Fibroids & Pregnancy Part 1 - The Doula Difference: How Doulas Empower Aspiring, Expectant, and Fibroid Moms
By: Kiara Burroughs
Teneele Bruce - Maternal Health Professional, Certified Doula, and Director of Patient Education for The White Dress Project
As we start a new year and new beginnings, I am kicking off a multipart series on pregnancy to cover several wellness topics that fibroid patients should consider on their motherhood journeys. In this first part of the series, I report on an enlightening conversation with The White Dress Project’s own Director of Patient Education, Teneele Bruce, a certified doula. Our discussion covers a multitude of topics such as the powerful role a doula can play as advocates on your journey from pre-conception to post-partum and as champions for the health and well-being of you, your baby, and your family. Read ahead for the inside scoop.
Teneele, what is a doula and what inspired you to become one?
A doula is a birth support person that an expectant mother would typically add to her birth team in addition to her OB/GYN and any other type of specialists that she may be seeing during her pregnancy. Doulas are often categorized as community health workers and provide physical, emotional, and informational support to pregnant women prior to conception, pregnancy, birth and immediate postpartum. There are different kinds of doulas for different phases of the birthing journey – preconception, birth doulas (which is what I am), postpartum, bereavement and grief support, and abortion doulas.
I was inspired to start doing this work because it was a perfect segue from the yoga services that I was providing at the time. I’ve always had an interest in health and wellness, and how medicine and community health can work together. I finished my yoga teacher training in 2014, and there was a pregnant woman who reached out to me who was interested in receiving prenatal yoga services. During one of our sessions, she asked me “are you a doula by chance?”. I said “no, I'm not a doula. Why do you ask?” She said, “I was just curious because you're so good with me and my daughter, and you really have just been amazing with our whole family.” So, my gears started turning, and the more I thought about it, the more the light got brighter.
When my best friend was pregnant, she called me up randomly and said “we’ve got action.” I literally got out of bed, threw some clothes on, grabbed something to eat, and made my way to the hospital. I was there with my best friend from the moment her and her family got to the hospital until her first son was born. Later, I researched doula trainings that were being offered and I was able to find one that was happening about a three-hour drive for me. So I participated in a Full Circle doula training that was being offered by the International Center for Traditional Childbearing (ICTC), which is now known as the National Association to Advance Black Birth (NAABB). I was trained under the Shafia Monroe consulting curriculum for Full Circle doula support.
What a beautiful story! This is the perfect segue to my next question: how can working with a doula help a mom-to-be practice wellness on her pregnancy journey?
A doula can have many resources and tools in their tool belt. For me, they are prenatal yoga support, an understanding of herbalism and nutrition, and keeping my patients accountable for their doctor’s appointments and being vocal when something does not feel right. I bring a lot of that with me to my doula practice. For herbalism, I focus on this heavily in the second and third trimesters, and nutrition as early as preconception. Nutrition is important whether you’re pregnant or not, but a doula brings that extra encouragement to maintain proper nutrition and hydration during your pregnancy.
I let pregnant women know that, hey, you are in fact eating for more than one so take everything in moderation. I commit to doing an amazing job of making pregnant individuals and families think more proactively when it comes to their health and the life that the mother is growing. It really brings a lot of things into perspective because health-and-wellness is more than just physical. It is also mental, emotional, and spiritual. I believe a doula is a great companion to bring awareness and provide support in all these areas for the clients and their families.
That is so true! Health-and-wellness is about so much more than physical. The other areas that you mentioned are of equal importance. Let’s shift gears a bit and talk about the specific experience of fibroid patients. Can fibroid patients work with doulas?
Yes, absolutely. If a patient not only finds themselves pregnant, but also pregnant in the presence of fibroids, they most certainly can work with a doula. It’s very important that their doula and obstetrician be partners in their care because there are so many things that must go right for a pregnancy and a delivery to be a healthy and a positive experience. Unfortunately, the presence of fibroids can present a barrier to that positive experience, so there are certain things that we have to be mindful of. The presence of fibroids could make pregnancy high risk.
