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Please note: the
term 'death midwife' is used by various
alternative death-care
providers (who may or may
not provide services throughout the whole
of the pan-death process), and with
somewhat varied meanings. Our
organization can only make assertions about
those Death Midwives who have been formally
recognized by CINDEA.Therefore,
all uses of the term 'death midwife' on
the CINDEA site will refer to either
a CINDEA-recognized one or the equivalent.
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Death
Midwifery
CINDEA's
summary definition of Death Midwifery
In
the simplest sense, a modern-day Death
Midwife is a facilitator, who offers a
continuum of direct and integrated guidance
and support to the Death Journeyer and
their family throughout a personalized
and participatory pan-death process.Although
traditionally this role was considered
women's work, today men also serve as
Death Midwives (as they
also do as Birth Midwives).The
CINDEA definition seeks to honour
and parallel the role of a Birth Midwife
— while acknowledging that the comparable
aspects to the medical side of a birth
midwife's responsibilities are presently
offered by palliative care nurses, doctors,
physiotherapists, etc. [see
Parallels
between a Birth and Death Midwife
below]
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Definition
of a CINDEA-recognized Death Midwife's
Role
A
Death Midwife's primary roles are to:
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provide
information on various options throughout
the pan-death process (especially
those which are alternatives to the cultural
norms or less institutionalized), advance
planning issues, necessary
documents (death certificates,
permits, etc. and filing them), and
other support resources in the community |
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support
the exploration of options that are most meaningful
to the Death Journeyer/family, and how to
fulfill them |
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guide
the family through whatever family-based/at-home
options they choose, as well as support them
in the any that may or may not include the
use of a Funeral Home for specific individual
services if needed, such as transporting the
body (according to their choice) |
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provide
in-person emotional and spiritual support,
or facilitate access to specialists who can
do so |
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generally
support, and advocate for, the wishes of the
Death Journeyer and their family throughout
all of the pan-death stages [see
7
Stages on the Pan-Death Movement page]
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Expectations
of a CINDEA-recognized Death Midwife
CINDEA
expects a Death Midwife to:
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provide
information about, and access to, appropriate
services in the community; |
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work
with the Death Journeyer and their family
— as 'gatekeeper' — to arrange the
best way to provide visitation access for
family members and friends; while at the same
time protecting the Death Journeyer's privacy,
need for rest, etc.; |
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journey
with (or witness for)
the Death Journeyer and their family throughout
the whole pan-death process; and
provide a continuum of integrated service
(to the degree that they wish)
—
which may be unavailable within the current
split between pre- and post-death services; |
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—
as well as integrate all of the values listed
under Values
of the Modern Pan-Death Movement |
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Web
of Facets of Pan-Death in the Role of a Death
Midwife
 |
Please
click on the thumbnail to the left for a full-size
view of the web of facets.
The
inner blue ring in the web indicates the
facets of pan-death care that a Death Midwife
will support the family to do — and
that is their primary responsibility.The
outer green circle represents the additional
elements of developing pan-death care that
CINDEA encourages our recognized
Death Midwives to participate in —
although some practitioners may focus more
on certain facets than others.
For
more specifics on the full range of pan-death
care, please see our pages on Advance
Care Planning, Post-death
care/Home Funerals, and Greening Death
(the last one upcoming).
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Advantages
of a Death-Midwifed Pan-Death Process
While
other alternative death-care providers (see
list on the Modern Pan-Death Movement page)
may or may not offer all of the services in the
Web of Facets above, a CINDEA-recognized
Death Midwife is required to provide all of the
inner green circle — either directly, or
by having enough knowledge to both supply general
information and recommend any specialists that
might be required (supportive Funeral
Homes for individual services, grief counsellors,
etc).The
primary advantage of this role — besides
offering a comprehensive range of direct services
— is the continuum provided to the Death
Journeyer and family throughout the whole of the
pan-death process.
