Phenomenological study of the lived experiences of pregnant women following the diagnosis of fetal abnormalities in the second half of pregnancy

Abstract

With advances in medical technology, prenatal screening tools have become increasingly accurate, enabling parents to better prepare for the birth of their child. However, some parents face the unexpected diagnosis of fetal abnormalities through these screenings and experience complex and multidimensional personal, social, and psychological challenges. Cultural context, personal beliefs, and individual attitudes can influence the intensity and persistence of these experiences, which are often misunderstood by society. The aim of this study was to explore and describe the lived experiences of pregnant women in the second half of pregnancy who had undergone fetal anomaly screening. This qualitative study was conducted using Colaizzi’s phenomenological approach. The study population included all pregnant women in the second half of pregnancy who had undergone fetal anomaly screening. A purposive and accessible sample of 20 women who attended a screening clinic in Tehran in 2025 was selected. Data were collected through semi-structured interviews and analyzed using MAXQDA-24 software, following Colaizzi’s seven-step method. Analysis of 20 interviews yielded 186 codes and 28 concepts, which were categorized into seven main themes: (1) cognitive and behavioral reactions, (2) maternal identity and role, (3) beliefs, spirituality, and hope, (4) social support and interactions, (5) grief, loss, and sorrow, (6) anxiety, fear, and psychological distress, and (7) coping style and emotion regulation. The findings revealed the pregnant women, despite limited understanding from society and their surroundings, shared common experiences when facing the crisis of fetal abnormality diagnosis. They need reliable information, genuine support, and educational guidance for themselves and their families. These findings may inform the design of culturally sensitive support and educational programs in similar contexts.

Introduction

Pregnancy, although a natural process, is often accompanied by high levels of anxiety and concern for women. Evidence suggests that symptoms of anxiety are common during the perinatal period and tend to be more severe among women facing medically complicated pregnancies¹. One of the major sources of this anxiety is prenatal screening, which is designed to identify fetal abnormalities in the early stages of pregnancy². These screening tests, by providing a non-invasive assessment of the risk of conditions such as aneuploidies and structural defects, offer parents preliminary information and time to make decisions and prepare psychologically³.

However, research indicates that the psychological consequences of prenatal screening extend beyond its clinical benefits. When results suggest a possible fetal abnormality, women experience significant psychological distress, including financial concerns, family conflicts, and uncertainty in the diagnostic process^4–6. The “prenatal paradox,” described by⁷, reflects the tension between reported and perceived risks, the conflict between informational benefits and moral decisions regarding pregnancy continuation, and the contradiction between scientific knowledge and lived experience. Moreover⁸, identified the multifaceted psychological burden of post-test anxiety as a key factor influencing women’s decision-making, including considerations of fetal health, access to medical information, and financial pressures.

Although⁹ found limited research on the psychological consequences of non-invasive prenatal testing (NIPT), existing studies generally show short-term anxiety reduction following negative results and low decision regret overall¹⁰. emphasized that prenatal testing decisions occur at individual, contextual, and relational levels, encompassing demographic, clinical, psychological, technical, and social factors that collectively shape women’s experiences and choices.

International studies reveal that women undergoing prenatal screening face considerable challenges related to anxiety, adequacy of counseling, and decision-making. Many women report feelings of anxiety and confusion following positive screening results, and fewer than half perceive the counseling they receive as sufficient¹¹. Clinical settings significantly affect women’s decision-making conflicts, although individualized counseling can improve decision clarity and perceived support¹².

In the United States, pregnant women confronted with fetal abnormalities, particularly in cases of uncertain prognosis or social-demographic risk factors, experience higher levels of anxiety¹³. Qualitative research in the United Kingdom and the Netherlands also highlights that termination of pregnancy due to fetal abnormalities is associated with complex emotional experiences such as grief, guilt, depression, and post-traumatic stress, underscoring the need for structured psychological support¹⁴. Women use diverse coping strategies such as acceptance, denial, and information seeking, which demonstrates the importance of educational and structured support to promote adaptive coping methods¹⁵. Qualitative findings emphasize the importance of comprehensive information and effective communication in prenatal counseling, as women consider multiple factors including uncertainty, personal values, emotional responses, and social support when making decisions¹⁶.

Most international studies have been conducted in diverse cultural and social contexts and do not fully reflect the specific circumstances of Iran, including religious beliefs, legal restrictions on therapeutic abortion, and the central role of family. Iranian women face unique challenges during prenatal anomaly screening, including difficulties in decision-making, negative pregnancy experiences, abortion-related concerns, and inadequate health system support¹⁷. Their main sources of concern include physician uncertainty, family dynamics, financial worries, and misinformation, while the most common coping mechanism is “sharing concerns with relatives”⁴. Evidence from systematic reviews suggests that educational interventions alone do not reduce maternal anxiety and that structured psychological interventions are needed¹⁸.

Religious and cultural frameworks play an essential role in shaping Iranian women’s attitudes toward medical procedures. For instance, 85% of women perceive abortion as dangerous, and 86% believe that their partners should participate in decision-making¹⁹. Fear, shame, and embarrassment often prevent women from undergoing preventive screenings, though religion can also promote positive preventive behaviors²⁰. Iranian women face significant psychological challenges during anomaly screening, including “bitter pregnancy experiences” and decision-making difficulties¹⁷. These findings align with international patterns indicating that gendered socialization, inequality, and limited empowerment influence screening decisions, while male partners often act as gatekeepers to healthcare resources²¹.In Iran, few studies have explored the psychological and social experiences of women undergoing fetal anomaly screening. Most research has focused on medical outcomes, prevalence of disorders, or ethical aspects of therapeutic abortion^22,23 Despite the importance of previous work, limited attention has been paid to the emotional and experiential dimensions of women’s lives. Quantitative studies and clinical outcomes dominate the literature, leaving the lived experiences of women during the second-trimester screening underexplored.

