Sarah: This is At the Core of Care, a podcast where people share their stories about nurses and their creative efforts to better meet the health and healthcare needs of patients, families, and communities.
I'm Sarah Hexem, Hubbard, Executive Director of the Pennsylvania Action Coalition and the National Nurse-Led Care Consortium.
As part of our special COVID-19 vaccine confidence efforts, we're creating a series of podcast episodes that can be helpful to nurses at this time, and the communities they serve.
We've heard perspectives from nurses across the country, and on this episode, we'll discuss how to share your vaccine experience with registered nurse Melody Butler. Melody is an infection preventionist at Good Samaritan Hospital Medical Center on Long Island. She also runs Nurses Who Vaccinate, which she founded a decade ago.
And at the end of the episode, we're going to hear from two nurse practitioners on the west coast. Melina Moran, a family nurse practitioner in a rural area of Oregon. We'll discuss how she's been talking with patients who are unsure about whether to get vaccinated. We'll also talk to Deepika Goyal, a professor and family nurse practitioner specializing in OB-GYN care. She'll share with us some of the vaccination concerns that have come up for this population and some of her research around the impact of the covid-19 pandemic on maternal mental health.
But first: Melody, welcome. Before we dive in to talking about vaccines, can you share a bit about your background and career trajectory with us? What inspired you to pursue nursing and what led you to start nurses who vaccinate well before this pandemic?
Melody: Well, thank you so much for having me today. I'm very honored to be here and among the great group of nurses, you've had on the show and will have. I became a nurse in 2007. I took my boards. Before that I was a nursing assistant. So, I had been in the hospital setting for quite some time prior to my registered nurse career. I worked adult med surgical floors, and I worked pediatrics for a number of years. I then made the switch to infection prevention. And if you're not familiar with what infection prevention [was] a year ago, I am sure that with the current pandemic infection prevention is probably on your speed dial at this point if you work in the hospital or long-term care setting.
But the best way to describe what infection preventionist is, is I am basically a nurse educator who specializes in germs. And I work very hard to make sure that we keep our patients and the staff very healthy. Everyone gets to go home at the end of the day without bringing home any extra critters.
I started nurses who vaccinate a couple years ago before I was an infection preventionist. And behind it is actually a catalyst of events that occurred. One being one main event that took place when I was in pediatrics. During the flu season, we had pediatric deaths from flu and RSV. Those particular patients, they stuck with me. I've never forgotten their little faces and the family and the sorrow and the pain they went through. And knowing that these kids had died from a vaccine-preventable disease.
But then I found myself in the midst of the H1N1 flu outbreak. And in New York, during the h1 and one outbreak, the State Department of Health and the state, you know, powers that be they decided to make it mandatory that all healthcare workers needed to get the H1N1 vaccine. And if you didn't, your institution can fire you know. At the time, this was a very new vaccine, and had not been given out before to the public. I was pregnant with one of my children. And I did some online research. And I came across some websites that were sharing stories that the H1N1 vaccine, when it was administered to either clinical trial participants or military base soldiers, that anyone who received it was very sick. It was causing a lot of adverse reactions. They claimed that it was causing miscarriages and pregnancy complications. So, I took this information and spoke to my clinical nurse educator. And I told her that, “Listen, I don't think I want to get the vaccine. If I get fired, I get fired. I need to do what's right for myself and the baby because I'm just not comfortable with this. There's too many scary stories out there.” She took the time to ask me, “Well, tell me tell me about these websites. What are you looking at? What are you reading and what are you hearing?” So, I brought them up to her. And now just mind you this is not a one-time conversation. This is a conversation, dialogue, that took place over a couple shifts. So, you know, when you're working in the nursing world, you know, you maybe got like five minutes downtime here and there. So, this is not like something that, you know, was like one and done, Oh, I'm good to go now. This was a conversation that myself and this educator had. And I would show her website, she would look at it. Some of these stories that were being shared on these websites, they weren't verified. And we discovered, she showed me, that they were really there to lead to more clicks, to drive more traffic to the sites. There were no credentials behind these stories. And then she showed me what the evidence really was saying, on the CDC side. What was the evidence-based information that was out there? That wasn't being frequently shared because it wasn’t exciting. Basically, the information that was out there was that the vaccine was safe, it was working and, as a pregnant mother, I should have been first in line to get it because I was at the most risk for adverse reaction from the actual virus. So, you know, over time, over a couple of shifts – this is early in the flu season-ish – I made the decision to get vaccinated. So, I got the vaccine.
