Death is too Medicalized: Death Midwifery and Home Funerals

Death Midwifery and Home Funerals

By Cassandra Yonder

This piece is an excerpt from the upcoming book: Journey’s End: Death, Dying, and the End of Life, written, compiled, and edited by Victoria Brewster, MSW and Julie Saeger Nierenberg, MA Ed with an anticipated release date of Spring 2015.

A social movement has arisen in response to the cultural alienation we feel from death and dying. As the sick and dying members of our families and communities are institutionalized, death itself is “medicalized,” and post-death care is undertaken by strangers outside our homes. Indeed, we have come to recognize ourselves as a death-denying society.

Just as the slow food movement brings communities back in touch with the production and distribution of their own food in a small, local, familiar market, and birth midwifery empowers women to reclaim the labour and delivery of their own babies, death midwifery reminds us how to be present for those who are at the end of life and how to care for our own dead.

One might even say that death midwifery is to palliative care as the slow food movement is to large-scale agriculture and as birth midwifery is to obstetrics.

Many people respond negatively to the term “death midwifery.”  At the most basic level I believe this is an innate sort of recoil from the word and concept of death itself, some of which I would argue is a healthy and necessary revulsion we feel because of the practical need to dispose of things that have died and sever our physical attachment to them. But there is also what I would call an unhealthy taboo around death and dying that results from our almost complete and utter disengagement from it.

The backlash against the state of denial we find ourselves in takes many forms; the most common of which is something I observe in the social media and among those wounded healers who seem to feel an irresistible urge to prove to others that they are cool with death. Some even go so far as to tout their “lack of fear” of the subject as a professional asset! I believe this to be a misguided attempt to overcome denial with denial and it is something I have wrestled with personally.

Self-awareness sheds light on the real purpose and value of death denial and simply accepts it as a starting point for further investigation. I would call such investigation the practice of death midwifery. It is a practice that involves being present to what is, while modeling a mature understanding of death as well as acceptance of the normalness of dying, death, and grief in all its iterations.

The ability to witness what is, recognizing the centrality of those who are living and dying their own authentic experience without directing or manipulating in order to forward one’s own agenda is what is meant by midwifery to me, and birth midwives seem to understand that in a deeper way than others do. Death midwifery is not about claiming a set of professional skills as much as validating the ways in which we serve our families and communities as we empower one another to remember what it is to re-inhabit the deathbed, as well as the bedside, of those among us who are dying, those who have died, and those who are bereaved.

Therefore, all the discomfort that is created by the use of the words “death midwifery” articulates the purpose of the movement itself. And the movement is just that: it is dynamic. We are beginning to co-create a shift away from the post-industrial model of handing off our dirty business to private enterprise and instead reinvesting in doing it ourselves; and in doing so, we rediscover expected, as well as unexpected, benefits.

Most of the benefits associated with reclaiming death care are difficult to identify because they are so obvious. Like the difference between a fast food meal and one cooked and eaten at home with produce from one’s own garden, it is understandably relevant and meaningful to participate in the most basic and essential acts of living within community.

Under the huge umbrella of the death midwifery discourse, I find myself most compelled to offer presence in the areas of education and post-death care.  With an educational background in gerontology and sociology, as well as a certificate in grief and bereavement, in addition to training as a home funeral guide, I am particularly moved by how well the obvious and practical psychosocial-spiritual benefits of hands-on, family-led, home-based, post-death care make sense through the lens of grief theory.

As a contemporary homesteader, home funerals make sense because we don’t hire professionals to do anything for us that we can do for ourselves. The intrinsic and palpable satisfaction that results from such a lifestyle comes not only from the cognitive closeness and connection one feels with the rhythms of nature and the ecosystem that sustains us, but also from a visceral, physical participatory involvement with our surroundings. Producing our own food (including slaughtering and butchering our animals) and engaging in a hands-on way with birth and death are experienced as an affirmation of life, and help me to confirm my own personal sense of integrity.

