BIPOC Mental Health Month 2024: Mandy Breaux
“I feel like everything before I became a mom, it's just textbook. When I became a mom myself [I realized]: one, nothing is as easy as the textbook says; and two, it's such a lonely period. I have my husband, I have family coming to visit, but I don't know what I'm doing. I don't even know what I need help with!”
Mandy Breaux is a Women’s Health Nurse Practitioner with 12 years of experience after getting her degree from Boston College. She is fluent in both Mandarin and English. She has been working alongside the Director of the OB/GYN department, Dr. Lucy Chie, at South Cove Community Health Center since 2014. Mandy takes care of patients with different gynecological issues during the perinatal and postpartum periods. She is also a Certified Breastfeeding Specialist (CBS) for patients who need extra support on their breastfeeding journey. She has gone through training and was a Group Peer Support (GPS) facilitator for the Moms of Infants Group. In her free time, Mandy likes to spend time with her two children, travel, and try new foods.
This blog is made possible by a sponsorship from Sage Therapeutics, Inc. and Biogen Inc. All content on this page has been curated by the Mass. PPD Fund without input from Sage Therapeutics, Inc. or Biogen Inc.
July 2024 | Interviewed and edited by Jessie Colbert, Executive Director, Mass. PPD Fund
For BIPOC Mental Health Month 2024, we’re proud to feature a conversation with Mandy Breaux, Women’s Health Nurse Practitioner at South Cove Community Health Center, a Boston-Area Federally Qualified Health Center serving a primarily Chinese immigrant population. We were grateful to sit down with Mandy to learn more about her work, what inspires her, and how her experiences as a new mom have deepened the care she offers her patients.
In this interview Mandy also shares her painful experience losing a pregnancy during the pandemic, and how she reached out for help. In sharing her experiences and clinical practice, Mandy exemplifies so many important ways we can support the mental health and wellbeing of all new parents: reducing isolation; understanding people’s unique circumstances, cultural and otherwise; tackling stigma through education and, when it makes sense, sharing our own mental health struggles; and finding ways to go the extra mile to support parents, even in a rigid and limiting medical system.
Can you share how you got into your field, and what inspired you to become a women’s health NP?
I was pre-med in college, and I did a bunch of volunteer work. One thing I did for a long time was a student-run clinic. It was a free clinic with a lot of teaching patients, I feel there’s a lot of need for that. Then I did a multilingual outreach program for breast cancer awareness. It was just a bunch of college students setting up tables with pamphlets outside of grocery stores. I went to school in San Diego, and there are a lot of Asian grocery stores. We'd go to different stores and teach women about breast cancer awareness, and self-exams, and how to start routine screening. I was the leader for the Mandarin team. Because a lot of women don't have time to take care of themselves, especially moms, the only time you can catch them is when they get groceries! So that got me thinking, Okay, I like being in the community, I like teaching, I like to work with women.
Also, growing up in Taiwan, in Asian culture, there wasn't a lot of sex ed and things like that, and everything was taboo. Nobody talks about sex, nobody talks about birth control. I wanted [that information] myself in college, and then I realized, everyone needs this knowledge, not things from the internet.
I was debating whether I should go to PA [Physician’s Assistant] school or NP school, and for NPs, I needed to choose a specialty. I thought women's health is what speaks to me the most, and here I am! I graduated from Boston College in 2010, and my first job was as a women's health NP in a community health center in Hartford, Connecticut. And then I came to Boston and started at South Cove in 2014, it's been 10 years.
You were a women’s health NP for many years before you became a mom yourself. What surprised you in terms of what you expected versus the reality of having a new baby? How has being a mom changed how you practice?
It changed everything. I feel like everything before I became a mom, it's just textbook. When I became a mom myself [I realized]: one, nothing is as easy as the textbook says; and two, it's such a lonely period. I remember I asked my mom friends, Did you feel lonely? I felt so alone. I have my husband, I have family coming to visit, but I don't know what I'm doing. I am looking up Google every day. Even though I do this for living, I still need that validation, that support. And I don't even know what I need help with! It was a big reality check.
I also had a hard time breastfeeding the first couple weeks. I had a lactation consultant coming to help me, and that was just so much help and support I didn't know that I needed. It inspired me so much that I decided to get a breastfeeding specialist license. At the clinic, we just tell people, “Breast is best.” Well, now it’s “Fed is best,” but we try to encourage everyone to try breastfeeding. But really, it's not free, you have to buy all the equipment. And time is money, we spend so much time just being latched with a kid.
A lot of my friends had babies after me, and I reach out more than before I became a mom. I'm there for them because I know how lonely I felt. It changed me as a friend and as a clinician.
At South Cove, your team under Dr. Lucy Chie (South Cove’s OBGYN Director and the Fund’s Board Clerk) has instituted a range of wonderful supports for birthing people, including group prenatal care. How do you see group care making a difference for moms?
Lucy and I did two cohorts of group prenatal care, and they went great. We had about 10 to 12 people each time. Regularly, we see each OB patient just 15 minutes, but in the group they get two hours. So we see them chatting with other moms, we interact with them more; it's a different kind of relationship. I feel like they trust us more, and they open up more. We set up a little snack every time and they learn about healthy eating, we talk about exercise, we talk about birth control. It’s easier, it’s not a lecture. We had a post-session questionnaire, and everyone did like it. They all told other people in the community and a lot of people wanted to join.
Patients loved coming because that's when they finally got to talk to another pregnant mom. A lot of our patients come from China by themselves, they don't really have a social network. They created a chat group after the session to keep in touch with each other. Lucy just saw one of the patients last week – she was pregnant again – and she said, Why don't you guys have the group again? I really was looking forward to it, that's the only time I get to make friends. The pandemic happened, that’s why we stopped. I was pregnant too with the second group! It was really fun.
