Family-centered care in the context of fetal abnormality

Understanding the experiences of mothers receiving perinatal palliative care: A qualitative study

BACKGROUND

Despite the diagnosis of life-limiting foetal conditions, some mothers choose to continue their pregnancies. The experiences of these individuals are relatively unknown, making it difficult for perinatal palliative services to be targeted towards their needs.

AIM

To examine maternal experiences in perinatal palliative care among those who choose to continue their pregnancies despite life-limiting foetal condition.

DESIGN

Qualitative, retrospective study involving semi-structured interviews. Braun & Clarke's reflexive thematic analyses using a constructionist-interpretive approach were conducted.

SETTING/PARTICIPANTS

A total of 15 adult women participants who decided to continue their pregnancies after learning of life-limiting foetal diagnoses were recruited from a Singaporean tertiary hospital. Interviews were conducted in-person or via video conferencing.

RESULTS

Seven themes were synthesized from the data: (1) Internal upheaval - 'World turns upside down'; (2) Role of religion and spirituality in hope of miracles; (3) Support from family and close friends; (4) Navigating a fragmented healthcare system; (5) Value added by the perinatal palliative service; (6) Goodbye and grieving and (7) No regrets and other personal reflections.

CONCLUSIONS

Continuing a pregnancy despite the diagnosis of a life-limiting foetal condition can be challenging for mothers. To better meet their needs during this difficult period, perinatal palliative care must be patient-centred, multidisciplinary and non-judgmental. Efforts must be made to streamline the healthcare delivery process.

A Novel Framework for Abnormal Risk Classification over Fetal Nuchal Translucency Using Adaptive Stochastic Gradient Descent Algorithm

In most maternity hospitals, an ultrasound scan in the mid-trimester is now a standard element of antenatal care. More fetal abnormalities are being detected in scans as technology advances and ability improves. Fetal anomalies are developmental abnormalities in a fetus that arise during pregnancy, birth defects and congenital abnormalities are related terms. Fetal abnormalities have been commonly observed in industrialized countries over the previous few decades. Three out of every 1000 pregnant mothers suffer a fetal anomaly. This research work proposes an Adaptive Stochastic Gradient Descent Algorithm to evaluate the risk of fetal abnormality. Findings of this work suggest that proposed innovative method can successfully classify the anomalies linked with nuchal translucency thickening. Parameters such an accuracy, recall, precision, and F1-score are analyzed. The accuracy achieved through the suggested technique is 98.642.%.

Reimagining Perinatal Palliative Care: A Broader Role for Support in the Face of Uncertainty

Perinatal medicine is confronted by a growing number of complex fetal conditions that can be diagnosed prenatally. The evolution of potentially life-prolonging interventions for the baby before and after birth contributes to prognostic uncertainty. For clinicians who counsel families in these circumstances, determining which ones might benefit from early palliative care referral can be challenging. We assert that all women carrying a fetus diagnosed with a life-threatening condition for which comfort-focused care at birth is one ethically reasonable option ought to be offered palliative care support prenatally, regardless of the chosen plan of care. Early palliative care support can contribute to informed decision making, enhance psychological and grief support, and provide opportunities for care planning that includes ways to respect and honor the life of the fetus or baby, however long it may be.

Addressing Perinatal Mental Health Risk within a Fetal Care Center

Diagnosis of a fetal anomaly in pregnancy increases the risk for perinatal mental health difficulties, including anxiety, depression, and traumatic stress among expectant parents. Common emotional challenges include uncertainty about the diagnosis/prognosis, anticipated neonatal course, fears of fetal or neonatal demise, loss of a typical, uncomplicated pregnancy and postpartum course, and disruption of family roles due to medical care-related activities and restrictions. Psychologists in multidisciplinary fetal care centers are uniquely positioned to assess mental health risks and address the needs of expectant parents. Psychologists bring additional expertise in screening and assessment, clinical interventions to promote coping and symptom reduction while preparing for birth and a complicated neonatal course, consultation and effective communication, and programmatic development. This review paper provides an overview of the challenges and behavioral health risks for expectant parents carrying a fetus with a birth defect and the unique role psychologists play to support patients and families within fetal care settings.

Increased nuchal translucency after low-risk noninvasive prenatal testing: What should we tell prospective parents?

