Communicating Unexpected News in the Fetal Medicine setting: Experiences of Pregnant Individuals 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. Training in fetal medicine remains limited, often excluding lived experience and focusing only on the moment of diagnosis. One in four pregnant people 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 individuals with MHCs, identifying barriers, facilitators, and opportunities for improvement. Methods This co-produced qualitative study involved 22 virtual semi-structured interviews with individuals with MHCs (anxiety, depression, PTSD, and psychosis) who had previously received unexpected fetal medicine diagnoses. 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 emotional burden of uncertainty; (2) the quality of the information; (3) empathy and sensitivity in communication; (4) building or breaking trust in the interactions with HCPs; (5) time for processing information, decision-making and access to care; (6) the need for ongoing mental health support. Conclusions The study underscores the urgent need to strengthen 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.