General Medical Information

Issues at Birth And The Neonatal Period

Sarah E. Herbert

Significant issues in the neonatal period are the diagnosis and assignment of gender to the child with ambiguous genitalia at birth. This is generally a very stressful time for the parents and extended family. It has been considered vitally important to provide support to parents at this time. Time is devoted to educating the parents about normal sexual differentiation of the fetus to help them understand better what has gone wrong in their child’s development. It has been feared that parents who do not get a clear early message about the child’s gender will pass this confusion on to their child or, worse, that the parents will reject their child. At the time of birth, it has been suggested that physicians address the issue with parents by telling them that their baby’s genitals are not fully developed, and further testing will be necessary to determine the baby’s sex. Telling parents that the baby is half-male and half-female is only likely to increase their anxiety and confusion. At this stage, it often is helpful to allow parents the opportunity to voice their feelings about having a sexually atypical baby. Feelings of humiliation, shame, or self-blame may be present. It may come as a shock to the parents, because the technical advances associated with ultrasound and amniocentesis have allowed many parents to know the sex of their child before delivery or to feel reassured that there were no major birth defects. If parents have informed other family members and friends of the child’s sex ahead of time, they may need assistance in knowing what to say or how to disclose information about the infant’s gender under these circumstances.

The speed with which medical professionals are advised to assign a gender to the child no doubt heightens anxiety in the immediate postnatal period. Medical textbooks traditionally have informed medical professionals that it is vitally important to quickly assign a gender to the child born with ambiguous genitalia. Therefore, multiple tests are performed in the immediate postnatal period to determine what the child’s gender assignment should be, and parents must await these results before announcing to which gender the child has been assigned. Many surgical and pediatric textbooks recommend early surgical correction of the genitalia, thereby increasing the pressure on medical professionals to make an early and appropriate decision and likewise increasing the anxiety experienced by parents. Thus, the parents may experience pressure to give permission for surgical procedures early in the infant’s life, without much time to consider alternatives for a condition that may not be life threatening. The rationale for early surgery apparently is to help the child look normal and thus avoid rejection by parents and other caretakers. There is not much documentation, however, to support the claim of parental rejection of infants whose genitals remained ambiguous and without early surgical intervention. In the past few years, there have been newer recommendations suggesting less surgical intervention or deferring surgical procedures until the child is older. If early surgical intervention does not take place and the genitals remain ambiguous, then parents may need counseling about what to say to others who provide care for their child, such as grandparents or day care workers.