Three decades ago, the observation that first trimester fetuses with excess fluid accumulation at the back of the neck were more likely to be aneuploid, gave rise to a new era of prenatal screening. The nuchal translucency (NT) measurement in combination with serum biomarkers and maternal age, resulted in the first trimester combined screening (FTCS) program. The introduction of noninvasive prenatal testing (NIPT) over the past decade has introduced the option for parents to receive highly sensitive and specific screening information for common trisomy from as early as 10 weeks gestation, altering the traditional pathway FTCS pathway. The retention of the 11-13-week NT ultrasound remains important in the detection of structural anomalies; however, the optimal management of pregnancies with a low-risk NIPT result and an isolated increased NT measurement in an era of advanced genomic testing options is a new dilemma for clinicians. For parents, the prolonged period between the initial diagnosis in first trimester, and prognostic information at each successive stage of investigations up to 22-24 weeks, can be emotionally challenging. This article addresses the common questions from parents and clinicians as they navigate the uncertainty of having a fetus diagnosed with an increased NT after a low-risk NIPT result and presents suggested approaches to management.

Termination of Pregnancy for Fetal Anomalies: A Qualitative Study of the Informational and Educational Needs of Women

Background:

Diagnosing congenital fetal anomalies before birth is considered an emotionally devastating experience. To facilitate the process of compatibility with this event, healthcare providers should determine various needs of these women. The present study was conducted to explore the informational and educational needs of women who have experienced pregnancy termination because of fetal anomalies.

Materials and Methods:

The present study was a qualitative content analysis. Forty participants (women, their spouses, and healthcare providers) in Rasht city, Iran, were selected using purposive sampling method with maximum variety and their data were gathered using in-depth interviews and field notes. Data were analyzed using conventional qualitative content analysis with Graneheim and Lundman approach.

Results:

After analyzing the text of the interviews, the informational and educational needs of women who have experienced pregnancy termination because of fetal anomalies were categorized in three main categories of “receiving information tailored to the client's circumstances,” “learning life skills to cope,” and “getting prepared for the next pregnancy.”

Conclusions:

The results, by exploring and magnifying the informational and educational needs of these women, could present an appropriate context for providing principal care and cultural-based interventions with an emphasis on comprehensive education and counseling. Also, proper implementation of the process of obtaining informed consent from the women to terminate the pregnancy is essential. These could facilitate the conditions for their return to normal life and ultimately promote their health.

A qualitative study exploring the needs related to the health system in women with experience of pregnancy termination due to fetal anomalies in Iran

Background

In order to provide appropriate and adequate care to women who have experienced termination of pregnancy due to fetal anomalies, the health needs of this group should be assessed. Considering the lack of information about the care and services required by these women in Iran, this study was conducted with the aim of exploring the needs related to the health system in women with experience of pregnancy termination due to fetal anomalies.

Methods

This study was conducted with a qualitative approach. 40 participants were selected through purposive sampling, and the data were collected through in-depth semi structured interviews and field notes, and analyzed using conventional qualitative content analysis.

Results

After analyzing the texts, the needs related to the health system in women with experience of pregnancy termination due to fetal anomalies were categorized in the three main categories: “efficient treatment team”, “optimal organizational structure in providing services” and “financial support for families”.

Conclusions

The findings of the present study by exploring and highlighting the needs related to the health system in different dimensions in women with experience of pregnancy termination due to fetal anomalies can be helpful for designing and providing basic and comprehensive care programs.

Integrative Review of Nursing Practices in Fetal Therapy

OBJECTIVE

To synthesize nursing practices related to fetal therapy (intervention to correct or treat a fetal anomaly).

DATA SOURCES

We searched electronic databases, including PubMed, Embase, OvidSP, and CINAHL, for all relevant published work. We identified additional resources through discussion with experts in the field, hand searches of relevant resources, and examination of the reference lists of articles in our search results.

STUDY SELECTION

Any published literature about fetal therapy in which nursing practices were discussed by nurses.

DATA EXTRACTION

We used Whittemore and Knafl's methodology to guide this integrative review (2005). We completed data extraction using an analytic review template organized to compare results to Kim's (2015) theoretical framework for nursing practice.

DATA SYNTHESIS

We used qualitative techniques described by Miles, Huberman, and Saldaña (2014) to code and thematically interpret the data. Nurses described their contributions to the establishment of fetal therapy programs through the development of entirely new technical and caring skills and their work in relation to care quality, clinician education, ethics, research, and health policy. Data were synthesized under three philosophies of nursing practice: therapy, care, and professional work.

