Jukebox
www.jukeboxprint.com

While the resources listed above can help with all your printing needs,
here is some advice about two types of materials that are particularly
important for marketing purposes – business cards and brochures.

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Business Cards
The first thing on your list of marketing tools is your business cards.
This is one item that you can’t do without. A business card gives clients
the essential contact information for your business, and every time you
hand one out you should think of it as a mini advertisement.

Business cards should state your name, your business name, your
phone number, your email address, and your website. You can list your
home address as your business location, but most people who work
from home choose to leave this detail out. This prevents anyone from
bothering you after hours, or losing business because people think you
are area-specific.

The basic information to list on your business cards includes:

• Your name

• Your title (such as founder or end-of-life doula or death midwife)

• Your company name

• Your contact information (phone numbers, email address)

• Your web address

In addition, consider including the following items to promote you and

your doula services.

• Professionalmemberships and certifications (e.g. National End-

of-Life Doula Alliance (NEDA) Member, Certified End-of-Life
Doula, Certified Death Midwife, Certificate of Completion for
XYZ Doula Training, etc.)

• Your specializations and services offered

• Company logo

• Your mailing address (use a personal mailbox from a company

such as Mail Boxes Etc. in lieu of your home address)

Keep business cards the standard size, 2 x 3 ½ inches, and if possible,

invest in a sturdy card that has a good weight and feel to it. The cost of

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business cards can vary depending on how much or how little of the
work you do creating them.

You can hire a graphic artist to design a logo, do the layout and even
arrange for printing; most print shops have a design specialist on staff
to help with these matters. Or, you can easily do it yourself. Whichever
way you decide to go, make sure your business card is a reflection of
you and your end-of-life care business. For example, an illustration of
a dog would work for a pet death doula, but not someone who focuses
on working with people (even if the dog illustration is cute).

Your business card should be printed on good-quality card stock, in a

font that reads clearly. You might find that a photo of you is not out of
place on your card. You should be able to get several hundred business
cards printed for less than $100. Expect to pay a bit more for gloss or
four-color printing when you include a photo.

If your budget is limited, a good source for high quality low-cost

cards is VistaPrint at www.vistaprint.com. Visit their site to see a wide
variety of designs you can consider; you can upload your logo and do
the design yourself in a matter of an hour or so.

TIP: Check online at sites like RetailMeNot for a VistaPrint

coupon; there is almost always one available.

Once your cards are printed, always keep some on hand, you never
know whom you might run into. Keeping your business cards in a case
is more professional than keeping them scattered across the bottom of
your briefcase or bag. It will also ensure that you only hand out pristine
cards, and not a worn or stained card.

Pass your business cards out whenever it is appropriate. Give them to

your friends, your relatives, people you meet at social functions, the
people behind the counter at your local coffee shop, your dentist, your
mail carrier. After you have been volunteering for awhile at a hospice
or cancer center, give your card to staff members you have developed
a relationship with. Mention that you are an end-of-life doula when
handing out your card, so that people will look at it later and make the
connection. When you send letters to people, stick a business card in
the envelope.

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Brochures
You will have many opportunities to give out your business card. But
there are also times to give out brochures. For example, when you give
a presentation at a networking meeting (see section 5.3.3) or when
people seem particularly interested in your services. You should also
provide some to the hospices with whom you do a lot of volunteering
in case someone asks them if they know an end-of-life doula they could
recommend.

Brochures give prospective clients an overview of what your business

is about. Some death midwives choose to develop very detailed
brochures while others prefer a clean look with less detail. A brochure
can explain the finer points of your business when you are not there
to do it yourself; it should be colorful enough to catch the attention of
clients, but not too busy; professional, flawlessly proofed, informative,
interesting, and memorable.

You may choose to have several brochures for different target markets.
Along with the information found on your business card, brochures
might include:

• Information about the services you provide

• A description of your professional qualification

• Benefits of hiring an end-of-life doula (e.g. peace of mind, a

“better” death, etc.)

• Photographs of a workshop you gave, of you performing a ritual

of some sort, stock photography of holding hands, a lit candle,
etc.

• A short bio and photograph of you

• Testimonial quotes from satisfied clients

• Your association affiliations and their logos

• Anything else that you feel gives your business credibility

What if you aren’t a writer or you have never made your own brochure
before? You can still put together a great brochure if you follow these
steps.

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Get Some Examples

Networking or attending a trade show are great ways to gather
marketing materials to look at. You don’t necessarily have to see the
brochures of other death doulas — any brochure that sells a service
prepared by a self-employed or small business owner is helpful for you
to view.

Jot Down Your Ideas

These ideas can later be used to create a rough draft for your brochure.
You can also use the work you did in Chapter 4 in which you
brainstormed about and described your business to come up with your
brochure ideas.

Write Your Bio

A bio is a short, biographical paragraph (or two) about you. It should
include your name and company’s name, and the area your business
serves; your professional focus or specialty; your recent claims to
fame; and products or services your business offers that are especially
interesting. You can save this bio and use it with press releases, articles
you write, and on your website.

Make a Rough Draft

You can make a rough draft with the information you have so far. One
easy way to do this is with a pencil and a piece of paper. Just take a
standard-sized piece of paper and fold it as your brochure will be
folded. Most brochures are three-panel brochures, so fold your rough
draft paper just as if you are folding a letter to place in an envelope.
Sketch out how you want the information to appear.

Lay it Out
Now that you have a rough draft, you are ready to move to your
computer. Some software programs like MS Publisher have “wizard”
features that allow you to move through pre-organized template steps
and simply fill in your text and add pictures and logos. If you are new
to desktop publishing, MS Word is a little easier to use, but has some
limits to it as well.

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If you want to design your own brochures, you can find brochure
templates at the Microsoft Office website mentioned at the beginning of
this section. To illustrate it, you can purchase low-cost photos through
websites such as iStock (www.istockphoto.com), Dreamstime (www.
dreamstime.com), and Shutterstock (www.shutterstock.com). If you
want to publish photos of your own clients or staff, whether on your
website or in print, be sure you have them sign a release form that gives
you permission to use the images in any of your promotional materials
without compensation. Most people are happy to have their images
used in such a positive way but there may be exceptions. Here is a
sample of a release form you can use.

Sample Release Form

I hereby give (insert your name) permission to use my
photograph taken of me on (insert date) at (insert location) for
promotional, on-line or commercial purposes. I am of legal age.

_____________________________ _______________________
(Print Name) (Date)

_____________________________
(Signature)

If you don’t think you can design this yourself, a printer should be able
to put together what you have in mind, for an additional cost.

Also consider postcards, which do not have to be mailed to be useful;

they’re a cost-effective item to give out in person as well. Most larger
printing companies can easily print postcards for you. Many printing
companies offer postcards at reasonable prices, and some (for instance
www.postcardmania.com and www.modernpostcard.com) specialize
in both printing and mailing them from a mailing list you provide.

After any printed materials are designed, proof super-carefully; get a

friend with a sharp eye to look, too, and let you know if any areas are
unclear. You’re then ready to find a printer and select paper.

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5.2.2 Your Portfolio

A portfolio shows examples of your work; generally, you will use this
in person when you are presenting to a client. You might assume that
portfolios are primarily for people with “visual” or public work: like
designers, artists, or event planners. But a portfolio can also be used
to sell your doula services. You may possibly wish to prepare your
portfolio on a DVD, which may be left with the potential client or even
mailed to certain clients that you are waiting to get an appointment
with. A portfolio is generally not made available except to parties
who have indicated a sincere interest. Your portfolio may include the
following items from events you have planned, or been involved with:

• photographs of your work or of you demonstrating your work

• testimonials or letters of recommendation individuals you’ve

worked with

• testimonialsor letters of recommendation from nurses or staff

from hospices where you volunteered

• newspaper or article clippings where you were interviewed

• anything else that shows your skill as a death doula

A portfolio offers a prospective customer proof that you have the skills
and creativity to do the job. Read on to find out how to get items for
your portfolio and how to put it together. At the end of this section
you’ll find some tips on how to create a portfolio if you don’t yet have
materials from actual events.

Photographs
They say a picture says a thousand words. Getting images of your
death doula work may sound difficult, but with a little creativity, you
can do it—even if you have no clients willing (or available) to share
photos from.

Some ways to get photos of your work include…

• Acting out a ritual or comfort technique and taking a photo

(without real clients, ask friends or family to act as models if
needed)

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• Photos of a living funeral you conducted

• Photos of a legacy project—if you don’t have a client’s project to

use (only with permission, of course!), you could create your own
legacy project and take a picture of that

• Before and after photos of a post-death home organization

• Photos of a saying goodbye pet ritual ceremony

• Pictures from a workshop you’ve conducted

• Pictures from meeting with clients to discuss end-of-life or

advanced care directive planning – this could actually be posed
for by friends, or taken when you do the planning with a friend or
family member

If you do have photos from working with clients, and signed releases
for them, remember that your portfolio should be a collection of your
best examples. Most clients do not have time to look through hundreds
of photographs, so be selective about what to include.

Letters of Recommendation
The best letters of recommendation are those written by friends
and family for whom you’ve provided end-of-life doula support
for their loved one. Second best are letters written by hospice staff
where you have volunteers. However, you can also include letters of
recommendation from past employers if the letters say good things
about your abilities in areas that are important in the death doula
business, such as interpersonal skills or your calming presence. If
you have worked as an area that offers somewhat related services—
massage therapy or as a hospice nurse—this may make better sense.
You can also include appropriate thank-you notes you have received.

Every time you do end-of-life doula care for someone — even a friend
or family member (preferably with a different last name from yours!)
— ask for a letter of recommendation. When you ask for a letter, keep
in mind that many people are busy, so they are more likely to do what
you ask if you can make it as easy as possible.

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To help get the kind of recommendation letter you want, and make the
job easier on the person writing the letter, you could supply a list of
points they might mention. For example, you could mention:

• what you did (write it out for them — chances are you remember
exactly what you did more clearly than they might)

• how you saved them money by helping them navigate funeral

costs or end-of-life support services

• how you got along well with everyone you worked with

• how you offered specific comfort by XYZ skills or rituals

• how you handled every detail so well they didn’t have to worry
about a thing

Of course, all these things don’t have to be included in a single letter!

The specifics will depend on the particular job you did, but even a few
glowing sentences can help you look good to customers.

If you feel your relative or friend will not write a great letter – even if
you specifically suggest of what to include – you can offer to compose
the letter yourself and have them simply supply the signature. You
should have a couple of different letters written specifically for this
purpose and propose one of them as an alternative. Here is a sample
reference letter:

TIP: A recommendation letter should preferably not mention

that you worked for free. You want to give the impression
that your work has value, and a customer may assume the
reason you received such a glowing recommendation is
because you didn’t charge anything. Remember, good work
is good work no matter how much you were paid for it.

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Sample Recommendation Letter

Dear Dianne Death Doula,

Josh and I would like to take this opportunity to thank you again
for the amazing support you offered us while my mom was in
her last year. When Mom got her ovarian cancer diagnosis, our
world just collapsed. We all felt overwhelmed, unsure what to
do. A nurse handed us your brochure at the oncologist’s office,
and we are so glad she thought to offer it to us.

Your support was truly transformative. From when we first

contacted you, to the last days, your energy, comfort, and help
in planning made this difficult life transition into something
beautiful. Mom wanted to die at home; you helped us make
that possible. You put us in touch with local home hospice
organization, and made sure we knew our options and rights.
Her passing was peaceful and spiritual.

In the early days together, you sat with all of us to discuss

advanced care directives and vigil planning. This brought peace
to Mom and also to us.

After Mom passed, we weren’t overwhelmed with funeral

planning and estate management because we had already
discussed and considered it earlier. I know friends who struggled
with what to do with social media and email accounts after
death, but we were prepared for handling all of this.

We will certainly recommend your service to family and friends

and wish you success in the years to come.

Sincerely,

Comforted Carolyn

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What Else to Include

Your portfolio can include anything else that could impress someone
who is considering hiring you. For example, if you have a certificate of
membership in a related association or for completion of death doula
course, put the actual certificate in your portfolio. If that’s not possible,
include a photocopy or a photograph of the certificate.

Likewise, if your death doula business has been mentioned in a

newspaper or magazine story, you could include a clipping or
photocopy of the published article. Later in this chapter, you will find
information about how to write articles for publication, and other ways
to establish your reputation as a death doula expert.

Putting It All Together

There are several different options for displaying the materials in
your portfolio. One possibility is to put everything into a professional-
looking three-ring binder with plastic sheet covers to protect the pages.
If you wish, you can mount your photographs and other portfolio
materials onto thin cardboard. All of these supplies are available from
any office supply store.