Understanding these experiences can provide a deeper and more realistic picture of how screening affects women’s lives. A qualitative and phenomenological approach, particularly Colaizzi’s method, allows for an in-depth exploration of the cognitive, emotional, and social complexities of women’s lived experiences. Therefore, the present study aims to explore the lived experiences of Iranian women facing second-trimester anomaly screening, identify cognitive and emotional aspects of these experiences, and provide insights for improving maternal health policies, enhancing counseling and psychosocial support services, and developing culturally sensitive educational and clinical protocols.

Methods

Study design

This qualitative study employed a descriptive phenomenological approach based on Colaizzi’s (1978) method to explore the psychological and emotional experiences of pregnant women undergoing second-trimester fetal anomaly screening. The aim was to identify the cognitive and emotional dimensions of their lived experiences and to understand the challenges involved in decision-making following screening results²⁴.

Participant selection

Participants were pregnant women in the second half of pregnancy who had undergone fetal anomaly screening and received results indicating a possible abnormality. Inclusion criteria were: (1) being in the second trimester of pregnancy, (2) having undergone anomaly screening, (3) receiving a suspicious or abnormal screening result, and (4) willingness and ability to share personal experiences. Exclusion criteria included unwillingness or inability to participate effectively, or the presence of a medical or psychological condition interfering with participation²⁵.

Sampling

Study participants for in-depth interviews (IDIs) were selected using a purposive and convenient sampling method. Eligible women were identified when they attended the fetal anomaly screening and counseling clinic for follow-up or consultation after receiving abnormal or suspicious screening results. After initial contact and assessment by the clinic’s healthcare professionals, potential participants were approached by the principal investigator and invited to take part in the study.

Purposive sampling was chosen because it enables the selection of individuals who have rich and relevant experiences related to the phenomenon under investigation, thus allowing for a deep and nuanced understanding of women’s psychological and emotional responses rather than making statistical generalizations²⁶.

Sample size

A total of twenty pregnant women in the second half of pregnancy were interviewed. The final sample size was determined by the principle of data saturation, which occurs when no new information, categories, or themes emerge from subsequent interviews, and the data become sufficiently rich and comprehensive to address the research objectives²⁷.

Study setting

explore the lived experiences of pregnant women following the screening for fetal abnormalities in the second half of pregnancy. The study was conducted between January and June 2025. Phenomenology provided the conceptual foundation for this study, as it seeks to identify and describe the essence of a phenomenon from the participants’ own perspectives. The phenomenological approach aims to capture how individuals perceive and make sense of their experiences, focusing on their cognitive, emotional, and behavioral responses to specific life events²⁸. In this study, phenomenology was used to explore the complex psychological and emotional processes that women undergo when confronted with uncertain or abnormal fetal screening results. The goal was to reveal the underlying meanings, emotions, and decision-making challenges embedded in their lived experiences.

This design enabled the researchers to record participants’ subjective experiences as accurately and richly as possible, grounded in their own words and meanings. Semi-structured, in-depth interviews were used to facilitate open dialogue, allowing participants to reflect deeply on their personal journeys and emotional responses. The descriptive phenomenological framework guided the entire process—from data collection to thematic analysis—to ensure that findings authentically represented the lived realities of these women⁸.

The setting of the data collection

The study was conducted among pregnant women in the second half of pregnancy who attended a referral fetal screening center in Tehran, Iran. This center provides specialized prenatal diagnostic services, including ultrasound anomaly screening, genetic counseling, and follow-up care for pregnancies with suspected or confirmed fetal abnormalities.

Aligned with the aim of the study, participants were selected based on specific inclusion and exclusion criteria to ensure that they had direct lived experiences relevant to the phenomenon under investigation.Inclusion criteria were: (1) being in the second half of pregnancy (after 20 weeks of gestation), (2) having undergone fetal anomaly screening, (3) receiving an uncertain or abnormal screening result, and (4) willingness and emotional readiness to share personal experiences through an in-depth interview.

Exclusion criteria included: (1) lack of willingness or inability to participate effectively in the interview, and (2) presence of severe medical or psychological conditions that interfered with participation.

The selection of participants was purposeful, focusing on women who had personally encountered psychological or emotional challenges following screening results. Efforts were made to ensure diversity in participants’ demographic and obstetric backgrounds—such as age, parity, education, and place of residence—to capture a rich and varied understanding of the lived experience.

Data collection tools

Instrument

Data were collected through semi-structured, in-depth interviews and direct observational notes. Each interview began with broad, open-ended questions such as “Can you describe your experience when you received the screening result?” and was followed by probing questions to deepen understanding. Interviews lasted 20–40 min and were audio-recorded with participants’ consent. Observational notes regarding participants’ emotional expressions and contextual details were also documented to enrich data interpretation.An interview guide developed based on literature review and expert consultation was used to ensure consistency across interviews. The guide focused on emotional reactions, cognitive processing, coping strategies, and social interactions related to the screening experience^29,30.

Data saturation

Data collection continued until thematic saturation was achieved, meaning that no new categories or insights emerged from additional interviews. Saturation was confirmed after analyzing the 18th interview, but two more interviews were conducted to ensure completeness and confirmatory consistency^27–29.

Data analysis

Demographic and obstetric information for each participant was collected through semi-structured interviews. With the participants’ permission, all interviews were audio-recorded to ensure accuracy. The recorded interviews were transcribed verbatim in Persian and then translated into English for analysis. Data were analyzed using inductive thematic analysis, aiming to identify and interpret patterns of meaning within the participants’ lived experiences following the screening for fetal abnormalities in the second half of pregnancy.

Thematic analysis is a flexible qualitative approach that seeks to explore, examine, and describe emerging themes within data without being constrained by a fixed theoretical framework. This approach allows researchers to both reflect reality and uncover the underlying meanings within participants’ narratives^31,32.

The analysis followed the seven-step phenomenological method proposed by Colaizzi (1978), integrated with the seven-phase framework of Braun and Clarke for thematic analysis. The process was managed and organized using MAXQDA-24 software, which facilitated systematic coding, theme categorization, and retrieval of significant data segments^24,33.