With that in mind, there are certain ways that we as doulas can tailor our support and our care for the pregnant individual. For example, we can make sure that the expectant mother is mindful of any pain or sensations that she may be feeling. Red degeneration is common during pregnancy if you have uterine fibroids. So, we really want to have our clients be vigilant of any pain that they feel during pregnancy and to seek out the proper medical care and attention to get the care, medication and bed rest that they may need. With uterine fibroids, whether you’re pregnant or not, we still must be mindful of nutrition, hydration, and keep our physical activity in mind. While physical activity is encouraged during pregnancy, there are certain movements that you may want to avoid when pregnant with fibroids.
Fibroids literally have a mind of their own. Certain tumors will shrink significantly during pregnancy and others may grow significantly. Everyone’s body and pregnancy are different, and the fibroids are going to respond accordingly. If the patient can connect with a doula during their pregnancy, then I highly encourage it because it helps to just give that extra support that she may need. Pregnancy is a rollercoaster and marathon already without any complications. So, just imagine a woman that’s navigating pregnancy with uterine fibroids or with any other health complications that may arise, such as hypertension, gestational diabetes, and things of that nature.
Fibroids do certainly have minds of their own and can be a concern for expectant mothers. What are some of the differences you've seen between working with fibroid patients and patients without fibroids?
From personal experience, I previously worked with a client who had a myomectomy prior to conceiving via IVF. While having an ultrasound done during one of her doctor’s appointments, the doctor discovered a small fibroid. So, this client had to get a cerclage because the cervix was starting to open a little bit, be mindful of her hydration, and really keep her stress down. Fibroids feed off any number of things, and we know that one of those things is stress. During pregnancy, our bodies are going through so many different changes and it’s just a very sacred and emotional time. We want to work with our birth clients with regard to nutrition, hydration, keeping stress down, staying on top of doctor's appointments, and possibly requesting additional doctor’s appointments so that we’re able to monitor not only the progress of the pregnancy, but also whether that tumor is behaving.
I've heard that some fibroid patients request or are assigned a high-risk doctor to help them navigate their pregnancies. Is that something you typically see happening?
Yes, that is a common thing. Fibroids aside, there are other things that can influence a decision of going with a high-risk physician or even being referred to a high-risk physician. For example, if you are a person who has had multiple cesarean births, then there is a chance that you may be referred to a high-risk physician. If at some point during pregnancy you develop what is called a “placenta accreta”, which is when the when the placenta starts to attach itself to other organs like the bladder, then that's grounds for being referred to a high-risk physician. So yes, it is common. Fibroids do present a challenge and can change pregnancy from being uncomplicated to being high risk.
Speaking of multiple cesarian births, some fibroid patients may need to have C-section after having surgical treatments like a myomectomy. Can doulas support women who need to have C-section births? If so, then how do they provide support?
Women who have had a myomectomy or another type of abdominal procedure to remove fibroids more than likely will need to have a cesarean delivery once they’re due to give birth. Personally, I had a myomectomy a couple of years back and I know that if I conceive that I will more than likely need to have a cesarean birth. The way that doulas can support patients during cesarean birth is dependent on the hospital since every hospital has different policies and procedures in place. A cesarean delivery is considered surgery and is performed in the operating room. To keep the operating room sterile, hospitals try to keep the room limited to necessary individuals only. Usually, the expectant mother is limited to one additional person – their partner, parent, whoever their support person is at that time – to be in the room with them. Some patients must choose between their doula, husband, mother, or best friend. In that instance, if I've been supporting this person leading up to this point and we have drafted a birth plan, then I typically will take a step back. I let them know that I am there for them and understand that their husband, best friend, or whoever they choose is best for them to have in the room – unless of course they really want me in there. I understand this is a special moment between them and their loved one. There have been other instances where I have been the sole support person.
I've witnessed cesarean births in my practice and they’re just as special, beautiful, and magical as vaginal birth. So, it’s always nice to be in the operating room when that birth is happening. If I am not in the operating room, then I'll wait until the procedure is done, and the mother and their support person are in recovery to reunite with them. From there, I make sure that things are going well as far as the baby latching if they choose to breast or chest feed, answering any questions that they may have, and making sure they are stress free during that sacred bonding time immediately postpartum. Once a mom is like, “I'm ready to eat!”, then that’s usually my signal to go haha! Once they're discharged and settled at home, I give them a few days to adjust before I start doing my check-ins and postpartum follow-ups.