Another possibility is to use a portfolio case, which you can find at

sources such as Dick Blick (visit www.dickblick.com and search for
‘portfolio’) or at a local art supply store. Portfolio or presentation cases
comes in a variety of sizes (for example, 11” x 14”, 14” x 17”, 17” x 22”)
and cost from about $15 to $150-plus, depending on the size, material,
and how fancy you want it to be. However, customers are interested in
what is inside the case, so you don’t need to spend a lot of money on
the case itself (for example, you could get vinyl instead of leather).

5.2.3 Your Website

Your website can be an important tool for marketing your services. It
gives prospective clients an opportunity to learn more about you and
your services at their convenience any time of day. It may also introduce
you to new clients you might otherwise not encounter through other
marketing activities.

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Also, because end-of-life doula work is so new, a website can allow

you to explain really what you do to people who may be looking for
support but not have a word for that support just yet. Having a blog or
posting your own articles can not only help people find you in search
engines, but also inform the public about this new and important
support option.

Plus, people may be looking to hire you from another city. For example,
if they want someone to provide death doula or elder care support to a
family member living in another location. They are unlikely to find you
by word of mouth or from local advertisements. But they may find you
via your webs presence.

Today’s consumers expect you to have a web presence, and will often
decide not to do business with you if you neglect this aspect of your
marketing. While the idea of creating a website may seem intimidating,
it doesn’t have to be complicated.

What to Include on Your Website
Any information you would include in a brochure (described in section
5.2.1) or in your portfolio (5.2.2) can also be included on your website.
You should also visit websites of other successful end-of-life doulas to
get ideas for your own site. Here are some ideas of what to include on
your website to get you started:

• Home page with links to navigate through your site.

• “About Us” page so that your customers can learn more about
you and your company. This should include your credentials
and a photograph of you. Including a photo of yourself is
very important in this work—people will decide if they “feel a
connection” with you by looking at your picture

• A way to contact you, including at least your company name,

telephone number and email address. This should ideally be
on every page, but you can also have a “Contact Us” page with
your business mailing address, email address and other contact
information.

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• Information about your services and the benefits you offer to

potential clients, including where you work out of and where you
are willing to travel to.

• Testimonial quotes from satisfied clients.

• FAQ (Frequently Asked Questions) with answers so you can

save time during consultations. Include general death doula or
midwife FAQ and those specific to your business or services.

• Helpful information you have written such as articles on end-of-

life care, checklists, advice, and other content that shows your
expertise. Adding new content on a regular basis can keep people
returning to your site.

• Video of you talking about end-of-life care, which is just another

way to build connection and trust with potential clients

• To build up a contact list, you could offer a free email newsletter,

and include a place at your website where visitors can subscribe.
Your newsletter could include articles about the types of services
you offer and information on end-of-life care. Your newsletters
can also be posted online.

TIP: You can send out email newsletters inexpensively

through a company such as Constant Contact at www.
constantcontact.com. The cost starts at $20 per month for
a list of up to 500 people, and a free trial is available. Other
companies that do email newsletters and autoresponders
include AWeber (www.aweber.com), Campaign Monitor
(www.campaignmonitor.com), and MailChimp (www.
mailchimp.com).

Developing Your Website

Next, you’ll need to get an address, or domain name, for your site.
There are a number of sites where you can search for and register a
domain name. One web host we have found that provides good service
for a low cost is www.godaddy.com. Yahoo! also offers a quick search
for domain name availability at https://smallbusiness.yahoo.com/
domains.

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If your preferred domain name is available, but you’re not yet ready
with your website, you can also “park” your domain. This means that
you register the domain so that someone else does not take it before
you’re up and running with your business website. You then park the
domain with your web host.

Once you register your domain, you will need to find a place to “host”
it. You can host it with the same company where you’ve registered the
name. For example, if you register a domain name through GoDaddy,
you might use their hosting services to put your website online.
Another low-cost option is Bluehost (www.bluehost.com). Yahoo!
offers a popular low-cost web hosting service at service at http://
smallbusiness-domain.com/yahoohost. You can find a wide variety
of other companies that provide hosting services by doing an online
search. Before choosing a web host, use the internet to research web
hosting scams to help you avoid similar problems.

Another option is to use a free blog service such as WordPress. It allows

you to set up your site as a traditional web site rather than a blog, if you
wish.

First impressions mean a lot! Your potential clients/customers will

judge the quality of your business and services by what they see
on your website. If you don’t have the time or expertise to design a
polished, professional website yourself, you should hire a professional
web developer to build and maintain your website.

Feel free to reach out to the FabJob webmaster Eric Davis (owner of
Jaber Marketing, LLC: jabermarketing.com) at eric@jabermarketing.
com or contact him via his website. He will be able to help your
business with all of your online needs.

But creating the website is only half the battle — adding to and
updating it frequently is important, yet time-consuming. If you don’t
have the time to spend on maintaining a website, you may prefer to pay
to outsource its ongoing maintenance.

Software such as Microsoft Expression Web or Adobe Dreamweaver

has made creating web pages possible for just about anyone with the
time and energy. If you are already experienced at creating web pages,
or learn quickly, you can design your website yourself; if you don’t

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have design software already, check out free programs like SeaMonkey
(available at www.seamonkey-project.org). You may also use the
website development tools offered by domain and hosting companies,
described above.

Promoting Your Site

A great site is only as good as how many people it attracts. No matter
how much you spend on creating your website, if people don’t know it
exists, it won’t help your business. Once you have set things in motion
and your website is ‘live,’ put your website address on absolutely
everything you send out. Put it in your email signature and on all your
printed materials. Encourage people to visit your site by mentioning it
as often as you can, for example, whenever you write an article, give a
presentation, or are interviewed by the media.

Make certain you list your site on all your business forms, cards,
brochures, signs, and even your car, van or truck. (Check out car door
magnets at www.vistaprint.com/signs-posters/car-door-magnets.)

When you list items for sale on any other website, like eBay for example,
add your website address. If you spend time on blogs or newsgroups,
add your site’s hyperlink to your signature.

Make sure people can find your website by getting it into the search
engines and listing it with industry websites. While some sites and
search engines charge a fee to guarantee that your website will be
included in their directory, you can submit your website for free to
Google at https://support.google.com/webmasters/answer/6259634.
Once you’re on Google, your site is likely to be found by other search
engines as well.

Your web hosting company may offer a search engine submission

service for an additional fee. You can find information about
“optimizing” your website, to help it rank higher on search engines,
at the Search Engine Watch website at http://searchenginewatch.com
and at Google’s Webmaster Help Center at https://support.google.
com/webmasters/answer/35769. And don’t miss the Search Engine
Optimization (SEO) Starter Guide at https://support.google.com/
webmasters/answer/7451184.

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Be sure that your business can easily be found online by listing your
business at major search engines and internet directories, including:

• Angie’s List
https://business.angieslist.com

• Bing
www.bingplaces.com

• CitySearch
www.citysearch.com

• Foursquare
http://business.foursquare.com

• Google My Business
www.google.com/business

• Super Pages
www.superpages.com

• MerchantCircle
www.merchantcircle.com/corporate/landing/signup.html

• Yahoo Local
https://local.yahoo.com

• Yelp
https://biz.yelp.com

And to be sure you are easy to find on GPS navigational devices, unless
you are doing business out of your home, register your business at:

• GPS Data Team

www.gps-data-team.com/corporate_customers.html

• Express Update
www.expressupdate.com

In addition to the free search engine listings, you can advertise on the
search engines. See section 5.3.1 for more information.

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5.2.4 Social Media

If you have a good chunk of time to devote to online marketing, you
can use social networking sites such as Facebook (www.facebook.com)
and LinkedIn (www.linkedin.com), do micro-blogging (brief updates)
at Twitter (www.twitter.com), create videos to post at YouTube (www.
youtube.com), and create pages for sites such as Hub Pages (http://
hubpages.com), among other online marketing activities.

Given that a big part of your work will be educating the public on what
you do and how you can help, social media can help not only spread
awareness of your business but also help people find you who may not
know what a “end-of-life doula” or “death midwife” is.

Effective use of social media platforms has fast become almost a

necessity in marketing small businesses. One important way to learn
and to interact is to follow what content your competition is presenting.
The bookseller Amazon lists over 200 titles in the category ‘Social
Media for Business,’ and the Internet offers countless articles as well.
I will not attempt to cover the topic in detail but rather provide a brief
overview of several major social media venues that you may find offer
useful accessories to your website.

Yelp
www.yelp.com
Yelp provides a business review guide in major urban areas. Originally
started in San Francisco in 2005 as a restaurant review site, Yelp is now
used by over 84 million unique users per month in over 20 countries
to check out local businesses providing goods and services ranging
from nightlife to auto repairs to medical services. Anyone can read
Yelp reviews, but users must open a free account to be able to write
reviews, which allow the user to assign a one-star to five-star rating as
well as to write about what they like (or don’t like) about businesses
they’ve patronized. A free Business Owner account is also available, by
which businesses may reply to reviews as well as message users, add
photos to their listings, engage in a variety of promotional activities,
and view trends and statistics for their own page. Yelp is supported
by advertising revenue; advertising can be targeted in a variety of
ways, including having your business ad appear when users view your
competitor’s page and blocking competitor’s ads from appearing to
viewers of your page.

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Tumblr
www.tumblr.com
Owned by Yahoo, Tumblr is a microblogging and social networking
platform. Profiles may be public or private; many features are free,
but some premium features are offered for an initial or a monthly fee.
Registered users may follow other users (and be followed), re-blog
posts, and post ‘likes’ so that one’s friends may view what one has
found interesting. Along with text, both still images and videos may be
posted, and a limited amount of ecommerce can take place via PayPal
or other avenues. Users can choose their pages to appear with a free
theme, or hire a designer to provide a custom theme. Launched in 2007,
on some days over 100 million posts are made by users around the
world. Advertising revenue is the main support for Tumblr, although
recently companies have been offered opportunities to pay to promote
their own content to larger audiences.

Facebook
www.facebook.com
With over 1 billion users and translated into 37 languages, Facebook
nation is the world’s largest social network with three times the
population of the United States. You must first register to create a
profile, then you can access features such as posting photos/videos;
adding contacts with whom you may exchange messages and live chat;
publicizing events including issuing invitations and tracking planned
attendance; and posting ‘classified’ listings in the Marketplace. There
is no charge to join and use Facebook; it is supported by advertising
revenue.

Twitter
https://twitter.com
Twitter is a social networking and microblogging service that allows
users to send and read text messages limited to 140 characters, which
are referred to as “tweets.” Founded in 2006, there are already over
200 million registered users sending 58 million tweets per day. As a
registered user, you can both post and read tweets, but unregistered
users can only read tweets. You may tag each of your tweets with a
hashtag (#) subject line, allowing users who were not actually sent
the original tweet to access the message. Twitter offers analytic tools
that which allow the user to review the performance and impact of
their various messages. There is no charge to join and use Twitter; it is
supported by advertising revenue.

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Pinterest
www.pinterest.com
Pinterest is a social networking site that lets users create visual bulletin
boards of their interests including recipes, images, videos, and ideas.
It is a virtual bookmarking tool where you “pin” things of interest.
Your “pins” can be shared on other social networks like Twitter and
Facebook. For businesses, it is a great way to showcase your work
portfolio, and others can “pin” images from your board onto their
Pinterest and other social media accounts. You can also embed Pinterest
to function within your own website.

Instagram
www.instagram.com
Instagram is a popular social media app for sharing pictures and videos.
Snatched up by Facebook as a huge opportunity, as of September 2015,
the app boasted over 400 million users worldwide. You can embed
Instagram photos onto your website or blog, making it a useful tool
for marketing, as well as link it directly to your site. You can cultivate
a following through sharing engaging posts and tips related to your
business, as well as engage potential clients.

Periscope
www.periscope.com
Periscope is an app that allows you to live stream video broadcasts
from anywhere in the world. Owned by Twitter, Periscope boasts over
10 million subscribers and has over 4 million active daily users as of
this year. Although video streams are in real time, they can be saved
and posted for later viewing. It can help bring exposure and help you
connect with potential clients. Q&A chats and live demonstrations are
a couple of ways you may want to use it.