That inspired us to try to do a postpartum support group. We went for the GPS training, and then the pandemic again – we didn’t know if people would join via Zoom. A lot of the patients, they have stigma, like, we don't want to air our dirty laundry in front of other people. This person might know my aunt or my cousin or something, because it's a tight community. Patients don't really understand how group therapy would benefit them, we need to do more education on that. It's good to know other people have the same concerns. I think when people join and see how it’s run, then they stay.
I also worked for GPS for a year. I did the postpartum support group with one other co-facilitator, and it was powerful. It’s such an honor to be there with all the women and be so vulnerable at the same time, because as a facilitator, we share what's heavy in our heart, too.
You’ve shared that before you had your second living child, you lost a baby about halfway through the pregnancy. I am so sorry. Are you able to tell me what happened, and how you came to reach out for extra support? How can we provide better care for birthing people who face this unfortunately pretty common experience?
With my second pregnancy, at around 19 weeks, we went for the full fetal survey and they told us the baby's brain wasn't developed correctly. It was one in 10,000. I went for an amniocentesis, I went for a fetal MRI and all this stuff to confirm, talked to a special neonatal neurologist. [We learned] she might have seizures, chronic headaches, developmental delays, and things like that. We couldn't bring her into the world. It wouldn't be fair for her, or for our firstborn. We had to terminate, it was the hardest decision.
It was also during COVID, so my husband couldn't be there with me [for the procedure]. I went into pre-op myself, woke up by myself, and then he came to pick me up. I was crying the whole time. This was carrying on throughout months [all the testing and making the decision to end the pregnancy] so I thought I was prepared. And then my milk came in, and I started to second-guess my decision. I just cried and cried and cried. I remember, before leaving the hospital, the social worker came and asked, Are you okay? Do you need any help? I was like, I'll be fine. But then, a week after we got home, I was a hot mess.
What was it like to find a therapist to support you? How did that help?
I went online and looked up a bunch of therapists that focused on neonatal loss and maternal mental health. I left a message [with a therapist], crying, saying, I think I need help. The next day, she called me back. I started talking to her, and it’s been two a half years. I didn't realize how much help I needed to process the loss, to help me through the grieving process – to learn how to forgive myself for making a decision, and how to accept what had happened and move forward. All this is very difficult, because no one talks about it.
As a clinician, when someone loses a baby, we say, Okay, you can try again. But now that it happened to me, I'm like, Well, that's not the answer that helped me. We need to give them time, we need to give them extra support. I sit with them, and I really try to talk to them the way I wish someone had talked to me. I say, Well, I know you're trying to assign a why, and we could try, but there's not always an answer.
I check in with them more often now, instead of just at two weeks and back to an annual. All the clinicians in my clinic think it's ridiculous that postpartum we only see patients once or twice, and then back to annual. We all hate how the system is. What we do in the clinic now is, we check with everyone at two weeks, and then we'll see them in six weeks. But then when I know a patient might need extra help, I just suggest to them, Why don't you come back in another month? I don't tell them, I want to check your mood. I’ll usually say, Oh, I just want to see how you're doing with the baby, how the breastfeeding is going. If they hear that they're more open.
I do open up to my patients when they seem like, How do you know what I'm going through? I share my experience with them. At the beginning I didn’t, because it was like reopening my wound. But after a while I thought, Okay, I need to tell them. I told them I had to go see a therapist because it was affecting me so much. I feel like just normalizing that to my patients might help change the stigma.
I’m sure that makes a huge difference for them, thank you so much for sharing. In terms of either loss or postpartum mood disorders, how do you determine when a patient needs behavioral health support, and how do you make that connection?
We have our patients fill out the PHQ-9 depression screening throughout their pregnancy and postpartum. And sometimes that gives us a little hint, like, okay, this score is a little high. I usually try to poke my patients a little bit, especially if I see their affect not matching with the score. A lot of it is intuition. Sometimes they kind of get teared up if I ask how things are going at home, or ask how's breastfeeding going.
A lot of our patients have to do sitting the month [a traditional Chinese practice involving resting, staying home, and other restorative practices after childbirth], so they can't leave house for a whole month after baby. A lot of patients get upset and depressed during that time, because they can't eat what they want to eat, or drink what they want to drink, they can't leave the house. I try to ask them how that's going, and sometimes I welcome their partner in so I can figure out what's going on at home. I usually assess them to see how severe their symptoms are. If they seem depressed, if they seem really anxious, really upset, I talk to them about maybe therapy, maybe medication, maybe seeing behavioral health. Some patients are more resistant, they don't want to see behavioral health. In that case, I usually have them come back more often to just see me. At least I know they feel comfortable with me, and they could talk to me.
If I feel they are in danger, we call our Behavioral Health Department right away. And they're really good, sending someone up to our department right away after the visit. Our relationship with behavioral health works really well.
That’s great. We know that all new parents need so much more support than they get in the current system. If you had a magic wand and money was no object, what would you do to provide moms with the best care and support postpartum?
Do you know those postpartum centers that are a really big thing in New York and on the West Coast? It’s like a luxurious, five-star hotel. You have a 24-hour snack bar, a lactation consultant on call, you get a daily massage, a daily meal plan – the best, healthiest food. And people just help you with the baby, help you breastfeeding, help you exercise. It’s like a postpartum vacation! I mean, a lot of my friends have night nurses, but this is next level. If had the ability, every mom would get to stay free at this postpartum center. In Europe, they have midwives and doulas visiting. If our system could make that happen, that would also be very helpful for postpartum moms, just to have home visiting, or more frequent [clinical] visits.