The detailed analytical phases are described as follows:

Phase 1: familiarizing with the data

The research team immersed themselves in the data to gain a deep understanding of the participants’ experiences. All interviews were transcribed verbatim, and the researchers repeatedly listened to the audio recordings and read the transcripts line by line to grasp both the explicit and underlying meanings. During this phase, notes and reflective memos were taken to capture emerging ideas, emotions, and patterns related to the women’s lived experiences after receiving abnormal screening results. This immersion provided the foundation for all subsequent analysis steps^34,35.

Phase 2: generating initial codes

In this stage, significant statements and meaning units relevant to the research question were identified and coded manually using an inductive approach. The research team developed a preliminary codebook in MAXQDA-24 to organize these codes systematically. Each code represented a meaningful fragment of data capturing cognitive, emotional, or behavioral reactions of the participants toward the screening results and decision-making process. The coding was iterative, and adjustments were made as new insights emerged³⁶.

Phase 3: searching for themes

After initial coding, similar codes were clustered together to identify broader themes that reflected patterns within the data. These emerging themes represented essential aspects of women’s psychological and emotional experiences during the second half of pregnancy following the screening for fetal abnormalities. The research team reviewed all coded data extracts to ensure that each potential theme was coherent and distinct. Subthemes were developed to capture variations and nuances within each main theme³⁷.

Phase 4: reviewing themes

The themes were refined through continuous comparison and discussion among the research team. All coded extracts were re-examined to verify that they accurately represented participants’ voices. Some themes were merged, others were divided, and irrelevant codes were excluded to enhance conceptual clarity. This phase ensured internal consistency within themes and meaningful differentiation between them³⁸.

Phase 5: defining and naming themes

Once a coherent thematic structure was achieved, each theme was clearly defined and named to capture its core meaning. The researchers described the essence of each theme, illustrating them with direct quotations from participants. The final themes reflected the multidimensional nature of the lived experiences of pregnant women — encompassing fear and uncertainty, emotional turmoil, coping strategies, and the moral weight of reproductive decision-making. The final thematic map represented a comprehensive understanding of the phenomenon under study³⁹.

Phase 6: producing the report

In the final stage, the themes were integrated into a rich, descriptive narrative supported by participants’ quotations to convey their emotional depth and authenticity. The findings were interpreted in light of phenomenological principles, remaining faithful to the women’s voices while situating the results within existing literature on maternal psychology and prenatal decision-making⁴⁰.

Trustworthiness

Several strategies were employed to ensure the trustworthiness of this study. First, the interview guide was developed through an extensive review of relevant literature and evaluated by experts, including a professor with extensive experience in qualitative research and specialists in reproductive health, midwifery, and public health. The guide was also checked to ensure cultural sensitivity. All interviews were conducted by the principal investigator in Persian, the local language, following ethical guidelines and in a private, secure setting to ensure participants’ comfort and confidentiality⁴¹.

Credibility was ensured through multiple measures. The research team rigorously examined the data, presenting findings based directly on participants’ descriptions rather than researcher assumptions or biases. To enhance conformability and reflexivity, participants’ own words were incorporated in the findings. The systematic data analysis process, including thematic mapping using Colaizzi’s approach, ensured internal coherence and validity of the identified themes. Additionally, ongoing contact with participants during and after the interviews helped maintain a deeper understanding of their experiences.Member checking was conducted with three participants, who reviewed their transcripts to verify that the content accurately reflected their experiences. A detailed description of the participants’ demographic characteristics and the study setting further supports credibility. The presentation of a diverse range of lived experiences in the results enhances transferability, allowing readers to apply insights to similar populations.Dependability was ensured through a transparent description of the research process, including the study aim, participant selection, motivations, data collection procedures, and duration, as well as the methods for data reduction, transformation, and analysis. Finally, the sample size was determined based on data saturation, which was reached when no new themes or insights emerged from subsequent interviews, confirming the completeness of the dataset^42,43.

Ethical considerations

The study was approved by the Ethics Committee of Hormozgan University (Approval No.: IR.HUMS.REC.1404.018). All procedures were conducted in accordance with institutional guidelines and the Declaration of Helsinki. Written informed consent was obtained from all participants prior to enrollment. Participants consented to audio recording and to the publication of anonymized quotations. Confidentiality and anonymity were strictly maintained; identifiers were removed from transcripts and all data were stored securely.

Reporting standards

The study reporting follows established qualitative research guidelines (e.g., COREQ) to ensure transparency and completeness.

Results

Demographic characteristics of participants

Twenty pregnant women participated in this qualitative study. All participants were in the second half of their pregnancy and had received suspicious results for fetal anomalies during prenatal screening. The participants’ ages ranged from 22 to 38 years, with gestational ages between 18 and 24 weeks. Most participants were married and living in various provinces across Iran, including Tehran, Borujerd, Varamin, Saveh, Mahalat, Maragheh, Rasht, Ilam, Karaj, Sari, Tabriz, and Bushehr, representing both urban and semi-urban settings.

The participants had diverse educational backgrounds, ranging from secondary school (diploma) to postgraduate degrees (Master’s). Approximately half of the women were homemakers, while the remainder were employed in various sectors, including education, healthcare, and administrative positions. Parity varied among participants: some were in their first pregnancy, others in their second or third, and one woman was in her fourth pregnancy with a history of recurrent miscarriage.

The types of diagnosed or suspected fetal anomalies were heterogeneous and included cardiac malformations, neural tube defects, chromosomal abnormalities (e.g., Down syndrome, Trisomy 18), renal insufficiencies, growth deficiencies, anencephaly, and skeletal deformities such as spinal curvature or limb malformation.

A few participants reported a history of miscarriage or blighted ovum, indicating prior pregnancy complications, whereas others had no adverse obstetric history. The support systems reported by participants varied: several women relied primarily on their husbands or families, while a few found strength through spiritual beliefs or close friends. Notably, some participants reported limited or no support network during this challenging period.

Table 1 summarizes the sociodemographic, obstetric, and clinical characteristics of the participants.

Table 1.

Characteristics of the participants.

