To Be Loved

I’m not great at receiving love. I move through the world in a trans body with brown skin, and when I started a medical transition thirteen years ago, my family was so fearful of what might happen to me that I quietly vowed never again to let on that I need anything from them. My parents remained pretty lost about how to love and parent a trans child, but it didn’t matter to me, as long as I didn’t lose them. I even fashioned myself into a form of success they could easily peddle to the community of Indian families I grew up with in the Midwest. I submitted my grad school applications the same week I started testosterone. I pursued a PhD and became a clinical psychologist. I made it my job to give care to others and have since hidden behind this role to avoid figuring out how to really receive it.

It’s not all on me. There wasn’t a ton of trans representation in the media in the early 2000s, when I first came out, and certainly not of transmasculine people of color. From what I did see, I internalized that my options were either trans tragedy or trans exceptionalism, and I decided that if I had enough of a survival instinct to pursue a medical transition, I was going to aim for the latter. At the time, I didn’t understand that cissexism and racism where shaping everything from the medical information I received about my body to the ways I was advised to mold my masculinity in order to “pass” better. Twenty-three years old and desperate to survive, I foreclosed on the idea of having a biological child because I could not afford gamete preservation and I was told by my provider that testosterone would make me sterile in three to five years.

I was thirty-six when I got pregnant. After more than a decade of carrying shame about my desire to be a gestational parent and the belief that it probably wasn’t possible, getting pregnant on our first try felt like I was waking up to my own limitlessness. Although pregnancy itself happened quickly for me, it wasn’t simple. I worked up the courage to tell my wife I wanted to try on a car ride back to Portland from Palo Alto in November 2020. We had brushed by the topic many times before in our eleven years together, but Ami expressed no desire to parent, and I had no desire to push her into it. However, after spending Thanksgiving weekend doting on my brother and sister-in-law’s two-year-old and newborn twins, I couldn’t shake the beautiful possibility of raising a child with her. I stared at a snow-capped Mount Shasta as I drove up I-5 and let the words flow. She cried. Not happy tears—tears of panic, fear, loss. But she hung in with me and agreed to stay open to the possibility as I explored whether my body could even do this thing anymore.

Even before going off hormones in January 2021, I could feel the ground shifting beneath me. Then, as my body softened and I started menstruating again for the first time in over a decade, I felt the core of myself slip out of view. More than ever before, I was becoming a funhouse mirror, reflecting other people's distorted beliefs about gender, health, family, and identity. Everything amplified as my pregnancy developed. This deep ancestral wisdom I hadn’t realized I was carrying was bubbling to my conscious awareness, only to get caught in the thick, grief-filled loneliness of being brown and trans and trying to navigate pregnancy.

On one hand, I was getting acquainted with my needs seemingly for the first time. I’d always been the friend who was up for whatever, and I suddenly found myself picky, fatigued, and unwilling. On the other hand, as I started to tell my family about the pregnancy, I realized how little they understood about who I am and how readily they had bought into harmful narratives about trans bodies. Everyone assumed I was pregnant because Ami couldn’t get pregnant. They were all worried about how testosterone had messed with the genetic material of my eggs. My mom asked what restroom I’d use now. Confronted with my community’s inability to see me, to love me wholly, I mourned for the ways I had trained myself to go with the flow and forgo my needs time and time again.

I remember staring up at the ceiling during one of our prenatal visits, tears pooling in my eyes as I tried and failed to dodge questions that one of my midwives, Olivia, was asking about my family. I had wanted to avoid hospitals as much as possible. I had even selected my health insurance plan to make sure I’d be covered at a birth center well before my pregnancy became a reality. What I hadn’t understood about midwifery at the time was how much my story mattered as a part of the care model. I almost resented Olivia’s questions because I knew there was little she could offer to improve the situation. I had been walking with such profound loneliness in this pregnancy, something that I imagine many other trans gestational parents also face, and it was my burden to carry—the price I’d pay a thousand times over to form my family. I wasn’t wrong; Olivia didn’t have a balm for the ways my sense of community was being ripped. But she listened—really listened. And then she performed my physical exam and handled my body with a confidence and care I had never experienced before in a medical setting.

At my twenty-week ultrasound I learned I had a short cervix. This was an incidental finding during the fetal anatomy scan, and the provider at the office where the procedure was performed counseled Ami and me on our options: to watch and wait, take daily progesterone suppositories, or undergo minor surgery to place a cerclage stitch to reinforce the cervix. She described progesterone suppositories as the gold standard of care, and we agreed to it. Unfortunately, I am listed as male with my insurance. When I tried to fill the prescription, the pharmacist informed me that my claim was denied and it would take over the weekend to get a prior authorization approved. I agreed to wait. I reasoned with myself that if my scan had been scheduled a few days later I wouldn’t even have this information to fret about yet and that all would be well come Monday. Still, I worried all weekend. I was afraid. I was afraid of having to interface with the hospital system, afraid of giving birth there, afraid of losing my baby, afraid my fear would hasten the loss, and afraid of being alone in my grief.