Thankfully, I did. Because later in the flu season, New York State ended up running out of H1B1 vaccines, they had very limited supply. They recalled the mandate, and then it was a really mad scramble to get the vaccine.
I always felt like I had this weight that I could have been scammed. Despite my college education, despite all the continuing education I had gone to and, you know, all the in services and the knowledge I had as a nurse, I had almost fallen victim to very dangerous misinformation that could have led me down a path where I could have lost my child or have died from this virus.
So, flash forward, a couple months later, I am coming home from work. And I come across a Facebook page called nurses who don't vaccinate. And as I'm going through their posts and their pictures and their comments, I see the same type of misinformation that had led me almost led me astray during the flu season. So, I reached out to them, just like my clinical nurse educator did for me, professionally and friendly: “Hey, I just wanna let you know that the information you're sharing, it's outdated, it’s inaccurate, you know, it's very dangerous. We know we can't have patients reading this misinformation, they're going to make really bad choices and end up in a bad place.”
Well, they were not receptive like I had been receptive. And that was my first encounter with how vile anti-vaxxers could be, and how mean and abusive sometimes people can be when they're confronted. And after enduring some very abusive messaging and death threats and some other stuff, in retaliation, I found in my own Facebook page called Nurses Who Vaccinate.
And long story short, here I am talking to you. We are now a national organization that has over 1,400 members. We have a very active Facebook group where we gather together to collaborate to debunk myths and misinformation, to help lead events (right now, mostly it's social media-based or online, like with webinars and online conferences, leading support, in that aspect). We help to provide our colleagues with the latest updates of recommendations and techniques, administration tips, you know, how do you give event to dual vaccines to a two-month-old who's, you know, not exactly the most cooperative? And, you know, any, just the normal support that nurses are looking for, whenever it comes to educating and sharing the messaging about how important vaccines are. So that brings me here today, and I'm very happy to be here with you guys.
Sarah: Wow, that's such an incredible story. And, so, obviously, Nurses Who Vaccinate – that’s nurses who are doing the vaccinating. How about you? Are you vaccinated? Have you gotten the COVID-19 vaccine?
Melody: Thank you for asking. I did. I was fortunate to be in the early crowd. So, I received it where I work as an infection preventionist. And I also was very honored to be able to give out the vaccine to my fellow co-workers, hospital staff and community. So, that was taking place. And I'll be looking forward to doing that when the opportunity arises also by volunteering myself and my services, when there's the need in my community, in my state of New York, as well.
Sarah: And how did it go for you? What was your vaccine experience like? Did you have side effects?
Melody: So I had, unfortunately, caught COVID early in the pandemic. And since then, going through that experience and having that first-hand knowledge of what the anxiety is, how sick you can get (I had a mild-moderate case, I didn't need any hospitalization, I needed a brief stint of medication. But overall, I was able to go back to work within the appropriate time, nothing too crazy) – but I did have like leftover residual, that you could just tell that there was something there. Not exactly like those long-term COVID cases that we've heard. But when I got the vaccine, it was just relief, just like I won. I know patients have had, unfortunately multiple cases of COVID. Sometimes people just can't shake it and they have the virus maybe revisits or we don't know if it's different strains. So, I knew the possibility of catching COVID, again, was out there. And I know I had gotten lucky once, and I didn't want to play the lotto again. So, I was very relieved to have received the vaccine. So, I have four kids. And it's but I got the vaccine, I was tired, and I have a headache. But that's normal for me. So, I'm, I'm a full-time nurse working and you know, running a full-time organization in my spare time. What am I not tired?
