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Transgender man has stillbirth

Nurses   (1,603 Views 19 Comments)
by DaveICURN DaveICURN (Member)

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Please move to appropriate section as needed. 

https://apnews.com/b5e7bb73c6134d58a0df9e1cee2fb8ad

This article denotes something that the nurses in my area have wondered about since early 2015.

To summarize;

"When the man arrived at the hospital with severe abdominal pains, a nurse didn’t consider it an emergency, noting that he was obese and had stopped taking blood pressure medicines. In reality, he was pregnant — a transgender man in labor that was about to end in a stillbirth."

 In school we were informed by our nursing instructor that the typical S/S of a heart attack were taken from male patient complaints. She went on the explain that the female patient has a diverse and varied complaints when it comes to heart attacks. We should use caution and critical thinking to allow us to come to a conclusion on pt condition during a possible heart attack.

Enter now the necessary doublethink that must occur when dealing with the trans-gendered community. You look, talk, reports as, and have legal documents stating your are a man, but I as a healthcare professional need to treat you as a woman. 

This, as the article has shown, is going to increase the number of inappropriate treatments and misdiagnosed issues, especially in trauma and emergent situations. This is something that we as healthcare providers need to begin to have conversations about to ensure own own safety in our professional lives. 

Edited by DaveICURN
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River&MountainRN has 4 years experience as a RN.

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It's something I came upon time and time again in primary care, too. Whether any of us like it or not, and it's a conversation fraught with triggers/touchy issues , there are requisite screenings for people who were born/remain in part biologically male and different ones for people who were born/remain in part biologically female. Something could easily be missed if we skip over these difficult/touchy conversations that lead to the appropriate screenings to the detriment of the patient even we meant well by skipping them because we didn't want to upset the patient.

 

Now, I'll be completely honest in that I haven't fully looked into EVERYTHING that goes into gender reassignment surgery (and, of the patients I cared for, each individual was in a different step along the way so we tailored our screenings to that person's specific remaining/original organs as necessary), but unless you are removing the prostate or the ovaries (or insert anything else that is uniquely male or uniquely female), we do need to look at one's "original" biological sex when it comes to screening things for the patient's own wellbeing

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TiffyRN has 26 years experience as a ADN, BSN and specializes in NICU.

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I cannot get to the original article, apparently too recent to appear in my university's library. What I could derive from the AP news report of the article, the patient was clear from the beginning about their medical history. That they had female organs, that they had no period for years and also a positive pregnancy test, that they had "peed" themselves which might be an indication of rupture of membranes. Yes, it is a challenge to integrate the patient's whole picture and not get caught up in the obvious answer (overweight male who is poorly compliant with medical treatment, probably a gut issue) but that is where nurses are supposed to have the advantage over other healthcare providers. 

If this patient had arrived unconscious and without medical records, it would have been much tougher to arrive at a timely and correct diagnosis but that wasn't what happened. 

Re-reading what I wrote it may come off as harsh towards this patient's providers. Truth is, I can't say I would have done any better, biases run strong. 

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Davey Do has 35 years experience and specializes in Psych, CD, HH, Admin, LTC, OR, ER, Med Surge.

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This situation could easily be seen as being confusingly androgynously ambiguous.

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Emergent has 25 years experience.

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So, this is a woman who is becoming a man? But, still has a vagina? And is engaging in sexual intercourse with men? So, is this person becoming a homosexual man? A bisexual man? 

I'm confused...

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LibraSunCNM has 10 years experience as a MSN and specializes in OB.

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1 minute ago, Emergent said:

So, this is a woman who is becoming a man? But, still has a vagina? And is engaging in sexual intercourse with men? So, is this person becoming a homosexual man? A bisexual man? 

I'm confused...

A transgender man = a person who was born biologically female and identifies as male.  Not everyone who identifies as transgender has had gender reassignment surgery, so yes--a trans man could still have a vagina.  Being trans has nothing to do with who you have sex with.

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TiffyRN has 26 years experience as a ADN, BSN and specializes in NICU.

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1 hour ago, Emergent said:

So, this is a woman who is becoming a man? But, still has a vagina? And is engaging in sexual intercourse with men? So, is this person becoming a homosexual man? A bisexual man? 

I'm confused...