No	ID	Age (years)	Residence	Marital Status	Occupation	Educational Level	Parity	Gestational Age at Screening (weeks)	Type of Anomaly	Previous Pregnancy Complications	Support System
1	P1	30	Borujerd	Married	Housewife	Bachelor’s	First pregnancy	18	Kidney failure	—	Family
2	P2	22	Borujerd	Married	Housewife	Diploma	First pregnancy	18	Kidney adhesion	Sister-in-law’s infertility	Husband
3	P3	41	Mahalat	Married	Housewife	Bachelor’s	Third pregnancy (one miscarriage, one live birth)	19	Brain cyst	Miscarriage in 2nd pregnancy	Husband
4	P4	32	Tehran	Married	Housewife	Bachelor’s	Third pregnancy (1 live birth, 1 miscarriage)	18	Cardiac failure	Family miscarriage history	Spiritual beliefs
5	P5	27	Maragheh	Married	Employee	Master’s	First pregnancy	24	Brain insufficiency	Genetic disorder in relatives	Spiritual beliefs
6	P6	29	Varamin	Married	Housewife	Diploma	First pregnancy	19	Brain cyst & heart spot	—	Husband
7	P7	31	Eslamshahr	Married	Housewife	Diploma	Second pregnancy	18	Growth deficiency	Short height in cousin	Husband
8	P8	35	Tehran	Married	Employee	Associate	Second pregnancy	20	Growth defect in one twin	—	None
9	P9	37	Saveh	Married	Employee	Bachelor’s	Third pregnancy (first and second miscarriages)	21	Limb growth anomaly	Two previous miscarriages	Husband
10	P10	36	Tehran	Married	Employee	Master’s	Third pregnancy (first blighted ovum)	20	Spinal curvature	Blighted ovum in first pregnancy	Husband
11	P11	26	Eslamshahr	Married	Housewife	Bachelor’s	First pregnancy	20	Right heart malformation	—	None
12	P12	29	Tehran	Married	Housewife	Bachelor’s	First pregnancy	18	Down syndrome	—	Friends
13	P13	31	Varamin	Married	Employee	Associate	Second pregnancy	18	Neural tube defect	Miscarriage in first pregnancy	Friends
14	P14	36	Rasht	Married	Employee	Bachelor’s	First pregnancy	19	Nasal bone gap & brain cyst	Heart defect in niece	None
15	P15	38	Ilam	Married	Housewife	Diploma	Fourth pregnancy (three miscarriages)	24	Growth defect & preterm birth	Miscarriages in 1st and 3rd pregnancies	Family
16	P16	35	Karaj	Married	Housewife	Bachelor’s	Third pregnancy (two successful)	20	Trisomy 18	Sister’s miscarriage history	Family
17	P17	29	Tehran	Married	Employee	Master’s	First pregnancy	19	Cleft lip	Down syndrome in maternal relatives	None
18	P18	24	Sari	Married	Employee	Bachelor’s	First pregnancy	22	Anencephaly	—	Husband
19	P19	26	Tabriz	Married	Employee	Associate	Second pregnancy	21	Brain failure	—	Family
20	P20	37	Bushehr	Married	Employee	Bachelor’s	Third pregnancy (two successful)	20	Structural defect	—	Family

Main themes and subthemes

During the data analysis, seven main themes reflecting the lived experiences of women undergoing prenatal anomaly screening in the second trimester were identified. These include1.Cognitive and Behavioral Reactions, 2. Maternal Identity and Role, 3.Beliefs, Spirituality, and Hope, 4.Social Support and Interactions, 5.Grief, Loss, and Sadness, 6.Anxiety, Fear, and Psychological Pressure, 7.Coping Styles and Emotional Management. These themes are illustrated in Table 2, providing a comprehensive overview of participants’ experiences throughout the prenatal anomaly screening process.

Table 2.

Main Categories, Concepts, and Themes extracted from qualitative analysis.

