What Is a Death Doula? Could You Benefit from One? A Conversation with Mangala Holland

Karen Lafferty | Continuum Counselling | Grief Unedited Podcast, Season 2

Most of us have heard of a birth doula. But what about a death doula? And what does end-of-life support actually look like in practice. Who is it for, what do they do, and how is it different from palliative care or grief counselling?

In this episode of Grief Unedited, I had the pleasure of sitting down with Mangala Holland, a woman who brings together two seemingly different worlds in her work: female sexuality education and end-of-life doula practice. As I said to Mangala during our conversation, the combination might sound surprising  but the more she explained it, the more connected it all became.

Mangala has spent 13 years supporting women to find confidence and overcome sexual blocks. Around three years ago, as she turned 50, she felt a pull towards the world of death and dying, trained with Living Well, Dying Well the only organisation in the UK offering a certified end-of-life doula qualification and has since joined their training team. She also brings three decades of experience in corporate training and education to the role.

This is a conversation full of honesty, warmth, and the kind of insights that come from someone who has sat with the big questions about life, death, and everything in between.

Sex and Death: Two Sides of the Same Taboo

When Mangala first described her background, she made an observation that stayed with me: sex and death are, in many ways, two sides of the same coin. Both are universal human experiences. Both are profoundly intimate. And both are topics we've been culturally conditioned to avoid.

It's this shared territory, the uncomfortable, the unspoken, the deeply personal that drew Mangala from one field into the other. And it turns out that the connection runs deeper than the taboo. Many of the women she works with on sexuality are midlife or later, and many are navigating significant grief: the death of parents, the losses of menopause, the grief woven into the shifting of identity that comes with age.

Grief, she has found, shows up everywhere, if you know how to recognise it.

What Does a Death Doula Actually Do?

This was the question I really wanted to get to the heart of, because despite working in the grief and bereavement field for over 15 years, I had never personally known anyone who had worked with an end-of-life doula.

The honest answer, Mangala explained, is that the role looks different for everyone and that's the point. A death doula is not a medical professional, and they're not there to replace palliative care or hospice support. Instead, they work in the spaces those services don't always reach. Depending on what the person needs, a doula might:

• Help with advance planning - getting financial affairs and admin in order

• Provide emotional support, simply being present and available to listen

• Act as a buffer or advocate between the dying person and well-meaning but overwhelming family members

• Support people in staying connected to their community as their world becomes smaller

• Help create the environment the person wants for their death -  the music, the scents, the lighting, the who's-in-the-room and who isn't

That last point was one I found particularly moving. Mangala described a reflective practice from her training where trainees are asked to consider their own death: what would you want around you? Fluffy socks? The window open? A particular scent? Silence or music? It sounds almost trivial and yet, as I reflected during our conversation, how many people never have that conversation with the people who love them? And how many families end up doing what they think their person would have wanted, rather than what they actually wanted?

With more people dying at home as NHS bed availability becomes increasingly stretched, these conversations matter more than ever. A death doula can help create the conditions for a death that feels like the person's own.

The "Woo-Woo" Misconception

Mangala was candid about the biggest misconception she encounters in her work, particularly from medical providers and those in the hospice world: that death doulas are all crystals, incense, and spiritual wafting.

She laughed as she described it and then gently but firmly pushed back on it.

The approach she trained in through Living Well, Dying Well is deliberately non-impositional. It's not about a doula's belief system, their sense of the afterlife, or their spiritual framework. It's about the dying person. What do they believe? What does a good death look like for them? Whether someone is deeply religious, completely agnostic, or somewhere in between, the doula's job is to show up for that person's death, not to shape it.

That's a significant distinction, and one worth making loudly, because it means end-of-life doula support is genuinely available to everyone, not only those who hold particular spiritual views.

Grief Is Not Linear,  and It Shows Up in Unexpected Places

When I asked Mangala what she most wished people knew about grief, her answer was clear: grief is not a five-stage process, and it doesn't move in a straight line.

The model we've all heard of,  the five stages of grief, has been widely misunderstood and misapplied, she said. In reality, grief is unique to every individual. It surprises us. It surfaces in places we don't expect. And learning to recognise it, to name it, can make an enormous difference.