LinkedIn
www.linkedin.com
LinkedIn is a social networking website for people in professional
occupations. Launched in 2003, LinkedIn now has over 250 million
members in over 200 countries and territories. Along with posting
profile information similar to that found in a resume, users can establish
and maintain ‘connections’ (people who have some sort of relationship
to the user). A contact network is then built up consisting of the user’s
direct connections, the connections of each of their connections (or
‘second-degree connections’) and also the connections of second-

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degree connections (or ‘third-degree connections’), so that the user may

gain access by messaging new virtual acquaintances through mutual
contacts. There is no charge to join and use basic LinkedIn, but there is
a subscription charge to access various ‘Premium’ services.

YouTube
www.youtube.com
YouTube is a video-sharing website owned by Google on which users
can upload, view and share videos; videos stream on your computer or
other device using Adobe Flash Player (a free download application).
Launched in 2007, there are currently over 4 billion video views per
day. Over one million users (known as ‘creators’) have posted videos,
which are viewed by over one billion unique users every month. You
need to register to post videos, but unregistered users are free to view
most videos (with the exception of ‘adult’ content). Youtube videos may
be viewed on the Youtube website or embedded in and viewed at other
websites. Although there is a premium subscription service available,
there is no charge to join Youtube, and the vast majority of videos on
YouTube are free to view, being supported by advertising revenue. In
fact, if you post a popular video, you can earn money by selling space
to run advertising (called a ‘pre-roll’) as an integral and unavoidable
part of your video.

Many entrepreneurs find the number of online “social media” sites

overwhelming. If you want to learn more about how to use them,
consider purchasing a book on the subject such as Social Media Explained:
Untangling the World’s Most Misunderstood Business Trend by Mark W.
Schaefer. Even if you decide not to use online social media, you can
nevertheless market your business online using methods discussed
earlier in this chapter, such as building a website and publishing an
email newsletter.

5.3 Marketing Techniques

“Get out in the community as much as possible. A lot of the work for
now is in public education about the services we (death doulas) offer.
I benefit from word of mouth, podcast and magazine interviews and
videos with Refinery 29. I am actively engaged on my Facebook and
Instagram.”

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Alua Arthur,
End-of-Life Doula
www.goingwithgrace.com

No two businesses are ever going to market themselves exactly the

same. You will use the information you have gathered about your target
market to determine what mix of the following techniques are likely
to work for you. Marketing is always a work in progress, so if certain
techniques don’t seem to be effective for you, you want to be open to
changing them until you find you are generating leads and results.

In this section we’ll look at a variety of marketing techniques, including

advertising, free publicity, networking, and promotional events.
Consider as many of these techniques as possible to help you get the
word out about who you are and what you do. Generating clients from
marketing is not formulaic and not every strategy works for every
doula with the same success. The key is to determine what combination
works best for you.

5.3.1 Advertising
Advertising involves paying to promote your business. There are
many places businesses can advertise – from bus benches to television
commercials to the internet. This section will focus on the forms of
advertising that are most often used by new doulas and include some
tips that may assist you in considering other types of advertising in
future.

The best thing about advertising your business is that you control the
message. Unlike word of mouth, where the information given out may
be haphazard, in advertising every word can have a positive spin.
You say where the message gets out, what the message says, how the
message looks, who gets the message.

It’s important to know what advertising cannot do for your death doula
business. It’s not a magic wand to instantly improve your cash flow. It
can’t fix the problem if your service is not valued or if it is sub¬standard.
Advertising money needs to be invested smartly. Investing 3 to 10
percent of your profits back into advertising is a typical amount, but
you should do whatever seems right for your business.

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When deciding where to advertise, you’ll want to know how much

a particular advertisement costs, how long it will last, and most
importantly, what consumers it will reach. You can find this information
by contacting local media outlets and asking them to send you a rate
card (also known as a media kit). Rate cards list the advertising options
offered by the media outlet, and often include other useful information
such as demographic statistics (age, gender, income level, etc.) about
the target audience — the viewers, listeners, or readers the outlet
reaches.

Online Advertising
In the last few years, online advertising has taken off, eclipsing more
traditional types of advertising such as print and broadcast media. To
ensure people find your business these days, you will need to advertise
online.

Firstly, you can look into companies that specialize in online listings.
One such service is Superpages. They offer a free business listing
service as well as an enhanced version for a fee. Check their website
at superpages.com for details. The most popular search engines, such
as Google, Yahoo, Bing, Yelp and Citysearch all offer business pages as
well, which will mean that your business will be more likely to show
up at the top of internet searches. These are basically free forms of
advertising, so don’t hesitate to register your business details with as
many of these services as you can find. Here are some to start with:

• Google Business
google.com/business

• Yahoo Local
smallbusiness.yahoo.com/local

• Bing Places for Business

bingplaces.com

• Yelp for Business

biz.yelp.com

If you find registering your business with each separate online directory
somewhat overwhelming, and you want to ensure your business is
getting as wide a reach as possible, there are services out there that

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will do that work for you, such as Thryv.com (who operate the online
version of the Yellow Pages: yellowpages.com or yellowpages.ca
in Canada) and ReachLocal (reachlocal.com). These types of media
services certainly cost but they can also take some of the headaches
away of managing your online marketing needs.

Many social media sites, such as Facebook, Instagram, LinkedIn and

Twitter, also offer paid advertising that can be targeted as widely or as
specific to your market as you choose. Check out Facebook for Busi-
ness for info and advice on marketing your business on social media:
facebook.com/business. Instagram for Business can be found here:
business.instagram.com. Twitter info is available here: business.twit-
ter.com, and check out details from LinkedIn here: business.linkedin.
com/marketing-solutions.

Many businesses also use “pay-per-click” advertising to attract

prospective clients. This involves paying for every visitor that a search
engine sends to your website. You can find information about using
pay-per-click advertising on Google, including how to target Internet
users in your city, at https://adwords.google.com. Other sites you can
advertise on include Yahoo!, Bing, and Facebook.

If you choose specific search terms that few other advertisers have bid
on, you may be able to attract some visitors to your website for as little
as five cents each. However, pay-per-click costs can add up quickly and
some of the people clicking on your ads may simply be curious (for
example, students doing research) and not serious prospects for your
business. So you should set a maximum dollar amount per day and
monitor your results to determine if this type of advertising is effective
for you. Note: the offers that result in sales online may also be effective
in your print advertising.

Internet advertising is an intricate field, and one that is subject to rapid

changes. Before you throw an interesting amount of money in this
direction, you may wish to read up on the subject; your local library
may be a source for recently published books, or try your favorite
bookseller.

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Newspapers and Magazines

Magazine and newspaper advertising can be expensive, and may not
create enough business to cover the cost. You could spend thousands
of dollars on an “advertorial” (an advertisement written as an article)
and not get a single new client as a result. Magazine and newspaper
advertising is most effective when it is targeted; you can spend some
money advertising in a format that reaches people who have a need for
your services, and get a return rate that more than justifies the cost.

Print advertising can be expensive, and may not generate the results
you want unless you do it repeatedly. (It has been estimated that people
need to see an advertisement three to seven times before buying.) If you
choose to buy advertising, it will likely be most cost-effective to place
ads in local health or retirement magazines or in the health section of
local newspapers, or classifieds.

Read a magazine or newspaper carefully to see if an advertisement for

your business would fit with the theme of the paper, the articles, and
the other ads. As mentioned, you can also ask for a rate card or media
kit to obtain information about their readership. This can help you
determine if their readers are the sort of customers you are looking for
and if it is the right publication for your ad.

A small ad that you run every week for a couple of months can generate
more business than a single full page ad. But even your first ad in a
publication should generate some inquiries. If you don’t get enough
business from your first ad in a particular publication to at least cover
the cost of the ad, try something else.

Creating Effective Ads

Some people spend years learning how to create the most effective ads.
Since we do not have years, we’re going to focus on a few key points.

• Create a consistent look, using your logo and layout to create ads
that are recognizably related to your business cards, website, and
other marketing materials.

• Include your website in your contact information.

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• Display information in easy-to-read fonts and use high contrast

for good legibility.

• Emphasize clarity. Too much information just becomes hard to

read.

• Rather than just listing your services, explain how clients can
benefit from your services.

• Tell readers what you want them to do and give them a reason to
call (for example, “Call now for a free initial consultation”).

• Get someone to help you proofread. Don’t take the chance of

spending money to publish an ad with errors in it.

• Make sure you’re available for people who respond to your ad. If
someone keeps getting your voice mail, they may give up.

One of the most effective ways to get people to call – and to test the
effectiveness of each ad – is with some sort of incentive. An incentive
can be anything from a discount coupon to a free gift or even a free
initial consultation. To measure advertising effectiveness with coupons,
it’s a good idea to put a time limit or expiration date on it. Make sure
this date is clearly printed on the coupon. It should allow customers
enough time to contact you if they pick up the publication after it’s
published – maybe a week or two – but not so much time that they
forget about the coupon, thinking they can use it well into the future.
Tie the coupon to a date that’s easy to remember, such as the end of the
month.

Consider consulting your local library or your favorite bookseller. For

a thorough grounding in the fundamentals of the topic, you can buy
an out-of-date textbook edition for pennies on the dollar. For instance,
McGraw-Hill’s 864-page 2008 textbook Advertising and Promotion: An
Integrated Marketing Communications Perspective, 8th edition by Belch and
Belch could at press time be acquired from amazon.com for a modest
one penny plus shipping. For that investment, you won’t need to read
it cover-to-cover; just take what you need and leave the rest.

While advertising helps many businesses to attract clients, you may

have much better results if you can get free publicity.

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5.3.2 Free Media Publicity

One of the best ways to market — with potentially excellent results
for minimal cost — is to get free publicity in the media (magazines,
newspapers, radio, television, and online). While you don’t have the
final say over what gets reported, the exposure can give a boost to
your business. When a business gets publicity in a magazine article,
newspaper story, radio or television talk show, it can result in a
tremendous amount of new business. This section describes a variety
of ways death doulas can get publicity.

TIP: Subscribe to HARO (Help a Reporter Out) at www.

helpareporter.com to receive a free email newsletter
containing requests from reporters who are seeking experts
to interview.

Newspaper and Magazine Publicity

One way to get a story written about your business is to send a press
release (also called a “news release”) to a writer, magazine editor,
or the editor of the appropriate section of the newspaper. The ideal
press release is a single page and should be written so that it could be
published “as is.” Read the magazine or section of the paper where you
would like to be published and use a similar writing style for your own
news release.

In order to get published, your press release should read like a story,
not an advertisement. A press release that simply announces you have
started your business is not likely to get published, unless there is
something unusual about your business. Instead, consider issuing press
releases to announce events or community activities that your business
is involved with (see section 5.3.5 for information about promotional
events).

Here is a quick list of tips for writing a press release:

• Make sure the press release is newsworthy. A community event

or workshop is newsworthy. A new business is not, unless there is
something particularly interesting about the business.

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• Give your press release a strong lead paragraph that answers the
six main questions: who, what, where, when, why, and how.

• Keep it short. Aim for a maximum of 500 words.

• Include contact information at the end of the press release so that

reporters can get more information.

You can find numerous online resources to help you write a press
release, including:

• CLASS PR:
https://class-pr.com/blog/how-to-write-a-press-release

• Forbes:
https://www.forbes.com/sites/
forbescommunicationscouncil/2017/11/02/writing-a-press-
release-14-elements-you-need-to-include/#51586eba719f

If you’re still feeling unsure about your press release, visit https://
fitsmallbusiness.com/how-to-write-a-press-release-template for a
free online template to help you through the press release composing
process.

Most magazines and newspapers publish contact information for

their editors. If the editor’s name is not published in the paper, you
can call and ask the receptionist. Newspapers may have dozens of
editors, so make sure you send your submission to the appropriate one
(for example, the Lifestyle Editor). They may print your press release
verbatim, or call you for more information to write an article about you.

When you send out a press release, you should have available on
request your bio and a professional-quality photo of yourself, some
FAQ (frequently asked questions) about the profession, clients who are
willing to be contacted about your service, a few unusual requests or
colorful stories, and some other news clips about the profession. These
can become part of your press kit, which you can use to land interviews
with media such as TV and radio.

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Sample News Release

Don Death Doula
ABC End-of-Life Doula Care Services
123 Health Lane
Anytown, USA 12345
(555) 555-1212
[email protected]

For Immediate Release

October 1, 20XX

Free Workshop on Green Burial Choices

A free workshop on green burial options will be given at the

Anytown USA Chamber of Commerce, located at 1234 Business
Road, on October 24, 20XX from 7 p.m. to 9 p.m.

Don Death Doula will share information on local and non-local

green burial options, the growing popularity of green burial, how
it’s never too soon to start thinking about your funeral options,
and how to reduce the burden on your loved ones by making
financial and practical plans now. Discussion of health hazards
and the environmental impact of traditional burial practices will
also be covered.

