Perspectives on Fetal Sex and Prenatal Diagnosis of Differences of Sex Development Among Midwives.

Objective: Cell-free DNA screening has increased prenatal diagnosis/suspicion of fetal differences of sex development (DSD). This study explored how midwives discuss fetal sex and possible DSD with pregnant patients.

Method: Active members of the American College of Nurse-Midwives were surveyed electronically to assess terminology use when discussing fetal sex and DSD, terminology influences, and comfort and preparedness levels when discussing a fetal DSD.

Results: Most participants (59.1%) reported a preference for use of gender-specific language (e.g., baby boy or baby girl) when disclosing predicted fetal sex results, often reflecting language used by patients. However, use of non-gendered language increased (40.9% vs. 76.2%) with suspicion of fetal DSD. Participants reported discomfort (41.9%) and unpreparedness (48.1%) when disclosing results related to genital variation. Additionally, some participants reported comfort with using terminology that may be inappropriate or outdated when discussing DSD (e.g., hermaphrodite, 16%). While a minority of participants (20.3%) reported having prior education about DSD, most participants (81.7%) desired education on this topic. Notably, participants with prior DSD education consistently expressed higher levels of preparedness for discussing DSD compared with those who did not receive this education.

Conclusion: Findings underscore the importance of DSD education for midwives to increase knowledge, comfort, and preparedness in this area of care.