Medria Connolly remembers the night her husband, Dino, died.

In early October 2014, a death doula woke Connolly from a brief nap and said “it’s time.”

Connolly, along with the doula, went to Dino’s side, and experienced his last living moments. He died in the house he helped build, accompanied by his wife of 25 years.

With the help of the doula, Connolly washed Dino’s body with the soap he liked, dressed him, and set up a room in the house where his body would be displayed in the following days.

Friends and family came and went, and an intimate home funeral was held that weekend. During this process, Connolly, 64 at the time, was able to sit with Dino and talk to him at any moment. She was fully present in her loved one’s death in a way most people aren’t.

Connolly said the guidance of her doula empowered her to do right by Dino.

Medria and Dino.

Photo courtesy of Sacred Crossings

Without a doula, Connolly said she wouldn’t have been so involved in giving Dino the funeral he deserved. Instead, Dino would most likely have undergone a funeral process that would have left her detached from his death.

“It was such a gentle transition,” Connolly said. “If he had died that night and someone came in here with a body bag, that would have completely freaked me out. That would have been so harsh and antithetical to the way we lived our lives.”

A death doula is someone who helps with the non-medical, holistic responsibilities leading up to a person’s death. Doulas provide “emotional, spiritual or practical care,” as well as general education and guidance of death and funeral processes, according to the National Home Funeral Alliance.

Death doulas have been around for decades, and some of the death care practices they undertake are rooted in centuries-old-traditions. While the industry isn’t new, the work of death doulas remains widely unknown.

With death care in the United States evolving, death doulas continue to face scrutiny and questions of legality from local and state officials. For death doulas to survive, they may have to change their practices to accommodate the industrialization of the funeral industry.

Before he died, Dino was diagnosed with leukemia — his prognosis was about five years.

In February 2014, nearly four and a half years after Dino’s initial diagnosis, Connolly saw an advertisement in her local newspaper for a weekend training program in hospice care. With Dino likely needing to enter into hospice care soon, Connolly said it was “wonderfully convenient” to have the chance to participate in the training.

At the end of the program, a death doula was brought in to talk to the participants. Part of that discussion was on home funerals. Connolly had never heard of a death doula or even knew home funerals were possible, but she was instantly inspired.

Connolly returned from the training, talked with Dino about doing a funeral out of the comfort of their own home, and contacted Olivia Bareham a few weeks later.

Bareham has been a practicing death midwife for almost two decades and operates Sacred Crossings, an organization specializing in home funerals and conscious dying education. While some would refer to her as a doula, she uses the title midwife instead.

A death midwife often shares similar responsibilities as a doula, but they also take on the role of helping people with after-death care services, such as Dino’s home funeral. Someone who identifies as a doula might not have the same kind of training a midwife would to handle the deceased in this way.

Bareham instructed Connolly to contact the people who would be responsible for putting together Dino’s funeral; friends and family gathered to partake in the planning shortly after.

As spring turned to summer, Connolly said Bareham would occasionally stop in to talk with her and Dino to get to know them better. Summer turned to fall, and Dino’s condition began to worsen.

Connolly’s training that summer allowed her to recognize when it was time to bring in a hospice caregiver. She said at that point Dino’s needs were beyond what she could provide.

While Connolly and Dino had been talking for months about what he wanted for his funeral service, the planning stage quickly ramped up. Connolly said Bareham was actively involved in making sure Dino got what he wanted.

On the night of Dino’s death, Connolly contacted Bareham to let her know his time was coming. Bareham came immediately to be present for his death.

Bareham was there to help Connolly in the moments before, during and after Dino’s death.

“[Bareham] said, ‘Why don't you just lie down for a little while? I'm watching, I got this,’ and I said, ‘okay,’” Connolly said. “So I laid down and then she came up maybe an hour later. She said, ‘It's time,’ she got me up and went downstairs — and he died.”

After preparing him for the viewing, Bareham brought dry ice every day to keep Dino’s body preserved, instead of using embalming fluids typically required by most funeral homes.

Bareham told the couple in advance of an option for Dino’s body to be placed in a cardboard box before his cremation. This type of box gives loved ones the chance to decorate it with images and drawings that commemorate the deceased's life. Connolly said two of her artist friends agreed to paint Dino’s coffin.

