homebirth Q: did you/how did you get indirect coombs?

[rollergirl]

we are having homebirth with #2. had first with MWs in another state (PA then, MA now), got rhogham shot after 1st pregnancy miscarriage, at 28 wks with 2nd pregnancy, and after birth 'cause DS is Rh+ (as is papa, i'm Rh-). have seen our homebirth MW this whole time, and only went to PCP once to confirm pregnancy in case something came up and we had to switch to OB care so insurance wouldn't freak out and be all, "wait, what? you're PREGNANT??" on us. am now 34 wks along and suddenly am wondering if i should have the indirect coombs done to see if am sensitized to Rh+ from last pregnancy (although i shouldn't be, right, given all the rhogham i got last time around). my MW can draw blood and send to a lab, but our insurance won't cover that. my PCP is NOT supportive of homebirth, and so basically i am being a wimp about not wanting to go to her to ask for an indirect coombs.

i just wondered what other mamas in a similar situation have done.

TIA!
xoxo

[Peony]

I've never done a indirect coombs with any of my homebirths. I'm sure if I would of asked then my MW would of ordered the test but I don't do any testing during pg so it wasn't necessary for me to even ask.

[jennmiller]

Sorry to sound like such an idiot, but what's "indirect coombs"? I just got back from an appt with my HB midwife and we were talking about rhogam (I'm o- hubby is ab+). I got the shot while pregnant with my first, but am weighing the pros and cons of testing after the birth vs. just getting the shot. Thanks!

[rollergirl]

no that's not idiotic! an indirect coombs test looks to see whether you, the mama, has any antibodies against the Rh protein -- you would only need it during a consecutive pregnancy, NOT for a first, and then only if YOU are Rh- and your partner is Rh+ AND you had a previous pregnancy with a baby who is Rh+ (or if you both are Rh- but you had an Rh+ baby, that can sometimes happen too). if mama is positive for antibodies against the Rh factor, those can cross the placenta and can cause hdn (hemolytic disease of the newborn). the mother can become sensitized to Rh factor by being exposed to the previous baby's blood through trauma from the previous pregnancy or birth, but otherwise it's pretty rare that the mama's and the baby's bloods mingle. i'm just trying to figure out if it's something i really want to go through to be tested for or not. ugh, i feel like i should just suck it up and go to my pcp, but i'm wimping out because i feel like i'm going to get a lecture and i'm already emotional and don't look forward to bursting into tears in front of a woman i don't like much already, which is stupid, considering it would probably be better to be taking the baby's health into extra concern! but i also feel like the risk is probably rather low, so i wanted to get some ideas about what other folks have done before

[Terrilein]

How about going to your PCP, but not going alone so that you have someone to support you if they start to bully you?

[Defenestrator]

It might be less than what you think. When I do that test for mamas, its $10. Even if I added a markup for interpreting the test, it still wouldn't be that expensive.

[aloneinid]

My HB midwife just draws the blood for me and we send it to a lab. I do have to pay out of pocket, but I don't remember it being much at all- definitely not a financial hardship. I would just pay up to avoid the PCP.

[Belle]

Its part of the routine prenatal blood work that my midwives do. I requested an indirect coombs test, but I got the impression the lab does that automatically on all Rh- mothers anyway. I've had two pregnancies with these midwives. First one I lost at 13 weeks and had Rhogam. The last one I declined the prenatal Rhogam and didn't need the postpartum one.

[frenchkissed]

Are midwives not licensed in MA or something? My homebirth midwife is a CNM here in NY and she just sent me to a lab with a requisition for an antibody screen. The lab didn't question where I would be delivering. I don't see why a doctor would question that when all you need is a form for a blood draw, either.

[rollergirl]

thanks for all your replies! just an update in case anyone in MA does a search later with a similar q. my midwife uses labs in NH so my insurance doesn't cover the out of state tests. but another midwife wrote me a requisition for lab corps which is covered by my insurance (masshealth) so i got the test and it was negative, yay