Q&A with Julia Brough about Death Doulas
Julia co-founded End of Life Rhode Island, an organization with a mission is to educate the public about the role of the end-of-life doula.
When Julia Brough is not sitting in front of a computer, she can sometimes be found by the side of someone who is dying. She is a death doula, also known as an end-of-life doula or death midwife, a growing vocation that is part of a larger movement that is changing how we look at death.
Although the term “death doula” might seem new and different, for thousands of years, societies across the world have had individuals trained in helping the dying. Today, there are about 1600 death doulas throughout the U.S.
Julia sat down with us to talk about her work and the organization she co-founded, End of Life Rhode Island, whose mission is to educate the public about the role of the end-of-life doula, as well as raise public awareness around death, dying, and end-of-life planning and support in Rhode Island.
This interview has been edited and condensed for clarity.
Memorial Funeral Home:
So, Julia, tell me what you do and what got you into this work?
Julia Brough: My 9-to-5 is a digital project manager, so I am at a computer about 40 hours a week. And then during 2020, I was speaking with my therapist at the time, I was just kind of ruminating on being on a computer for the majority of my week. I wanted to explore some other field to get involved in, ironically, during a healthcare shut down.
I was like, “what in this space could I do?” And I mentioned to her that I had just gotten a birth doula book, but I wasn't feeling compelled to open it, and she was like, “well, have you ever heard of a death doula?” I immediately went and googled it and found the University of Vermont Certificate program, which is one of the largest certificate programs, and signed up for it. I think it was about eight weeks.
Throughout the program, I was like, “this is literally what I'm equipped to do.” It just felt like all the little puzzle pieces were coming together, being a project manager. And really, that's what an end-of-life doula is, we have a point A and a point B. You have to kind of see at a high level and understand what your client wants to accomplish within that time. So it felt like a really nice marriage of everything I have worked towards.
After you get a certificate, there isn't really like a path. You have to either start your own business and have that entrepreneurial energy, or people will go and volunteer with hospice. So I went through the volunteer process with Hope Health. During that time, I was still talking about, “what do I want to do? How do I use this skill?” And I talked about it enough that at a dinner party, someone connected me to Judith Sutphen. Her and I met and we were like, “we need a community.” So we started End of Life Rhode Island with the intention of public outreach, professional education, and giving ourselves a space to be together.
We need to educate Rhode Island, like people don't know [what a death doula is]. And she happened to know a cohort of people that had gone through the program or were just really tangentially interested, like funeral celebrants and folks that work in grief therapy at the VA.
We started organizing in 2022. And then we went through our strategic planning last year because we were like, “okay, who do we want to be when we grow up?” And that was super helpful. Now, we're coming up on a year of having a marketing committee, a professional education committee, we've done a program every month and public outreach.
MFH: That's awesome. And how has the reception been?
Julia: A lot of the first questions are, “how much does it cost?” We're not regulated at this point--some people are doing it for their livelihood, some people don't need to do it for income. I try to price myself a at a sliding scale. I'm very flexible. I have a full-time job. I'd like to make some money for the skill set, but also, I'd much rather get the work done.
We've talked to a couple of cemeteries about the difference between hospice and end of life care. And so that's a really interesting question to get. I am 36 and I have talked a lot about this with a lot of my friends, many of them who are just starting a family or they already have kids, and a lot of them have responded with, “I could have really used this service with my aunt, uncle, grandfather, parent dying of cancer.” Like just someone to sit in it with and be available. There is a there is some overlap with the services. Mainly hospice is a medical provider and these medical professionals need to meet patients on a schedule. A doula can come at all of those in-between times and sit with their client, work with them, provide caregivers with respite. They are just more hands on deck, basically.
MFH:
What do you think drew you to this work?
Julia:
I've had a couple experiences that really resonated with me in different ways, one of them being my father died when I was 14 of a sudden heart attack at a Halloween party. I never saw him again. He went to the party with my mom, and then the next time I saw him was at the wake in Rhode Island.
And then my two grandmothers passed. My mom's mom, she died in 2018, I think it was. And my family, they always have seen me as very emotional. I'm a very emotional person. And so there was this, like cajoling that needed to happen for me to be there with that. The whole family was around her deathbed and they were like, “please come here, you can be here. We'll be here with you.”
And then when I got there, I was like, “Oh, my God, I don't know if I can handle this.” I was encouraged to sit with her and speak with her. That was incredible. To hold her hand and talk to her was something that I don't think a lot of people are reminded to do that.
And then my dad's mom passed, maybe three years ago, but she was very lucid all the way up to the very end. And when she knew I was going through the program, she was like, “Will you come and be with me when I die?” She was in Laconia, New Hampshire. And the minute I heard she was not doing well I dropped everything and cancelled my Thanksgiving plans with my mom's family. And I drove up there. I was by myself, and I spent two hours holding her hand. She was asleep.
