Birth and death are among the most profound issues of life. From a professional standpoint, dealing with end-of-life care, as well as dealing with obstetrical care have differences of course, but also many similarities. And for everybody, how these times in life affect us and those around us, are complex, difficult but often meaningful. In my musings, I would like to explore some of these complex thoughts and ideas in depth. Feel free to comment or add your ideas in the Contact page.
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Q – What is tokothanatology anyway?
Tokothanatology is a made up word, based on the Greek words tokos, meaning childbirth and thanatos, meaning death. I noticed so many similarities in the care we give at both ends of life, and the concepts of birth and death, that I decided to write a book about it!\
New boostThe most obvious thing at first glance is that pain medication for a woman in labour has to factor in the safety of the fetus, as well as the mother. In the palliative setting, while we don’t want to cause harm. Adequate symptom control is paramount, as long term effects and side effects may not seem as important, nor is the risk of addiction relevant.
However, many of the non-pharmaceutical measures such as breathing techniques, acupuncture, hypnosis, visualization etc. that have proven to be useful during labour are also helpful in controlling symptoms in the dying person.
Q – How does pain control in labour compare with pain control at end-of-life?
The most obvious thing at first glance is that pain medication for a woman in labour has to factor in the safety of the fetus, as well as the mother. In the palliative setting, while we don’t want to cause harm. Adequate symptom control is paramount, as long term effects and side effects may not seem as important, nor is the risk of addiction relevant.
However, many of the non-pharmaceutical measures such as breathing techniques, acupuncture, hypnosis, visualization etc. that have proven to be useful during labour are also helpful in controlling symptoms in the dying person.
Q – How does religion impact tokothanatology?
Religion shapes how people understand birth and death, as well as what may exist before and after life. It raises core questions: What is a human being? What is a soul? What happens before birth and after death? Some see life as predestined, others as shaped by free will. Some believe in reincarnation, others in judgment and an afterlife. These views influence how we welcome newborns and how we grieve a loss.
Q – Why does this matter in practice?
Understanding a person’s beliefs can reveal how they frame birth, death, and loss. It helps us understand family and cultural expectations. But we must avoid assuming that an individual’s beliefs fully match their formal religion.
Q – What role do rituals play in birth, death and tokothanatology
Religious rituals guide people through life’s transitions—welcoming a newborn, mourning a loved one. These structured practices reduce the burden of decision-making and provide meaning during overwhelming times. I discuss this more fully in “Bookends” chapters 4 and 5.
Q – How do emotions compare at both ends of life?
At first glance, the birth of a child is a joyful event- except for the fear of labour and delivery, anxiety about the health of the infant, the mixed or negative feelings about becoming a parent, financial worries…. you get the picture. And death and grief are sad. But in many cases, having a terminal illness can bring families together, to share memories, love support, which has its own kind of joy. Similarly, loved ones sit vigil at the deathbed, looking for that last breath.
Q – How to talk to children about birth or death ( tokothanatology)?
Children are a lot more savvy than we give them credit. They pick up their parents’ emotions, they listen to our conversation,and they often make assumptions.
How to tackle these big topics: someone they know has died or is very ill or is going to have a baby is very similar at both ends of life. It is age related and of course, very individual.
The important advice I can give you is to HAVE the conversations. Find out what their understanding is, correct any misconceptions in an age appropriate manner, offer to be available to answer questions at a later date. And reassure them they are important in the family structure, even when that structure is changing.
Q – What to say to someone who has had a recent stillbirth (or other negative outcomes in childbirth)
When a person is pregnant or has just given birth, friends and family often like to share in their joy, and to offer congratulations. But when things go wrong, whether the child has died, or if there are challenges, it is often difficult to know what to say. By taking a step back, we can realize that grief around pregnancy shares the same emotions associated with any loss. So all of the usual phrases: ” I’m sorry for your loss” etc are still helpful. But there are important nuances. You did not have a chance to know the person who has died, so you can’t comment on a memory. Fathers suffer the same sense of loss, but this is often not acknowledged.
The best options are really the same for any bereavement. Listen. Say something. Offer your acknowlegement of their loss. Offer your presence. Don’t offer advice unless asked.
Q – What is the current status of MAiD in Canada?
Medical assistance in dying is legal in Canada, for persons who meet specific criteria. They must be eligible for health services in the province or territory, be over 18 years, and be mentally competent. They must have a “grievous and irremediable medical condition.” This means a serious illness or disability that cannot be reversed and causes unbearable suffering that cannot be relieved in a way acceptable to the person. It does not require that the condition is fatal. At present, mental illness as a sole diagnosis is not eligible. However this is due to come into effect March 17, 2027.
Q – How many people have died with MAiD in Canada?
According to Health Canada, there were 19,660 MAiD requests in 2023, and 15,343 people received MAiD in that year. ( 2906 died before recieving MAiD, 915 were deemed ineligible and 496 withdrew their request.) In Canada, 4.7% of Canadians who died in 2023 received MAiD. By province, 36.5% were in Quebec, 30.3% in Ontario , and 18% in B.C.The median age of MAiD was 77.6 years in 2023.