Main category	Concept	Themes
Cognitive and Behavioral Reactions	Cognitive reactions	Logical reasoning in acceptance, sense of responsibility, ambivalence to avoid others’ judgment, distrust in physical ability, recommendation for autonomous and rational decision-making, feeling misunderstood, sound sensitivity, lack of concentration, denial, belief in the evil eye, negative thinking, cognitive avoidance, first anxious thoughts, mental turmoil, rumination, exploring causes.
	Behavioral reactions	Reduced daily activity and performance, social withdrawal to avoid questions, avoidance in facing crisis, avoiding related stimuli, isolation-seeking behaviors.
Motherhood Identity and Role	Perception of pregnancy	Whether pregnancy was planned or unplanned.
	Maternal role confusion	Emotional conflict toward the fetus, maternal inferiority, collapse of maternal identity.
	Mother–fetus connection	Hearing the heartbeat and increasing attachment, emotional transmission between mother and fetus.
	Maternal identity	Sense of maternal identity, existential doubt and identity crisis, concern for older children, opposition to abortion from maternal perspective, recurring dreams about the baby, bonding with the fetus, deep love for the child, confirmation of maternal identity even under stress.
Beliefs, Spirituality, and Hope	Pre-crisis experiences	Clarity through past experiences, good start to pregnancy, effort for conception, initial joy, early stress, difficult pregnancy, delayed conception, occupational influence, joy over fetus’s sex, detailed pre-crisis planning.
	Role of hope	Desire for positive belief despite negative conditions, hope for returning to normalcy, interpreting medical news as a ray of hope.
	Religious and spiritual beliefs	Complaints toward fate and God, reliance on science over religion, maintaining hope through faith, use of religious tools for calmness, role of faith in abortion decisions, family discussions on divine justice, doubts in prayer efficacy, encouraging other women to stay hopeful, waiting for miracles, spiritual connection with the fetus, viewing the situation as divine punishment or test.
	Meaning-making and attitude transformation	Finding meaning through shared experiences, gradual change of attitude toward pregnancy termination, comparison with previous hardships, hope after reading spiritual texts, redefinition of motherhood, search for meaning, emotional transformation, advice for calmness and acceptance, planning for future.
Social Support and Interactions	Social context	Effect of social support on anxiety reduction, stressful cultural discourse, cultural and social impact on psychological experience, social pressure for quick recovery, fear of social judgment.
	Gap between received and perceived support	Receiving bad news from medical staff, feeling lonely despite support.
	Expectations from healthcare team and others	Inability to understand medical jargon, reassurance through professional support, fear and doubt about medical interventions, feeling unsupported or distrustful toward staff, expectations of empathy and counseling, need for referral to psychologist.
	Empathy and shared experience	Sympathy with other women who experienced similar situations.
	Family and spouse	Husband’s role in spiritual support, family’s indifference, need or lack of support, marital relationship and conflicts, spouse’s guilt, family empathy, husband’s silence, advice to communicate with spouse for peace, spiritual and emotional spousal support.
Grief, Loss, and Sadness	Sadness and despair	Lack of motivation, crying, heavy grief, deep sorrow.
	Prenatal grief	Early mourning for the fetus, despair over failed amniocentesis.
Anxiety, Fear, and Psychological Pressure	Fear of pregnancy and miscarriage	Fear of future pregnancy, worry about child’s future, fear of infertility, fear of recurrence, fear of miscarriage.
	Decision-making and moral conflicts	Ethical dilemmas in abortion or continuation, indecisiveness, mental conflict, recommendation for patience, moral anxiety over abortion consequences, cultural and religious pressure, decision-making stress, fear of guilt.
	Self-blame and guilt	Self-blame for delaying pregnancy, feeling unlucky, guilt due to unplanned pregnancy or genetic issues, denial of guilt.
	Emotional and psychological reactions	Shock, disbelief, confusion, sadness, helplessness, fear, anxiety, hopelessness, loss of control, emotional numbness, depression, deep distress, ambivalence of emotions, feeling like a victim, physical and financial strain, intrusive memories, sense of emptiness.
	Physical reactions	Physiological responses to medical diagnosis (e.g., tremors, palpitations).
Coping Styles and Emotional Regulation	Facing reality and emotional control	Overcoming denial after ultrasound, belief in emotional effects on fetus health, accepting solitude or social support for calmness, self-soothing, release from guilt through reflection, need for counseling, hope through dreams, self-care, reconciliation with body, seeking silence to reduce anxiety.
	Effective coping styles	Need for emotional release, timely medical follow-up, information-seeking, peer encouragement, personal growth through crisis, emotional control, humor or distraction, gradual emotional stabilization.
	Ineffective coping styles	Inability to regulate emotions, persistence of distress, avoidance or denial as coping strategies.

Cognitive and behavioral reactions

Participants described a spectrum of cognitive and behavioral reactions to the emotional and physical challenges of pregnancy, especially when confronted with fetal abnormalities observed in ultrasounds. These reactions often followed a dynamic process: initial shock, disbelief, and denial, followed by gradual acknowledgment of reality and attempts to regain control over their emotions and decisions.

For example, upon seeing abnormalities in their ultrasound, many women reported feeling overwhelmed, anxious, and unable to fully process the information:

“Even in my own ultrasound, I saw that my baby’s spine was curved. At first, I couldn’t believe it; I kept hoping it was a mistake. The certainty I felt eventually pushed me to start facing the reality and think about what steps I should take.” (P4).

Some participants described behavioral attempts to manage their shock, such as seeking repeated medical opinions, gathering information about the condition, or comparing their experiences with those of other mothers:

“I immediately scheduled another ultrasound and consulted a specialist to make sure it wasn’t a misdiagnosis. I also spoke with other mothers who went through similar experiences; it helped me understand that I needed to accept what had happened and focus on what I could control.” (P9).

Others highlighted emotional regulation strategies, such as compartmentalizing fears temporarily to continue with daily responsibilities, or actively engaging in distraction techniques:

“At first, I didn’t allow myself to think too much about it because I had other children to take care of. I tried to focus on my routine and small joys, like reading or spending time with my family, just to keep from breaking down completely.” (P2).

These cognitive and behavioral responses illustrate a progressive adaptation process where initial denial slowly transforms into acceptance, problem-solving, and proactive engagement with the pregnancy and fetal health, setting the stage for subsequent coping and emotional management strategies.

Maternal identity and role

Participants highlighted the centrality of their maternal identity and the sense of responsibility that shaped their behaviors and decisions during pregnancy. Despite experiencing fear, anxiety, and emotional distress, women expressed a strong commitment to maintaining their health, attending medical appointments, and ensuring optimal conditions for their fetus.

For instance, many participants emphasized the direct impact of their emotions on fetal well-being, and the importance of emotional regulation as part of their maternal role:

“In this period, our emotions affect the baby. It’s better to resolve the problem to prevent fear and anxiety from harming the child.” (P11).

Some women described balancing personal needs with maternal responsibilities, showing resilience in the face of uncertainty:

“I tried to care for myself by resting, eating properly, and following medical advice, but at the same time, I focused on being calm for my baby. Even when I was scared, I reminded myself that my main job is to protect and nurture the child.” (P6).

Other participants reported adaptation strategies that reinforced their maternal role, such as seeking support from family, partners, or peers, and adjusting their daily routines to prioritize fetal health:

“Sometimes I felt alone and anxious, but I would spend time with my older children or talk to close friends who were mothers. Their advice and empathy reminded me of my role and gave me strength to continue.” (P13).

Women also expressed personal growth and a heightened sense of responsibility, stating that the pregnancy experience strengthened their maternal identity:

“Even with all the stress, I realized how strong and capable I am as a mother. This experience taught me that being a mom is not just about giving birth, but also about managing my emotions, making decisions, and caring for the. baby with love and attention.” (P17).

Overall, the findings suggest that maternal identity and role function as a motivating and regulating force, guiding women to manage emotional distress, adhere to health-promoting behaviors, and cultivate resilience in the face of uncertainty.