Sarah: So, have you shared your vaccination experience with others? What does that look like? Did you share it on social media? Did you take a pic? Direct conversation? What does that look like?
Melody: At Nurse Who Vaccinate, we really encourage nurses sharing their personal stories, sharing their experiences, and really getting out there and leading by example. So, of course, I took a picture, and I shared it. There was some back and forth among the public health community as to whether sharing your selfie getting vaccinated was the right thing to do, is the right kind of messaging. There was some pushback saying, “Well, you know, maybe it's seen as being obnoxious.”
But you know what, in the end of the day, people need to see our examples, people need to see the nurses who are getting vaccinated because you gotta walk the walk. We can't just be asking your patient to get vaccinated, and we're not willing to do that ourselves. And I found that was very influential. And being patient with others. Which, you know, I would gladly go my techniques when I'm talking about vaccine-hesitant colleagues and community members.
Sarah: I think that would be great to hear if you wanted to go into a little bit, you know, the techniques that are helpful when talking with someone who's vaccine-hesitant and maybe doesn't have that confidence in the vaccine.
Melody: Yes, so, nurses, advanced practitioners, APP (advanced practice providers), physicians – they can build confidence among colleagues and their community members who might be hesitant to receive a vaccine.
And when you're a vaccine advocate, you find yourself sharing the same story over and over again. But it's always important to remember that for that patience, that's the first time they might be hearing it. So, we need to make sure that we're very patient and we're understanding. That we don't want to lecture whoever we're talking to. We don't want to assume that we know what their concerns are. And it's so important that we let people know that it's okay to have questions, and having concerns is legitimate. The Nurses Who Vaccinate Facebook page and the group, we've set it up to be a safe place where people can have a conversation, ask questions and get the answers they need. And quite often, there's questions that I don't have the answers to. As much as I've been studying this for a number of years now, there are still experts who know a lot more about it than I do. And I am not afraid to defer to them. And let people know that, “Hey, I don't have the answer to your question. But I know the people who do. So, let me get back to you.” And I always do. I always follow up and close the loop on making sure that they get the answer. And sometimes the experts don't know either. But let people know that, “Hey, we're investigating it. They're looking into this. And hopefully, we'll be able to address that soon.”
But when it comes to addressing vaccine hesitancy, we make sure people understand that we know where they're coming from addressing their concerns about safety, and the misconceptions, sharing our stories. Nothing works as well as sharing personal experiences. And letting people know that “Hey, even myself, at one point, I was vaccine-hesitant. I understand what you're going through with the process of getting a new vaccine.”
Sarah: So, for those who want to share their vaccine experience, what do you recommend? How can they share that? Social media? What does that look like?
Melody: Being yourself, whatever format you're comfortable using. If you are your user of Instagram, use stories to tell your picture. If you're on Facebook, let people know how you're doing, you know, 12 hours later check in: “Hey, you know, I got it. I'm feeling tired, sore arm taking a nap, have a fever, you know, nauseous.” Twelve hours later, check-in: are you getting better? Is it getting worse? Twelve hours later, check-in. You’re kind of giving that people that timeline so that they know what to expect. And then if it occurs, they know: “Hey, this is normal. And I'm going to get better.”
My mother got vaccinated and I checked in with her every couple of hours. I must have been annoying. But I was, like, “Hey, how you feelin?” She's like, “I'm the same!” But I'm, like, “Okay, but you feel a little bit better?” And she’d be, like, “Yes, I can move my arm a little bit better now.” You know, and I was kind of showing that your immune system is working. And you may be feeling it. But think back to where you were before.