CONCLUSION

Nurses have made important contributions to the evolving practice of fetal therapy, a nuanced practice that is critical to the development and provision of comprehensive patient- and family-centered care. Clinical implications of this review include practical recommendations for enhanced support of nursing practice in fetal therapy, which includes the provision of reliable forums to learn and share feedback about nursing practice in this field. Future work should focus on increasing understanding and visibility of nursing in fetal therapy through interdisciplinary evidence-based practice development.

Family and Practitioner Perspectives on Prenatal Early Intervention

Increasingly, families know prenatally of certain diagnoses with a high probability of developmental delays. These diagnoses could result in eligibility for Part C early intervention (EI) postnatally. Although prenatal developmental interventions (e.g., Early Head Start, Nurse Family Partnership) are common for families with environmental risks, no research has explored the potential of prenatal EI for those families with EI eligible diagnoses. This online survey research explored family and practitioner perspectives of potential prenatal EI and project-identified prenatal outcomes (i.e., health and well-being, parent-child interactions, parenting to family culture, and navigating systems and supports). Overall, both samples reported the prenatal outcomes were clear and important prenatally. Families preferred EI practitioners help with all outcomes. Practitioners preferred to take the lead on some outcomes (e.g., knowledge of and comfort with EI services, intention of EI), whereas the medical community took the lead on others. Findings support the need for further research on the potential of prenatal EI and resulted in implications for current postnatal EI.

Development of a Perinatal Palliative Care Model at a Level II Perinatal Center Supported by a Pediatric Palliative Care Network

Objective: To describe the model build up to take care of fetuses and newborns eligible to perinatal palliative care (PnPC) followed in an Italian II level perinatal center. Methods: Retrospective chart review of all fetuses and newborn infants eligible to PnPC admitted to level II perinatal center within a 4 years period. Results: Forty-five of 848 infants (0.5%) referred to II level NICU were eligible to PnPC. Twenty-seven percentage had fetal diagnosis. Twenty percentage were preterm infants at the limit of viability, 35% were newborns with life limiting or life threatening disease diagnosed in utero or at the postnatal ward, 45% were newborns not responding to intensive care intervention with high health care needs or medical complexity. Fifty-seven percentage of neonates admitted to NICU died before discharge, while 16 (35% of population considered) were discharged home. Median age at death was 4 days after birth, and delivery room death immediately after birth occurred in six patients (13%). Conclusions: Despite the paucity of our population and the high variability in disease trajectories the perinatal palliative care program build up in our region provides a reproducible method for a structured taking in charge of fetuses and neonates eligible to PnPC and their families, from the time of diagnosis to bereavement, in both outpatient and inpatient settings.

Perinatal Palliative Care: A qualitative study evaluating the perspectives of pregnancy counselors

BACKGROUND

A prenatal diagnosis of a life-limiting disease raises complex ethical, emotional, and medical issues. Studies suggest that 40%-85% of parents decide to continue the pregnancy if given the option of Perinatal Palliative Care. However, structured Perinatal Palliative Care programs are missing in many European countries. In Germany, parents have the right to free psychosocial support from pregnancy counseling services after the prenatal diagnosis of a life-limiting disease.

AIM

We aimed to investigate whether German professional pregnancy counselors perceive the need for structured Perinatal Palliative Care and if so, how it should be conceived.

DESIGN

This is a qualitative interview study with purposeful sampling. The interviews were analyzed with the coding method of Saldaña.

SETTING/PARTICIPANTS

A total of 10 professionals from three different pregnancy counseling services participated in the study.

RESULTS

The main topics raised by the professionals were as follows: (1) counseling and parental support during the decision-making process; (2) fragmented or missing support infrastructure for parents; and (3) challenges, hesitations, and barriers, particularly from the different stakeholders, regarding a Perinatal Palliative Care framework. They highlighted the importance of the integration of Perinatal Palliative Care in existing structures, a multi-professional approach, continuous coordination of care and education for all healthcare providers involved.

CONCLUSION

A structured Perinatal Palliative Care program is considered as necessary by the pregnancy counselors. Future research should focus on (1) needs reported by concerned parents; (2) attitude and role of all healthcare providers involved; (3) strategies to include stakeholders in the development of Perinatal Palliative Care networks; and (4) outcome parameters for evaluation of Perinatal Palliative Care frameworks.

Moving toward a shared process: The impact of parent experiences on perinatal palliative care

Perinatal palliative care programs seek to support parents expecting a baby diagnosed with a serious medical condition. Clinicians have increasingly recognized the importance of parental perspectives on the medical care mothers and their fetuses and live-born children receive, especially regarding factors influencing individual choices and knowledge of the medical community. We describe, using literature on trisomy 13 and trisomy 18, how information shared between parents and providers can improve perinatal counseling and family support.