Her end-of-life experience blew my mind. And I was like, “I want to bear witness to that, to everyone's different religious views and like how that culminates at the end.” That was really, really intense. So these three stories kind of made this foundation. When I learned that I can educate people on showing up and stepping into the death space and that it can be scary and it can be beautiful and you can be there for your people is, you know, it is really powerful and I wanted to do that work.
MFH: That's really profound because it feels like we live in a very death-averse society and sometimes very emotionally averse, so to give people that opportunity to take those emotional walls down and give them that space, that's powerful.
Julia:
I appreciate you reflecting that back. I can get a little extreme talking to my friends where I ask a question like, “Have you guys talked about your body disposition planning?” And a lot of them don't want to talk about it. I get it. I have two nieces: five and one years old, and that has definitely changed this journey of being close to death. It is scarier now knowing that I will miss time with them, but I try to bring it back even when I feel myself getting scared. We are all going to die and I have lived such a beautiful life.
MFH: You refer to yourself as an emotional human being, does that work to your favor in this work?
Julia: You can still be emotional in that space. Your humanness is what makes you relatable and approachable to those that are going through a very intense time of grief. You're helping your client reach within themselves and navigate. They have this tool set to arrive at the end. You don't need to solve any problems, you don't need to give them any answers. You provide resources, but you don't need to solve any problems for them because we all have it within ourselves.
The work that you're doing is showing up and saying, “Okay, we're going to sit in this space. We're going to talk about this, and you're going to get to the next point.” Everyone brings their own experiences. But you arrive at a place where there is peace at the end, whatever that looks like.
MFH: So, walk me through what you're offering a family. Are you coming in weeks before a terminal diagnosis is given?
Julia: You can start working with an end-of-life doula when you're perfectly healthy. I've been hosting dinners for a handful of people and, facilitating conversations around death. They've been so wonderful. I really love facilitating them.
I have an end-of-life planner. It says “I'm dead. Now what?” In it you have your passwords, you have who you want to be called upon death, which I love because I'm like, “Oh my God, all my best friends.” And then there's also a document that we love to promote which is called Five Wishes and that is acknowledged in Rhode Island as your end-of-life document. There's like a whole bunch of things in there that you can circle. I've gone through it with my mom in pencil, and I just kind of reiterate to people that you can go through and change that at any point. So that end-of-life planning can start very early.
Then when there is kind of a timeline due to a diagnosis, working with that client to understand what they want their days to look like, if there are any efforts that they want to get done, whether it be finishing a book that they had started, and maybe they want to ask a family member if they would be interested in working with them, or the doula can work with them to operate, say, a computer or, record and type.
So definitely talking about different resources that would benefit what their wishes are. I'm working with them to understand their body disposition options, because there are options that are not legalized yet in Rhode Island that they can take advantage of elsewhere, whether it be aquamation or human composting.
Then working with them to map out what their memorial would look like, in partnership with a funeral home. They might want to have a living funeral, which is a really cool idea--to be able to be there, especially if you have a terminal diagnosis, and you have the time being able to plan for that. Also taking time to understand what they want their space at the end of life to look like and feel like and smell like and sound like.
If they want to have a pet around, creating a playlist. At the end it can be heart lifting [to have] a calming scent. Some doulas are 11th hour doulas. They show up when death is beginning.
We have some folks in our organization that are beginning to work with someone that goes through Swedish death cleaning: the practice of going through all of your belongings. Who do you want in your life to get this this piece? Or does something need to be donated? So, you're doing all of that legwork. Doulas can help in so many different ways, and it really comes down to what that person's life looks like and what they need and you're kind of tailoring it for them. It's pretty customizable.
MFH: Once someone has died, does the work of the doula continue after that?
Julia: Oh yeah. Yeah. I mean, if the client was interested upon death having their body cleaned and say they weren't interested in embalming, [we can work] work to close the mouth with a scarf and put coins on the eyes to make sure everything is prepped for rigor mortis and working with the family to wash, dress and shroud the body.
If the client is interested in having visitors come and spend time with their body, organizing that, calling the doctor, calling the funeral home, spearheading that communication so that the loved ones can grieve. Although some people do want to have a task so the doula can help direct those loved ones to go do X, Y, and Z. And then, I mean, being present for the memorial, kind of like a wedding day coordinator in a sense: showing up and making sure that everything goes smoothly.
MFH:
Say there are people that you don't want in the room in those last hours or minutes. Do you designate someone within the family to be like, “Hey, you can't come in here?” Or does the doula take on the role of having those hard conversations with family?
Julia:
Yeah, there's definitely mediation that is involved in this role. You're just going to let yourself be kind of a blank slate and be that neutral presence. Being able to have those hard conversations, it's really guided by the client's wishes. And maybe there's another way that you could communicate with a client. You don't want this person physically in your presence, [but] could they write you a note? Could they do something else, like send you flowers or something? A doula is happy to have those conversations.
MFH:
Julina, thank you so much for this conversation.
Julia: Thank you!