Disconnection
of supports and services
The modern pan-death process
is becoming exponentially complex.More
kinds of medical intervention and support services
are available; families are living at greater
distances from each other and often having chosen
very different lifestyles and traditions (even
being estranged); etc. [see
more under
Development of the Modern Pan-Death Movement.]
| Most
people no longer live in communities/neighbourhoods
where |
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there
are common cultural and religious traditions; |
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most
of the family members live close by; |
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neighbours
have known each other for decades; and |
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it can be reasonably assumed what choices
will be made and what support is needed (and
given, often without even being asked). |
General
Practitioners usually handle the overall direction
of the Death Journeyer's medical care, but often
have too many clients to be able to offer more
than their medical expertise.Although
the advent of hospice societies and palliative
care teams has made a very significant difference
to a Death Journeyer's ability to stay at home
(and most people, though not all,
would prefer to) — and to their caretaker's
ability to make that possible — it is not
yet viable for these teams to provide the same
range/kinds of care (particularly
the non-medical ones) in all local areas
of the country.As
a result, there may not be anyone — except
perhaps a solitary caregiver 
who fully understands the whole situation surrounding
the Death Journeyer's dying/death.
| Continuum
provided by a Death Midwife Especially
if a Death Midwife is hired soon after a terminal
diagnosis or has been consulted in EOL Advance
Planning, they will be aware of |
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what
issues arise for the Death Journeyer as they
contemplate their imminent death — which
can be substantially different depending on
their specific situation (such
as their particular practical, economic/professional,
spiritual, emotional, or personal values,
ethnic/cultural traditions, etc.); |
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the
choices/wishes of the Death Journeyer and/or
their families for the ongoing pan-death process,
and the personal values that those are based
on; |
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the
family dynamics, what issues or concerns are
arising as the result of this imminent death
and how they are being handled, and what influence
that has on the Death Journeyer and/or their
primary caretakers; |
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the
nature of the ethnic or cultural environment,
faith or professional community, etc. of the
Death Journeyer; and how it may influence
their choices or provide extra support; and |
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the
particular services provided by hospice/palliative
care. |
This
awareness of the Death Journeyer's situation means
that the Death Midwife can support the family
throughout the pan-death process, without the
family having to repeatedly explain what
their wishes/choices are and why to various
providers (for example, separate
providers for anticipatory-grief counseling and
post-death care).
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continuum may be especially significant, if
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the Death Journeyer's situation is complicated; |
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there are only a few family members and friends
available to help; and/or |
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the Death Journeyer chooses a 'self-aware
death' (also called 'conscious
dying' - ongoing self-exploration in the context
of imminent death, and preparation for it),
which might lead to significant changes in
their original end-of-life choices. |
In
short, the Death Midwife can be someone who is
always available as a helping hand, a listening
ear, and a mind that keeps track of all the individual
details needed to make the pan-death process as
ideal as possible for the Death Journeyer and
all the people who love them.
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Recognition
from CINDEA
If
you are interested in receiving recognition from
CINDEA as a Death Midwife, please click
on CINDEA
Recognition and then go to on General
Requirements for, and Questionnaire
to become,
a CINDEA-Recognized Death Midwife.
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Parallels
between a Birth and Death Midwife
Information on
Birth Midwives taken from Wikipedia
We
recognize that a Death Midwife's role (as
recognized by CINDEA) cannot exactly
parallel that of a Birth Midwife, unless the DM
has also had at least the medical training of
a palliative-care nurse.We
also acknowledge that there are long-term ramifications
to how a person enters our world
(birth) that are very different from the
considerations of those leaving it (death).
However, CINDEA feels that the rest of
the major aspects of a Birth Midwife's role are
generally paralleled in that of a Death Midwife.We
hope that, by only using the second term in relation
to those who are committed to offering services
throughout the pan-death process, we continue
to honour the culturally-held meaning of the term
'midwife' and the vital and specific role of the
Birth Midwife.