It can be complicated. The more we learn about humans, the more complicated it gets. Remember the nature versus nurture forces that clashed in the psych world for decades? Then it turned out in most cases, neither nature nor nurture tended to explain everything neatly but rather a mesh of the two, at inconsistent levels. 

I saw this meme and it kind of helped me understand some of the variations in human sex, gender, expression, and attraction. That and getting to know a few transgender individuals who blew apart pretty much everything I grew up believing. 
https://www.genderbread.org/resource/genderbread-person-minimal-3-3

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LibraSunCNM has 10 years experience as a MSN and specializes in OB.

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11 hours ago, TiffyRN said:

It can be complicated. The more we learn about humans, the more complicated it gets. Remember the nature versus nurture forces that clashed in the psych world for decades? Then it turned out in most cases, neither nature nor nurture tended to explain everything neatly but rather a mesh of the two, at inconsistent levels. 

I saw this meme and it kind of helped me understand some of the variations in human sex, gender, expression, and attraction. That and getting to know a few transgender individuals who blew apart pretty much everything I grew up believing. 
https://www.genderbread.org/resource/genderbread-person-minimal-3-3

What a cool little graphic!  #themoreyouknow

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ruby_jane has 10 years experience as a BSN, RN and specializes in ICU/community health/school nursing.

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I think in the best of circumstances a thorough history, while invaluable, gets skipped sometimes because of work load.

I'd like to think I'd do better. Given all those variables I don't know how I would have done. The no-period-for-years would have thrown me off track. I think the one question missing is (and I ask it all the time as appropriate, of everyone who looks to be past puberty, whenever someone complains of abdominal or G/U pain) - when was the last time you had sex? What kind of sex? A report of vaginal intercourse would have made someone stop and think.

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I had to read this two or three times. I think I got it now.

Yes, we need to ask patients their biological sex as part of their medical history. Not to be asinine but to be safe for the patients and ourselves. We can't monitor, treat, and care for patients if we don't know we need to monitor, treat, and care for certain aspects. Sometimes our treatment is as good as our information.

I can't read the full story but I hope the patient had a positive outcome, in terms of physical health, and received emotional support. Transgender or not, birthing a stillborn baby can be traumatic.

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sarolarn is a BSN, RN and specializes in Telemetry.

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On 5/16/2019 at 9:32 PM, Emergent said:

So, this is a woman who is becoming a man? But, still has a vagina? And is engaging in sexual intercourse with men? So, is this person becoming a homosexual man? A bisexual man? 

I'm confused...

Simply put, sexual orientation and gender identity might not have anything to do with one another. This person is a man who was born biologically female and never had gender assignment surgery. Because this person is a man who has sex with men, we don't know what his sexual orientation is but we can ask this. As sensitive as it is, we need to ask about gender identity and biological gender as it relates to health status. Many may not wish to identify with their biological sex, and it is our responsibility to create a safe environment for our patients to tell us about their histories.

LGBTQ+ issues need further emphasis in our education, training, and in continuing ed. How can we obtain this information from patients if we don't think to ask, if we were never taught to, if it never came up before? Lots of organizations are forming groups and offering classes, conferences, and workshops on LGBTQ+ health issues and how we as clinicians can improve care delivery. Check with your HR dept, there are plenty of forums in person and online that welcome honest questions because this community and especially the trans community are woefully underserved in healthcare. 

Edited by sarolaRN

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On 5/16/2019 at 11:34 AM, DaveICURN said:

Enter now the necessary doublethink that must occur when dealing with the trans-gendered community. You look, talk, reports as, and have legal documents stating your are a man, but I as a healthcare professional need to treat you as a woman. 

Actually, it’s not either-or. Gender and sex are not the same. One is biological and the other is a societal construct. 

The best example of this is people who are born intersex (having some of both male and female sexual organs and characteristics). Historically their parents would be pressured to “choose” a gender for them at birth, since we categorize people into binary (male/female) genders. But medically they are intersex. Now that is changing somewhat since there is more visibility.

A trans man born with female sexual characteristics and has had no surgeries would be a man (gender) with female sexual organs. And then yes you would need to find out and factor in any hormone therapy, just like you would with a cis gender patient who might also be on hormone therapy for various reasons. 

It’s definitely possible to treat the whole person with respect and dignity, acknowledging both their gender identity and their physical traits as needed for care, but it definitely should be something that hospitals and agencies provide teaching and policy on for the sake of patients and healthcare professionals.

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