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On this page
Definition of Death Midwifery
Description of a Death Midwife
Expectations of a Death Midwife
Web of Facets in a Death Midwife's Roles
Advantages of a Death-midwifed Pan-Death Process
Training options (Canadian and/or online) for Alternative Death-care
Recognition from CINDEA
Philosophy in Practice

The practice of death midwives addresses the opposite end of life from (birth) midwives, although they share a similar philosophy.   Death midwives are not registered with any of the Colleges of Midwives in Canada, nor do they operate under the Health Professions Acts or the Midwifery Acts for any of the provinces or territories.

Please note: the term 'death midwife' is used by various DWENA practitioners (who may or may not provide services throughout the whole of the pan-death process), with 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.



Death Midwifery

Summary of CINDEA's 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 of a death midwife's role 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]

Description of a Death Midwife

A CINDEA-recognized death midwife's primary roles are to:

  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
  support the exploration of DWENA options that are most meaningful to the death journeyer/family, and how to fulfill them
  educate and 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)
  provide in-person emotional and spiritual support, or facilitate access to specialists who can do so
  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]

Note: Death midwives are not health professionals, nor are they registered with any of the Colleges of Midwives in Canada.

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Expectations of a Death Midwife

CINDEA expects a death midwife to:

  to be knowledge about both regular and DWENA services in their local community; and provide information about, and access to, those services as appropriate;
  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.;
  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;
  — 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 DWENA 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 DWENA practitioners (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.

Cultural disconnection of supports and services    The modern pan-death process is becoming exponentially more complex.A broader range of medical intervention and support services is 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
  there are common cultural and religious traditions;
  most of the family members live close by;
  neighbours have known each other for decades; and
  it can be reasonably assumed what choices will be made and what support is needed (and given, often without even being asked).

General practitioners (MDs) 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
  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.);
  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;
  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;
  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
  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).

This continuum may be especially significant, if
  the death journeyer's situation is complicated;
  there are only a few family members and friends available to help; and/or
  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 clear 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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Training Options (Canadian and/or online) for Alternative Death-care

Since DWENA deathcare roles are still very new and evolving in Canada, it can be difficult to find appropriate training.    However, a variety of courses (singular) or programs are available.    Some of them are more academic (University or College based, in Thanatology and related topics); and useful for expanding one's awareness of the issues involved, traditions from various religions or ethic groups across the globe, etc.   Others are more focused on the direct/hands-on involvement with the death journeyer and their family — whether centred on pre-death or post-death support, or both.    

CINDEA has a list — Training Options for Alternative Death-care May 2014 — which includes 35 options, most of which are Canadian and/or online.    Please feel free to contact us for support in figuring out what combination of courses might work best for you, in terms of the particular service you wish to offer.

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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 General Requirements and the Questionnaire.

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Philosophy in Practice
Information on (birth) midwives taken from Wikipedia

CINDEA  understands that a death midwife's role (as recognized by CINDEA) cannot exactly parallel that of a birth midwife.We are also well aware 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) in particular that a birth midwife is responsible for sustaining two lives, mother and child.

Canadian birth midwives are required to have considerable medical training and certification.   A death midwife does not require medical training, since they are not responsible for sustaining the life of any individual.
   Thus, death midwives are not health professionals, nor are they registered with any of the Colleges of Midwives in Canada.   On the other hand, death midwives are required to have skills that a birth midwife does not need especially in the development and performance of ceremony.

Despite the differences between the two practices, they share a comparable philosophy.   One description of the philosophy of birth midwives can be found at "Philosophy of Midwifery Care in Ontario".   If one replaces the birth-specific words in that description by death-related words, that statement would then describe the philosophy of death midwifery.

It is CINDEA's intention to honour both the ancient and conventional modern meanings of the term 'midwife', as well as the vital and pan-birth role of the birth midwife.   Therefore, we only use the term 'death midwife' to refer to those who are committed to offering services throughout the pan-death process.   A critical aspect of both philosophies is continuity of care, whether pan-birth or pan-death. Below is a list of aspects of death midwifery practice, outlining that continuity.

[Note: in terms of a life-passage event, 'birth' — not 'life' — is the opposite of 'death'.]

Elements of Pan-Death Practice
(from terminal diagnosis through active dying, death, and post-death care)

Educates the public about the range of options for death care

Assists with advance care planning — Advance Directives/Expressed Wishes and other related documents

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)

Primarily deals with at-home or hospice deaths, where family and friends want to participate directly throughout the pan-death process.   Generally supports and encourages a natural/at-home/hands-on pan-death process, wherever practical

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

Focuses on supporting the family's direct participation, as much as possible throughout (family and friends mostly do it themselves) — but is prepared to take over when needed

Works in partnership with the death journeyer (and family, palliative care team, etc.)

Suggests specialists if the death midwife can't offer appropriate support in the circumstances (palliative-care team/doctor, funeral home, or grief counsellor for anticipatory or post-death grief issues)

Offers support to both death journeyer and family — especially guiding the immediate after-death care — and continues support for some time afterwards

May be involved in grief counseling or emotional support

Mainly assists in the pan-death process, although may also help with other issues around the death as needed

Offers an empathic disposition and active listening skills to understand and support values and choices

Provides necessary equipment and/or informs the family of what they need to prepare (stretcher to move the body, Techni-Ice, copies of certificates and/or permits, etc.)

Assists with developing and/or performing various kinds of ceremonies that may be desired before, during, and after the death — including celebrations of life, wakes, funeral and/or memorial services, as well as any rituals that may spontaneously arise

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Last updated July 2015   © CINDEA  (To use more than a brief extract, please contact us for permission.)