Abstract
OBJECTIVE: The leading cause of maternal mortality in high-income countries is cardiovascular conditions. The highest risk period for women with cardiac conditions is usually the early postnatal phase; however, postnatal care is often under-resourced. We aim to inform supportive care pathways that address the medical and emotional needs of women with cardiac disease during the postnatal period. DATA SOURCES: To identify studies, Medline via Ovid, Embase via Ovid, CINAHL via EBSCO, PsycINFO via EBSCO, Scopus, Web of Science Core Collection, and ASSIA via ProQuest were searched (database inception-June 2025). STUDY ELIGIBILITY CRITERIA: Studies reporting qualitative data about the postnatal experiences of women with any cardiac condition globally were included. The postnatal period was defined as the events occurring between delivery and 1 year postpartum. STUDY APPRAISAL AND SYNTHESIS METHODS: The Critical Appraisal Skills Programme checklist for qualitative research was used to perform quality assessment and reduce risk of bias. Inductive coding and thematic analysis were performed using NVivo v.15. RESULTS: Eleven qualitative studies were included in the meta-synthesis. We identified a chronological framework to describe the postnatal experiences of women with cardiac conditions. We identified key themes of (1) initial fragmentation of attention, (2) physical and psychosocial transitions, and (3) planning for the future. Women described a fragmentation of attention after delivery of their infant, as their own mindset frequently shifted toward motherhood, while their care team focused more on the infant and maternal cardiac recovery. Their experience of motherhood often differed from their expectations, adding to feelings of stress around their postnatal experience. Emotional recovery from complex pregnancies was influenced by desire for future pregnancies and by the degree of support available from family and wider community. CONCLUSION: Cardiac conditions profoundly influence postnatal emotional and psychosocial well-being. During the early postnatal phase, care must balance the needs of mother, infant, and maternal cardiac condition. Postnatal cardio-obstetric care should include debriefing appointments with providers, with thorough, sensitive discussion of the risks of potential future pregnancies. Supporting women's transition into motherhood is critical to help them process experiences and engage with care to improve their long-term cardiac prognosis.