Dino's home funeral service.

Photo courtesy of Sacred Crossings

A small group of Dino’s loved ones gathered in a backroom once housing the couple’s television. Chairs were set up, and vases filled with roses and lilies were placed along the bottom of the coffin.

When the home funeral was over, Dino’s coffin was placed into a van from the Neptune Society, one of the nation’s largest cremation providers. The ceremony may be long over, but Connolly’s memory of the peace it brought her lives on.

Connolly said Bareham was there through it all to provide support, comfort and education. From the moment Connolly first contacted her, Bareham helped Connolly navigate her husband’s death in a way a traditional funeral director can’t.

Dr. Andrea Deerheart, who’s based in Nevada county, has been talking to people about death for over 35 years. As a practicing doula she helps people come to terms with dying.

Deerheart has guided hundreds into death, and she’s trained dozens of aspiring doulas to take up that same mission.

Despite her welcoming approach toward death, Deerheart hasn’t always been so accepting.

While family members around her were dying when she was a young girl, she was often kept away, shielding her from one of life’s most natural occurrences. As a result, she grew fearful of the end.

“Death grew into a monster,” Deerheart said. “I was terrorized as a little girl to the point where I was walking and looking over my shoulder because I was afraid death, or the grim reaper, was at my door. It took my breath away.”

Wanting to understand this phenomenon, Deerheart would hide under her covers, with her doll and dog there for protection, and hold her breath. She wanted to know what death felt like, but she didn’t want to die.

It was hot and claustrophobic though, and it only made her fear of death worse. Deerheart carried this perception into her early twenties.

When she was 28, Deerheart received an invitation to volunteer for a hospice care center in San Diego. She took the plunge, and her perception of death evolved immediately.

Death wasn’t something to shy away from anymore, and she knew her life would be dedicated to helping the dying.

Doulaship is an evolving field, and an industry-wide definition doesn’t exist yet, but Deerheart offers one she believes encompasses a doula’s responsibilities: “[A doula] assists in co-creating a visionary map with the dying and their families to help navigate through the labyrinth of fear, perplexing medical systems and practical end-of-life decisions.”

While anyone can call themselves a doula, Deerheart said there are nuances to understand before anyone can immerse themselves in the role.

Everybody dies, but processing death looks different for everybody, Deerheart said. There’s no one right way to experience death, so doulas need the ability to help people process dying in a way that makes them comfortable.

Sometimes this includes music, meditation, dance, performance, spiritual practices, or simply physical touch. A doula’s role is to talk with the dying person and their loved ones to figure out a ritual that helps the transition into death, Deerheart said.

The nuances of a person’s death can be difficult for loved ones to process, so doulas can help them along the way, Deerheart said. She also helps those who struggle to understand or accept death, either through educational or emotional support.

Though there’s no formal training or course requirements for doulas, Deerheart said they need to have an understanding of what death looks like.

“For [a doula] to understand and be able to remind loved ones that this is part of the process, here's some of the details, here’s some of the ways we can bring additional comfort — It takes the trauma out of it,” Deerheart said.

Death care can be difficult for people to navigate on their own, Deerheart said, and that’s where a doula can help.

Britt Keehn has a familiarity with death most people don’t.

Keehn, 39, has had four near-death experiences in her life. Most recently, Keehn experienced major health complications due to ongoing Crohn's disease. With the progression of the disease came the deterioration of her body.

“I remember having this moment where I felt I was learning so much about this process, just feeling my body make all these changes… And I was just like, ‘I could take this wisdom and give it to the people I feel it would help. But I can't do that if I die,’” Keehn said.

While she was recovering, Keehn found an online doula training program. She decided it was the perfect time to utilize the wisdom she gained while battling Crohn’s.

In 2020, before the rise of the coronavirus pandemic, Keehn began her work as a death doula. She said she has to regularly explain what a doula is and the work she does because it’s simply not public knowledge yet.

People might not know what a doula is, but everyone understands how difficult death can be, so planning for it ahead of time is crucial, Keehn said. Part of her work includes helping people plan for their unexpected deaths because “no days are guaranteed.”