Beliefs, spirituality, and hope

Participants frequently described relying on spiritual beliefs and hope as a mechanism to cope with stress, uncertainty, and emotional distress during pregnancy. Spirituality was not limited to religious practices, but included trust in a higher power, prayer, and rituals, which helped women maintain optimism and resilience.

Many women highlighted that faith provided comfort and a sense of control, especially when facing fetal abnormalities or uncertain outcomes:

“I try to entrust everything to God. Praying calms me and reminds me that I am not alone in this journey.” (P5).

Some participants expressed that hope motivated them to adhere to medical advice and pursue proactive behaviors for their child’s well-being:

“Even though I was scared when I saw the ultrasound, I kept telling myself that everything happens for a reason and that I should follow all medical recommendations. Hope helped me stay calm and focused on what I can do for my baby.” (P8).

Others described using spirituality to regulate intense emotions, such as fear, guilt, or despair, and to cultivate inner peace:

“When I feel overwhelmed, I sit quietly, pray, and imagine my baby growing safely inside me. This makes me feel stronger and more in control of my emotions.” (P15).

Overall, spirituality and hope acted as emotional anchors, helping women navigate fear, uncertainty, and psychological pressure, while reinforcing their maternal commitment and resilience.

Social support and interactions

Participants highlighted the critical role of social support in coping with emotional and psychological challenges during pregnancy, especially after learning about fetal abnormalities. Support came from multiple sources, including partners, family members, friends, and healthcare providers.

Many women emphasized that emotional reassurance and practical assistance were essential for reducing anxiety and maintaining maternal well-being:

“My husband stayed by my side when I first saw the ultrasound. He helped me calm down and reminded me that we could handle this together.” (P1).

Some participants described peer support as particularly beneficial, as interacting with women in similar situations helped them normalize their feelings and reduce isolation:

“Talking to other women who had experienced similar fears made me feel less alone and more confident about making decisions for my child.” (P10).

Healthcare providers also played a key role by offering counseling, guidance, and empathetic communication, which helped participants understand medical information and make informed decisions:

“The doctor explained everything step by step. Knowing what was happening and what I could do eased my anxiety significantly.” (P14).

Social support, therefore, acted not only as a buffer against stress but also as a facilitator of maternal resilience, enabling women to better manage their emotions, engage in positive coping strategies, and fulfill their maternal responsibilities despite fear and uncertainty.

Grief, loss, and sadness

Participants reported experiencing intense grief, sadness, and feelings of loss upon discovering fetal abnormalities during pregnancy. These emotional reactions were often profound and long-lasting, affecting both psychological well-being and daily functioning.

Some women described an initial sense of shock and disbelief, followed by sorrow as they confronted the reality of the condition:

“When I saw the ultrasound and realized my baby had a spinal curvature, I felt a deep sadness. It was hard to accept that my child might face challenges.” (P3).

Others highlighted the emotional burden of anticipating future difficulties for their child, which sometimes led to feelings of guilt and self-blame:

“I kept thinking, ‘Did I do something wrong? Could I have prevented this?’ These thoughts were overwhelming, even though I knew it wasn’t my fault.” (P12).

The participants also noted the interplay of grief with other emotional states, such as anxiety and fear, intensifying their distress:

“I was sad, but also anxious about what would happen next. The sadness made it harder to sleep and focus on daily tasks.” (P16).

Some women found comfort in sharing their feelings with trusted individuals, which helped them process their grief:

“Talking to my sister about my fears and sadness made it feel less heavy. I realized I didn’t have to carry this alone.” (P7).

Overall, grief, loss, and sadness were central emotional experiences that shaped women’s pregnancy journey, highlighting the importance of emotional support and interventions to help them cope with these profound feelings.

Anxiety, fear, and psychological pressure

Participants frequently reported high levels of anxiety, fear, and psychological pressure throughout pregnancy, particularly after learning about fetal abnormalities. These emotions were persistent, intense, and multifaceted, affecting both mental and physical well-being.

Many women described immediate fear and distress upon seeing the ultrasound results:

“Even in my own ultrasound, I saw that my baby’s spine was curved. I felt certain, which made me anxious, but it also helped me start facing reality.” (P6).

Some participants emphasized the fear of the unknown and potential complications, both for themselves and their babies:

“I was terrified that my emotions might harm the baby. I tried to stay calm, but every worry about the child kept me awake at night.” (P18).

The study revealed that psychological pressure was not only related to the medical condition but also to social expectations, familial concerns, and self-blame:

“I felt pressured to stay strong for my family, even though inside I was panicking. I blamed myself at times, wondering if my actions caused this.” (P10).

Participants described strategies they used to manage anxiety, including controlled breathing, prayer, relaxation, and engaging in activities that brought calm:

“I tried to calm myself in ways that worked for me. Sometimes I would pray, or spend time alone to process my thoughts.” (P14).

The narratives highlighted the dynamic nature of fear and anxiety, showing that these emotions fluctuated depending on medical updates, support from family, and personal coping mechanisms:

“Some days I was calmer, especially after talking to the doctor or receiving advice from friends. Other days, fear would overwhelm me again.” (P3).

Overall, anxiety, fear, and psychological pressure emerged as major emotional challenges, strongly influencing participants’ experiences during pregnancy and emphasizing the need for supportive interventions and psychological guidance.

Coping styles and emotional management

Participants reported using various coping strategies to manage their emotional reactions and psychological stress during pregnancy, particularly after discovering fetal abnormalities. These strategies were both problem-focused and emotion-focused, aiming to reduce anxiety, regain a sense of control, and maintain maternal well-being.

Facing reality and emotional regulation was a common approach:

“After seeing the ultrasound, I tried to accept the reality. I told myself that denial wouldn’t help; I needed to focus on what I could do.” (P8).

Spirituality and trust in a higher power were also frequently cited as coping mechanisms:

“I relied on prayer and trusting in God. It helped me calm down and feel that I wasn’t alone in this.” (P5).

Social support played a crucial role in emotional management. Participants sought comfort and advice from partners, family, friends, or peers experiencing similar situations:

“Talking to women like me helped reduce my anxiety. Sharing experiences made me feel understood and less alone.” (P13).

