Dreadfully sad case reported of a transman whose medical records said 'male' with tragic consequences

[GabrielleNelson]

This is a tragic case involving stillbirth. From the report I've just read in the Washington Post, that might have happened anyway, but the report suggests there were delays in treatment and confusion because the patient records said 'male'. The patient said 'I'm transgender' but the implications don't seem to have registered.

www.washingtonpost.com/national/health-science/blurred-lines-a-pregnant-mans-tragedy-tests-gender-notions/2019/05/15/00463b30-7755-11e9-a7bf-c8a43b84ee31_story.html?utm_term=.ee047038899f

Sequence of events:
Patient starts taking cross-hormones and medication for high blood pressure (not sure if the two are related)
Patient loses insurance (in the US), stops taking all medication but menstruation doesn't resume
Patient becomes pregnant, not clear from the news report how early patient realised this, but my hunch is only when abdominal pains started, so no antenatal care
Patient goes to emergency room and reports positive pregnancy test, says 'I have peed myself' which nurse fails to realise means the waters have broken, nurse does not triage patient as an emergency
Hours pass, doctor sees patient, realises belatedly that patient is in labour, discovers fetal heartbeat is very weak, cord has prolapsed into vagina, EMCS, baby is stillborn.

The Washington Post's take on this is that health services need to up their game. Transgender people often run into problems getting gender-specific health care such as cervical cancer screening, birth control and prostate cancer screenings. They mean sex-specific, as (interestingly) all five comments below the line point out.

“He was rightly classified as a man” in the medical records and appears masculine, Stroumsa said. “But that classification threw us off from considering his actual medical needs.” ..... Transgender men, who are considered female at birth but who identify as male, may or may not be using masculinizing hormones or have had surgical alterations, such as womb removal. Considered female! Observed as female, surely.

Transmen shouldn't be classified as men in medical records. By all means add a field for gender presentation, but if a patient clearly recorded as of the female sex arrived at A&E looking obese, hadn't had a period for a long time, suffering serious abdominal pains, mentioning that she'd 'peed herself', I'm pretty sure it wouldn't take several hours before anyone thought to check whether she was in labour.

I’m not sure how the records stating female would have helped here - they were told the patient was pregnant so they did know. Sounds like the care was appalling.

I agree, and US obstetric care appears to be very patchy, but I assume the patient turned up looking very male and the nurse just didn't really grasp what was going on. I've never been to the US but the impression I have is that if you have no health insurance and have to fall back on medicare, you don't get much priority, and I assume an ER taking uninsured patients would be swamped.

They were told that a man was pregnant, to be fair.

I assume the patient turned up looking very male and the nurse just didn't really grasp what was going on

I honestly doubt it although that’s terrible if so. I doubt this person “passed” as male plus they said they were pregnant.

They knew the patient was pregnant and assumed he was 'stable'. No idea why they didn't check foetal heartbeat etc right away. Shocking.

I certaionly don't think it helps calling the patient 'a man. Some nurses may not have treated transgender patients, or there may have bias at work ('he's a man - how can he be pregnant'?).

But surely the transman must have felt some pregnancy symptoms? People are also responsible for their own health.

In the article it says that the variance between the declared gender and the actual sex proved that people are diverse. If anyone wanted ‘proof’ that sex is varied, the fiction is slowly but surely bring turned into fact.

The patient said 'I'm transgender' but the implications don't seem to have registered.

Given how blurry all the definitions have become, a male-presenting patient could have been a non-binary man. However, as soon as the patient informed staff that they were pregnant, they should have treated appropriately.

They probably were too petrified of losing their jobs and not had time to read the 'how to treat a trans person' procedure properly.

Or they assumed it was a male who identifies as a female. And therefore not an 'actual' pregnancy.

This is why words matter.

Confuse and scare the fuck out of people and this is what you get.

Time to have TWO sections. One for SEX and one for GENDER.

This was the case where a transman had an obvious female condition and wasn't treated for it.
But what about a heart attack? Women are already getting delayed treatment because the Stanton’s If heart attack don’t match between men and women. As their symptoms aren’t the ones men present with, they dint get treated as quickly.
Not what about that some transman arriving to hospital with the female version of Heart attack, which doesn’t include chest pain. Will he ever be treated as such?? Nope.

It’s time to accept that a transperson will never be ‘fully’ like the gender they want to be. Some stuff will always be associated with their sex and symptoms and medical condition is clearly one of them.

With severe abdominal pain an abdominal examination should have been done. At term the pregnancy would have been obvious!

Sex is not diverse, it proves you can't change sex however hard you try and however well you "pass". The person was female and medical records need to reflect that.

The care sounds bad but without prior experience if the records said male and they looked male they medical staff may have been confused or thought the patient was confused.

