Angela Laakso traces a name etched in stone with the tip of her index finger.
Nearly 200 years ago, Glendale Cemetery was founded in Akron’s West Hill neighborhood.
Today, it holds the city’s dead in more than 26,000 graves.
On a humid, summer morning, Glendale’s hills are lush against a gray sky. At the main entrance, a row of elaborate family mausoleums stretch around a curve in the narrow road.
“I’ve always been enamored with the dark side of things,” Laakso says. “I was into goth music in high school and in my early 20s. I always loved hanging out in cemeteries. [I had] kind of a fascination with death, but also a good dose of healthy fear of death.”
“This must have been a child,” she adds, finger still pressed to the stone.
As a death doula, Laakso, now in her late 40s, helps dying people and their loved ones navigate the dying process and what comes after.
Often, she takes on more pragmatic tasks, like drafting a living will or health care power of attorney, planning or officiating funerals or advocating for the dying in medical settings like hospitals or hospice care centers.
But death doulas also practice spiritually and emotionally intimate work with the dying and their loved ones, and they can help families learn to care for their own dying in the process.
It’s that type of work Laakso hopes will spark a thriving death positive community across the city — and radically change the way Akronites think about, talk about and experience death and dying.
What is a death doula?
To help make that death positive community a reality, Laakso and her teenage son, Casper — a student enrolled in Firestone Community Learning Center’s International Baccalaureate Programme — launched Astral Dragonfly, an Akron-based nonprofit designed to provide death education, promote death positivity and provide death doula services to dying people and their loved ones.
Much like birth doulas, death doulas have a long legacy spanning cultures and continents.
During the COVID-19 pandemic, Laakso completed a program with the International End of Life Doula Association (INELDA) and earned an official certification. But death doulas, sometimes called death midwives or end-of-life-doulas, don’t always operate in an official capacity.
INELDA began offering doula certifications in 2016, but this type of intimate, communal death work has been practiced for centuries, and it is often deeply connected to indigenous customs and ancestral knowledge.
Death doulas treat dying as a natural process rather than a medical emergency, and they help the dying and their loved ones prepare for and navigate the experience of death and dying.
Either through formalized training or cultural and generational tradition, death doulas are often taught to recognize and respond to signs of active dying — like changes in breathing patterns or discolored skin.
But when it comes to the spiritual, emotional and psychological experience of death, not every death doula practices the same way, and not every dying person has the same wants and needs.
Sometimes, dying people want to die surrounded by nature, or have simple requests — like a specific type of chapstick, a bouquet of flowers or their favorite music.
“When someone is dying,” Laakso says, “let’s try to get [the details] right.”
Laakso also does a “summing up” with the dying person to learn more about what’s most important to them. In those moments, Laakso focuses intently on what the dying person wants or needs to share.
“The most important thing to me is the honoring of sacred space and active listening,” she says. “I think that’s the most important thing we can do for someone, and for families. Just listening [and asking], ‘What do [you] want?”
Still, a person’s death may be emotionally, spiritually or psychologically difficult for their loved ones, even if it’s an expected death they helped plan and prepare for themselves. Many doulas, including Laakso, also offer grief coaching services for family and friends after a loved one’s death to help remind them of their strengths and set and achieve personal goals.
What is death positivity?
Mostly, Laakso says the process of planning and talking about death and dying with loved ones helps the dying person experience a “good” death — whatever that may mean to them.
Slowly, the social and cultural perception of death and dying is shifting in the United States, Laakso says. Especially with the growing popularity of the death positivity movement — a term coined by Los Angeles mortician and death educator Caitlin Doughty.
Death positivity works to destigmatize death and dying, educate people about the dying process and encourage ways of dying that center peace, healing and autonomy in place of trauma, chaos or fear.
Death positivity encourages ordinary people to make decisions about death, burial, cremation, medical and end-of-life care that bring them comfort and align with their values — regardless of societal norms.
For instance, death positive communities often encourage green burials, which allow for burial or cremation in ways that don’t harm the environment with caskets, concrete vaults or toxic embalming chemicals, but rather, enrich the earth as a person’s body begins to decompose.
Rather than deny death, or live in fear of it, death positive communities seek to acknowledge and embrace it as a natural part of life.
“If you can be at peace about your death, what a wonderful life you can live,” Laakso says. “That’s 90% of why we all fear death so much: we’re not in control. We don’t know. But if you can control those last moments, or feel that you have some control, how wonderful is that — and how does that change the way we live, even as healthy, functioning adults?”
Death care was considered domestic work in many cultures and comminutes
In the United States, death care is a $20 billion industry. But prior to the 1860s, women often cared for the dying in their own families or communities, then passed down that knowledge between generations.