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Birth
Midwife
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Death
Midwife
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| Pan-birth
care (pregnancy, labour, birth
and postpartum with nursing/etc.)
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Pan-death
care (from terminal diagnosis
through active dying, death, and post-death
care) |
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| Family
planning — advice on conception or contraception,
as well as nutrition counselling and advice
on home or hospital births |
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Advance
Care Planning — Advance Directives/Expressed
Wishes and other related documents
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| Primarily
a specialist in low-risk pregnancy, where
a hospital birth may not be needed (though
can assist with hospital or emergency births
as well) |
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Primarily
deals with situations where the dying person
does not need to be hospitalized and is not
comatose or in severe dementia (though
can assist
family in such cases) |
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| Primarily
deals with natural and/or at-home births,
where family and friends may want to participate
directly throughout the pan-birth process
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Primarily
deals with at-home deaths, where family and
friends want to participate directly throughout
the pan-death process |
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| Acts
as the woman's advocate — with doctors,
nurses, nutritionists, etc. — to ensure
that the mother retains choice and control
over her childbirth experience |
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Acts
as the Death Journeyer's and/or family's advocate
— with doctors, palliative care team,
cemeterians, etc. — to ensure that they
retain choice and control over the death experience |
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| Focuses
on supporting the family's direct participation,
as much as possible throughout — but
prepared to take over when needed (mother
and partner mostly do it themselves)
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Focuses
on supporting the family's direct participation,
as much as possible throughout — but
prepared to take over when needed (family
and friends mostly do it themselves)
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| Works
in partnership with the mother (and
partner, birth coach, etc.) |
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Works
in partnership with the Death Journeyer (and
family, palliative care team, etc.) |
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| Refers
to other specialists if the Birth Midwife
can't handle the circumstances (obstetrician
or gynecologist, or GP, or psychiatrist for
postpartum depression) |
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Refers
to other specialists if the Death Midwife
can't handle the circumstances (palliative-care
team/doctor, funeral home, or grief counsellor
for anticipatory or post-death grief issues)
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| Cares
for both mother and child — especially
the immediate after-birth care of the child
— and including mother and child for
a month or more after the birth |
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Cares
for both Death Journeyer and family —
especially guiding the immediate after-death
care by the family — and including the
family for some time afterwards |
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| May
be involved in health counselling and educating
the public in the range of options for birth
care |
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May
be involved in grief counseling and educating
the public about the range of options for
death care |
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| Mainly
assists in the pan-birth process, although
they may also help with other medical problems
relating to women when needed |
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Mainly
assists in the pan-death process, although
they may also help with other issues around
death as needed |
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| Offers
empathic disposition and active listening
skills to understand and support values and
choices |
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Offers
empathic disposition and active listening
skills to understand and support values and
choices |
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| Provides
necessary equipment and/or informs the family
of what they need to prepare (birthing
chair, stethoscope, other supplies needed
for the birth) |
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Provides
necessary equipment and/or informs the family
of what they need to prepare (certificates,
permits, stretcher to move the body, dry ice,
etc.) |
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| Birth
Midwives generally support and encourage natural/at-home/hands-on
childbirth in all practical settings |
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Death
Midwives generally support and encourage a
natural/at-home/hands-on pan-death process
in all practical settings |
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| The
term "Lay Midwife" has been used
to designate an uncertified or unlicensed
midwife who was educated through informal
routes such as self-study or apprenticeship,
rather than through formal medical training
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Since
Death Midwives don't do medical palliative
care (unless also a nurse),
there is currently no need to distinguish
between a 'lay' and a 'professional' Death
Midwife.At
least for the present, most will be self-trained,
or develop their knowledge base from a variety
of related training programs, or an apprenticeship |
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Licensed
Birth Midwives undergo an extensive period
of training, at least equal to the qualifications
of an RN
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Recognized
Death Midwives require skills and experience
in developing and performing various kinds
of ceremonies |
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