Because we want people to understand that when they feel the immune response, it's a good thing. It means it's working. It means your body's building protection. Also, we want people to know that if they don't feel immune response, don't freak out, it's okay, we still know that your body is making some type of protection. So, it's so important that, you know, when we share our story, it gives something people some kind of guidelines to, you know, compare their own experience with as well.
Sarah: Nurses Who Vaccinate has a presence on different social media platforms: Facebook, Twitter, LinkedIn. Do you have a strategy for choosing an article or vetting an article? What do you decide to share and has that evolved over time? Does it look different in the COVID-19 era? What does that look like for you?
Melody: I try to be very timely. I utilize several different tools to keep up on the latest and greatest information, especially with COVID. But I make sure that we are addressing all types of vaccine immunology, public health issues. There's a lot going on with COVID. But it's so important that we pay attention to what else is happening.
For example, there's a huge decline in pediatric vaccines right now. We have a huge backlog of patients who need to get vaccinated. We have a problem. There are a lot of pediatric patients who are vulnerable to measles, chickenpox, meningitis, mumps, you name it. If they have not been vaccinated for it, we're gonna have a problem.
Adolescents are a huge population of our communities who have not been vaccinated and they have fallen behind with their meningitis and HPV vaccines. It's not always apparent that your child's in danger, because it's a long-term effect. Right? So, if you're not vaccinated for HPV, you're not gonna see HPV infection right away. It’s something down the road. If you don't get it, now, maybe you might miss the opportunity, and then a child graduate goes to college. And then, you know, it's out of sight out of mind. Maybe you missed the window to get them vaccinated. We don't want that to happen. Especially with meningitis, we want to make sure we don't miss the availability to vaccinate them, before kids go to college. Because maybe they don't have access on their campus or whatever their reason may be. So, we want to make sure we're not missing these windows of opportunity. And this is a serious problem.
So, with regards to our social media, we're always reminding our colleagues, you know, Nurses Who Vaccinate, while it's a nurse community, we also understand we're doing a lot of patient education with what we're sharing as well. We're speaking to the public; we're speaking to the communities. And we're making sure that we're sharing webinars and conferences and any type of evidence-based research articles. Whatever nurses need. And whatever patients need to get the best information to make the best decisions.
We work very closely with organizations of partners, such as Voices for Vaccines. They are a parent-driven organization. And we help to amplify their stories that they're sharing of parents who have become vaccine advocates. Sometimes they have experiences that they share of maybe a very prominent anti-vaxxer who was fortunate to have a nurse or a friend who kept walking them through the process of education for vaccines, and they eventually have changed their minds. And so, their stories are shared on Voices for Vaccines. And we at Nurse Who Vaccinate, we amplify that message. And we explain, you know, “Hey, you can do the same thing, too.” And explain the techniques behind that.
And we help to share stories of the global immunization practices that are occurring overseas. With regards to what's happening over to help Africa be declared polio free. Working with our vaccination immunization colleagues over in India, we're making sure that they're having full access to the vaccines they need to protect their families. Sharing the stories of the frontline workers in those countries, bringing them back here to America.
And we also help share stories with our members. For example, some of our members have gone on to start and found their own campaigns. For example, my secretary Patti Wukovits, she started the Kimberly Coffey Foundation. She started that when her daughter died from meningitis B. So, one of their main missions, the Kimberly Coffey Fundation is to make sure that college and high school students know that they need two types of meningitis vaccines to be considered protected. Most states only require one, the one that protects you against the A, C, W, Y strain. It’s not required to get the meningitis B vaccine. Parents and students need to ask for it. It will be covered by insurance, but you're not going to get it unless you ask for it. We help share Patti's efforts and the work that she's doing to educate all these high school students and college students.
We have our own original content. We have a blog, you know, we have our own thoughts and messaging we want to get out there. But we're really working hard to amplify the work that our nursing colleagues are doing and our partner organizations are doing. And making sure that the nursing world is being made aware of all this work being done around the world. Because sometimes, you know, it's really hard for nurses to have access to all this information. So, we're kind of like a main hub for nurses to go to to see what's happening in the public health vaccination world.