Mr. Death Doula, in practice since 2005, will talk about the
positive effects of planning for end-of-life care, and offer many
resources and handouts for workshop participants, including
a list of local funeral homes offering green options. He has a
Certificate of Completion from End-of-Life Doula Training.

For more information, call the Anytown USA Chamber of

Commerce at (555) 555-1234.

As an alternative to writing a press release, you could find out who

the editor is, and either phone or send a brief “pitch letter” by email
or mail to suggest an idea for a story. In your pitch, remember to focus
on something that will be interesting to readers. For example, you

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might suggest a story on how to save money in funeral costs or how to

support a friend or family member facing a chronic or terminal illness.
Do some brainstorming or consider a story based on the most common
kinds of questions customers ask you.

While it is not necessary to submit photographs to a daily newspaper

editor (most newspapers have their own photographers), photographs
may help attract the editor’s attention. They might also be published
in a smaller magazine, newspaper or newsletter that doesn’t have a
photographer on staff.

If you send photos (remember to make sure you have permission from
the people in the photos as well as the photographer), put them in an
attractive two-pocket folder with your business card and a cover letter.
Then follow up a week later with a phone call.

TIP: A press release published through services such as www.

prweb.com may be distributed for you for a moderate
investment.

Television and Radio Talk Shows

Phone local radio and TV shows to let them know you are available
to provide death doula advice to their viewers or listeners. Shows
that might be appropriate include morning shows and afternoon talk
shows. The person to contact is the producer of each show.

When you contact them, be sure to emphasize how much the show’s
audience will benefit from an interview with you. Keep in mind that
they are not interested in giving you free advertising – their ultimate
goal is to improve their ratings, so anyone they interview should be
dynamic and interesting.

Also, keep in mind that many station employees are overworked and
underpaid. If you can make their job easier you are much more likely
to land an interview. The best way to make their job easier is to include
a list of “frequently asked questions” with the letter or news release
you send them. This is a list of questions that you think listeners might
like the answers to. Chances are, whatever you find people asking your
advice about are questions that an audience would be interested in, as
well.

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Write an Article or Column

One of the best ways to establish yourself as an expert is to write
articles or a column for a newspaper, magazine, newsletter, or websites.
While it can be tough to break into large daily newspapers, there may
be an opportunity to write for smaller newspapers or local magazines.
Anything you write can be submitted online as well.

You could write on any topic related to providing comfort and support
to those with terminal illness, or propose an “Ask the End-of-Life
Doula” column where you would answer questions from readers. The
length and frequency of your column will depend on the publication.
You might produce a weekly 500-word column for a local newspaper,
or a monthly 1,000-word column for a newsletter or magazine.

Make sure your article or column provides valuable information to the

publication’s readers. As with press releases, articles that sound like
an ad for your services are not likely to get published. Write about
something in your area of expertise; for example, if you specialize in
pet death support, you could write about rituals to help heal after the
loss of a pet.

If you are hoping to get published in a newspaper or magazine, phone

the editor after you have written your first column or article to ask if
they would be interested in seeing it. If so, they will probably ask you to
email it. If they want to publish it, they may offer to pay you. However,
even if they don’t pay, you should consider letting them publish it in
return for including a brief bio and your contact information and web
address at the end of the article or column.

As well as offering articles to print publications, consider offering them

to online publications. A popular site you can use to distribute your
articles is EzineArticles at http://ezinearticles.com. Once your articles
are posted at EzineArticles, they may be published at a variety of
websites and ezines (email newsletters).

5.3.3 Networking
“I have a website, a blog, and contacts. I go to conferences,
networking meetings, meet funeral directors, nursing home directors,
pastors, physicians, clinicians (palliative care, hospice, geriatrics)

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psychotherapists, attorneys, etc. I talk to everyone about my work. I also

just got people to mentor me in business. I am putting myself out there.”
Nathalie Bonafé,
PhD, CEOLD (Certified End-of-Life Doula)
https://www.agentlerparting.com/

Networking may be a little intimidating at first but is a valuable

marketing tool and one that gets easier every time you use it. So what
exactly is networking? Simply put, it is interacting informally with
people for the purpose of finding new clients. The people you network
with can either be prospective clients, or anyone who could refer you
to clients.

Friends and Family

The first people you should network with about your business are
people who already know you. This includes your friends, family
members, neighbors, former co-workers, members of organizations
you belong to or have volunteered for, and anyone else that you have
a relationship with. These are people who are likely to be interested in
hearing about your new business because they are interested in you.

You can tell these people in person that you have started a new
business, but it can be even more effective to mail a personal letter
letting them know that you have opened a business as an end-of-life
doula business. Include a few business cards in the envelope and
encourage the recipient to pass them on to people they know who may
know someone facing a chronic, terminal, or serious illness. (Or those
with older pets with health problems, or those with aging parents who
need help caring for them, or… whatever your specialty is.)

You might assume that if a friend or acquaintance of yours knew

someone facing a terminal illness that they would have already told
you, or you would have heard about it, especially with social media
sites like Facebook. (Where it seems like people share their entire
lives…) However, many people remain silent about these life struggles,
sometimes until the very end. Even someone who seems to share his
or her entire life on social media may keep something like this a secret.

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If you reach out, you may be surprised to discover someone you know
could use your support right now.

While people who know you may send some business your way, you
can greatly increase the number of potential clients you can reach by
meeting and networking with new people.

Networking Clubs
Networking clubs typically include one member each from a variety of
industries (for example, insurance, financial planning, law, real estate,
etc.). Meetings may include a meal, an opportunity to network, and
presentations by speakers. In some clubs, each member is expected to
bring a certain number of leads to the group each week or month.

Connecting at a Networking Event

To help you strike up a conversation at a networking event,
business consultant Marg Archibald recommends using an
elevator pitch (see the following section) and developing a
tag line that you can use to quickly identify yourself and what
you do. If your tag line is interesting or intriguing people will
naturally ask you for more information. You could try something
like:

“I’m David Death Doula, and I help individuals and their

families face terminal illness with a greater sense of peace and
grace.”

Once you start talking about your business, ask others about
theirs and show an honest interest in what they do; don’t start
scanning the room for your next prospect. For the next few
minutes at least, the person in front of you is the most important
person in the room. Meeting people and getting to know them a
little better is the first step toward effective networking.

To become a member you are either recommended to the group by an

existing member or you might approach the group and ask to sit in
as an observer for a couple of meetings then apply for membership if

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you find the group is a good fit for you. You may be asked to give a
short presentation about your own business and what you can bring
to the group. The types of activities will vary with different groups,
so don’t settle on the first one you visit if they don’t seem to offer what
you’re looking for. Make sure the members represent the kind of people
you’re trying to connect with for clients, or who might know others
who would benefit from your services.

One way to find a networking club is through word of mouth. Ask

people you know who are in sales such as financial planners. You can
also look for networking groups online. Business Network International
(www.bni.com) has more than 2,300 chapters around the world. Also
consider joining a local Meetup group for entrepreneurs. Search for a
local group at www.meetup.com.

Membership Organizations
Another excellent way to network is by joining associations that
prospective clients may belong to. Some examples include:

• Business organizations such as your Chamber of Commerce or a

group for women business owners

• Service clubs such as Rotary Club or Kiwanis Club

• Organizations of any group you are already a member of, such as

alumni associations or ethnic groups

• Clubs that attract the wealthy, for example, golf, polo, yachting,
and country clubs

• Retirement clubs or caregiver support groups (if that applies to

you)

Membership fees may vary from $20 to hundreds or even thousands

of dollars (the latter if you want to join an exclusive country club or
private golf club). The more expensive clubs usually require current
members to introduce you and put you up for membership, so you
may have to join some less exclusive clubs in order to meet people who
might also belong to the more expensive clubs. Many less exclusive
clubs will let you attend a few times for a nominal fee so you can decide
if you really want to join.

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TIP: If you can put yourself in the public eye in a positive light it
will help your business. Almost all death doulas give back
to the community whenever possible. They help charities,
or they donate their time. Besides being a truly good thing
to do, providing service to the community is good for an
end-of-life doulas’ business reputations. Look for ways in
your community in which you can “give back” on behalf of
your business.

You can find organizations by asking your friends and colleagues what
they are involved with. You can also find them online. A few women’s
business organizations to look into are:

• American Business Women’s Association (ABWA)

www.abwa.org

• National Association for Female Executives

www.nafe.com

• National Association of Women Business Owners

www.nawbo.org

If you simply attend club functions without getting involved, the

value of the membership will not be as great as if you truly pitch in.
What sorts of things can you do to help out and gain the attention of
others whose good will can help your business grow? Here are some
suggestions:

• Serve on a committee

• Write articles for the association newsletter

• Volunteer to help out with the organization’s events

• Run for election to the Executive Committee

TIP: You should also join professional organizations in your

industry, such as those listed in section 3.3.3. If there is a
death café meeting in your area, go. If there isn’t, start one.
Or host a death over dinner at your home. (See section 3.3.3
again for more on these movements.) You might be able to
partner with other death doulas or an established death
midwife might be able to send work your way. At the very

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least you’ll be able to learn more about the culture of death

and dying.

“Death Midwifery is by nature, intersectional with a variety of multi-

disciplinary professions. Build relationships and network with those
people. However, this work cannot be forced. You cannot understand
something until you know it. Experience is your friend.”
Rev. Angie Buchanan
www.DeathMidwife.org

5.3.4 Your Elevator Pitch

Imagine you have stepped onto an elevator with someone who has
just asked what you do. During that elevator ride, you’ll have about
60 seconds to give a brief explanation of your business and services.
Because this person – like most other people you meet – may be
someone else who could become a client or otherwise help your
business, you want to say something to get the listener immediately
interested in you and your business.

What you would say in this situation is your “elevator pitch.” And
while most occasions to tell people about your business won’t happen
while you’re riding an elevator, a well-crafted elevator pitch may be the
single most effective, and least expensive business development tool
you can have. Your elevator pitch, like your business card, is a basic
business marketing tool. But it can be particularly powerful in helping
you generate sales. Here is advice on creating an elevator pitch from
Marg Archibald, co-author of the FabJob Guide to Become a Business
Consultant:

Whether you are speaking to a group or to a single person, the principles

of a good pitch are the same. It needs to be simple and memorable, and
because we store memories based on the emotions attached to them,
a pitch that generates feelings is going to be remembered. In business
consulting, saying something memorable that offers proof you can save
a business time or money is the strongest card you can play.

An effective elevator pitch provides people with memorable words

they can tell others and creates positive impressions that could lead to
more word-of-mouth business for you. Your elevator pitch is always

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targeted, as closely as possible, to your audience. When you’re pitching

to a group you focus on what is common to the group. Your elevator
pitch is a chance to make the group sit up and pay attention because
you connect with what matters to them.

When you are speaking to one individual, two things change. You can
tailor your pitch very specifically to that person, plus you can turn the
speech into a dialogue in less than one minute since you already have
the person’s attention. Note that the core elevator pitch is the same, but
how you fit it into a conversation changes.

Group Elevator Pitch

You have 60 seconds to connect with the group and their priorities. You
open with your name, title and company name. You briefly describe
your business and an overview of your services. The key here is to be
brief. You sketch out the things you do that would most interest this
particular group. You outline the kinds of clients you serve (ideally
clients just like them), and tell a story proving how effective you are.
This may include a quote from a happy client. You express interest in
working for them or receiving referrals. You close with a memorable
phrase, repeating your name and company. This is perfect when it is
your turn to stand up at a luncheon and introduce yourself, although it
is a bit too long in a one-on-one situation.

One-On-One Elevator Pitch

People can tune you out in 10 seconds or less. An engaging, interactive,
one-on-one elevator pitch gets the same information across that you
would present to a group but involves the listener in dialogue sooner.

First, you need to find out more about the person you’re speaking with.
Use every bit of information you can glean about the person you’re
speaking to in order to make your pitch relevant. Your observations
are providing you information from the time you approach each other.
Keep the focus on the other person.

• Where might you have met before?

• Is he or she wearing a name tag? Does it list his or her company?

Is that company one you could work with?

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• What is his or her title?

• Who has he or she just been talking to? Have you picked up any
additional information from that observation?

• How does the other person react to your name tag?

• How confident does he or she appear to be in this group?

When you initiate the conversation, you can open with: “Hello. I’m
(your first and last name) with (your company name). I don’t think
we’ve met.” Then pause to get the other person’s name and if possible
any other info on what he or she does. When the other person asks
what you do, you can follow simple steps:

Step 1 - Connection

• “I work with people like you.”

• “I work with businesses like yours.”