Mangala spoke personally here. Her father has Alzheimer's, meaning she is living inside anticipatory grief right now. Learning that there was a name for what she was experiencing, that it was normal, that it was a recognised stage and not just chaos and dread that, she said, was incredibly helpful.

She also raised something that rarely gets discussed openly: the relationship between grief and sexuality. The common assumption is that grief kills libido. And often it does. But for some people, grief can provoke the opposite response, a heightened need for closeness, for aliveness, for physical connection as a way of processing loss. There is often shame around this, Mangala noted. People keep it hidden, assuming something must be wrong with them. She was clear: it's a normal response. And naming it as such can be quietly transformative for those who need to hear it.

This connects to a broader theme in grief work: disenfranchised grief - grief that isn't socially sanctioned or recognised. The person grieving a relationship that wasn't publicly known. The child scolded for being more upset about a pet's death than a grandparent's. The colleague who quietly falls apart after losing someone they couldn't openly mourn. The more we normalise all of it, Mangala said, the better.

The Body Knows How to Die

One of the most striking threads in our conversation was the idea, which Mangala encountered in her doula training, that the body knows what to do when it comes to dying.

Just as the body knows how to give birth, it knows how to die. A changing breath pattern, a withdrawal from food and drink in the final days - these are not signs that something has gone wrong. They are part of the process. And one of the most powerful things a death doula can do is help family and friends understand this, so that what might otherwise feel terrifying becomes something they can be present for rather than frightened by.

Mangala has taken this insight beyond death work. Going through her own menopause journey, she found herself applying the same frame: my body knows what it needs to do. It doesn't always feel comfortable, but there is wisdom in trusting the process rather than fighting it.

A Friendship, a Spa Day, and a Death Without Regrets

When I asked Mangala about a moment that had confirmed she was in the right place with this work, she shared something deeply personal.

Just over a month before we recorded this episode, her close friend Nicola died, in her early 50s, from ovarian cancer. After her diagnosis, they talked openly about mortality, about what Nicola had done with her life, about how she wanted the end to feel. There was laughter. There were frank words. And there was a sense, Mangala said, that Nicola had no unfinished business, that she had said what she needed to say to the people who mattered.

Mangala wasn't Nicola's doula in any formal sense. But because Nicola knew that Mangala lived in this world, she could lean into the conversation in a way that wasn't always possible with others who loved her - relatives who weren't ready to go there, friends for whom it was too painful.

That, to me, is exactly what this work is about. Not just the formal, professional role of a death doula but the gift of being someone who can show up for the hardest conversations without flinching.

And Mangala was clear: there was laughter in those conversations. Plenty of it. That, too, is part of how we die, and how we grieve.

If You'd Like to Know More

Living Well, Dying Well is the UK's leading end-of-life doula training organisation and offers the only certified doula qualification in the country. Their sister organisation, End of Life Doula UK, has recently become a charity and can sometimes help fund support for those who could not otherwise access a doula. They also list trained doulas by area on their website worth checking if you're in Scotland, as training and provision is growing here too.

Mangala Holland can be found at mangalaholland.com and on Instagram, Facebook, and LinkedIn. She is also listed on the End of Life Doula UK directory for doula work.

For those who want to read more on this subject, Mangala recommended With the End in Mind by Dr. Kathryn Mannix  a compassionate and accessible look at what dying actually looks like, written by a palliative care physician. Dr. Mannix also has talks available on YouTube, including a TED Talk, for those who prefer to listen.

Listen to the Full Episode

There's much more in the full conversation  including a discussion of the sensory environment of death, Reiki at end of life, and why end-of-life planning might be one of the most loving things you can do for the people who will be there with you.

You can find Grief Unedited wherever you get your podcasts. If this post has been useful, please share it with someone who might benefit - it really does help more people find these conversations.

To connect with me directly, find me on Facebook and Instagram at @ContinuumCounselling or at www.continuumcounselling.com.

Karen Lafferty is a grief-specialist counsellor and the host of Grief Unedited. She has been working with individuals and couples navigating loss and bereavement for over 15 years through Continuum Counselling.