Sarah: We'd love to know if you have any insights into folks who maybe don't have access to that type of technology – that don't have a smartphone, maybe not consistent internet access, maybe not comfortable with the technology – from your experiences, what you've seen be effective outside of the digital setting. Or if you have suggestions or guidance for how to share your story, or how to have those conversations outside of those digital platforms.
Melody: So pre-COVID, we worked really hard to have a community event where we as members would go into the community and host Q&A sessions, give presentations, events. Looking at the pediatric schedule for, you know, the elderly population, addressing questions. You know, breaking it up, so that way people had an opportunity to hear this information about the vaccines.
We had myth-busting presentations. So, people who maybe had heard something, but they didn't follow up with social media or didn't follow up on the internet to investigate it, they had an opportunity to find out the full story behind that.
We do encourage our members to write letters to the editor. For example, this month, we are working with one of our partners. Shot@Life is a United Nations campaign that helps provide vaccines to children overseas. So, what we're doing this for this month for Advocate2Vaccinate is we're encouraging our members to talk to the legislators, both state and federal, to make sure that they are educated on the importance of global immunization. So that requires not just tweets, but meeting with your local representative. Well, I mean, right now, meeting, face to face is more like a zoom conversation. But we want to foster those relationships.
Because nurses, we have so much authority when it comes to the topic of vaccinations. And we don't always realize that. Or sometimes maybe that authority, if you have an anti-vaccine nurse, it could do a lot of damage. So, there's a lot more pro-vaccine nurses than there are anti-vaccine nurses. But we're not always the loudest. Being pro-vaccine, we just kind of assume it's the norm. And we don't brag about it. But we need to brag about it.
And that's what we're trying to do with Nurses Who Vaccinate: we're trying to get people to be more vocal about vaccination, the process, the need for it, share their stories, get out there and brag about the fact you got the COVID vaccine, that you're gonna get your flu shot, your kids got vaccinated, your grandma got pneumococcal. That’s good. The more that we talk about it, the more normal it becomes.
So, we're encouraging not just love social media, but that face-to-face relationship, you know, and even among family members, you know, there's a lot of opportunity for education with nurses and their families. You know, as a nurse, you get asked a lot of questions, maybe outside your spectrum of your expertise. But vaccines is something – maybe you don't have the confidence in it. But hey, that's what we're here for at Nurses Who Vaccinate. To bring you the information and the knowledge you need to become a vaccine champion, whether it's in your family, your workplace, your community or on social media. We’re here to help you become that expert that we know you can be.
Sarah: I would love to hear about the education strategies that have developed over this time. What has been successful in the education sphere, when you're talking with colleagues in the hospital and agencies in the community?
Melody: So, when I'm educating my colleagues, my coworkers, patients, even my family, and friends, about vaccines, there is a framework conversation that I like to use. It's called the case method, C-A-S-E. And it stands for: corroboration, about me, science, and explain. And basically, it gives you this walking-through guideline when you're having this conversation, which keeps the conversation when you're talking about vaccines on track and focused. And keeps you calm. And allows you to have a dialogue that's professional and productive.
So, for example, let's say you, Sarah, have a question about the COVID vaccine. And you have heard. … Give me a question about the COVID vaccine.
Sarah: I heard that COVID-19 vaccines can cause infertility.
Melody: Okay. So, corroborate, “C”: Sarah, thank you for that question. I've heard that concern, too. I know that as a young woman, you're you're – I don’t know what your story, status is. But maybe you're trying, maybe you have family members who are trying to start a family. And I totally understand why you are concerned about getting a vaccine when you have these plans.
About me, “A”: What I have done. I have been working with members of ACOG, the Society for Maternal-Fetal Medicine, CDC, and National Institute for Health. And there's a lot of information out there that I have been privy to, attending conferences and talks and webinars on this very subject. That's “A”, right? And here’s “S”, what the science says: As of right now, this vaccine that we've been looking at for over a year is safe for pregnant mothers and that was trying to have babies. And how do we know that?