In days gone by, post-death care took place at home because there was no alternative. Things got done simply because they needed doing. Children didn’t need to be introduced to death intellectually because they lived with it. They assisted their families and communities to care for their older relatives in the corner of the living room; and when they died, the children watched their families gather, make food, wash the body of the deceased, hold a vigil at home, build coffins, dig graves, etc. The working together and problem-solving made meaning of death, the physical involvement provided an opportunity to process the emotions that accompany bereavement, and participation in traditions and rituals contributed to a cultural narrative that actively included death over time and in communities.

Today, those at end of life are usually institutionalized. We often get news of our loved one’s death by telephone, and perhaps we are even in a place where no one understands the relevance of our relationship to the person who died, thus the loss is experienced in a decontextualized way. We may travel to take part in a funeral service, but most often that means attending a short formal service and maybe an interment that is a paid service being offered by professionals who conspire to protect us from our grief by shielding us from the realities associated with death.  As a society that is now suffering the consequences of such alienation, we are coming to realize that hiding dying and death and post-death care doesn’t emancipate us from grief.

Quite the opposite is true. Grief counsellors help clients process grief by empowering us to investigate our bereavement and doing any unfinished grief work, such as acknowledging the reality of the loss and coming to terms with how the bereavement changed our assumptive world. Without ruminating, we need to find ways to contextualize our experiences and make them part of our personal stories and those we share with our community. I believe that the most effective way to accomplish this is to remain present at the time of death to whatever extent one is able and to take part in the changes that occur in relationships when our loved ones die by taking an active role in the ordinary everyday things that lead to the disposition of their bodies.

Anyone who has been present to death knows that it is not an instantaneous event. Even when death is sudden and tragic it unfolds within us as we perform the hard work of relocating a sustainable, ongoing relationship with the one who has died as we come to realize that they don’t move or breathe or talk or eat or see anymore. While I wouldn’t go so far as to say that everyone needs to be viscerally involved with their loved one’s death care to have healthy grief, I do feel confident that the chance of accommodating bereavement in a healthy way is much more likely when we participate. Regardless of one’s spiritual beliefs with respect to a soul that leaves the body at the time of death, everyone needs to find the bond that continues with the person who died in order to come to terms with a future without their physical presence as it was previously available.

I view the home funeral movement as one dimension of the death midwifery movement. More and more North Americans are eager to learn how to care for their own dead. This is due in part to the changing demographics; Baby Boomers have always been savvy consumers who wish to understand all their options. Concerns about the environment and the rising costs of funerals as well as the apparent benefits of family and community-centred, home-based, post-death care have fueled the burgeoning home funeral movement and, as a result, the funeral industry is responding.

Increasingly, personalized funerals are rising in popularity and there is an emerging option from those who sell services as home funeral guides. I believe that a home funeral guide’s job is to empower families to reclaim death care by maintaining the locus of control with the realization that they don’t necessarily require any professional service to care for their dead. It is a poor business model since my message is that folks don’t need my service. Most often I find myself educating families and the public that they have the ability to provide body care, transportation, paperwork, ceremony, disposition, and memorialization on their own if they so desire. In general, it is safer and more legal than most people realize.

There tends to be an animosity between the funeral industry and home funeral guides, which is unnecessary. I’m thankful for all the different kinds of service that are available and thankful that we are becoming more educated with respect to our choices and alternatives at the end of life. I don’t think that families should feel pressured to have a “home funeral” any more than they should feel pressured to buy a “traditional” funeral package from a funeral home. Post-death care is unique in each situation. My hope is that communities reclaim the right and privilege to care for their own dead in whatever way brings them as close to participating as they are able to be, given their support systems and circumstances.

I wish for families and communities to reap the benefits of coming to terms with the denial of death that has come to define our culture and to respond to that with an openness to investigate the possibilities of re-engagement as we remember our dead and how to care for them and ourselves.

A special thank you to Cassandra for allowing us to publish this excerpt.

**BEyond Yonder Death Midwifery
www.deathmidwifery.ca