Health-care provider communication with expectant parents during a prenatal diagnosis: an integrative review

The pregnancy and health-care experience of expectant parents who receive a prenatal diagnosis of their unborn infant is distinctively fraught with uncertainty. Health-care providers (HCPs) that care for parents during this uncertain time have an exceptional opportunity to positively impact parental outcomes. An integrative literature review was conducted to explore HCPs' impact on parents' experiences of receiving a prenatal diagnosis. Thirty-three articles met study inclusion criteria (n=18 qualitative; 6 quantitative; 9 mixed methods). HCP communication was the major theme identified, because of its overarching impact on parents' experiences of receiving a prenatal diagnosis of their unborn infant. Parents' perception of the information communicated to them about their unborn infant's diagnosis by their HCP, and the manner in which that information is communicated to them, affects parents' ability to cope with the diagnosis. Recommendations for health-care delivery models, and for future research are discussed.

Feeling Cared For Versus Experiencing Added Burden: Parents' Interactions With Health-Care Providers in Pregnancy With a Lethal Fetal Diagnosis

This article reports on parental responses to and needs from health-care providers during pregnancy with a lethal fetal diagnosis (LFD). Sixteen mothers and 14 partners participated in a longitudinal, phenomenological study of continuing a pregnancy with an LFD. During individual and joint couple interviews conducted during pregnancy and postpartum, parents described numerous health-care interactions throughout pregnancy. From the participants' words, Categories of the Content, Process, and Outcome of these interactions emerged. They sought health care for the Content (information and expert guidance), but they desired providers who maintain hope, were caring and nonjudgmental, used a straightforward manner, and showed sensitivity to their developmental journey ( Process). They also desired health-care systems that provided continuity of care and minimized waiting times ( Process). We propose data-based recommendations for health-care providers to address the two identified opposing Outcomes: Feeling Cared For and Experiencing Added Burden.

The role of satisfaction with social support in perceived burden and stress of parents of six-month-old infants with a congenital anomaly: Actor and partner effects

This exploratory study examined the role of satisfaction with support from family and friends on the burden and stress of parents of infants with a congenital anomaly (CA). The effects of social support were examined within the couple (actor and partner effects). A total of 36 couples whose six-month-old infant has a CA participated in this study. The parents completed questionnaires regarding satisfaction with support, burden (Impact on Family Scale - Revised), and parenting stress (Parenting Stress Index). The results showed that fathers directly benefited from the support they received from friends in reducing their burden, while mothers only indirectly benefited from it through the father's adjustment. The pattern was different for stress: mothers directly benefited from the support they received from their family in reducing their stress levels, while fathers benefited both directly from the support they received from friends and indirectly from the support that their partners received from family. These results highlight that (1) the different support needs of mothers and fathers (due to their different roles during transition to parenthood) and (2) the diffusion of benefits of social support within the couple should be taken into account when developing strategies to promote support to families of six-month-old infants with a CA.

Perinatal palliative care: barriers and attitudes of neonatologists and nurses in Poland

Objective. To identify barriers and personnel attitudes towards realization of palliative care principles in neonatological units. Study Design. An anonymous questionnaire was posted to all heads of departments and head nurses of all the 27 neonatological units in the Lodz area. Results. We received 46 (85%) questionnaires. Final analysis comprised 42 properly filled-in questionnaires (by 22 doctors and 20 nurses). In case of prenatal diagnosis of a lethal defect, 77.27% of doctors and 65% of nurses opted for informing the mother also about the possibility of pregnancy continuation and organization of palliative care after delivery. Most of respondents accepted conditions for abortion pointed by the Polish law. The most common barriers pointed out by both groups were insufficient knowledge of the personnel on palliative medicine and family preference for life sustaining treatment. Conclusions. Understanding attitudes of personnel towards palliative care and identification of barriers are a starting point for future efforts to improve the system of neonatological care.