“E”, explain: We’ve been keeping track of everyone who has gotten pregnant while they were in clinical trials. And we have seen that there were no adverse reactions reported. There was nothing out of the norm, in regards to women trying to conceive. When it came to delivering babies, the rate of healthy babies was the same as those who were not vaccinated. And I know many of my colleagues who are pregnant or who work in the specialty of maternal medicine, they have gotten this vaccine. So, I do highly recommend that if you are trying to have a family, you get the vaccine now, for your protection. Because your risks of this disease are greater than those that you may be facing with the actual vaccine.
Sarah: And that was a tough example. So yeah, thank you. Thank you for walking us through that. And always bringing it back to that cost-benefit of every individual who's weighing a decision.
Thinking back on the past year, how do you think your experiences during this pandemic during the covid 19 pandemic are going to affect your practice your approach going forward? What's your hope for how the pandemic is going to shape healthcare delivery more broadly, in the future?
Melody: My hope is that there will be a better respect for the process and development of vaccines. I'm hoping that with all the attention and media focus that we've had on this development of the common vaccine, people have a better understanding.
I hope that we have a better awareness of all the work and effort that goes into that one little vial and all of the work and all of the knowledge that went into producing such an important, life-saving vaccine. You know, there are so many stories that need to be shared from the researchers, from the clinical scientists, from the participants in the clinical trials to the institutions that have produced these vaccines. We want to make sure that their stories are being heard. And people understand the “why” behind it. These scientists, they have friends and family that they lost to the COVID pandemic as well. And it's so important that people understand that this is a labor of love when it comes to producing the vaccine, to administrating it, to educating people about it.
I'm here tonight because I love my community. And I want to protect everyone who's there. And I want to make sure that they have access to this vaccine, and they know that they should get it because it's important and it could save their life. And if people have questions, I want them to know that they are comfortable asking them in a safe place.
I hope that with this pandemic, that when it comes to an end very soon. And while I may not know what that end may look like, I'm hoping that it's one where we don't lose any more lives. And we have a better appreciation for the public health.
Sarah: Thank you so much. This was such a great conversation. Just really appreciate the work that you're doing with Nurses Who Vaccinate and elevating this aspect of healthcare and public health. So, thank you so much for joining us.
Melody: Thank you so much for having me. It was great being here and I hope that I get to speak to you guys again in the future.
Sarah: And now we're going to hear from two nurse practitioners on the west coast. First, we'll hear from Melina Moran. She's a family nurse practitioner in Oregon and will share how she's been talking with her patients who are unsure about whether to get vaccinated.
And then, Deepika Goyal from California. She's a family nurse practitioner specializing in OB-GYN care and a professor. She'll share with us some of the vaccination concerns specific to reproductive health and some of her related research.
Melina: My name is Melina Moran. I'm a family nurse practitioner and I work in a clinic in Redmond, Oregon. It's considered a rural community about three hours from Portland, Oregon, and three hours from Eugene. In the middle of Central Oregon. There's a lot of farmers and ranchers and then also a lot of retirees. I was an ER nurse for a lot of years at Oregon Health Science University, which is a level one trauma center. During that time, I was part of the national disaster team. And I taught wilderness medicine for first responders. After that, I taught and did medical flights overseas. And back in the States, I was a Life Flight nurse for 10 years. After doing that kind of work, I decided I wanted to prevent what I was seeing. I wanted to prevent the heart attacks and strokes and trauma. And so, I decided to go back to school to be a family nurse practitioner.
I feel like I look at patients a little bit differently. I see their comorbidities, and I imagine how COVID would affect them. I definitely stress even more prevention of diabetes and cardiovascular disease and stress healthy diet and exercise so that their bodies could be strong to overcome and fight any disease or infections that they are exposed to.
