Key result
Parents facing prenatal CHD diagnosis maintain hope and desire greater active clinical engagement postnatally.
Why the study?
To better understand parents' prenatal and postnatal experiences, emotional processing, and coping mechanisms following a prenatal diagnosis of CHD to identify strategies to improve support.
Observational (n=27)
No
Understanding how parents conceptualize hope and their evolving desire for active engagement in decision-making postpartum can help clinicians improve support following a prenatal diagnosis of CHD.
Supports attention to evolving parental needs in prenatal CHD counseling; leaves open whether targeted interventions improve outcomes.
OBJECTIVE: To better understand parents' accounts of their prenatal and postnatal experience after prenatal diagnosis of CHD - particularly emotional processing and coping mechanisms - to identify strategies to improve support. METHODS: This single-centre, longitudinal qualitative study included pregnant mothers and their support persons seen in Fetal Cardiology Clinic at Vanderbilt Children's Hospital from May through August 2019 for probable complex CHD. Twenty-seven individuals from 17 families participated in 62 phone interviews during pregnancy and postpartum: 27 conducted after the initial prenatal cardiology consultation, 15 after a follow-up prenatal visit, and 20 after birth. Applied thematic analysis approach was used to code and analyse transcribed interviews. Coding and codebook revisions occurred iteratively; intercoder reliability was >80%. RESULTS: Patients included mothers (16 [59%]), fathers (8 [30%]), and other support persons (3 [11%]). Initial fetal diagnoses included a range of moderate to severe CHD. Prenatally, parents sought to maintain hope while understanding the diagnosis; planning for the future rather than focusing on day-to-day was more common if prognoses were better. Postnatally, with confirmation of prenatal diagnoses, parents' sense of control expanded, and they desired more active engagement in clinical decision making. CONCLUSIONS: To enhance effective communication and support, understanding how parents conceptualise hope in relation to diagnosis and how that may evolve over time is critical. Expectant parents whose child has a significant risk of mortality may demonstrate hope by focusing on positivity. As prognostic uncertainty diminishes postpartum, the parental role on the team may shift, requiring clinicians to provide different support.
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Harris et al. (2022) conducted an observational in Prenatal diagnosis of congenital heart disease (n=27). Prenatal diagnosis of congenital heart disease was evaluated on Parental emotional processing and coping mechanisms. Parents facing a prenatal diagnosis of congenital heart disease maintain hope while understanding the diagnosis prenatally, and their sense of control and desire for active engagement in clinical decision-making expands postnatally.
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