• “I work in your industry.”

If you know absolutely nothing about the other person, you can say, “I
work with (types of people/businesses).”

Step 2 - Promise
“I support/empower/advocate, etc. (whatever you do, very simply).”

Step 3 - Proof
“Clients say/my last client said/most people who use my services
say…”

Step 4 - Probe
Connect the proof back to the other person and how similar issues are
handled in his or her work (like if they are a hospice nurse), or how
much trouble the other person has with a particular issue: “Is this a
struggle for you too?/Do you have that problem?/How do you handle
that problem?”

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Step 5 - Close
If this is a strong prospect, you probe further and gently work toward
trying to set up a meeting. (See the sample on the next page for an
example of how to do this.)

If this is a weak prospect, you can ask if he or she knows of anyone that
might be interested in your services. Consider that every single person
you meet is a conduit to people that will be helpful even if they are not
actual prospects.

Practice Your Pitch

Armed with an elevator pitch that you have practiced until it sounds
and feels natural, you can practice on friends, family, colleagues
and acquaintances. Ask for honest feedback. Pay attention to their
suggestions and make any changes necessary to create a more effective
pitch. Once you are comfortable with your elevator pitch, you’ll be able
to use it to market your business.

Sample One-on-One Elevator Pitch

Connection
“I work with the same kinds of families you do in your work at
the hospice.”

Promise
“I support and empower individuals and families to face end-of-
life with greater peace.”

Proof
“I just helped a client recently diagnosed with pancreatic cancer
write up their advanced care directives.”

Probe
“What’s your experience with patients you encounter at the
hospice? Do they tend to come knowing their options, or do you
find they need more guidance?”

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Close
[Strong Prospect]
“I’m interested in chatting with you further. When I used to work
as a hospice nurse, I know I hoped to spend more time with my
patients to talk in more detail and offer more support. I may be
able to help some of your patients.”

[Weak Prospect]
“I’m interested in helping individuals and their families at the
end-of-life.” Insert some chatting about the target industry
and its problems, relate to his or her industry. Feel your way to
gradually asking: “Do you know anyone who might need extra
support?”

5.3.5 Promotional Events

Give a Speech or Seminar
Even if you don’t join organizations, you may still be able to connect
with their members and get new business by being a speaker. Many
organizations have speakers for breakfast meetings, luncheons,
workshops, and annual conventions.

To let people know that you are available to speak, contact membership
organizations mentioned in section 5.3.3 and ask friends and
acquaintances if they belong to any groups that have presentations
from speakers. To prepare a talk that the audience will find interesting,
consider what their needs are. For example, if you’re speaking to a
retirement group, you might talk on “How to Support Your Elderly
Parents While Taking Care of Yourself.” If you’re speaking to a cancer
support group, you might talk on “Rethinking Death and Dying: How
to Be Less Afraid.”

While you probably will not be paid for your presentations, it can be an
excellent opportunity to promote your business. Your company name
may be published in the organization’s newsletter, it will be mentioned
by the person who introduces you, and you will be able to mingle

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with attendees before and after your presentation. You may get a free
breakfast or lunch too!

Instead of or in addition to speaking for organizations, you could

present your own free seminars or workshops. You can hold it at your
office, if you have one, or you may be able to rent a meeting room
inexpensively at your local Chamber of Commerce or a local hotel or
convention center. To help you market your event you could set up
a Meetup group at www.meetup.com. Although you can ask people
to pre-register, you may get some last minute attendees if you accept
registrations at the door.

TIP: Way back when, all public speakers used easels that held a
giant pad of paper and then wrote on the paper and flipped
each page as they went along. Although many public
speakers now use overhead projectors for audio-visual
presentations, many other public speakers use presentation
software to get a point across. PowerPoint, Microsoft’s
powerful presentation software, is based on the idea of an
outline. There are bells and whistles that allow you to make
quality presentation slides, which you can then use on an
overhead or a presentation projector that hooks up to a
computer.

To get people to attend, make sure it is a topic that people are interested
in, and present it at a time that is convenient for your audience. If you
are marketing to retirees, schedule your event during the weekday
mornings. If you are marketing to the public, you’re likely to have the
best turnout on a Tuesday, Wednesday, or Thursday evening. You’re
likely to get a larger turnout for a shorter event (e.g. an hour) than one
that lasts for hours.

If you give a good talk and offer useful advice, you will be seen as an
expert. As long as there are people in the audience who need end-of-life
support services, this can be an excellent way to attract clients. On the
day that you deliver your speech, be sure you bring plenty of business
cards and brochures so you can hand them out to everyone who
attends. You’ll want people to remember you and have your contact
information if they decide they might be able to use your services.

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TIP: If you feel your speaking skills could be better, you can get
experience and become more comfortable talking to groups
by joining Toastmasters, an international organization
that helps people develop their speaking skills. To find a
Toastmasters chapter near you, visit www.toastmasters.org.

Teach a Class
Teaching a class can be a great way to earn extra money, establish your
reputation, and meet prospective clients. You don’t have to have a
degree to teach adults—just lots of enthusiasm and knowledge of your
subject. Teaching a class allows potential clients attending your class
to get to know you and your abilities and talents before they hire you.
This benefit works both ways — you get a client base from people you
know. It is an effective way to “advertise” your services — and one that
allows you to get clients who are already very comfortable with you
before they hire you.

The first step is to review the current catalog of continuing education

courses offered by local colleges, universities and other organizations
that provide adult education classes in your community. Call and
ask for a print catalog if they do not have course information at their
website. Once you have reviewed their current list of courses, come up
with some ideas for new courses. (They already have instructors for
any courses that are in their catalog.)

Once you have an idea for a new course in mind, call the college or
organization and ask to speak with whoever hires continuing education
instructors. They will tell you what you need to do to apply to teach a
course.

Community college courses you might consider putting together

include…

• advice on caregiving

• how to take care of elderly parents

• creating a legacy project (where you teach students what it is and

then guide them through the process together, like a creativity/art
class)

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• memoir writing (popular with those at the end of life)

• a course on the history and culture of death and dying

• preparing for the end of life before the time comes

Trade Shows
A trade show is an event to promote specific types of products and
services. If you have ever attended an event such as a “home and
garden show” or a “wedding show,” then you have been to a trade
show. As a death doula, you may be able to market your services to
prospective clients by participating in a health and wellness show. An
alternative wellness exhibit or spiritualty trade event may also be a
good fit.

The cost to become an exhibitor (i.e. to get a booth at the show) will
vary depending on the particular show, the location, the number of
people expected to attend, and the amount of space you require. It may
range from as little as $50 to $1,000 or more for public shows, or up to
thousands of dollars for industry shows. To cut costs, you could partner
with another non-competing exhibitor and share a booth space.

However, before investing in a trade show booth, attend the event

if possible, or speak to some past exhibitors. Find out all the costs
involved, what it includes, and what you have to pay extra for (for
example, chairs, carpet, electricity).

You can find out about upcoming shows by contacting your local
convention centers, exhibition halls, or chamber of commerce. You can
search for events by industry, type of event and location at www.tsnn.
com. For most events, you can then click on a link to find out contact
information. Many shows now have their own websites and provide
registration information as well as site maps and logistical information.

You’ll need to provide your own display. Unless you know that you’ll
be exhibiting at future shows, look for low-cost options for your display
such as getting a local printer to blow up a few photos and signs for
your booth. You should also bring business cards, your portfolio and
your company brochures for display at your booth, and be prepared to
schedule appointments with prospective clients.

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One way to attract people to your booth is with a promotional gift

such as a list of tips for caregivers. When speaking with prospective
clients, mention a few of the ideas you have for coping with the stress
of caregiving and how they can take care of themselves, as they take
care of a loved one. If you don’t have an assistant or partner, see if you
can find a friend or family member to help out at the show. The days
can be long and tiring, and you won’t want to close down your booth
to take breaks.

5.4 Selling Your Services

When you hear the word “salesperson” what do you think of? Do you
imagine a friendly, confident person who understands your needs and
is dedicated to helping you get the services you want in a way that
makes you comfortable and happy? Or do you think of someone pushy,
dishonest, and rude?

If you answered “pushy, dishonest, and rude” you aren’t alone. Many
people have a bad impression of salespeople, but to run your end-of-
life doula business, you will have to sell your services. The goal is to be
the kind of salesperson you want to be – one who projects a friendly,
confident, caring attitude – and truly helps their clients get what they
really need.

No matter what marketing techniques you use, you can expect to start
getting calls from people interested in using your services. In this
section you will find some tips for working with prospective clients
and turning them into paying clients.

5.4.1 Responding to Inquiries

Your first contact with prospective clients may be over the phone, when
they call in response to your marketing to ask about your services and
prices.

For this reason, it is important that your telephone is always answered

in a professional, friendly voice with your company name. If you
are not available, have your voice mail take a message. Do not allow
children or anyone who isn’t involved with your business to answer
your phone, and be sure to have your voice mail pick up if you are

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run¬¬ning after a screaming child or the family dog. A harried response

does not make a good first impression of your business.

Have a full packet of your promotional materials on your desk near the
phone so you can refer to them, and be sure you don’t leave anything
out. If possible, get the caller’s phone number and email address.
Then you’ll have it to enter it into your database if the caller becomes
a client. You’ll also have it if the caller doesn’t immediately become a
client but is someone you wish to keep in touch with. (Remember to get
permission before adding a prospective client to an email list.)

Members of the public calling you for the first time will typically be
searching for information about your services and what they cost.
Many prospective clients may still be unclear on what an end-of-life
doula or death midwife is, so be prepared to explain what your role is
and how you can help in a clear, concise manner.

If someone sounds like a likely prospect, you can use this first call to
arrange a face-to-face meeting to discuss your services in greater depth
than what a phone call will allow. To arrange a meeting, gently taking
control of the conversation, keep your answers concise, and focus on
what a valuable service end-of-life doulas provide — a more peaceful
approach to end-of-life. Your conversation could go something like this:

Sample Script for Telephone Inquiries

CAREGIVER: Hello. I’m looking for some information on your end-of-

life doula services. What do you do exactly?

YOU: Thank you for calling. I’d be happy to talk to you about
my work. My name is April. May I get your name?

CAREGIVER: Caregiver Cathy.

YOU: Would you prefer if I called you Cathy or Ms. Caregiver?

CAREGIVER: Call me Cathy.

YOU: Well, Cathy, an end-of-life doula offers emotional,

practical, and informational support for those facing a
life limited illness. We offer support both to those who
are sick and their family and friends. Being a full-time

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caregiver can be overwhelming, and there are so many

decisions to make at the end-of-life. We can help you
and your loved ones navigate those choices. Have you
had a chance to see my website or any information on
our company’s services?

CAREGIVER: No. I just got your number from a pamphlet I found at

the cancer center, and thought I’d call. I’m not even sure
I understand everything an end-of-life doula does.

YOU: Cathy, I’m not sure what another end-of-life doula

would tell you, but I can tell you my goal is to help you
and your loved ones approach end of life with a great
sense of peace and closure. I offer help with writing up
advanced care directives, and I can offer practical help
and physical comfort support to those who are ill. The
idea is to take some stress away from you, to help the
sick get their “affairs” in order, and even have a “good”
or better death. There is so much fear around death and
dying, but it can also be a beautiful, peaceful transition,
with the right support and planning. I offer a free one-
hour initial consultation and I’d be pleased to meet with
you to take the mystery out of what an end-of-life doula
does and to discuss options with you. I have Tuesday,
Thursday and Friday open — which day would be good
for you?

There are many ways to deliver information about your services to

clients (email, your website, brochures, etc.), but many death doulas
find the best way to sell their services to prospective clients is with a
personal meeting.

If Cathy Caregiver decides she’d rather get the information in the mail,
send it at once. Make absolutely certain you spell her name correctly
and repeat the address back to confirm it. Ask for her phone number
for follow-up purposes, mail your materials in an appropriately-sized
envelope (don’t squish them in), and make sure you use the correct
postage. Send a cover letter thanking her for her interest in your
services and tell her you will follow up within a few days. Call in a
couple of days to ensure she received the materials and ask if she has
any questions. Then ask if she would like to hire you or meet for more
information.

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The Right Attitude

Selling is a learned skill that can be simple and natural. Selling
doesn’t have to be some high-pressure sales pitch that makes
everyone uncomfortable.

Try to keep the following “mental tips” in mind as you learn

more about selling techniques:

1. Have a positive outlook about what you are selling, its

value, and your ability to deliver it.

2. There is enough business for everyone, and enough for

you to sustain your business.

