Communicating unexpected news in the fetal medicine setting: experiences of pregnant women with mental health conditions (The UNDERSTAND study)

BACKGROUND: Receiving unexpected news in pregnancy is highly distressing, and how it is communicated strongly influences psychological outcomes. While clear communication can support understanding and decision-making, poor communication may intensify trauma and isolation. Communication training in fetal medicine remains limited, often excluding lived experience and focusing only on the moment of diagnosis. One in five pregnant women have a mental health condition (MHC), yet no studies have explored how unexpected news is communicated to this group, leaving a critical gap. This study explores the experiences of pregnant women with MHCs upon receiving such news, identifying barriers, facilitators, and opportunities for improvement in communication. METHODS: This co-produced qualitative study involved 22 virtual semi-structured interviews with women with MHCs (anxiety, depression, PTSD, and psychosis) who had received unexpected fetal medicine diagnoses in a past pregnancy. A novel approach to thematic analysis was used, with themes identified in collaboration with members of the public with lived experience. RESULTS: Participants reported significant emotional distress, compounded by poor communication practices, lack of empathy, and feelings of being rushed or unsupported. Key themes included (1) the Unknown; (2) the Information; (3) Trust in Healthcare; (4) the Human Element; (5) the Concept of Time; (6) and Ongoing Mental Health Support. CONCLUSIONS: The study underscores the urgent need to improve communication in fetal medicine by ensuring healthcare professionals deliver unexpected news with empathy, allow time for processing, and offer appropriate mental health support. Continuity of care and proactive follow-up can help reduce distress and improve experiences. Training should be informed by the perspectives of those receiving care and emphasise compassionate communication, shared decision-making, and awareness of mental health challenges. Integrating mental health support systematically into fetal medicine pathways is essential for comprehensive care.