Personal strategies for emotional relief included activities such as music, writing, spending time with children, and brief moments of solitude for reflection:

“Sometimes I would write my fears down or talk to myself quietly. Other times, being with my kids helped me feel better.” (P2).

Active engagement in medical care was another coping approach, as participants believed that timely tests, consultations, and following medical advice helped them feel more in control:

“I made sure to attend all appointments without delay. Doing everything possible medically helped me feel proactive, not helpless.” (P17).

Some participants also reflected on previous coping experiences, such as exercise, meditation, or prior counseling, which they adapted during this pregnancy:

“I used to calm my anxiety with exercise and talking to friends. Now I combine that with meditation and focusing on my baby’s health.” (P9).

Overall, the findings reveal that coping styles were diverse, dynamic, and personalized, combining internal strategies, spiritual beliefs, social support, and engagement with healthcare to manage.

anxiety, fear, and emotional distress. This highlights the importance of holistic support systems for pregnant women facing fetal health challenges.

Discussion

This study aimed to explore the lived experiences of pregnant women following the diagnosis of fetal abnormalities in the second half of pregnancy. The findings illustrate the psychological, emotional, and behavioral responses of women as they navigate pregnancy and early motherhood under these challenging circumstances. The results provide new insights into the “lived experience” of these women, highlighting how the diagnosis affects their daily lives, maternal identity, emotional management, and social interactions.

Because the diagnosis impacts multiple aspects of the participants’ lives, experiencing pregnancy and postpartum during this period is particularly challenging. The findings reveal that women’s lived experiences are characterized by initial disbelief and denial, fear and anxiety related to fetal health, coping strategies and emotional management, adaptation to maternal roles, and reliance on social support and spirituality. Furthermore, the study emphasizes the participants’ resilience, commitment to maternal responsibilities, and the strategies they employ to maintain psychological well-being, as well as the critical role of interactions with healthcare providers in supporting women through this difficult period.

Participants reported a gradual process of adaptation that began with shock, disbelief, and denial, followed by progressive acknowledgment of the fetal condition and active engagement in problem-solving and emotional regulation. This process indicates that women confronted with unexpected health-related information during pregnancy employ cognitive and behavioral strategies to regain a sense of control. For example, they sought additional information—through online sources, consulting multiple physicians, and undergoing further medical tests—and compared their experiences with other mothers to reduce uncertainty and enhance self-efficacy. Emotional compartmentalization and distraction techniques also enabled them to manage immediate stress while maintaining daily responsibilities. These findings are consistent with previous research emphasizing that coping involves continuous cognitive-behavioral efforts to manage stress^44,45.

The findings highlighted the importance of maternal identity as a motivating and regulatory force. Women’s commitment to maintaining fetal health, attending medical appointments, and regulating their emotions reflects the centrality of the maternal role in guiding behavior under uncertainty. Prior studies have also shown that maternal self-concept promotes health-oriented behaviors and resilience in the face of pregnancy complications^46,47. Participants’ narratives suggested that maternal identity is not static but evolves during pregnancy—strengthening responsibility, resilience, and self-control even amidst fear and anxiety. This evolving sense of maternal self appears to foster motivation and psychological endurance in expectant mothers.

Spirituality and hope emerged as key mechanisms for managing psychological distress. Many women reported that prayer, trust in a higher power, and maintaining hope helped them cope with fear, guilt, and despair. These findings align with previous research indicating that spiritual beliefs provide emotional support and enhance the capacity to cope with stressful life events^48,49. Hope also motivated adherence to medical advice and proactive health behaviors. Thus, the cognitive and emotional dimensions of spirituality—such as belief in meaningful outcomes and divine protection—worked alongside practical health actions to promote resilience and emotional stability.

Social support from partners, family members, peers, and healthcare providers was a crucial factor in managing stress, anxiety, and grief. Participation in peer groups and communication with other mothers reduced feelings of isolation and normalized emotional experiences. Empathetic communication and effective information-sharing from healthcare professionals further facilitated understanding and reduced uncertainty. These findings are consistent with earlier studies showing that social support buffers stress, enhances psychological resilience, and promotes maternal and fetal well-being during complicated pregnancies^50,51. In the Iranian sociocultural context, where family structures are typically close-knit and decision-making is often collective, the role of partners and extended family members becomes particularly influential. Participants frequently described involving their spouses and relatives in understanding medical information and making decisions, which both alleviated emotional distress and, in some cases, introduced additional pressure due to differing opinions and expectations.

Participants experienced profound grief and sadness after learning of the fetal abnormality, often accompanied by guilt, anxiety, and anticipatory worry. These emotional reactions echo findings from prior studies on perinatal grief and the psychological impact of adverse fetal diagnoses^52,53. Moreover, within the Iranian cultural and religious framework, feelings of grief and guilt may be intensified by moral and spiritual interpretations of the condition. Some participants framed their experiences in relation to divine will or personal responsibility, reflecting how cultural beliefs can shape the emotional meaning of fetal abnormality and influence coping responses.

High levels of anxiety, fear, and psychological pressure were observed throughout pregnancy. These emotions were influenced not only by medical conditions but also by social expectations, family concerns, and self-blame. Participants used various strategies—controlled breathing, relaxation exercises, prayer, and engagement in purposeful activities—to regulate anxiety. These findings align with previous research showing that prenatal anxiety arises from multifactorial causes and that effective coping strategies can mitigate its adverse effects on maternal and fetal outcomes^54,55. The dynamic nature of anxiety across pregnancy reflects the continuous interaction between external updates (e.g., medical information) and internal coping capacities⁵⁶. Importantly, the legal context in Iran, where therapeutic abortion is permitted only under specific medical conditions and within a limited gestational timeframe, adds an additional layer of uncertainty and urgency to decision-making. This constraint may intensify anxiety and psychological pressure, as women must navigate complex medical, legal, and moral considerations within a restricted time period.

