Abstract
Non-invasive prenatal testing (NIPT) has been clinically available since 2011, however, there has been little research investigating how Certified Nurse-Midwives (CNMs) include this new testing option in their practice. The purpose of this study was to learn whether CNMs offer NIPT, to whom they offer it, details about their pre- and post-test counseling, and challenges they have encountered since introducing NIPT to their patients. We distributed an anonymous, online mixed-methods survey to 9,500 members of the American College of Nurse-Midwives’ e-mail list. Of 502 respondents meeting inclusion criteria, we found that 90% of CNMs are offering NIPT to at least some of their patients, and of these, 38% offer NIPT to all of their patients and 58% offer testing to low risk women at least some of the time. When offering testing, 80% of respondents provide pre-test counseling often or always. Respondents ranked the following topics as most important to include in pre-test counseling: NIPT is only a screening test; it cannot detect all chromosomal conditions; and its detection rate is higher than that of maternal serum screening. More than half of CNMs who have received a positive NIPT result provided post-test counseling to their patients themselves, while the others primarily referred to Maternal Fetal Medicine specialists or Genetic Counselors. Major challenges identified by respondents included: the absence of consistent professional guidelines and clear insurance reimbursement policies for NIPT; the difficulty counseling patients regarding positive or indeterminate results, including incidental findings; and the struggle to stay up-to-date with advances in NIPT. Our results demonstrate that while almost all CNMs offer NIPT to patients, not all are confident in their knowledge of NIPT or how to discuss results and their implications with patients, signaling a need for further education and guidance. Genetic Counselors are well suited to help address some of these challenges.