And if I could just add a little nugget in here: recovery from cesarean birth is different from recovery after vaginal birth. Recovery after cesarean birth is very, very similar to recovery after a myomectomy. So, for anyone that is on a fibroid journey, has had a myomectomy, and is thinking about getting pregnant, they have kind of had a practice round with this because their recovery process will be very similar.
That is a great nugget and important for fibroid patients to know if they have had a myomectomy as a treatment option. What strategies do you recommend for fibroid patients to maintain their emotional well-being both during pregnancy and postpartum?
Aside from considering having a doula as a part of their birth team, I would encourage patients to become partners in the success of their pregnancies. Pregnant women will go for their doctor's appointments, and those are typically in-and-out, ranging anywhere from 15 to 20 minutes. It leaves room for questions and for our minds to spiral. Sometimes women may have burning questions that we don’t feel we have the time or the space to ask. I really encourage women who are either pregnant with fibroids, on a fibroid journey and thinking about conceiving, or wherever you are on your journey, to become involved with a doctor that sees you, recognizes your journey, and is willing to hold your hand, because the journey doesn’t end once the baby is here. Give yourself permission to be picky about who you’re receiving care from. You want to feel comfortable with this person and know that you’re going to have the time and the space to ask questions and contact them outside of the office appointment time. Be your own best advocate. That's something that we preach through The White Dress Project. I would also encourage finding community – whether that looks like online community through organizations like White Dress, or mom groups like Mocha Moms, where you can see yourself in the experiences of others.
I recommend journaling. Sometimes community looks like the community that you build within yourself first. The more that we’re able to empty our brains of our racing thoughts, typically the better off we tend to be. I highly encourage journaling during preconception, pregnancy, and most definitely during postpartum because women experience a lot of emotions bubbling to the surface that can look like baby blues, postpartum depression, and other forms of perinatal mood conditions.
Finally, I recommend being open with people that you trust. That can look like family, friends, a therapist or even your pastor. Choose someone that you feel comfortable with, seen, and heard by. These are the types of people that you want in your village and surrounding you during pivotal times.
You are so right. Community is so important and is highly promoted by us at The White Dress Project. Our community is so special, and we always encourage members to be advocates for themselves and the importance of a support system. As we wrap up, what advice would you offer fibroid patients or a mom-to-be who is looking for a doula?
I encourage everyone to do their homework when deciding on a doctor and to do the same when seeking out a doula. There are some character traits that I think are great for doulas to have: Someone who has empathy, is proactive, who is not afraid to work in partnership with your medical team, and who isn’t afraid to stand in that gap between you and the healthcare system. Unfortunately, we know that the healthcare system isn't always kind to women in general, but black women specifically. So, when looking for a doula, I think it's important to ask them how comfortable they are with speaking up or standing in the gap for others. The woman should also seek someone who is detail-oriented and going to tailor their support to your needs – whether you need them to hold your hand the entire way from point A to point Z or be a little less hands on. It’s important for people to ask a doula if they are flexible and willing to meet them where they are. Finally, an expectant mother should seek someone who’s non-judgmental and not going to impart their feelings and beliefs onto the patient or client. We all have a personal way of thinking about things or may disagree with a decision that the patient or client is making. However, it’s important for the doula to check those feelings at the door because if the other person isn’t causing any harm to you, themselves, or to others, then those opinions may need to be contained.
Great advice! Are there any final nuggets of information that you would like to share with our audience?
From a nutrition standpoint, if you are pregnant, there are certain foods that are powerhouses and borderline magic. For example, if you and okra are not friends, then you want to become friends with it during your pregnancy. Okra is an amazing food. People are usually put off by the slime, but you want that slime during pregnancy, especially as you near the end of your pregnancy, for the extra lubrication. Dates are another food that is amazing, especially towards the end of your pregnancy, as they really start to pack their punch during the second and third trimesters of pregnancy. Finally, if you don’t like what your doctor is saying to you or if you don't feel seen or heard by them, then please get another one. You can do that, and you will not be penalized.
Want to keep in touch with Teneele or have an interest in her doula services? Check out her contact information below:
IG handle: @teneele_michelle
Email: rootedwombs@gmail.com / Teneele@thewhitedressproject.org
This interview has been edited for length and clarity.