Coping strategies were diverse and integrative, combining problem-focused and emotion-focused approaches, spiritual practices, and social support. Participants relied on prior successful coping experiences (such as meditation or exercise) and personalized their strategies to effectively manage stress. These results resonate with⁵⁷ transactional model of stress and coping, which emphasizes flexible, context-sensitive adaptation. The integration of medical adherence, emotional regulation, spiritual practices, and social support illustrates a comprehensive coping framework essential for maternal resilience^58,59.

These findings have significant implications for healthcare providers. Comprehensive prenatal care should extend beyond medical monitoring to include psychosocial and emotional support, counseling, and the facilitation of social and peer support networks. Recognizing the roles of maternal identity, spiritual beliefs, and coping styles can guide the development of targeted interventions that enhance resilience, reduce anxiety, and promote maternal and fetal well-being.

Conclusion

This study highlighted the multifaceted psychological and emotional experiences of pregnant women upon discovering fetal abnormalities. Findings indicate that women experience a dynamic progression of cognitive and behavioral reactions, starting with shock, denial, and disbelief, followed by acknowledgment, problem-solving, and proactive engagement with their pregnancy and fetal health. Maternal identity emerged as a central motivating force, guiding women to regulate emotions, adhere to medical recommendations, and prioritize fetal well-being even under uncertainty and emotional distress.

Spiritual beliefs, hope, and social support were critical resources that facilitated coping, enhanced resilience, and reduced psychological burden. Women relied on trusted partners, family, peers, and healthcare providers for emotional reassurance, guidance, and practical assistance. Grief, sadness, anxiety, and psychological pressure were persistent emotional challenges, highlighting the profound impact of fetal abnormalities on maternal mental health. Coping strategies were diverse and adaptive, including problem-focused behaviors, emotion regulation, engagement with healthcare, spiritual practices, and social support. These mechanisms collectively enabled women to maintain maternal responsibilities, make informed decisions, and foster personal growth despite significant stressors.

Overall, the study underscores the importance of considering the emotional, social, and spiritual dimensions of maternal experiences during high-risk pregnancies. Supporting these dimensions is essential to promote maternal resilience, psychological well-being, and positive pregnancy outcomes.

Recommendations (Revised Version)

Clinical practice recommendations

1. Provide structured post-diagnosis counseling: Based on participants’ initial reactions of shock, denial, and uncertainty, healthcare providers should implement structured counseling sessions immediately after abnormal screening results to support emotional processing and decision-making.

2. Enhance clarity in risk communication and information delivery: Participants frequently reported confusion and uncertainty; therefore, clinicians should deliver clear, step-by-step explanations of fetal conditions, diagnostic pathways, and possible outcomes to reduce anxiety and support informed choices.

3. Actively involve partners and family members in care: Given the central role of social support in coping, healthcare services should encourage the presence and involvement of partners and close family members during consultations and counseling sessions.

4. Integrate spiritual-sensitive care approaches: As spirituality and hope were key coping mechanisms, providers should acknowledge patients’ belief systems and, where appropriate, facilitate access to culturally and spiritually aligned support resources.

5. Implement routine psychological screening and early intervention: Considering the high levels of anxiety, fear, and psychological pressure reported, early screening for emotional distress should be integrated into prenatal care for women with suspected fetal abnormalities.

Policy and program recommendations

1. Develop integrated psychosocial care models in prenatal services: Health systems should incorporate psychological counseling and emotional support as standard components of care for high-risk pregnancies, reflecting the multidimensional distress identified in this study.

2. Train healthcare professionals in empathetic communication: Given participants’ sensitivity to how diagnostic information was delivered, training programs should focus on communication skills for delivering difficult news and responding to emotional reactions.

3. Strengthen family-centered and culturally sensitive care policies: Policies should recognize the influence of family dynamics and cultural beliefs in maternal decision-making and ensure care models are adapted accordingly.

Research recommendations

1. Explore longitudinal trajectories of maternal coping: Future studies should examine how coping strategies identified in this study (e.g., emotional regulation, spirituality, social support) evolve across pregnancy and postpartum periods.

2. Evaluate targeted psychosocial interventions: Intervention studies are needed to assess the effectiveness of structured counseling, peer-support models, and spiritually integrated care in reducing maternal distress.

3. Investigate cultural variability in maternal experiences: Further research should compare how cultural, religious, and legal contexts shape emotional responses and decision-making processes in pregnancies complicated by fetal abnormalities.

Limitations

This study has several limitations. First, the findings are based on a qualitative phenomenological approach with a relatively small sample of pregnant women, which may limit the generalizability of the results. Second, the study participants were recruited from specific medical centers, and their experiences may not reflect the experiences of women in other regions or healthcare settings. Third, data collection relied on self-reported experiences, which may be influenced by recall bias or social desirability. Finally, while the study focused on the second half of pregnancy, experiences from earlier gestational stages were not captured, which could provide additional insights into coping and emotional management.

Author contributions

Sabzevari Fatemeh: Conceptualization, data collection, preliminary coding, and manuscript drafting. Zarei Eghbal: Study design, supervision of data analysis, critical revision of the manuscript, and final approval. Najarpourian Samaneh: Data management, thematic analysis, and contribution to manuscript writing. Hantooshzadeh Sedigheh: Clinical guidance, participant recruitment, and verification of findings in relation to medical perspectives.All authors read and approved the final manuscript.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. (Or if you have funding, replace this sentence with the funding body and grant number.)

Data availability

The datasets generated and analyzed during the current study are not publicly available due to the sensitive nature of the interviews but are available from the corresponding author on reasonable request.

Declarations

Competing interests

The authors declare no competing interests.

Ethical approval and consent to participate

The study was performed in accordance with the relevant guidelines and regulations. Ethical approval for this study was obtained from the Ethics Committee of Hormozgan University of Medical Sciences (HUMS). The approval code is: IR.HUMS.REC.1404.018 (date of approval: April 26, 2025). All participants provided written informed consent prior to their inclusion in the study.

Consent for publication

All participants provided written consent for the publication of anonymized quotations and descriptions derived from their interviews.