Lack of antenatal care is a really big factor in stillbirth.
So I think there's a link between the care this person received and the stillbirth.

I think we need ways to encourage people to come to terms with our biology. It shouldn't mean denying any hardship that comes with gender dysphoria. It should be part of supporting it.

I know it's been incredibly hard for me to come to terms with things like periods and I'm nearly past them now. I didn't clock that I was pregnant once until I was 17 weeks. As an autistic woman it's a big struggle for me.

Finally there's a book for women and girls with autism which helps with periods.

I know this is a bit of a derail from discussing a tragedy but the gender identity lobby is saying that helping people learn about their bodies is akin to gay conversion therapy.
But I do think it would help many.

Lay people and presumably a lot of medical care staff get easily confused between transman and Transgender male. As you can see with the coverage on Gregor Murray.

Of course people have responsibility for their own health. However, lots of people have all kinds of psychological issues that prevent them from realising what's wrong with them and from tackling it effectively. E.g. people who can't give up smoking or other drugs, struggle with eating disorders, OCD, phobias.

The patient here presumably suffered from gender dysphoria so was probably trying to block out having a female body, including the need for contraception. For all I know it was a reasonable surmise that periods had stopped for good as a result of a few years on testosterone.

I think it's barbaric that people in that amount of mental distress are simply given hormones (especially with inadequate monitoring/follow up), when what they clearly need first is counselling/therapy to see if they can resolve their issues without permanently altering their bodies physically to the detriment of their future health.

Confuse and scare the fuck out of people and this is what you get.
Oh for goodness sake sackrifice, the patient said they were transgender and pregnant on arrival. Any health care professional who is too thick to process that information sufficiently in order to decide on care is a SHIT hcp. Your comment sounds like you're saying 'ner ner na ner ner'.

With severe abdominal pain an abdominal examination should have been done. At term the pregnancy would have been obvious!

Don't some women go the full term without knowing they are pregnant?

This is a terrible thing to have happened. It looks more like poor care to me, although I have not read the full account in the New England Journal of Medicine that is referred to.

The patient explained he was transgender and had a positive home pregnancy test. Why would more training have helped here?

Nothing in the article about the risks of uncontrolled high blood pressure for a pregnant person (using person specifically here) who was unable to afford medication to reduce it or the awfulness of a system in which people are encouraged to take cross sex hormones but only while they afford to pay for them.

You are right Gabrielle. It is tragic and I am lost as to why better trans ‘awareness training’ is thought to be the answer to a rotten system.

Obvs did have womb, also piv sex by the looks of things.

Maybe the nurse thought the man was having a miscarriage but at the same time couldn't grasp him actually taking a home pregnancy test... I still cant wrap my head around a transgender male having vaginal sex... kind of like the Gigi gorgeous story using 'her' penis to get her GF pregnant

"A pregnant man's tragedy"

After reading that, I found little incentive to waste my time reading the rest of the article.
I am getting tired and very frustrated at this whole charade.

Was only a matter of time and a self fullfiing prophecy of the trans agenda.

There should be 2 fields on all medical records. (Biological/Birth) Sex and Gender. Would stop the health surveillance and prison stats getting messed up too as researchers could search on the Sex field.

Whilst I feel very sorry for the poor baby, I am finding it had to feel that much sympathy for the transman, who did this to themselves.

Brownsalon, Sacrifice makes a valid point.

A) a lot of FTM pass really well
B) trans lobby are forcing people into following their mantra rather than reality and misgendering can get you in very serious trouble
C) Some of the really extreme mft are bonkers enough to rock up at a hospital with tummy ache saying they are pregnant, most don't pass so would come across as a bonkers fat bloke as this FTM maybe did
D) A&E is often crazy busy and in the US if you don't have insurance - as this person didn't - you can be treated pretty bad, sadly

Medical records need to state biological fact not fiction, sex is not diverse, a spectrum or changeable - facts!

This is so sad to the family, hope they are able to find peace.

It’s hard to tell how much being trans was a factor though, as it seems the patient wasn’t certain of being pregnant? Hence the hospital doing another test (although surely an abdo exam should have told them).

Home tests are wrong sometimes - and if you’d not had a period for 7 years, you would hardly expect to be pregnant.

My sister upon presenting was told to “go home” then gave birth minutes after they said it - and she was in Maternity, not ED.

What I mean is - hospitals get it wrong sometimes, and the same tragic event could have happened in a typical birthing scenario. But then it wouldn’t have made the news.

Which is not to lessen the sadness of the situation though.

I think it sounds like very poor healthcare and think blaming the transman for their stillbirth, when hcps knew about the pregnancy, is terrible.