Providers' Perspectives and Education in Caring for LGBTQ+ Families in the Neonatal Intensive Care Unit: A...

To explore the prior experiences and educational needs of neonatal intensive care unit (NICU) health care providers in caring for LGBTQ+ families, as a foundational needs assessment for the development of an inclusive educational curriculum.

This qualitative study was conducted at a single level IV academic NICU in New England between October 2024 and January 2025. Using convenience sampling, we recruited NICU-based nurses, advanced practice registered nurses, physician assistants, fellows, and attending physicians. Semistructured interviews were conducted virtually by a non-affiliated, trained research team to minimize bias. Interviews focused on previous experiences with LGBTQ+ families, prior training, communication challenges, and suggestions for future education. Interviews were transcribed and analyzed using iterative thematic analysis. Recruitment continued until thematic saturation and representation across years of experience were achieved.

Twenty participants were recruited and interviewed. Five major themes were identified as follows: 1) Institutional reinforcement of gender norms, 2) Provider-related bias in caring for LGBTQ+ families, 3) Discomfort and disconnection in transgender birthing encounters, 4) Walking a fine line: fear of harm and the pursuit of normalcy, and 5) Building capacity for inclusive communication for all families in neonatal care settings. Participants frequently reported discomfort and uncertainty, particularly when caring for transgender birthing parents, largely due to a lack of training and concern about misgendering or causing harm.

Findings highlight critical gaps in LGBTQ+-inclusive training among NICU providers. Addressing these needs through targeted educational interventions is essential to improving confidence, communication, and inclusive care for LGBTQ+ families in the NICU setting.