Born-female patient ‘identifies’ as male to hospital staff, doctors miss real problem
A baby has died after a pregnant born-female transgender patient was rushed to hospital with abdominal pains but “identified” as male to medical staff, causing doctors to miss the pregnancy-related emergency.
After doctors eventually realized the real issue, they performed an emergency cesarean but the procedure was too late and the baby was born stillborn.
When the unnamed 32-year-old “man” arrived at the hospital with severe abdominal pains, the patient was examined and told a nurse they had stopped taking blood pressure medicine but didn’t reveal themselves to be a biological female.
The nurse did not consider it an emergency, noting the “man” was obese and had stopped taking the medication.
Tragically, by identifying as a male, the pregnant woman caused a devastating misdiagnosis, resulting in the unnamed patient’s baby dying before it could be delivered.
In medicine, there’s a similar danger of missing diseases such as sickle cell and cystic fibrosis that largely affect specific racial groups, the authors write.
“The point is not what’s happened to this particular individual but this is an example of what happens to transgender people interacting with the health care system,” said the lead author, Dr. Daphna Stroumsa of the University of Michigan, Ann Arbor.
He was “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.”
According to NBC, Stroumsa would not say where or when the case occurred, and the patient was not identified.
A born-male #transgender weightlifter, who “identifies” as a woman, smashed four women’s world records in a single day, igniting a backlash from female Olympic champions.
READ MORE: https://t.co/mVnmtASVk6#TransgenderAthletes #MaryGregory
— Neon Nettle (@NeonNettle) May 1, 2019
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.
The 32-year-old transgender patient’s electronic medical record listed them as male.
The patient hadn’t had a period in several years and had been taking testosterone, a hormone that has masculinizing effects and can decrease ovulation and menstruation.
But the patient had quit taking the hormone and blood pressure medication after they lost insurance.
Hospital staff noted that the patient had “peed himself” — a possible sign of ruptured membranes and labor.
A nurse considered the patient to be stable and the problems non-urgent.
Several hours later, a doctor evaluation and a hospital test confirmed pregnancy.
An ultrasound showed unclear signs of fetal heart activity, and an exam revealed that part of the umbilical cord had slipped into the birth canal.
Doctors prepared to do an emergency cesarean delivery, but in the operating room, no fetal heartbeat was heard.
Moments later, the transgender man delivered a stillborn baby.
A woman showing up with similar symptoms “would almost surely have been triaged and evaluated more urgently for pregnancy-related problems,” the authors wrote.
“It’s a very upsetting incident, it’s a tragic outcome,” said Dr. Tamara Wexler, a hormone specialist at NYU Langone Medical Center.
Nic Rider, a transgender health specialist, and psychologist at the University of Minnesota blames anti-transgender bias by medical staff for the tragedy.
“There are implicit biases that need to be addressed,” Rider said.
Health records may use male/female templates for gender but “it doesn’t mean that we just throw out critical thinking or think about how humans are diverse,” Rider said.
The case is horrifying but “not terribly surprising,” said Gillian Branstetter, a spokeswoman for an advocacy group, the National Center for Transgender Equality in Washington.
Transgender people often run into problems getting gender-specific health care such as cervical cancer screening, birth control, and prostate cancer screenings.
Identifying as a gender opposite to their biological sex can lead to confusion among medical staff, especially when medical records support the claims.
“The consequences can be so dire, as this case shows,” Branstetter said.