He went to the ER with abdominal pain, but it took hours for anyone to realize he was in labor.

When a man arrived at the emergency room with severe abdominal pains, a nurse took note that he was obese and had stopped taking blood pressure medicine, but she didn't consider his case an emergency. Then, hours later, it became clear that the man was actually in labor. He was transgender, and like anyone who's about to have a baby, he needed medical care ASAP.

According to the case report in the New England Journal of Medicine, the 32-year-old's medical record listed him as a male, but he told the nurse he was transgender when he arrived at the hospital. He hadn’t had a period in several years and had been taking testosterone, which depending on the dosage can cause ovulation and menstruation to cease. But he had stopped taking the hormone as well as his blood pressure medication after he lost his health insurance.

He had used a home pregnancy test earlier that day and got a positive result, but he thought it might have been wrong. He also said that he "peed himself" that morning, which was likely his water breaking, or the amniotic sac rupturing, signaling labor. The nurse did order a pregnancy test, but she still marked him stable and his case non-urgent.

A few hours later, a test confirmed he was pregnant, and when a doctor examined him, she noted that he was not only obese, but also had high blood pressure and possibly had a ruptured amniotic sac. That meant he could be in labor, have preeclampsia (dangerously high blood pressure when pregnant), or placental abruption (when the placenta separates from the uterus before delivery, which can be dangerous for the mother and baby). All of these conditions require urgent or emergency treatment.

After doing an ultrasound, doctors said it wasn't clear whether the fetus had a heartbeat, but an exam showed that part of the umbilical cord had slipped into the vaginal canal, putting the baby at risk. Doctors prepared to do an emergency cesarean delivery, yet no fetal heartbeat was heard once they were in the operating room. The man delivered a stillborn baby shortly after.

A woman showing up to the hospital with symptoms similar to this man “would almost surely have been triaged and evaluated more urgently for pregnancy-related problems,” the authors of the report wrote.

This authors of this case argue that the classification of gender in medical records is flawed. They note that transgender people should be able to legally change their sex for a number of reasons, "including safety, health insurance, employment, housing, and restroom use." Therefore, taking away transgender people's ability to legally change their sex is not the solution. However, making sure that all medical records include sex at birth, gender identity, and legal sex could help people get the care they need and deserve.