And I let them know that, you know, “Let's just try and get you as healthy as possible. So that you could be strong.”
You know, the first thing I say is, you know, “Hello, how you doing? And did you get your vaccine yet?” And I could tell the ones that didn't just by their body language. And in their minds, they're probably thinking, ‘Oh, gosh, here she goes, she's gonna try and talk me into getting my vaccine.’ But then, you know, as the visit goes on, and we start talking, and they loosen up. And then that's when I could really start the conversation: why they're hesitant and, you know, what's their biggest concern. And then lots of times, they always ask me, if I got mine. And I have a little pin that says, “I'm COVID-19 vaccinated” on my name badge. So that's visible for them to see. I just really think it's important to build that trust with them. And make it a safe place for them to talk.
The ones who are interested in being vaccinated are very excited. They send me emails or, you know, call me. Or when I see them in clinic, they show me their card. And they're very proud that they got vaccinated. And they know that this is the beginning to the end. The more challenging part is with my vaccine-hesitant patients. It’s created my appointments during the day to be elongated because I have to address what they're there for. But then also I want to address, you know, why they're hesitant to get the vaccine.
So, I'm hearing a lot of different things. I guess the most common one is that it was made too fast. But there's a whole gamut of different reasons why they don't want to get vaccinated, you know. So, I just asked them what their hesitancy is, and I listen to them. And a lot of my patients are getting information from their friends and family or social media. You know, it's challenging for them. They listen to the news, and one new station says one thing, and the other one says something completely opposite. So, I understand their hesitancy, and you know, not getting clear, easy-to-understand information. So, I enjoy being a source of information for them. They trust me with their health care, you know, they trust me to treat their hypertension and their diabetes. And so, I feel that they're trusting me to give them good, accurate, true information.
I encourage my patients to talk with their friends and family after they got vaccinated. I've seen a lot of people on social media posting, you know, that they were vaccinated either a picture of their vaccination card or the sticker that they got.
I think that we just need to keep working together as a medical community to get everyone vaccinated. And I think if we continue to enlist, not only the medical community, but our patients, and then they can start talking to their friends and family, and it will just spread the importance of getting vaccinated so that this could be the beginning of the end, or the beginning of the living with COVID-19. Because, as far as we know, it's not going away, but learning to live with it.
Deepika: I'm Dr. Deepika Goyal. I'm a professor at San Jose State University in San Jose, California, and I'm also a family nurse practitioner at Santa Clara Valley Medical Center in the outpatient OB-GYN clinic.
All of the studies that were done on the vaccine, pregnant women weren’t included. So, you know, when women ask, you know, “What do you think about the vaccine? Or “Should I get vaccinated?”, we all go back to the American College of Obstetricians (ACOG) and kind of use their information as our starting point. They do recommend COVID vaccines for pregnant women.
But at this point, we can't tell you whether there are any fetal anomalies that are gonna happen. So, it's difficult. I mean, I've had pregnant women and family members who have contacted me now, “What do you think? What would you do?” And it's really difficult.
So, it's a shared decision-making. I try to share decision-making in the sense that give the patient all of the information that we have. And then they really have to make that decision for themselves, you know, talk to their family and make that decision. It's an individualized plan. It's not like some of the vaccines that we talked about in pregnancy, like Tdap vaccine. In the third trimester, we recommend that for all women, right? Or the flu vaccine, we recommend [that] for all pregnant women. But this one is a little bit different. I think it has to be individualized. I don't think any woman should be forced, and we need to support our patients, you know, whichever decision they make.