Who receives home-based perinatal palliative care: experience from Poland

Context. The current literature suggests that perinatal palliative care (PPC) programs should be comprehensive, initiated early, and integrative. So far there have been very few publications on the subject of home-based PC of newborns and neonates. Most publications focus on hospital-based care, mainly in the neonatal intensive care units. Objective. To describe the neonates and infants who received home-based palliative care in Lodz Region between 2005 and 2011. Methods. A retrospective review of medical records. Results. 53 neonates and infants were admitted to a home hospice in Lodz Region between 2005 and 2011. In general, they are a growing group of patients referred to palliative care. Congenital diseases (41%) were the primary diagnoses; out of 53 patients 16 died, 20 were discharged home, and 17 stayed under hospice care until 2011. The most common cause of death (56%) was cardiac insufficiency. Neurological symptoms (72%) and dysphagia (58%) were the most common clinical problems. The majority of children (45%) had a feeding tube inserted and were oxygen dependent (45%); 39 families received psychological care and 31 social supports. Conclusions. For terminally ill neonates and infants, perinatal palliative care is an option which improves the quality of their lives and provides the family with an opportunity to say goodbye.

State of the science on perinatal palliative care

OBJECTIVE

To report the state of the science since 1995 on the concept of palliative care for parents who opt to continue a pregnancy after receiving a life-limiting fetal diagnosis.

DATA SOURCES

PubMed, Ovid, PsycInfo, CINAHL, and Medline were searched from 1995 to July 2012 using the terms perinatal palliative care and perinatal hospice.

STUDY SELECTION

Inclusion criteria included empirical studies written in English that focused on experiences of parents who opted to continue a pregnancy in which the fetus had a life-limiting condition or on perinatal palliative care. Twenty studies met inclusion criteria.

DATA EXTRACTION

Results from empirical studies contributing to the knowledge base of perinatal palliative care are presented.

DATA SYNTHESIS

Women are confronted with powerful emotions, challenging decisions, and considerable uncertainty following the news of a life-limiting fetal anomaly. Women choose to continue their pregnancies for a variety of reasons and when doing so embark on a search for meaning. The science suggests that perinatal palliative care is welcomed by parents and is a medically safe and viable option. Women voiced positive feedback about their decisions to continue their pregnancies, and parents cited personal growth in the aftermath. Perinatal palliative care programs provide services that incorporate early and integrative care beginning in the antenatal period. A multidisciplinary coordinated approach provides parents with comprehensive, holistic support.

CONCLUSION

More research is needed to elucidate the factors that will benefit parents who continue their pregnancies. Investigating the needs and perceptions of clinicians and their willingness to participate in this new model of care is necessary as is examining barriers that may undermine care. Nurses can lead research on these topics and implement evidence-based practice grounded on study findings.

Women's experiences receiving abnormal prenatal chromosomal microarray testing results

PURPOSE

Genomic microarrays can detect copy-number variants not detectable by conventional cytogenetics. This technology is diffusing rapidly into prenatal settings even though the clinical implications of many copy-number variants are currently unknown. We conducted a qualitative pilot study to explore the experiences of women receiving abnormal results from prenatal microarray testing performed in a research setting.

METHODS

Participants were a subset of women participating in a multicenter prospective study "Prenatal Cytogenetic Diagnosis by Array-based Copy Number Analysis." Telephone interviews were conducted with 23 women receiving abnormal prenatal microarray results.

RESULTS

We found that five key elements dominated the experiences of women who had received abnormal prenatal microarray results: an offer too good to pass up, blindsided by the results, uncertainty and unquantifiable risks, need for support, and toxic knowledge.

CONCLUSION

As prenatal microarray testing is increasingly used, uncertain findings will be common, resulting in greater need for careful pre- and posttest counseling, and more education of and resources for providers so they can adequately support the women who are undergoing testing.

Heart for bonding: a new protocol of care for hypoplastic left heart syndrome

There are significant challenges involved in the perinatal and postnatal care of an infant with hypoplastic left heart syndrome (HLHS) and the infant's family. In the blink of an eye, the perfect child is lost, and a fragile infant is about to join the family. This case study and discussion is an overview of HLHS , a family's desire to make the birth of their infant normal, and how that desire initiated a change in philosophy and practice in our neonatal intensive care unit.

The model of Palliative Care in the perinatal setting: a review of the literature

BACKGROUND

The notion of Palliative Care (PC) in neonatal and perinatal medicine has largely developed in recent decades. Our aim was to systematically review the literature on this topic, summarise the evolution of care and, based on the available data, suggest a current standard for this type of care.

METHODS

Data sources included Medline, the Cochrane Library, CINAHL, and the bibliographies of the papers retrieved. Articles focusing on neonatal/perinatal hospices or PC were included. A qualitative analysis of the content was performed, and data on the lead author, country, year, type of article or design, and direct and indirect subjects were obtained.