“You’re going to die,” Keehn said. “This is a reality for all of us. And I find that the people that are really knocked for a loop in their grief are the ones who have not spent any time themselves having conversations about death.”

Kelly — who spoke on condition of anonymity — was diagnosed with breast cancer in 2016, and had to have surgery in 2019. Her post-surgery prognosis was two months to live.

She sold her house, donated her possessions and went into hospice care in San Luis Obispo, where she was assigned her death doula, Karen, who would help plan Kelly’s final days. Over three years later, Kelly is still alive.

Kelly, 71, doesn’t know how much longer she has, but with the guidance of her doula, she said she’s found peace in dying.

“I wouldn't be here now if it wasn't for her,” Kelly said.

Throughout her experience in hospice care, Kelly said her doula has been there every step of the way in planning for her death, including accompanying Kelly to doctor’s visits and discussing medical aid in dying options if Kelly’s health conditions become unbearable.

When her time does come, Kelly said she and her loved ones will be prepared because of her doula.

After working in hospice for several years, Deerheart left in the ‘90s when the industry became largely monetized. Deerheart said those in power capitalized on care centers, and workers were forced to go along with it. She had to get away.

Deerheart continued her studies and eventually opened The HeartWay, a nonprofit organization focused on death care support, education and training. She doesn’t charge for her doula services, and instead operates on the money she makes from donations and doula training.

As state legislators grapple with the prospects of the growing doula industry, Deerheart said it’s only a matter of time before it’s regulated. When this happens, she said, it could mean doulas would need to undergo practical training and acquire professional licenses in order to continue their work, similar to funeral directors.

Unlike traditional funeral directors though, Deerheart said most doulas don’t handle dead bodies and the majority of the work is usually done before death. Deerheart said like any professional practitioner though, such as psychiatrists or doctors, having regulations might not be a bad thing in the long run.

Not only could regulations require people to be properly educated on what they’re teaching clients, it could also allow many doulas to be paid better wages for their work if it’s their primary income.

“As a practitioner, but more importantly, as an educator of practitioners, I would wish for them to be treated with respect, to be able to make time, to be able to earn a living doing this work,” Deerheart said. “The way that's going to happen more is with accreditation and licensing.”

Along with the positives though, Deerheart also said there could always be unintended consequences, such as doulas charging more for their services or people being turned away from the practice if they aren’t able to pass certain exams.

Dr. Vanessa Carlisle, a Los Angeles based doula, agreed that regulating the doula industry would bring about positive and much-needed changes, but it could also be devastating in ways.

“Anything that's completely unregulated has a huge, vast spectrum of capacities of people who are working within that field,” Carlisle said. “There are death doulas who are excellent at death care and there are doulas who are not — and we can all use the same title.”

Carlisle said people have been doing the work of doulas for forever and it has largely been outside of the government’s control. As someone whose work has been criminalized before, Carlisle said state involvement isn’t always a solution.

Vanessa Carlisle talking with a patient who had ALS.

Photo courtesy of Carlisle.

With regulation, Carlisle worries some of the work doulas do could also become criminalized. Subsequently, doulas could also end up being sued for their work. She said sometimes when people are in grief, as many people facing death are, emotions and anger tend to be high, and lawsuits could be just on the horizon for doulas.

“Oftentimes doulas come from a perspective of ‘let someone go on their own terms’ and families don’t always agree with that,” Carlisle said. “That’s where the regulation of doulas becomes tricky.”

There’s no easy solution to the question of whether the doula industry should be regulated or remain unfettered, Carlisle said.

Discussions with a doula

Jeannie Palermo

Andrea Deerheart

Vanessa Carlisle

Shawn LaValleur Adame

Medria Connolly said the current funeral industry in the United States has removed the care and love that families used to show their deceased and has made the process of dying convoluted.

With the help of a doula though, Connolly was able to be completely present when her husband died, caring for him even after death. She said that wouldn’t have been a reality without the guidance of a doula.

The death doula industry is rapidly changing and the way forward still remains widely unknown.

When Medria Connolly goes though, she hopes a doula is there to guide her on the journey toward death.