When the COVID-19 pandemic began in March 2020, San José State University Nursing Professor Deepika Goyal, ’02 MSN, recognized that it could pose significant risks for pregnant and nursing mothers — especially to their mental health. For many pregnant and postpartum women, social distancing limited access to critical support networks, while fear of the virus itself increased the likelihood of them experiencing anxiety and depression.
Over the past 18 months, Goyal has partnered with colleagues across the United States and Europe to study pregnancy, birth and postpartum outcomes — and how they were affected by the pandemic — resulting in multiple studies and five publications.
In addition to serving as a professor at SJSU, Goyal is a nurse practitioner at Santa Clara Valley Medical Center’s obstetrics and gynecology department. In spring 2020, she reached out to University of Connecticut School of Nursing Professor Cheryl Beck and researchers in the United Kingdom to collect data from women who gave birth after Feb. 1, 2020.
Their forthcoming study, “Postpartum Depressive Symptoms & Experiences During COVID-19,” is one of three papers Goyal co-authored that will be published in early 2022 in a special issue of MCN, The American Journal of Maternal Child Nursing, dedicated to COVID-19 and maternal mental health. Goyal and her research partners found that 75% of women surveyed were living with depressive symptoms.
“Women described this time as challenging due to changes in health-care delivery — virtual versus in-person appointments — and limiting in-person appointments to the mother, often excluding dads or partners,” said Goyal. “Women felt lonely and isolated and had limited social support, all while caring for a newborn and sheltering in place.”
It doesn’t help that the pandemic has increased the risk of depression and anxiety, two conditions that pregnant and postpartum mothers are especially vulnerable to experiencing. While her first study focused on postpartum experiences, Goyal still wanted to understand how the pandemic affected women during pregnancy.
To do this, she partnered with Cindy Liu, director of the Developmental Risk and Cultural Resilience Laboratory at Brigham and Women’s Hospital and assistant professor of pediatrics at Harvard Medical School, to examine data obtained from pregnant women who participated in the hospital’s Perinatal Experiences and COVID-19 Effects study from May to November 2020.
Together, they published “Patient Satisfaction with Virtual-Based Prenatal Care: Implications after the COVID-19 Pandemic,” and collaborated on a second paper, “Unmet prenatal expectations during the COVID-19 pandemic,” to be published in the same MCN 2022 special issue.
The study concluded that nearly 90% of women preferred in-person care under non-pandemic conditions. While the majority of respondents appeared satisfied with their virtual care, Goyal added that the constant shift in COVID-19 protocols caused miscommunications between women and their health-care providers.
“Unfortunately, the new and changing nature of COVID has created inconsistent messaging and care, which creates miscommunication, misunderstanding and frustration,” she said. “For first-time mothers, this is the only experience they have. However, women who have given birth in non-pandemic times are just trying to get through the best they can.”
Throughout her collaborations with academic partners during the pandemic, Goyal noticed that Asian Americans were not well-represented in COVID-19 studies. So she collaborated with Meekyung Han, professor of social work at San José State, and they conducted a separate study to examine the experiences of pregnant and postpartum Asian American mothers, which included interviewing first-time moms and women with children already at home.
Dr. Huynh-Nhu Le and graduate student Talia Feldman-Schwartz from George Washington University in Washington, D.C., helped with the data analysis. The study, entitled “Perinatal experiences of Asian American women during COVID-19,” is also in press with MCN.
Goyal’s research since the start of the pandemic has revealed some similar themes, regardless of race.
“Pregnancy and childbirth are vulnerable times for women, their partners and their families, and COVID only added to this already vulnerable time by shifting health-care delivery,” she said. “The additional risk of severe illness for pregnant women who contract COVID-19 and subsequent adverse outcomes such as preterm birth also added to the heightened stress.”
As a health-care provider, she recommends that everyone — especially new mothers — get the COVID-19 vaccine. For those wishing to learn more about the vaccine, she urges people to rely on trusted resources, such as their health-care providers, the Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists.
“The ongoing threat of COVID-19 has changed nursing care,” she said, adding that her conversations with expecting mothers now revolve around “the virus, mutations and the risks and benefits of the COVID-19 vaccine.”
“As far as research, COVID-19 created a unique opportunity to study pregnancy, birth and postpartum outcomes during a large-scale public health crisis that only happens once a century.”