Often, the dead and dying were mourned, cared for, dressed, bathed and prepared for burial or cremation in their own homes — a practice that waned in many areas across the country as the funeral industry became more formalized.
After embalming gained popularity during and after the Civil War, women were largely excluded from the same care they had provided within their own families and communities for hundreds of years.
That cultural shift fundamentally changed the practice of death care in the United States: Death care became a profession, and it was no longer an extension of women’s domestic work as mothers and caregivers.
“There would be one woman in the town that knew what to do when someone was dying,” Laakso says. “When I think of my family, and probably a lot of families in Akron, Ohio, we certainly don’t have anyone like that. And we haven’t for a couple of generations.”
‘It is such an incredible honor to be with someone in their most vulnerable time’
Humans have always performed death rituals — from Second Line parades in New Orleans and open funeral pyres in the streets of Varanasi, India, to sky burials in Tibet and coffins hung from sheer rock cliffs in the northern provinces of the Philippines.
For thousands of years, cultures and communities across the world have also invented and passed down ways to care for the dying. That care may include instructions on how to clean, wrap or feed the dying, but may also utilize spiritual, emotional or ancestral practices to connect with and honor the dying and their loved ones — like prayer, vigil, poetry or song.
For Laakso, those spiritual and emotional ties are sacred.
“It is such an incredible honor to be with someone in their most vulnerable time,” Laakso says. “Whether I’m officiating a funeral, or whether I’m talking to someone about their grief or whether I’m actually tending to a dying person, I can’t believe [that] somebody would trust me enough to bring me in.”
It’s important to establish trust with the dying and their loved ones, Laakso says, so she’s able to work with them in the ways that best fit their needs. Often, that’s some combination of medical care and the types of death care Laakso teaches and provides.
“People see a death doula as the antithesis of the health system,” she says. “We are not. We work with the health care system. Just because you have an absolutely fantastic hospice setup doesn’t mean a death doula doesn’t have a place.”
‘This is an ancient practice.’
Donna Baker — who founded Columbus Community Death Care in 2019 — says her own role and work as a death doula has taken on new meaning over the last three years.
Through Columbus Community Death Care, Baker and a small team of death educators help people plan ahead for their own deaths, make personal arrangements for their final days and discern exactly what a “good death” will entail for them.
Often, the people most interested in Baker’s work aren’t terminally ill or actively dying.
“I’m discovering that it really is a specific group of folks who are already seeing the world with a lot of imagination,” says. “It’s a lot of marginalized folks, people of color, single mothers, queer folks.”
“People either understand alternatives to [the processes] of birth and death or they don’t,” Baker adds. “And the people who seem to understand it and embrace it are people who are understanding and embracing alternatives in their daily life.”
Baker also offers end-of-life vigils and home funeral guidance — a practice she wishes more Ohioans knew was both a legal and affordable funeral option, particularly during the COVID-19 pandemic.
But overwhelmingly, Baker says people contact her not to perform doula work herself, but to learn how to care for their dead and dying independently.
To address that need, Baker is shifting her own ideas about doula work and death education. Instead of offering specific services at an hourly rate, Baker plans to expand her death care education efforts to better equip families and communities to care for their own dying.
The idea, she says, is to help return the honor and responsibility of death care and doula work to the families, communities and loved ones of the dying.
“I want to teach you how to be with your mother at the end of her life,” Baker says. “The right move is reminding people that this is in our bones. This is what we’ve been doing forever, and I’m not special because I attended an online program.”
“This is work we can all do,” she adds. “If we can just get a little guidance and trust [that] we are the best people to be with our dying loved ones, and that we don’t need experts.”
Flipping the script: ‘This is not how I want my kids to know or feel about death.’
Many Americans live with an intense fear of death — something Laakso and Baker hope to change through their work as doulas and death educators.
“[We need] to be able to kind of pause and say, ‘This isn’t working,’” Laakso says. “And this isn’t how I want my kids to know about death or feel about death.”
After losing more than 600,000 Americans to the COVID-19 pandemic, Baker and Laakso say thinking differently about how we die is more important than ever.
In Columbus, Baker holds virtual “death cafes” or “death dinners” at her home, where attendees are encouraged to discuss their fears and experiences with death.
Laakso hopes to host similar events in Akron, and build a community of people committed to incorporating death positivity in their own lives.
“We want to show families how to take care of their dying,” says Laakso. “You want to be able to take care of your own dying family? Then that’s what I want. I want you to be able to do this for the people you love.”
H.L. Comeriato covers public health at The Devil Strip via Report for America. Reach them at HL@thedevilstrip.com.
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