3. Sell only to people who can legitimately use your

services. Never sell to anyone who you know you can’t
help.

4. Everyone you meet has something of value for you.

If it isn’t a sale, it will be a contact, a referral, or more
knowledge about how to do a better job selling to future
clients.

5. Selling is about connecting with other human beings with

integrity and friendliness. You don’t have to be pushy,
you only have to connect. It is a process of seeing how
you can develop a positive working relationship with one
another.

5.4.2 Contacting Corporate Clients

Most of your clients will be individuals, but you may find yourself
doing business with hospices or non-profit organizations that serve the
terminally ill. Many of the techniques already mentioned in this section
can help you break into the corporate market. For example, clients may
hire you after meeting you at networking events, hearing you give a
speech, or reading about you in the newspaper. However, you don’t
have to wait for clients to call you. Instead, you can take the initiative
and contact prospective clients.

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Your Warm Market

When selling to corporate clients, start with your “warm market” of
family, friends, and other people who know you. Chances are, your
warm market includes a number of people who are “decision-makers”
in an organization that could use your services. In other words, they
are in a position where they could hire your company. If not, they
may be able to recommend your services to the decision-maker. So, as
suggested in the section on networking, get the word out to friends,
family, colleagues and acquaintances that you have started an end-of-
life doula business. Tell them what your skills are and how you might
be able to help them, and show them the areas in which you can help
enhance their business.

Cold Calling
Cold calling involves picking up the telephone and calling people
you’ve never met or talked to before. Although it can be intimidating
to make cold calls, this marketing technique can be effective. Martin
Wilkins, a consultant interviewed for the FabJob Guide to Become a
Business Consultant, says, “I make 200 phone calls a week. It’s the best
way to get your name and business into the minds of the president or
CEO of that company.”

Cold calling works best for those who are confident and not too afraid
of hearing the word “no.” Because the reality is that some people will
say “no”. Some will not even give you the opportunity to say why you
are calling. However, it is also a reality that there are people who need
end-of-life doula services who don’t know where to turn – and would
welcome a call from someone who can help them. With that in mind,
look at each call as an introduction of your services – services that could
possibly help this person and organization. Here are some tips to make
your cold calling more successful.

Deciding Who to Call

Do some research and come up with a list of prospective clients. Section
5.1 offers advice on finding prospects in your target market. If you’re
considering pitching to a particular company or individual, find out as
much as you can about the company or individual, what they do, and
how they can benefit from your services.

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When making a cold call to a prospective client company, be sure to

talk with the executive or manager who will make the decision about
whether or not to use your services. In many large organizations, the
key decision-maker in each department may have the title of Vice-
President, Director, or Department Head. If the company is small, there
may be a single individual you should talk to, such as an owner or
office manager.

If you don’t have the name of a decision-maker when you call a

company, simply ask the receptionist. You might ask: “Can you tell me
the name of the person who helps train volunteers for your hospice?”
Most busy executives have administrative assistants who field calls for
them so they don’t have to talk with everyone who calls. A friendly
attitude can help you get past these gatekeepers.

Using a Script
Having a script to follow when you make a cold call can make the
difference between failure and success. A script is simply an outline of
what you want to say during your call. It’s a good idea to have scripts
for leaving a message on voice mail as well as for your first conversation
with a prospective client.

Be prepared for the fact that many decision-makers screen their calls
with voice mail. They simply don’t have time to speak with everyone
who wants their attention. If you must leave a voice mail message for
the decision-maker, consider leaving it after hours so it will be among
the first messages the person hears in the morning. Whether or not they
return your call depends primarily on how intriguing your message is.

A script shouldn’t be followed verbatim, because you’ll sound stilted

and rehearsed. Instead, use your script to organize your thoughts and
to provide you with a guideline so that you don’t leave out any vital
information. Practice the script several times before making your first
call. It will become easier the more you do it, and eventually you won’t
need the script right in front of you.

The following is a sample script. As you can see, there is room to adjust
your message according to how the conversation evolves. But having
a script will help you to sound professional and keep the conversation
on track.

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“Good morning (afternoon) Mr. /Ms. Decision-maker.

My name is April Death Doula. I’m a death midwife working in

the greater Atlanta area. I specialize in offering vigil support and
training individuals on how to support their loved ones at the
end of life.

I’ve been conducting research on local hospices, and I think

my services can benefit your organization by talking to your
volunteers and maybe offering free workshops for family
members of patients.

I’d like set up a 20 minute meeting with you at your office to

discuss how my skills can contribute to the success of your
hospice. I have a couple of openings this week. Would Tuesday
afternoon or Wednesday morning be better for you?

Thank you and I look forward to our meeting.”

As the example above illustrates, you can avoid a mistake many cold
callers make of giving the decision-maker a choice between saying
“yes” to a meeting or saying “no.” Instead, give them a choice between
two possible meeting dates. Some experts also suggest setting a time
limit – ideally no more than 30 minutes –because many decision-
makers view their time as limited.

TIP: You are much more likely to get your call returned if you say
you were referred by someone the decision-maker knows
and respects. Ask for referrals from your warm market and,
wherever possible, slip “____________ suggested I call you”
into the script after your name. Or, if you have ever worked
or volunteered there, mention that.

Calling Again
You may not get through to a decision-maker on the first call, and when
you do get through, you may not make the sale on the first try. Many
sales professionals recommend trying again unless a prospect gives
you a definite “yes” or “no.” However, the experts we interviewed
had different advice about how often to call. Some felt you should
be prepared to call five or more times to set up a meeting with your

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prospect. Others said if a decision-maker is not interested after two

calls, you should move on and invest your time elsewhere.

Assessing Your Results

Don’t worry if your first few calls don’t go as planned. Consider
them practice. Once you have been using this approach for a while,
it should generate a respectable success rate. Depending on what you
are proposing, a good success rate for setting up meetings may be one
“yes” out of every ten calls or even one “yes” out of every two calls. It
is up to you to determine if making a lot of cold calls is a good use of
your time.

If this approach doesn’t work, go back and take a hard look at your
script. Are you clearly communicating the benefits of taking the action
you suggest to the decision-maker? If you believe you are, ask someone
you respect to listen to you make some of your calls. They may discover
something in the way you communicate that could be improved.

Having Someone Phone for You

An alternative to phoning yourself is to have someone phone for you.
This can give the impression that you are already an established end-
of-life doula. Like many of us, clients can be influenced by how things
appear, and may assume you are a successful professional to have
people working for you.

One way to have someone call for you is to hire someone you pay on an
hourly or commission basis. This person might work for you full-time
or part-time, from your office or from their home. You might find the
right person through word of mouth or from a classified ad. In addition
to phoning, you might have the person you hire assist you with other
tasks as well. (Section 4.3 has more information on hiring employees
and contractors.) Another alternative is to have a friend or relative call
on your behalf. Ideally this person should have a different last name
from yours, or they should simply introduce themselves by their first
name.

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Staying Organized
An important part of cold calling is keeping track of everyone you’ve
called. When gathering information for cold calls, the amount of
information can be overwhelming. To keep yourself organized and
help ensure success, use a spreadsheet to keep track of each contact’s
name, company, and information about when they were contacted and
the results. Below is an example.

Sample Contact Sheet

Company Name/ First Second Contact Meeting
Address Call Call Name Date

You can also use software like Microsoft Outlook or FileMaker Pro
(www.filemaker.com) to create a client contact database, track meeting
dates and make notes about your meetings. Or you could use a website
such as Free CRM (www.freecrm.com), which allows you to set
up a free account to track detailed client contact information, create
company notes, calendars, task lists, and more.

5.4.3 Meeting with a Prospective Client

The fact that a busy person has agreed to meet with you means they are
interested in your services. While there is no guarantee that you will
land a particular client or project, if they have a need for your services
and are meeting with you, you have a good chance of getting their
business.

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During your initial meeting your goal should be to learn as much as

possible about the prospective client and what they want, so you can
show them how hiring you will help them cope with the overwhelming
experience of facing the end of life. In addition to arranging to get
together with prospects who call your company, you can arrange
preliminary consultations with anyone you meet (for example through
networking) who mentions that they might be able to be a source of
referrals to those facing terminal illness. You could say something like:

“Let’s get together for coffee to talk about that. I’d be happy to talk
more about death and dying culture with you, and maybe how I can
provide additional support to some of your patients/clients.”

Where to Hold the Meeting
If you are fortunate enough to have an office outside your home and it
is a nicely decorated space, by all means have the consultation in your
office. You will be close to all of the materials you’ve gathered during
your research and learning stage and will be able to answer questions
with pictures as well as words. Likewise, if you have a home office that
is nicely decorated and free from interruptions (i.e. no children, barking
dogs, etc.) and you are licensed to have a home-based business, you can
have the meeting there.

If, on the other hand, you do not have either of these spaces available
to you, you should meet at a spot you know will allow you to have
a private and uninterrupted conversation. This could be the client’s
home or office or a quiet room in a tea house or restaurant. You may
also meet a client or caregiver at the bedside in a hospital or hospice. If
so, be sure you get all the information you need for visitors. You may
need to sign in or provide room number details to the front desk. The
café or cafeteria in a hospital or hospice may also be a possible meeting
location.

Preparing for the Meeting

During your initial meeting, the client will be deciding whether or
not to hire you. It is therefore important to remember that the client
will be making judgments about your professionalism based on how
you look and behave. Make sure your clothing and grooming are

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impeccable, arrive on time or a few minutes early, and make sure you
have everything you need.

What you wear to the first meeting should be dictated in part by the
type of client you are meeting. For instance, a navy suit that you would
wear to a meeting with the president of a hospital may be too formal
for a meeting with a spiritual yoga instructor looking for support with
his personal terminal illness diagnosis. When in doubt, wear a two-
piece suit (pants or skirt with jacket) over a shirt or sweater so you can
remove the jacket if necessary. Business casual may be even better, for
meeting with an individual. To express your creativity, you can add a
funky accessory such as jewelry, a scarf or tie. (Note: If you’re meeting
with a caregiver next to the bedside of a confused patient, do not wear
long, flowing clothing. They may see the fabric ripples and think you
are a ghost, and this can cause distress.)

Remember your mother’s advice: You only get one chance to make a
first impression. Yours should say professional, forward thinking, and
creative.

Over time you will develop your own checklist of what to bring to an
initial consultation. In the meantime, here is a list of items to bring:

• Your business cards

• Your brochure (see section 5.2.1)

• Your portfolio (see section 5.2.2) OR reference letters from past

clients (family or friends included)

• A notepad and two pens

• A calculator

• Optional: a laptop computer

• A client questionnaire (see section 2.4)

• A planning calendar or PDA

• Blank contracts (see section 5.5)

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Although this initial consultation may be seen only as an opportunity

for the client to assess whether they want to hire you as their end-of-life
doula, it is a good idea to come prepared to write up a contract.

What to Say
As mentioned above, while there is no guarantee that you will land a
particular client, if someone has a need for your services and is meeting
with you, you have a good chance of getting their business. Your
purpose during this meeting is to turn a prospective client into a client.
The way to do this is by identifying what your client needs and wants,
so you can communicate how your services will benefit them.

Fine-Tuning Your Communication Style

The face-to-face meeting is where your interpersonal
communication skills will really pay off (see section 3.1.3 if
this is an area you need to improve). Becoming aware of your
mannerisms, your behaviors, and your unconscious habits is a
sometimes uncomfortable realization. Everyone has mannerisms
that are part of who they are, it is just when those mannerisms
become constant or magnified that they can become a problem.
Think about your friends. Don’t you know at least one person
with a truly grating voice, or a phrase they always repeat? Being
aware of your own mannerisms is an excellent way to begin to
see yourself as others see you.

On the other hand, there are many positive ways you can express
yourself to clients. You can let your own best qualities shine
through, you can be charming and personable or friendly and
caring — all things that clients like and remember. People like
friendly business relationships — and the clients you work with
as a death midwife are no exception.

Recording yourself using a video camera is an excellent way to

get a sense of how you appear when you are speaking in front
of a group. Use a tripod to secure the camera in one place, and
place the camera so that the shot includes your whole body to
observe any mannerisms you may be unaware of.

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You can begin by giving a quick overview of your services, however,

during your meeting you should mostly ask and listen. Aim to have
your client do about 80% of the talking. Of course, take your cue from
the client. If they prefer not to do a lot of talking, don’t try to force it.

Instead of simply describing all your services, focus specifically on what

the client wants. Of course, you shouldn’t tell clients every detail how
to put together advanced care directives themselves, unless you have
been hired. But you could offer a few ideas for without worrying about
them deciding not to use your services because they feel they don’t
need your help anymore. Being willing to share a few compassionate
thoughts and suggestions will leave the impression that you have many
more which you haven’t shared.

