For Rita Ball, there's nothing more meaningful than holding a person's hand in their final moments. "It is absolutely raw," Ball says, "to witness this life that is leaving the world." She's been there at someone's last breath multiple times, working as a trained "death doula" in London for three years, supporting individual families and volunteering in care homes for the NHS as a non-medical end-of-life companion.
Ball says people often ask what they're "allowed to do" when their loved ones are dying. "I hear a real sense of relief when I say it's OK to hold them, kiss them, play music, talk to them." You've heard of doulas for birth; now meet the soul midwives for the exit. Death doulas have been growing in popularity over the last decade. Emma Clare, chief executive of End of Life Doula UK, says 114 doulas joined her organisation in 2025 - a big increase on previous years. Celebrities including Nicole Kidman and Ruby Wax have announced they're training to become end-of-life doulas, and Davina McCall says she plans to join them when she retires.
"Sometimes the silence after someone dies can be huge," Ball says, but doulas can sit with the bereaved and recount those last few days. Depending on training, a doula costs between £25 - £45 an hour, according to Clare, though some offer services free of charge. Fanny Behrens from Devon first approached death doula Sarah Parker 10 months before her husband died of cancer. "Sarah was just amazing with me while I just sobbed and sobbed in her kitchen," Behrens says. "It was incredible to be able to talk to someone who wasn't family, who wasn't involved, and who could just be there, while I let myself fall apart with the grief of it."
Parker encouraged Behrens to broach difficult questions with her dying husband - including where he wanted to be buried and what he wanted his funeral to be like - and helped her navigate the "death admin" of contacting undertakers and registering the death. "She was good at reminding me to look after myself too and not just get lost in the other person's needs." Parker also carefully explained the process of how the body begins to shut down during the final days of life. "There's something about being with someone who's very familiar with the process, who is matter-of-fact and at home with it and compassionate - that really helps," Behrens says. "Even though it doesn't take the pain of it away, it kind of normalises it."
Clare believes people today have "lost a lot of knowledge about ordinary death," getting their ideas from dramatic films or sudden death. By explaining the physical process in as much detail as people want, doulas help remove fear, unlocking time for more meaningful moments. For example, Parker explains that when people are dying, their body temperature and breathing change. "At the end there can be a death rattle - a sound of hard breathing that can be frightening for people in the room. If you've already told them to expect it, it can feel easier."
Soul midwife Krista Hughes, who also works at cancer charity the Mulberry Centre, says developing a strong bond with the dying person is important to allow them final moments as they wish. "When someone is born they are born into loving hands," Hughes says, "and we hope they are able to die into loving hands." She recalls a person who wanted to die in a garden but couldn't due to medical intervention; she recreated an imaginary garden with pictures, lavender oil, birdsong, and a narrated walk through lavender fields.
End-of-life doulas often provide support beyond death. Ball has visited funeral homes on behalf of families to relay messages and has helped organise memorial services. Others hold death cafes to "open up conversations" over tea and cake. Marian Krawczyk, researcher in end-of-life care at the University of Glasgow and founder of the End-of-Life Doula International Research group, says end-of-life care must evolve because fewer people die from short infectious illnesses or accidents, and more live for years with life-limiting diseases. "There are also now expectations of lifestyle choices in every aspect of our life," she says, "including the ability to craft our own dying."
While death doulas could help with this, it's a complex issue with no regulation or mandatory training in the UK. Some believe doulas should be incorporated into the health system; others think the service should remain separate. Questions about costs and concerns about "opportunism around vulnerable people" have been raised. But according to Krawczyk: "The reality is that, appropriate end-of-life care is a postcode lottery," and doulas can help fill the gaps. Dr Paul Perkins, chief medical director at palliative care charity Sue Ryder, says the healthcare system can be "hard to navigate for patients especially when they are going through all the emotions that a diagnosis can bring." He believes those dying should be helped to "have the best quality of life possible," adding, "so they can spend time with the people who bring them joy."