Homebirth, miscarriage, Rhogam

[IdentityCrisisMama]

I am curious to get an opinion on "responsibility" when it comes to a planned homebirth that ends in miscarriage if the woman is RH-. Would you expect your chosen homebirth MW to flag that for you if you had only seen her once? Or would you consider that to be your responsibility? I'm just curious.

[Belle]

I'm not sure what you mean by "responsibility". Do you mean "is the midwife responsible for administering it" or is this an ethics question about refusing rhogam after a miscarriage?

For the record, I got Rhogam after my MC. I'd also lost half my blood volume and thought Rhogam was a good idea under the circumstances.

[tangledblue]

With my first pregnancy, I saw a CNM when I miscarried at 7 weeks and she saw to it that I got the Rhogam.

[IdentityCrisisMama]

I mean who's responsibility is it to be aware of the option to take Rhogam.

For instance, a woman miscarries in the 1st trimester, calls her chosen MW to let her know that she miscarried at home. Should the MW ask her her if she is Rh- and tell her the option of taking Rhogam or should the mother be responsible for being aware of this option?

[MsBlack]

I would think that from the first time you see a mw, there is discussion of Rh- status and Rhogam, at least so a mama understands the basics and the potential need for Rhogam whether there is a m/c or a normal birth later. As for 'responsibility' upon actually having a m/c--well, that is first a mama's responsibility IMO. Your body, your future babies--I would not be waiting around for someone else to remember or take responsibility. Certainly it seems reasonable that if you have initiated mw care, and you m/c, your mw would also take responsibility in discussing the issue with you. I just would not, as a mama in such a situation, hand that responsibility off to anyone else entirely, but instead make sure to discuss it w/my mw.

[MsBlack]

Ah--we posted right at the same time, now I see your clarification.

Well, as a mw I would not necessarily feel responsible for mentioning Rhogam if care had NOT YET been initiated. I've had interviews w/clients who decided to hire me; then, before we meet to initiate care, she calls w/possible m/c issues or actually does m/c. Rh- status may not have been mentioned yet, in other words. If Rh- status HAD been discussed during the interview, then it's likely I'd mention it w/respect to a m/c occurring at 8wks or later. Still, it's not something I routinely mention to women who have not yet actually signed on for care. I tend to get 'm/c guidance calls' from people I've never met, or occasionally from those who have stated they are going to hire me but care/contract is not yet initiated. In those cases, no, I don't see it as my responsibility to mention all the possible issues--Rh-/Rhogam is just one possible issue. I keep the advice pretty general on 'what to expect, how to treat yourself, when to seek med help'.

Does that make sense?

[IdentityCrisisMama]

Yes, MsBlack, thank you!!