RESULTS

Among the 1558 articles retrieved, we did not find a single quantitative empirical study. To study the evolution of the model of care, we ultimately included 101 studies, most of which were from the USA. Fifty of these were comments/reflections, and only 30 were classifiable as clinical studies (half of these were case reports). The analysis revealed a gradual conceptual evolution of the model, which includes the notions of family-centered care, comprehensive care (including bereavement) and early and integrative care (also including the antenatal period). A subset of 27 articles that made special mention of antenatal aspects showed a similar distribution. In this subset, the results of the four descriptive clinical studies showed that, in the context of specific programmes, a significant number of couples (between 37 and 87%) opted for PC and to continue with the pregnancy when the foetus has been diagnosed with a lethal illness.

CONCLUSIONS

Despite the interest that PC has aroused in perinatal medicine, there are no evidence-based empirical studies to indicate the best model of care for this clinical setting. The very notion of PC has evolved to encompass perinatal PC, which includes, among other things, the idea of comprehensive care, and early and integrative care initiated antenatally.

Making a case: creating a perinatal palliative care service using a perinatal bereavement program model

This article explores the innovative approach of creating a perinatal palliative care service in an institution that already has a perinatal bereavement program. The proposed model focuses on the importance of establishing and maintaining relationship among and between nurses, other clinicians, and parents. The authors examine theoretical and clinical perspectives, recognizing the presence of both grief and hope from the moment of a life-threatening fetal diagnosis. The article identifies key program development processes, potential barriers, and practical implementation strategies as methods to ensure the delivery of seamless perinatal palliative care from diagnosis, through pregnancy, delivery, and the baby's living and dying.

Continuity and change in mothers' narratives of perinatal hospice

OBJECTIVES

(1) To broadly explore the experiences of women who chose to continue pregnancies affected by lethal fetal diagnoses and (2) to develop knowledge useful to nurses and other healthcare professionals who provide perinatal hospice (PH) care.

DESIGN

Qualitative descriptive study using narrative analysis.

PARTICIPANTS

Fifteen women who learned during their pregnancies of a lethal fetal diagnosis and chose to continue the affected pregnancies.

METHOD

Participants' stories of their PH experiences were recorded in face-to-face interviews. A qualitative approach using narrative analysis was used to identify themes and develop suggestions for care.

RESULTS

The element of time was prevalent in mothers' stories. Some aspects of mothers' experiences continued, particularly feelings of love and connection to their babies. Mothers also reported evolving changes in their thoughts and feelings. Personal changes such as increased compassion, faith, and strength were frequently mentioned. Mothers described transient phases of highs and lows. Drawing personal meanings or life lessons was the main way mothers connected their experiences to their present lives.

CONCLUSIONS

Mothers' descriptions of their experiences can enhance nurses' understanding of perinatal loss. Established care practices, such as birth planning and creating mementoes, were supported. Nurses can help mothers experiencing loss by elucidating and reflecting their personal meanings.

Prenatal consultation with a neonatologist for congenital anomalies: parental perceptions

OBJECTIVES

To investigate parental expectations of a prenatal consultation with a neonatologist for a prenatally diagnosed congenital anomaly, to identify parents' values and unmet needs, and to obtain recommendations for improving physician-parent communication in a prenatal consultation.

METHODS

Parents referred to neonatology for prenatal consultation after the diagnosis of a congenital anomaly. Completed 2 qualitative interviews: the first within 1 week of the consultation and the second 1 week after delivery. Interviews were analyzed for themes by using the constant comparative method associated with the grounded theory method.

RESULTS

Thematic saturation was achieved after 42 interviews (22 women); only mothers participated. Five main themes emerged: (1) preparation; (2) knowledgeable physician; (3) caring providers; (4) allowing hope; and (5) time. Mothers believed that a consultation with a neonatologist helped them prepare for the perinatal course. They wished to know the management plan and all possible outcomes. Mothers wanted information specific to their situation and tailored to their knowledge base. Receiving conflicting information from physicians increased anxiety and eroded confidence. Seeing the NICU during the consultation was emotionally difficult but valuable. Mothers wanted realistic information, regardless of how grim, yet wanted to retain hope. All mothers would recommend a prenatal consultation with a neonatologist.

CONCLUSIONS

Mothers perceived that a consultation with a neonatologist, which included a NICU tour, prepared them for the perinatal course. Parents want realistic medical information, specific to their situation, provided in an empathetic manner and want to be allowed to hope for the best possible outcome.