I went for a walk on Monday morning. I took a short bath. I laid on the bed with Ami and asked her to believe in me and in my capacity to finish walking the lonely path of carrying our child. We cried together and held each other, and she placed her faith in the palm of my hand. We ate lunch and then I called the pharmacy. The pharmacist confirmed the authorization had come through, and I said I’d be on my way shortly. As all pregnant people do before going anywhere, I went to use the restroom.

There was blood in the toilet—bright red and billowing in the bowl like fresh drops of paint. I called out for Ami, and then I called the birth center’s emergency line. Olivia answered and told me to go to the nearest hospital. Seventeen minutes later I was standing at an emergency department reception desk saying the words, “I am twenty weeks and six days pregnant, and I am bleeding.” We were sent to find our own way to Labor and Delivery. In the triage room, a medical resident shoved a speculum inside me while a student and the attending physician looked on. The more my body tightened and recoiled, the harder she fought to locate my cervix. We learned I was three centimeters dilated and eighty percent effaced, with visible gestational membranes but no signs of active labor. A few hours later, the same resident and student came in with another doctor who asked unnecessary questions about how I liked my workplace and where I’d gotten top surgery. I was on the edge of eligibility for an emergency cerclage, but they wanted to admit me for observation and reevaluate in the morning.

I felt small waves of pain start to build overnight. At about 2:00 a.m. the attending physician confirmed I was now five centimeters dilated with the membrane bulging down from my cervix. I understood that I, at twenty-one weeks pregnant, would have to deliver my baby, perfectly healthy but too underdeveloped to survive outside my womb. Ami got some fitful rest. I let infomercials play as I tried to wait until morning to text my midwife. I made it to 5:35 a.m. Olivia called me immediately, and I could hear the sleep in her voice. She listened with care and offered to come to the hospital. Despite myself, I said yes.

Nothing much happened in the next several hours. We briefly bargained with the gods, made a sad attempt at eating brunch, stared out the window as the sun turned to hail, and cried a great many tears. I had declined an epidural because I wanted freedom to move, and I had declined augmentation of labor because I didn’t want to rush my baby out of me. The hospital staff was understanding but at a loss for how to support me without these medical interventions. Ami and I spent the time choosing a name for our baby and getting clear on how we wanted to parent for the minutes we’d spend transitioning our child into and then out of this plane.

When Olivia arrived in the afternoon, something got unstuck. Although I was still learning to trust her, she carried the stories of beauty and pain in my pregnancy in ways I hadn’t realized. She stepped out to discuss my care with the hospital team, and I learned later how she helped bridge the vast divide between the out-of-hospital birth I’d been planning and what was transpiring. Her decision to turn toward my family in our most painful moments, to witness us fully, helped make me brave.

I ended up augmenting my labor with misoprostol because I hated the idea of my baby experiencing the slow and torturous loss of a home that was once secure. My labor was short and intense, and I was inside myself for much of it—eyes and mind shut to my surroundings while I connected to the full sensation of my beautiful child undulating out of me. I wanted them to know as much of my love and pride as I could summon; I wanted them to be born into freedom instead of fear. We named our baby Sanchal Thangamani—a tremble of water, a precious golden gem. They were born en caul at 7:18 p.m. For their few moments of life, I held them to my bare chest, caressed the nose and spindly fingers they’d inherited from me. Ami whispered to them in Gujarati that it was okay to let go. When we offered, Olivia took Sanchal into her arms without hesitation and beheld every bit of their beauty.

As is common with preterm deliveries, complications followed. I spent the next several hours hemorrhaging and shaking from blood loss, from hormones, from medication, and from the emotional overload of everything that had happened. I suffered more than necessary because the hospital team was so uncomfortable treating my unanesthetized trans body. Through all of it, Olivia stayed with me. She responded to every tremble by repositioning my blankets. She wiped blood from my legs to help stave off the cold. She helped position the bedpan so I could empty my bladder when no hospital nurse could be found.

A little before midnight, the attending physician finally came to perform a pelvic sweep to try and stop the bleeding. She insisted on giving me fentanyl and joked that she’d wait to see my eyes roll back in my head before penetrating me. Olivia took my hand and tried to give me back my agency. When it was clear a dilation and curettage was needed to remove retained bits of placenta from my uterus, Olivia waited with Ami until I got back from the operating room. She stayed, she witnessed, and she loved us through all of it.

In the days and weeks that followed, she came and sat with us in a pile of blankets on our living room floor, held us and cried with us, and engaged every unanswerable question we had about what had happened and why. Her presence helped give meaning to our child’s short life, helped validate our identities as parents, and helped us name and heal from the injustices we lived through.

I hope to get pregnant and to carry a child again. I hope when that time comes I remember how to navigate the loneliness and how to give other people’s assumptions back to them. As Joy Harjo writes in "I Give You Back," I hope I am not afraid to be loved. And I hope that the legacy of my first-born child will be my ability to show up for myself as fully as I did for them in their birth, as fully as Olivia did for me.

Aakash Kishore, PhD, is a clinical psychologist and a cultivator of queer, trans, and BIPOC joy. Aakash is a novice writer, whittler, and sourdough bread maker. Aakash grew up in St. Louis, Missouri, and currently lives in Portland with their favorite writer and wife, Ami.