On this page Definition of Death Midwifery Description of Practitioners of Death Midwifery Expectations of Pan-death Guides Web of Facets in Pan-death Guide's Roles Advantages of a Pan-Death Process Training options (Canadian and/or online) for Alternative Death-care Recognition from CINDEA Philosophy in Practice Parallels between birth and death midwifery Clarification of new terms: After winning the right to continue to use the term 'death midwife' in the lower Supreme Court (CMBC vs MaryMoon), it was lost in the appeal (CMBC/AGBC vs MaryMoon). Although we are continuing to explore ways to reclaim the term 'death midwife', we are legally bound (in BC) to use new terms for the time being.  The terms we are currently using are: Practitioner of death midwifery: someone who is practicing the philosophy of midwifery applied to deathcare, through the pan-death continuum. Pan-death guide: someone who offers death midwifery support in a continuum of pre-death (EOL/death doula role), immediately after death (home funeral guide role), and funeral/memorial ceremonies (celebrant role). For the most part on this site, 'practitioner of death midwifery' and 'pan-death guide' will be used interchangeably.  We realize that this may be a little confusing.  However, we felt it was important to retain the connection to 'death midwifery' (philosophy), as well as have a term that describes 'what they do' — as 'death midwife' did both.

Summary of CINDEA's definition of Death Midwifery In the simplest sense, a modern-day practitioner of death midwifery/pan-death guide 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. 'Community deathcare' is a broader term than 'death midwifery', though the first includes second.   Community deathcare supports all pracitioners who contribute to deathcare in some form, but more specifically to those which are alternatives to conventional care.  In a sense, it is a synonym for what CINDEA refers to as DWENA options. The CINDEA definition seeks to honour and parallel the ancient double (birth/death) role of midwives, while acknowledging that practitioners of death midwifery are NOT required to have the medical side of a birth midwife's responsibilities. [see Parallels between Birth and Death Midwifery below] Disclaimer: Practitioners of death midwifery/pan-death guides are not conventional (birth) midwives or health professionals, nor are they members of any of the Colleges of Midwives in Canada.

Description of Death Midwifery

CINDEA recognition of 'practitioners of death midwifery'/'pan-death guides' includes the following primary roles:

		provide information on various options throughout the pan-death process (especially those which are alternatives to the cultural norms or less institutionalized) including 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 (home funeral); as well as support them in those that may include the use of a funeral home for specific individual services if needed, such as transporting the body (according to their choice)
		support the family in accessing their legal rights in situations where the death journeyer is not able to die at home, or other complicated situations — ex. bringing the body home from hospital after death, etc.
		provide in-person emotional and spiritual support, or facilitate access to specialists who can do so
		collaborate with the family to develop whatever ceremonies they wish — including, but not limited to, funeral/memorial ceremonies
		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 Death Midwifery Practitioners

CINDEA expects practitioners of death midwifery to:

		to be knowledgeable 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
Practitioners of Death Midwifery/Pan-Death Guides

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 care that a pan-death guide will support the family to do, and which are their primary responsibility.The outer green circle represents the additional elements of developing DWENA pan-death care that CINDEA encourages recognized practitioners of death midwifery 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 and Post-death care/Home Funerals.

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Advantages of a Pan-Death Process

While other DWENA practitioners (see list on the Modern Pan-Death Movement page) may or may not offer all the services in the Web of Facets above, a pan-death guide (by definition) 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 using a pan-death guide — 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 have often 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: instead
		there is a loss of common cultural and religious traditions;
		often no or very few family members live close by;
		neighbours may not have known each other at all (rarely for decades as in the past);
		it can no longer be assumed what choices will be made, and what support is needed (and given, often without even being asked), by the death journeyer and family.

General (MDs) or nurse 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.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 carer' 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.    Furthermore, they are likely to have limitations on the amount of time that they can spend with the death journeyer and family.   As a result, there may not be anyone — except perhaps a solitary carer who fully understands the whole situation surrounding the death journeyer's dying/death.

Continuum provided by a Pan-death Guide    Especially if the practitioner 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 carers;
		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 pan-death guide 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 palliative care 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 practitioner of death midwifery 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 close to 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, an exponentially-growing variety of individual courses 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 ethnic 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.   However, we note that this list is now out-of-date and many more options are available (especially in Death/End-of-Life Doula training).   So please feel free to contact us for support in figuring out what programs or combination of courses might work best for you, in terms of the particular service you wish to offer.   

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

CINDEA  understands that a pan-death guide's role 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, and be registered with a provincial college.   A pan-death guide does not require medical training, since they are not responsible for sustaining the life of any individual.   Thus, such practitioners are not health professionals, nor are they registered with any of the Colleges of Midwives in Canada.   On the other hand, they 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 (birth and death midwifery), 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 philosophy/approach of the double birth/death role within midwifery, as well as the vital and pan-birth role of the birth midwife.   Therefore, we only use the terms 'practitioner of death midwifery' or 'pan-death guide' 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'.] 
 

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Parallels between Birth and Death Midwifery
Information on birth midwives taken from Wikipedia

Canadian birth midwives are required to have considerable medical training and certification.   A pracitioner of death midwifery does not require medical training, because they are not responsible for sustaining the life of any individual.   On the other hand, they are required to have skills that a birth midwife usually doesn't — especially with the development and performance of pre/post-death ceremony.

However, CINDEA believes that the rest of the major aspects of a birth midwife's role are generally paralleled by that of pracitioners of death midwifery.We hope that, by only using our designated 'pan-death' terms in relation to those who are committed to offering services throughout the pan-death process, we will continue to honour both of the traditional and culturally-held meanings of the term 'midwife' — as well as the vital and pan-birth role of the birth midwife.  

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