The issue of money, and if your fees and service are worth the cost,
is bound to be raised either on the phone or at the meeting. If you
followed our script for the telephone call you have already planted the
seed in the caregiver’s head that you will take much of the stress and
fear away, and hopefully, you won’t have to justify your fee during the
consultation.

If you do get involved in this conversation, remember to focus on the

benefits of your services, which include:

• You can help the dying individual face death with a greater
sense of peace, comfort, and resolution. People are often afraid of
“being a burden” on others, and the planning and extra support
can reduce these feelings. Also, things like legacy projects or
discussing “unresolved” conflicts can occur with guidance, and
this can help the dying face death with more peace.

• You can actually save them money because if they plan ahead
for burial and funeral options, they can make those decisions
when they have time and space to consider what they all really
want. Sometimes when someone dies, there is this pressure to
“spend money” to show their respect and love for the dead… but
when the dying individual can make those choices or be a part of
the decision making process, it’s less likely to lead to emotional
buying decisions.

• You can save them the anguish of having to make end of life
decisions themselves during a crisis, when these choices can be

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made with the dying individual. The next of kin won’t be put into
a position of wondering if they should or shouldn’t offer tube
feeding, or should or shouldn’t continue life support.

• You can provide a tremendous amount of relief and reduce stress

by offering practical help with respite care, or by sitting by the
ill’s bedside and offering active comfort and conversation, so the
primary caregivers can have time to themselves or to attend to
other household needs that have been neglected.

• You can help them rethink what it means to die and approach the
natural life transition with a sense of awe and spirituality. You can
also offer rituals and comfort to help with the grieving process.

Remember to focus on what the individual wants. Ask them why they
are interested in hiring an end-of-life doula, and what they think an
end-of-life doula can do for them. They may talk themselves into hiring
you!

Following Up
After this initial meeting, make sure you follow up with the client.
Decisions can take time, especially when there is more than one person
involved in deciding whether to hire you. Keeping in touch ensures the
client keeps you in mind. After the meeting, you can send the client a
proposal letter summarizing the points you addressed in your meeting.

When you get the good news that a client wants to work with you,
you’ll be putting other parts of this guide to use, starting with sending
out a contract as described in section 6.5.

5.4.4 Preparing a Proposal

A proposal is a written document outlining what you propose to do for
a client. In some cases, a proposal can be as simple as a short letter. In
other cases, where a client uses a formal “Request for Proposal” or RFP
process as described below, a proposal may be a detailed document
that is dozens of pages long. (This is more common with a corporate
client.)

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If you have done an effective job of identifying the client’s needs

during the meeting, the proposal should simply put in writing what
you agreed to during the meeting. However, you may occasionally be
asked to prepare a proposal when a client is not seriously interested in
doing business with you. So before you invest hours in preparing the
proposal consider whether or not it is a good investment of your time.

Why Clients Ask for Proposals

Sometimes the request for a proposal may come unexpectedly from
a client you haven’t approached. The beginning end-of-life doula
typically thinks this is great news! After all, why would they ask for
a proposal if they were not interested? Actually, there are a number of
reasons organizations ask for proposals:

It May Be a “Brush Off”

This scenario may happen when you have approached a prospective
client. Some clients find it difficult to say “no” and want to avoid a
confrontation. They can delay saying no by having you submit a
proposal. The client can then say “they are thinking about it” until you
either give up or they finally work up the courage to tell you they are
not interested.

It May Be Used to Confirm a Hiring Decision

Some clients ask for proposals because they want to have written
comparisons of several death doulas. (If you happen to live in an area
with many options!) Often, they have a “preferred” doula they want to
hire, and the purpose of the written proposal is to help them confirm
their decision.

TIP: If you are the preferred doula, you will know it. The client
will have discussed the project with you in detail, and you
will have reached a tentative agreement to do the work. If
it’s a corporate client, they will explain that their regulations
require them to review written proposals and may even
assure you that it will be “just a formality.”

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If you are the preferred doula and you want the job, then it is worth
your time to put together a proposal confirming the details you have
discussed with the client. This can be in the form of a proposal letter
or engagement letter (described in section 5.5). Otherwise, your time
might be better spent focusing on clients who are seriously interested
in you.

Prospects who approach you will not generally start off by asking for a
proposal if they are seriously interested in working with you. If they do
need more information, they will usually want to discuss it first. If you
suspect that a prospective corporate client is not serious, but don’t want
to miss out on what could potentially be a good opportunity, you might
try what some other consultants do when asked for a proposal. They
charge a “proposal preparation fee” such as $150 which is deductible
from their fee if they get the job. However, you can’t expect to get this
fee if you are responding to a formal RFP as described in the next
section.

Requests for Proposals (RFPs)

Wikipedia.org defines a Request for Proposal or RFP as “an invitation
for suppliers, often through a bidding process, to submit a proposal
on a specific … service.” An RFP process may be used by large
organizations such as a corporations or government departments to
get written proposals from businesses and consultants that wish to
become “suppliers” and get hired to do work for the organization. The
companies that submit proposals are known as “bidders.”

An RFP typically has information about the organization that is

requesting proposals, some background on the planned project, how
and where to submit your proposal, how the proposal should be
formatted, and what specific documents and other materials need to
be included. An RFP typically asks bidders to submit a proposal that
contains the following:

• A description of your company

• The services you propose to provide

• Evidence of your capability to provide the services

• Details about how you will provide the services

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• A proposed timetable

• A fixed price quotation

• Specific resources (including people) that you will assign to the

project

• References from organizations you have provided similar services

for

• An explanation of how you will measure results

The RFP may also include the project’s proposed budget and time
frame, eligibility requirements for those wishing to submit a proposal,
and information about the client’s selection process. The bid process
may also require you to make an oral presentation.

When pricing your services for a proposal (see section 4.2.5 for advice
on setting your prices), keep in mind that the client may not be
obligated to award the contract to the lowest-cost bidder. Instead, they
may make their decision based on a number of factors, including the
bidder’s previous experience with similar projects.

TIP: To avoid a costly mistake, your proposal should specify

anything that is not included. For example, if you were
proposing to train future hospice volunteers, you should
mention that your proposal doesn’t include interviewing
or managing all the paperwork (like getting fingerprint
clearances) for those volunteers. You’re just offering the
training.

How to Find RFPs

If your company becomes well known, RFPs may come to you. Just
as corporations may contact you to ask you to submit a proposal, you
may be contacted directly by departments and agencies that invite you
to reply to an RFP. However, you will first have to make them aware
of your services, using some of the techniques described earlier in this
chapter.

As a beginning end-of-life doula trainer, you are more likely to get

RFPs by finding them posted online. The U.S. government offers free
access to RFP information at FedBizOps (visit www.fbo.gov), while

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the Canadian government offers RFP information at www.merx.com

and advice on how to do business with the government at https://
buyandsell.gc.ca. Find RFP (www.findrfp.com) posts RFPs for all
levels of government in the U.S. You can try it out free for one week
and get a subscription for $19.95 per month for a regional plan or
$29.95 per month for a national plan; discounts are available for annual
subscriptions.

Submitting a Proposal
When responding to an RFP you should follow the instructions exactly.
To improve your chances of getting the job, make sure you emphasize
your experience directly related to their needs, and include written
references. The description of your company should also include any
relevant information about the backgrounds of yourself and other
representatives of your company who will be working on the project,
including education, experience, professional memberships, and
pertinent awards.

The decision-makers who will be reviewing your proposal need

evidence that you are ready and able to handle their needs. They want
to know that you have the qualifications to successfully carry out
the project. This is where it really pays off to have acquired as much
relevant experience as possible using the techniques described in
section 3.2 of this guide.

TIP: If there are skills or experience that you don’t have, consider
partnering with someone who has the necessary skills or
experience.

Even if you decide not to respond to RFPs, you can prepare proposals
for clients you have met with that have indicated they are potentially
interested in working with you but require more information. However,
while a formal proposal in response to an RFP may be up to 25 pages
or more, you can prepare much simpler proposals for most prospective
clients.

In some cases, a proposal can be as simple as an engagement letter, as

discussed in section 5.5. In other words, you describe what services you
will provide based on your discussions with the client. The client signs
the letter, and you start working for the client.

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Proposal Resources
A number of companies specialize in writing proposals. You can find
them by doing a web search for “writing proposals” and “contract.”
Bizfilings.com offers many valuable resources with advice on proposal
writing and government contracting at www.bizfilings.com/toolkit/
sbg/run-a-business/govt-contracts/negotiated-solicitations-for-govt-
contracts.aspx. Onvia is another resource for further information. In
addition to a paid subscription to receive RFP leads, they offer excellent
free advice which you can find by going to www.onvia.com/business-
resources/articles/proposals-and-bids.

Recommended books on proposal writing include Proven Proposal

Strategies to Win More Business by Herman Holtz, Persuasive Business
Proposals: Writing to Win More Customers, Clients, and Contracts by Tom
Sant, and Win Government Contracts for Your Small Business by John Di
Giacomo and James Kleckner.

5.5 Client Contracts

A contract is vital. It can help avoid misunderstandings by ensuring
you and your client have the same expectations of the work to be done.
It may also protect you. For example, if the dying individual who hires
you is not able to express their wishes, and a family member doesn’t
want your services any more, having a contract in place can help you
get paid.

Your contract or agreement should explain what services you will

provide for the client and how you are to be paid. Your contract may
include all of the following:

• Your name, company name, address and contact information

• The client’s name, company name (if applicable), address and

contact information

• Description of the services being provided

• When the services will be provided

• Any services not being provided

• Fees,including payment terms, deposits, and reimbursement of

expenses
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• Cancellation policy

• Signature lines for you and the client

On the pages that follow you will find two samples. You can adapt
these contracts to fit your needs. The first is a sample engagement letter
you might use with an individual client. You could ask your clients to
sign it at your initial meeting, or have them return it to you later.

The second is a services agreement which you could adapt for use with
a corporate client. It covers a number of additional areas, such as a
liability disclaimer.

Before using any contract, make sure you have it reviewed by your
lawyer to ensure it protects you and meets your particular needs.
For example, even if you will only be working on small projects for
individuals, ask your lawyer about including additional clauses in your
engagement letter, such as a limitation of liability clause.

Sample Engagement Letter

(On Your Letterhead)
[Insert name of Client]
[Insert address of Client]
[Date]
Dear [Name of client],
As promised, I have set out below a description of the services
that [your name/company] will provide to you.
I will provide the following services:
[Insert somewhat detailed description of the services, such as
consultations with the client, a particular number of hours of respite
care, rituals or vigil planning, or active vigil support, etc.]
My fee for the services performed will be as follows:
[Insert rates, amount of deposit, etc.]

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FabJob Guide to Become a Death Doula

In the event that services cannot be delivered as planned, the

following payment agreement is in effect…
[This especially required for services like active vigiling, since a client
may pass quickly without you ever having a chance to sit by their
bedside and offer support. However, you will likely have offered other
services like consultation or on-call support, or have a future service
waiting like a processing consultation meeting scheduled for a few
weeks after death. So you should still be paid a portion of the original
agreed upon fee. Being as clear as possible in the contract about how
this situation will be handled is a must.]
If you agree that the foregoing fairly sets out your understanding
of our agreement, please sign a copy of this letter in the space
indicated below, and return it to me at
[insert address or email address].
Yours sincerely,
[Name]

Agreed and Accepted:

__________________________________
[Insert name of client]
__________________________________
Date

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Sample Services Agreement

THIS AGREEMENT is made this [date] day of [month], 20__.

BETWEEN
[insert name of your client] (the “Client”); and [insert your name
or your company’s name] (the “End-of-Life Doula”), collectively
referred to as the “Parties.”

1.1 Services
The End-of-Life Doula shall provide the following services
(“Services”) to the Client in accordance with the terms and
conditions of this Agreement: [Insert a description of the services
here].

1.2 Delivery of the Services

Start date: The End-of-Life Doula shall commence the provision
of the Services on [insert date here].

Completion date: The End-of-Life Doula shall complete the

Services by [insert date here] (“Completion Date”).

Key dates: The End-of-Life Doula agrees to provide the following

parts of the Services by the specific dates set out below: [insert
dates here if you have agreed to specific milestones].

1.3 Fees
As consideration for the provision of the Services by the
Consultant, the fees for the provision of the Services are [insert
fees here] (“Fees”). The Client shall pay for the End-of-Life
Doula’s out-of-pocket expenses including [insert here] and other
expenses as agreed by the Parties.

