When I became pregnant, the reason was to start a family, not to somehow embrace femininity or to de-transition. I’m a transgender guy, born with typical female anatomy. I’d taken testosterone for a few years and then stopped in order to conceive. I’d also had chest surgery as part of my transition, so even as my belly grew, I sported a flat, masculine-appearing chest and I maintained my beard.

The pregnancy and baby were very much planned, but still, there was the question of how I would open up and give birth – an event centered around parts of my body with which I felt extreme discomfort, even anguish. I was sure I didn’t want my baby and me to have the drugs, risks and major surgery that came with a caesarean if I could avoid them, and that left only one way out.

Gender dysphoria is generally defined as a distressing sense of incongruity between one’s body parts and one’s inner sense of gender. Yet it may be experienced in many different ways, which explains in part why not every transition is alike. My gender dysphoria used to stem mainly from my breasts, and after my surgery I rarely experienced it any more. As long as I could be clothed from the waist down, I was happy to go about my daily business.

My pregnant belly did not bring up feelings of gender dysphoria for me, either. Inwardly, I thanked the short, cisgender guys around town whose beer bellies could have just as easily been pregnancies: in public, I blended right in. My belly was a source of great excitement about our future little one, and my partner and I relished every kick.

Yet from the first moments after peeing on a stick, the impending birth loomed large. Would it be so painful that I wouldn’t even notice gender dysphoria about my nether regions and what they were doing? Or would the dysphoria be so bad that my body would tense up and refuse to open? My point of reference was pelvic exams, which for me have always caused excruciating pain and gender-related panic.

My partner sensed the magnitude of my fear and suggested I talk to a therapist. My only previous therapy experience had been the kind where as a transgender person you try to present the expected stereotypical narrative about having played with trucks instead of dolls in childhood so that the psychologist will let you see the hormone doctor or surgeon. Not wanting to jeopardize my chances at receiving transition-related care in the future, I went to a different therapist this time.

She loaned me a copy of Birthing From Within, a classic book with exercises meant to help the reader visualize birth in a positive manner. I obediently drew pictures, molded a clay figure, practiced vocalizing and journaled, but didn’t feel much better.

The therapist also convinced me, despite my anxiety and embarrassment, to do the obvious and talk to my midwives about the issue. I spent long, tortured appointments describing my gender dysphoria and my fears about giving birth, and my midwives eventually promised that they would do everything they could to help me feel in control of my healthcare.

None of this advance planning ultimately solved my problem. My midwives brought their own fears to my birth, which amplified mine. During a pelvic check that triggered all the pain and traumatic gender dysphoria I was so scared of, my midwife broke my waters to speed things along. But then, in obvious horror, she mistook my slower adult pulse for the baby’s (which should have been much faster).

She imagined that she must have nicked a blood vessel in the amniotic sac, or that the umbilical cord was being pinched by the weight of the baby now that the cushion of fluid had been removed. It was my partner who checked my pulse at my wrist and pointed out her error. I remained terrified and in excruciating pain.

Labor went on so long that another pair of midwives had to be called to relieve the first ones. They arrived with a student in tow. My original midwives remained with us, perhaps because of their emotional investment in the process, or maybe because they were eager to witness a trans birth. My doula and friend, whom I’d asked to provide labor support, began a mantra, and I repeated her words: “I welcome this sensation. I am opening. I am opening, and I welcome this sensation.”

Even if I didn’t believe it at first, every time I said “opening”, I could feel myself drawing inward and permitting the work of the contractions just a little more, in spite of the midwives’ ringing cellphones and their frequent checks of the baby’s heartbeat and my pulse, blood pressure and temperature. In the face of fear and exhaustion, I opened, and my first child was born in fine health.

By the time we decided to have a second child, I knew much more about myself. I was no longer scared of my own body or how I would handle labor. Now I feared how my healthcare providers’ actions would affect my gender dysphoria. I hated the feeling of my body being watched, examined and labeled. My anxiety wasn’t about what my body needed to do, but how it would be seen and handled by others.

In the midst of a fast and furious second labor, I chose not to call my midwife. It took my entire focus to keep from falling apart completely amid the intensity of labor; I couldn’t fathom having to cope with an observer and medical checks as well. I felt my baby moving strongly inside me and I stayed solid and patient. I had an empowering, healing and healthy birth – alone.