So, I've been working at the mass vaccination sites in the county since January. And you walk out of there feeling like you've done some good. Like, I was at Levi's Stadium. And we did 9500 vaccines, it was just amazing. And we’ve done more since then. But it's just really amazing how well the county is running the vaccine clinics. It’s very organized. It's very rewarding. My main role over the last couple of months has been kind of the medical screener. People have to fill out a form when they come to get the vaccination that, you know, we just have to clear them medically that they can get the vaccine or give them the information really for the risks and benefits. So, the most common things we're seeing are people that are on blood thinners, or they might be actually pregnant or breastfeeding. They don't have to come to us. They can come to us for any questions, but some patients are sent to us. So, the ones that are sent to us are the ones that are on blood thinners. Or if they've had another vaccine within the last two weeks, right? It's not recommended to get the COVID vaccine if you've had another one that maybe that could tetanus or a shingles in the last two weeks, because we don't really know how they'll interact with each other. Right? So, we' like to have at least two weeks before you get your COVID vaccine. And so, a lot of people come to the table and just ask questions. So more recently has been the younger population because now 16 and older can get vaccinated. So, for anyone who's pregnant or wanting to get pregnant or postpartum, we really just refer them back to their own OB-GYN’s. Even though that's my area, we refer them to the ACOG information and then also back to their own OB-GYN.
I do a lot of research in postpartum depression, actually, maternal mental health. And with the pandemic, I kind of shifted to look at the impact of COVID-19 on maternal mental health. A lot of the women are talking about the isolation of COVID. But when you're forced to do that, as a new mother, you know, you don't have your family and friends around. What we do know is postpartum depression is the most common complication in the first postpartum year. So being isolated on top of that, due to the pandemic has left moms managing without that social support, you know, family and friends, in-laws or family coming to visit. I mean, grandparents are feeling left out, too, they're not able to come and visit. So, everyone getting vaccinated definitely is going to bring us back to quote unquote, “normal,” more quickly.
Just some of the things from the research I've been doing. Women are still having these questions about after maternity leave: “Do I go back to work? Do I send my child to a daycare? Or do I have someone come to the home to take care of my child?” And you know, the other things new moms are talking about is the development of their infant, right? If they have the person who comes into the home or even at the daycare wearing masks, how is that baby gonna see the facial expressions? There's a lot of unknowns still. So even if everyone has the vaccine, does that mean we don't wear masks anymore? You know, when does that happen? Right?
There's gonna be COVID stuff coming out for years. I mean, after we're gone, we're going to be hearing about COVID. And what we should have been doing this, that and the other. We just hope that whatever we do find out can help in our lifetime and our children's lifetime, inform future pandemics, right? And I do encourage women who have received the COVID vaccine and who are breastfeeding to see if there are any local studies that they can donate their breast milk to, you know, so we can research what happens to COVID vaccine in breast milk and take advantage of being in studies and women of color are very underrepresented in research. And so, I would encourage women of color to seek out research opportunities, especially around COVID-19, pregnancy and postpartum. All of the information we get will inform our care and help us provide better care – which, at the end of the day, we want to promote maternal-child well-being outcomes.
CREDITS
Sarah: Our special vaccine competence series was funded in part by a cooperative agreement with the Centers for Disease Control and Prevention or CDC. The CDC is an agent within the Department of Health and Human Services, also known as HHS. The contents of this resource do not necessarily represent the policy of CDC or HHS and should not be considered an endorsement by the federal government.
Stay tuned for more episodes coming up. We'll be exploring vaccine confidence, best practices, misinformation, hesitancy, partnering with community-based organizations and how nurses can share their vaccine experiences.
And for more information about related upcoming webinars and where to find COVID-19 resources, log on to nurseledcare.org. You can also stay up to date with us on social media @NurseLedCare.
At the Core of Care is produced by Stephanie Marudas and Emily Previti of Kouvenda Media and mixed by Brad Linder.
I'm Sarah Hexem Hubbard of the Pennsylvania Action Coalition. Thanks for joining us.
This project was funded in part by a cooperative agreement with the Centers for Disease Control and Prevention (grant number NU50CK000580). The Centers for Disease Control and Prevention is an agency within the Department of Health and Human Services (HHS). The contents of this resource center do not necessarily represent the policy of CDC or HHS, and should not be considered an endorsement by the Federal Government.
