RH- and Rhogam during pregnancy

[First Time Mama]

I am 28 weeks into my second pregnancy. I am RH- and trying to decide if I want to get the rhogam shot during pregnancy in addition to after the birth. I didn't get it prenatally when pregnant with DS, and since his birth ended in an unexpected cesearean I can't remember if I got it after. I am sure if I needed it I got it, (I told the hospital staff my blood type) but can't actually remember it being given to me. I don't know if DS is RH- or + but I think he is more likely to be + like DH. Anyway, my midwives are giving me a choice and I can't decide if I want it prenatally in addition to after the birth if needed for an RH+ baby. The risk of sensitization in pregnancy is really low anyway, so most likely I will be fine without it as I was last time, but I also don't see any drawbacks to doing it prenatally ( except the cost as we will have to pay out of pocket). I need to decide before my next appointment in a week because they need to order it and have it on hand, and I need to get my blood drawn at the lab before going in to see them. So I may have already waited to long. I was leaning towards not doing it, and then I became unsure again. What have other RH- homebirth/natural minded mamas done?

[HappyMommy2]

Search here on "rhogam" ... there are lots of us! And lots of threads.

With my HBAC, I chose NOT to get the shot at 28 weeks pregnant.

After the birth, my mw did a test using the cord blood, and discovered that I did need it. I went to the hospital and got the rhogam shot within 3 days.

I plan on doing the same thing again.

I think the docs just give it automatically at 28 weeks and again at birth without testing to see if it is even necessary. Any "standard of care" like that makes me immediately skeptical, based on what I have learned and experienced.

Good luck in your decision mama!

[Eresh]

The 28 week shot is purely prophylactic. The only test to see if it is "necessary" is the blood type of the mom. If she is RH-, then they give the Rhogam shot. Actually, the post-natal shot is also prophylactic though you would only conceivably need it if the baby is RH+.

Anyhow, because of the laws where I am, I had to find a doctor to write up the order for the 28 week workup (I am under the care of CPMs) and the post-natal shot. I ended up talking with my family doctor who was happy to do it for me. He is also very supportive of my homebirth. I know some women go in to the ER but I've been told that they code it up in such a way (non-emergency) that you end up getting stuck with a large bill.

[Peony]

I never do the 28 week Rhogam either, I have taken it after some of my births and refused on others.

[Jenne]

I'm going to have the prenatal genotyping done (google Lenix I believe they are the lab that does the test) so that I know without a doubt whether babe is RH- or RH+. That way I can get the rhogam or not without second guessing myself. The test will confirm the sex of the baby which we are fine with but if you don't want to know it may not be a good option.

Jenne

[St. Margaret]

I had the early shot last time and this time (at my OB then and backup OB/CNM now), for various reasons. It's perfectly debatable though. Personal choice IMO.

At the hospital here they just give you the PP shot, very one size fits all silliness. I mean, I think they asked ONCE about DH's type (we're pretty sure he's not neg but still) and then just assumed. Certainly no testing of DD to see if she was neg. My HB midwife this time will type the cord blood and if DS is neg, no shot-- if pos, then I'll get the shot. It's not even too pricey, thank goodness, b/c I ain't leaving the house just of that to be covered

[SilverLace]

The 28 week shot is purely prophylactic. The only test to see if it is "necessary" is the blood type of the mom. If she is RH-, then they give the Rhogam shot. Actually, the post-natal shot is also prophylactic though you would only conceivably need it if the baby is RH+.

Actually the test that is done at 28 weeks is not a blood type test. It is called an Antibody Screen and it looks to see if any reaction (caused by the mixing of negative maternal blood and positive fetal blood) is happening.

If it were to be happening then more testing would be done because that reaction will likely affect the current baby.

The test postpartum is to test the baby's blood type. If the baby is positive then Rhogam is recommended for the mother to stop a reaction from happening. If an antibody reaction develops that could have serious impact (including miscarriage) of the next positive baby that is conceived.

You should choose what is best for you and your situation, I just wanted to clear up a some misinformation.

[First Time Mama]

I understand that I will only need the shot pp if the baby is RH+, and then it is to protect any future babies. My midwives will test the cord blood and give it if needed themselves, I don't have to go to the hospital for it. I am sure that I will do it after the birth in any case if needed, but I am leaning toward not doing it during pregnancy. My midwives gave me some info that says that the medical standard of care gives it at 28 weeks, because the last 12 weeks of pregnancy there is a higher chance of maternal/fetal blood mixing, but it said the risk is still only 1 to 2% of women becoming sensitized in pregnancy. That is not a big risk in my opinion and I am doing an antibody screen. I just didn't think there were drawbacks either, unless there is thimerosol or aluminum in the shot, then I probably wouldn't want it. I probably won't do it, I just often second guess my decisions.

[MeepyCat]

I had planned to skip the prenatal Rhogam shot with my second pregnancy (DH is Rh+, but our first, DS, is Rh-). It's only prophylactic, after all. Then I had placenta previa, and a couple episodes of bleeding, and in the end, I wound up with two prenatal Rhogam shots (because they can wear out, apparantly) and one after delivery.

Nonetheless, I think it's safe to pass on *routine* prenatal Rhogam. If you bleed, or experience abdominal trauma, you can get the shot at the ER or in L&D.