1.4 Payment
The Client agrees to pay the Fees to the End-of-Life Doula on the
following dates: [e.g. 50% deposit payable before work begins; also
specify whether the price will be paid in one payment, in installments
or upon completion of specific milestones].

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The End-of-Life Doula shall invoice the Client for the Services
that it has provided to the Client [monthly/weekly/after the
Completion Date]. The Client shall pay such invoices [upon receipt/
within 30 days of receipt] from the End-of-Life Doula.

Any charges payable under this Agreement are exclusive of any

applicable taxes or other fees charged by a government body and
such shall be payable by the Client to the End-of-Life Doula in
addition to all other charges payable hereunder.

1.5 Warranty
The End-of-Life Doula t represents and warrants that it will
perform the Services with reasonable skill and care.

1.6 Limitation of Liability

Subject to the Client’s obligation to pay the Fees to the End-
of-Life Doula, either party’s liability arising directly out of its
obligations under this Agreement and every applicable part
of it shall be limited in aggregate to the Fees. The End-of-Life
Doula assumes no liability due to the quality of items or services
purchased for the Client.

1.7 Term and Termination

This Agreement shall be effective on the date hereof and shall
continue until the completion date stated in section 1.2 unless
terminated sooner. If the Client terminates this agreement for
any reason before the scheduled completion date, the Client will
reimburse the End-of-Life Doula for all outstanding fees and out-
of-pocket expenses.

1.8 Relationship of the Parties

The Parties acknowledge and agree that the Services performed
by the End-of-Life Doula, its employees, sub-contractors, or
agents shall be as an independent contractor and that nothing in
this Agreement shall be deemed to constitute a partnership, joint
venture, or otherwise between the parties.

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1.9 Confidentiality
Neither Party will disclose any information of the other which
comes into its possession under or in relation to this Agreement
and which is of a confidential nature.

1.10 Miscellaneous
The failure of either party to enforce its rights under this
Agreement at any time for any period shall not be construed as a
waiver of such rights.

If any part, term or provision of this Agreement is held to be

illegal or unenforceable neither the validity or enforceability of
the remainder of this Agreement shall be affected.

This Agreement constitutes the entire understanding between

the Parties and supersedes all prior representations, negotiations
or understandings.

Neither Party shall be liable for failure to perform any

obligation under this Agreement if the failure is caused by any
circumstances beyond its reasonable control, including but not
limited to acts of god, war, or industrial dispute.

This Agreement shall be governed by the laws of the jurisdiction

in which the Client is located.

Agreed by the Parties hereto:

Signed by: _________________________________________

On behalf of: ________________________________________

[the Client]

Signed by: _________________________________________

On behalf of: ________________________________________

[the End-of-Life Doula]

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6. Conclusion
Congratulations, you have reached the end of this guide to becoming
an end-of-life doula. If you’ve taken the advice to heart, begun building
your skills, and have gotten the planning and legal issues put into place
for starting your death doula business, then you’re ready to start. Yes,
you’re ready. You may not feel ready. You may feel like you need a little
more training, a little more volunteering before you ask for money, a
little more time. This may be true—after all, you should be sure you’ve
put in the time necessary to learn how to do this job before you dive in.

However, all that said, most people delay starting for longer than they
should. They attend a death doula training—but decide they need one
more training to really know what to do. Or, they have volunteered as
a death doula for months, possibly years, but decide they should really
volunteer a bit longer before they start doing this as a career.

I’m here to tell you that assuming you’ve put in your due diligence, you
are ready to start now.

Some people never feel “ready” or “prepared” enough. But the only
way you’ll learn is by going out there and doing the work. You will

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learn with every client. This is true when you start and will be true even
after you have years of experience.

I’d like to end this guide with words of encouragement, wisdom, and
advice from some successful end-of-life doulas and death midwives.
Let their words inspire you and be a source of support for you as you
begin this amazing journey.

“It’s going to be really exciting to see how the profession of the end-of-
life doula develops. Ideally, there will be a very diverse pool of EOLDs in
each community to serve the diverse populations they contain. The more
doulas there are, the more people there will be having doulas! My advice
to new EOLDs is to think creatively about how to keep learning, and
how to work collaboratively with as many end-of-life service providers as
you can. Keep educating those around you! We must all work together to
create compassionate communities. Health and wellbeing at end-of-life
is everyone’s business.* I believe that doulas can and will play a big part
in ensuring quality of life right to the end. But don’t be discouraged; the
world does not know about us yet. Turn to resources like the National
End-of-Life Doula Alliance (www.nedalliance.org) for support and
sustenance as you forge your path toward serving dying individuals
and their families. It can feel lonely at times, but there is a big swell of us
out there all working toward the same goals.”
Merilynne Rush,
MS Hospice and Palliative Studies,
BSN, Lifespan Doula Association,
Ann Arbor, Michigan
https://www.lifespandoulas.com/
President,
National End-of-Life Doula Alliance (NEDA)
http://www.nedalliance.org/

“Finding your way as an End-of-Life practitioner is not a linear path.

Trust your intuition. Let your practice unfold organically.”
Toula Saratsis
End-of-Life Doula/Palliative Care Advocate

[*Allan Kellehear; Compassionate communities: end-of-life care as everyone’s

responsibility, QJM: An International Journal of Medicine, Volume 106, Issue 12, 1
December 2013, Pages 1071–1075.]

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“You be you. My experience is that most who choose to become end-

of-life doulas do so because they have a consciousness, magnetic pull
within, calling, and/or knowing of this work that is beyond words. When
we listen to that still small voice within and open ourselves up to serve
from a place of love, compassion, humility, skill, and integrity, we are
truly sacred servants for others, as well as for ourselves. I hope aspiring
death doulas will always remember that we are valued professionals
who have much to share and empowering our clients to support our
work through financial remuneration or other exchanges of energy, is
important for all involved, as well as the future of our profession.

“I also hope all of us remember that we are a reflection of one another

and when someone wears the title of “end-of-life doula” or “death doula”
it reflects on my work too. With this being an emerging field, among
other things, I have a vested interest in each and every end-of-life doula
being the absolute best they can be. It serves all of us to remember that
the death rate is currently 100% so there are plenty of folks out there
who could choose to benefit from our assistance. I believe we are not in
competition with one another; encouraging and assisting one another
as we are able, helps us all and our profession as a whole. I encourage
all end-of-life doulas to engage in community with other end-of-life
practitioners for guidance and continued support.”
Nada Frazier,
Certified End-of-Life Doula,
Mentor & Trainer and Founder of The Sacred Servant
www.thesacredservant.com

“If it is difficult to begin this work, remind yourself why you are doing
it. Always come back to your ‘why’, move forward in that spirit, and you
will succeed.”
Emily Cross, End-of-Life Doula
www.steadywaveseol.com

“You have no idea how powerfully your presence, caring and support
will impact another who seeks your services. It is life-changing even as
another’s life is ending.
Please own this.

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“At those times when you doubt yourself, your skills or your ability to
make a living if you choose this as your life’s work—do remember those
moments when someone said... ‘I could not have done this without you,’
or ‘you have changed my life.’
Please believe this.
“The world needs your unique, signature brand of serving and wants
you to show up for this!”
Patty Burgess,
President of Possibility Teaching Transitions -
Doing Death Differently
https://doingdeathdifferently.com

“Be patient with yourself and your process. Be open to supporting

clients in ways other than you think they might need.”
Alua Arthur,
End-of-Life Doula
www.goingwithgrace.com

“Have mentors!! Connect with other doulas. Keep reading and learning
and taking classes and talking to people. Do not be afraid to do it!
Merilynne [of Lifespan Doula Association] always reminds me that I am
ready, to just do it, the rest will unfold as it is supposed to. Don’t let fear
hold you back! My first doula experience, I was fortunate to be with/work
with two other doulas. We formed a collective. It was really powerful
and helpful. It is nice to have back up, to not feel like you have to do it
alone. It was a great entry into my first experience. It made me realize the
possibilities and made me understand the complexities, uniqueness and
needs of each person’s situation that you (could) doula for!”
Jess Kilbourn,
Certified End-of-Life Doula and Licensed Massage Therapist
https://mkt.com/jessica-kilbourn

“Every death is as different as the individual experiencing it. That sacred

space is filled with meaning, and it can surprise or even blindside you.
Be prepared for anything. Protect your own heart, but keep it open—to
the dying, the grieving, and the rest of the world.”
Beth Mosley,
Death Midwife

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“My mother passed just last month in October. I sat with her daily for 22
days in an inpatient hospice facility. It was my ‘final exam’ in this work
as a doula. I learned so much, and I realized the value of assisting the
family members on this journey. I realize that this transition is as much
about the patient as the family. I sat and reviewed my life alongside my
mother. I healed so many wounds. I spoke directly from my heart and
chose to be fully open and vulnerable in ways I had never been. I have
no unfinished business. It was completely exhausting and rewarding in
ways I cannot express.

“After her passing, I have yet to return to my Hospice work. I have

not yet felt that internal call. I am still working with cancer patients
thru meditation. Teaching them to harness the power of imagination
and internal dialogue to aid in healing physically and or emotionally.
Imagination is your connection with your own source.

“In fact, I just got off the phone with a client. They are unaware I am a
doula for the dying, which is perfect because they are in total denial they
are dying. We will come together and work under the disguise of healing.
Healing has many faces. Emotional healing is the most profound of all
healings. It moves mountains. And who knows, anything is possible. The
choice to live or die is a personal one. And so I will begin this journey at
their side. Supporting them.”
Carol Neustadt,
Certified End-of-Life Specialist (CEOLS)

“Over time I have come to realize that being a death midwife - a death
worker, is less about an affinity for death and more about a passion for
life. There is a freedom to live that is created through the steps that can
be taken as we consciously prepare for death. We release some degree
of fear, we express beliefs and wishes, and sometimes we give voice to
our capacity to be with the unknown in such a way that we can face
it with a bit more grace. And in that...we find peace and even joy. As
a death midwife, perhaps that is the essence of the work: Supporting
a connection to peace and joy through times that are also filled with
profound sadness. This is deep work. It is courageous work. It is work of
mind and heart that is timeless and fulfills an unending need to bring
awareness and grace to all stages of life... right through the last breath.”

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Patricia Ballentine,
Death Midwife, Ordained Minister and Priestess
www.TheCreativeFlame.com

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 Earn a Certificate in Your
Dream Career
The next time someone asks you “Why should I hire you for your
dream career?” or “What are your credentials?” imagine being
able to say: “I am a trained professional with a certificate from
the International Association of Professions Career College!”

Benefits of Having a Certificate in Your

Dream Career
A certificate from the International Association of Professions
Career College (a division of FabJob) may give you:
• Respect as a professional plus a sense of confidence
and achievement
• A competitive advantage when marketing your services 
• A credential for your resume when applying for
employment
• Assurance to clients of your professionalism and
evidence of your expertise
• Higher earnings (according to the U.S. Bureau of Labor
Statistics publication Certificates: A fast track to careers)

Now that you’ve read

this FabJob guide, which
is the textbook for the
certificate course, you
can earn a certificate in as
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Continued on next page

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• Caterer • Hair Salon Owner
• Chocolate Shop Owner • Handyman Business
• Cleaning Business Owner • Home Decor Store Owner
• Closet Organizer • Home Stager
• Coffee House Owner • Human Resources
• Craft Store Owner Consultant
• Dance Studio Owner • Ice Cream Shop Owner

• Daycare Owner • Image Consultant

• Dog Daycare Owner

• Dog Walker

• Doula Business Owner

Continued on next page

• Interior Decorator • Public Relations
Consultant
• Interior Redesigner
• Relationship Coach
• Jewelry Designer
• Restaurant Owner
• Kitchen Store Owner
• Secondhand Store Owner
• Landscape Company
• Social Entrepreneur
• Life Coach
• Social Media Consultant
• Lifestyle Expert
• Spa Owner
• Makeup Artist
• Stationary Store Owner
• Matchmaker
• Tea Room Owner
• Motivational Speaker
• Time Management
• Nail Salon Owner
• Travel Consultant
• New Age Store Owner
• Virtual Assistant
• Nonprofit Business
Owner • Web Designer

• Organic Farmer • Wedding Planner

• Party Planner • Weight Loss Center

Owner
• Party Store Owner
• Wellness Coach
• Personal Assistant
• Wine Store Owner
• Personal Chef
• Winery Owner
• Personal Concierge
• Yoga Studio Owner
• Personal Shopper

• Pet Hotel Owner

• Pet Sitter

• Pet Spa Owner

• Professional Organizer

• Professional
Photographer