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

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. 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. 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 Additionally, some participants reported comfort with using terminology that may be inappropriate or outdated when discussing DSD (e.g., hermaphrodite, 16%).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. Findings underscore the importance of DSD education for midwives to increase knowledge, comfort, and preparedness in this area of care.