[Jenne]

Originally Posted by SilverLace

Actually the test that is done at 28 weeks is not a blood type test. It is called an Antibody Screen and it looks to see if any reaction (caused by the mixing of negative maternal blood and positive fetal blood) is happening.
....
You should choose what is best for you and your situation, I just wanted to clear up a some misinformation.

That is not true. There is a blood test the mother can take to find out the blood type of the baby. Here is a link for more information:

http://www.lenetix.com/html/rhd___sry_genotyping.html

Then you will know whether you need pre/post natal Rhogam.

Jenne

[First Time Mama]

Right, I remember my midwives saying that if I had any cause for concern, bleeding or abdominal trauma I could get the rhogam at that time. I guess it would still protect after the fact? It seems pretty safe to skip the routine shot then at 28 weeks and just do it if necessary, after the birth or if a concern comes up prenatally.

[SilverLace]

Jenne- I'm not sure what you think is false about what I posted. I wasn't saying there was no way to determine fetal blood type.... however the test you linked to is in no way commonly used or the standard of care.

What I was trying to explain is that there is an option for women who might want more information when trying to decide whether or not to get the 28 week Rhogam. In my experience many women would like to know that 1)no reaction is occuring and that 2) there is a way to monitor for that reaction. The way to do so is with the Antibody Screen.

What I have seen in practice is that some providers offer the Rhogam without the Antibody Screen and some offer Rhogam after a negative Antibody Screen. As I said above a positive Antibody Screen would require follow-up right away as it indicates a potential problem for the baby.

Here is a chapter from the Guide to Effective Care in Pregnancy/ www.childbirthconnection.org about this issue:

http://www.childbirthconnection.org/pdfs/gecpc3ch18.pdf

For those who are unfamiliar, this website is a non-profit dedicated to increasing evidence based medicine in maternity care.

My only intention was to provide more information and explain some of the options to mamas who are trying to make an informed choice about their own pregnancies.

[Jenne]

Sorry, Silverlace, totally preggo brain here! I read your post as saying there wasn't a test available! I apologize!

Jenne

[HappyMommy2]

Originally Posted by SilverLace

Jenne- I'm not sure what you think is false about what I posted. I wasn't saying there was no way to determine fetal blood type.... however the test you linked to is in no way commonly used or the standard of care.

What I was trying to explain is that there is an option for women who might want more information when trying to decide whether or not to get the 28 week Rhogam. In my experience many women would like to know that 1)no reaction is occuring and that 2) there is a way to monitor for that reaction. The way to do so is with the Antibody Screen.

What I have seen in practice is that some providers offer the Rhogam without the Antibody Screen and some offer Rhogam after a negative Antibody Screen. As I said above a positive Antibody Screen would require follow-up right away as it indicates a potential problem for the baby.
.

I think the point is that many doctors do NOT routinely do a 28 week test. They just give a prophylactic shot at 28 weeks. Another prophylactic shot is given again post partum, without checking the baby's blood type.

Those unnecessary shots are what many of us mamas are against. It is good to learn *why* they are giving shots, so that we know when we actually need a shot versus a questionable "standard of care" that may not be in a certain mama's best interest.

Quite often Rhogam shots are given to everyone RH- regardless of need, and regardless of the baby's blood type. This is a fact, it is not "misinformation".

Of course, if there is a real need, such as trauma or a positive test, then that is a different situation.

[healthyhappyyoga]

I just had the shot at 28 wks. My HB Midwife is very laid back and she just said I would get it when we found out my DH is +. So I trusted her. Are there side effects (other than a sore bum)? With the cord blood test do you have to cut the cord early? Maybe I should ask her about that?

[Belle]

Originally Posted by HappyMommy2

I think the point is that many doctors do NOT routinely do a 28 week test. They just give a prophylactic shot at 28 weeks. Another prophylactic shot is given again post partum, without checking the baby's blood type.

I had OB care the first time around and my blood was checked at 28 weeks along with my doing the GTT. They checked the baby's cord blood after the birth as well. (O-)

[MeepyCat]

Originally Posted by healthyhappyyoga

I just had the shot at 28 wks. My HB Midwife is very laid back and she just said I would get it when we found out my DH is +. So I trusted her. Are there side effects (other than a sore bum)? With the cord blood test do you have to cut the cord early? Maybe I should ask her about that?

I've had a lot of Rhogam shots and have never experienced side effects. Besides the aforementioned sore spot. If you read the patient information leaflet on Rhogam, you will note that a lot of scary possibilities are mentioned - it is a human blood product, and while it is carefully screened, etc., there are risks. HIV and Creutzfeldt–Jakob disease are the most alarming possibilities mentioned. HOWEVER - these risks are very, very small. They could, theoretically, occur, but have never been recorded or observed occurring.

[dayiscoming2006]

I'd personally not get the 28 week shot. I'd just wait and have my baby's blood type tested after he/she was born. Then MAYBE get the shot if the baby is positive and the delivery was difficult. I read that it's not usually needed unless there was a difficult delivery. This is what I think for now. I hate vaccines and shots. They all have some icky stuff in them from what I've seen so I just don't like any of it if I can avoid it.

[thepeach80]

If you don't remember getting the shot I dare say your ds is rh- then. They would most definitely done a type and cross match w/ any hospital birth, especially w/ a c/s. Then it's automatic that babies born to rh- moms get typed as well.