Four years on from completing my final Doula module, I find myself asking, “Why did I become a Doula in the first place?” Working in a hospice I had become painfully aware that there was not nearly enough provision for high-quality end of life care in our country. With a healthcare system that was overworked and underfunded, Doulas seemed like the obvious answer. What the NHS needed was highly trained, competent, compassionate Doulas who could jump in to fill the gaps in patient care at end of life, right? I did my training and entered the fray, full-bore, confident that Doulas were the answer to the medical establishment’s needs.
How very wrong my assumptions were.
Accompanying my first client into A&E, I was shocked to discover that not one of the professionals had the slightest clue what a Doula was. Furthermore, they weren’t interested. Far too busy working their way through the backlog of patients lying on stretchers and slumped over in chairs, they curtly dismissed me and me asked to leave the ward.
Having just completed my client’s Advance Plan, I knew his wishes were on the line. So I persevered. It wasn’t easy; I found myself locked in battle with the ward Consultants who insisted on running further tests and carrying out surgical procedures on my client despite my insistence that he had specified no further treatment.
My salvation came through the Palliative Care Team at the hospital. As soon as I met with the lead Palliative Care Consultant and briefed him on who I was and who Doulas are, I was backed by his team.
Expectation #1: Doulas are automatically welcomed as trusted members of the health and social care services.
Reality #1: We have a hard road ahead of us in becoming established, respected members of the team but, thanks to the concerted efforts of EoLDUK and many passionate Doulas, we are making inroads and are well on the way.
Another misconception I had to overcome was that the end of life doula role was established. I left my training eager to be inundated with referrals and assumed there were funding sources and local connections already in place. No such luck, I’m afraid. I’ve spent most of my time advocating, promoting and educating the public about who Doulas are and why our service is vital. Not all my efforts have been met with welcome approval. But I’ve stuck with it and have never been without a client to support.
Expectation #2: End of Life Doula UK will have your Doula practice lined up for you and will provide you with an established job and a steady flow of income.
Reality #2: Whilst End of Life Doula UK is working hard to promote the Doula role and is there to support practicing Doulas, it will take time and persistence to establish your own Doula practice.
Finally, there’s the reality of what it means to work as a lone practitioner. Accustomed to working in an institutional setting, surrounded by a multi-disciplinary team of professionals, it came as a bit of shock to find myself sitting alone in the front room of my first client – an elderly man dying of cancer. The air hung heavy with dust and mould, whilst the chairs were stained with what I prayed was NOT urine but smelled suspiciously of it. The patient was in denial and didn’t think he needed support; his wife even more so. I had been hired by the client’s children who weren’t local and wanted their father well supported as he died. The situation was chaotic, with essentially no parameters in place. It was up to me (with the support of my mentor, of course), to navigate the terrain.
I came into the Doula community assuming there was a clear map. End of Life Doula UK would match me with a client and tell me exactly what was needed, right? I would simply show up to wash dishes and vigil at the beside. Not so. Referrals come in at a moment’s notice. If you agree to take the client, you’re wading in knee-high on your own. Before you do anything, you have to assess the terrain and draw the map yourself. What are the client’s needs? Is there funding available? Can the client afford to pay; if not, how will I fund my work? And, even when you’ve charted a map, you have to assume that every step of the journey will be fraught with unforeseen developments you’ll have to respond to.
Several years – and a good number of clients upriver, I am more passionate about Doula practice than ever. Here’s why:
Whilst Doulas operate as lone-practitioners, we are part of the Doula community. My regional peer support group is like family to me, my fellow Doulas comrades in the trenches. My first port of call is always my mentor. Not only have my mentors become guides to me on my Doula-client journeys; we have forged deep bonds of friendship as we have accompanied clients through the highs and lows of their final journeys.
Then there’s the End of Life Doula UK organisation itself. The website is a rich source of materials that support practicing Doulas, as are the people at the end of the phone or email, ready to answer questions, give advice and provide support along the way.
My EoLDUK regional group is pursuing ways to work as a team in applying for funding and approaching the health and social care agencies. Why should every Doula start from scratch when others have paved the way? We only shoot ourselves in the foot if every new Doula approaches the same hospice, GP surgery and social prescriber seeking employment.
I have discovered an excitement and pioneering spirit among my fellow Doulas that will, over time, make inroads in establishing end of life Doulas as an accepted part of the palliative care services throughout the UK. We’ve got a challenging road ahead, but every mountain is summited one painstaking step at a time, and we’re well on our way. All we need are more troops, more enthusiasm, more inspiration and more Doulas!
Practicing as an end of life doula takes guts. It takes courage, stamina and most of all, passion to wade into the fray and get busy, learning as you go.
Welcome aboard!
- Rebekah H. Domer
