My Rhogam crossroads.

[moppet]

I'm rapidly running out of time to decide if I want the 28 week Rhogam shot. The last time I spoke with my midwife about it she said she understood my hesitation and she assured me that not doing it would not negatively impact this pregnancy at this point. Up until that conversation I had been severely sitting on the fence about it and half-hoping she would tell me it could somehow positively affect my current pregnancy just I could feel like the decision would be made to get it at that point.

DH and I would like to try for one more child, so if my little one is born Rh+ I will have no issues with getting the shot postpartum. He is very supportive about the whole thing, but I think would prefer if I just got the shot "just in case." My issue is that it seems like getting the 28 week shot would definitely negatively impact my baby, and all for a bunch of ifs. IF she's Rh+ and IF I have some kind of unlikely blood exchange with her and IF I am even able to get pregnant again in the future (we struggled with infertility for 3 years before gettingbpregnant due to my PCOS and his male factor issues.)

There is a knee-jerk frightened part of me that just wants to get the shot because all the studies say its relatively harmless and I'm terrified I would say no and end up having problems with future pregnancies. I cannot reconcile that part with the bigger part of me that is antivax, anti-medical fearmongering.

Plus, the 28 week mark just seems so utterly arbitrary. If I have a definite trauma issue, they would recommend another shot then anyway. I don't really understand the whole passive immunity claim, or why it magically lasts 12 weeks.

Sorry this is so long, but it has been preoccupying me a lot lately. Anyone have any experience/advice/info?

[Tumble Bumbles]

I don't have any useful advice but I didn't want your inquiry to go unanswered. Super dumb Q, but your dh is RH+ right? It was such a relief finding out dh was rh neg (I am as well so I avoided the whole thing). I know there's a super rare recessive gene that 'could' have made our first dc positive, but nope, neg too so we don't have to worry about it.

I would be likely to skip the 28w and get the shot pp if you choose.

Hope others weigh in with their experiences.

[Mamatoabunch]

There was a long thread in the Unassisted Childbirth forum on RH-.

[veganyogamomma]

I've been doing some research on this myself, and I'm currently leaning towards skipping the 28 week shot and waiting until after birth. There isn't any information that proves that the 28 week shot reduces the chances of being sensitized to the baby's blood, and I've been told it's only really necessary if you have an accident or something that could cause baby's blood to mix with yours prior to birth. If that were to happen, they would give you another shot of Rhogam then anyway.

Having the shot administered within 72 hours of birth lowers your chances of becoming sensitized to 2% (from 10-16% without a shot at all). Like I said, I haven't seen any proof that the 28 week shot will bring those chances any lower.

I'm mostly concerned about the thermosol content and the fetal exposure to mercury, which I'd like to avoid if it's not absolutely necessary.Mercury crosses the placental barrier and the unborn baby receives 30 times the concentration level of the mother. Who knows how this could affect the baby long-term?! That's a scary thought!

[stik]

Rhogam has been mercury-free since 2001.

[veganyogamomma]

Oh wow, okay! Thanks, I had no idea. The info I have says it's still in there. Must be seriously outdated... yikes!

[moppet]

Thanks for the responses. Baby's father is indeed Rh+. How I envy you for dodging that bullet.

I think there are still some versions of Rhogam out there with Thimerosol in them. Their website wasn't helpful. I had my midwife look and the one she stocks in her office is clearly labelled Thimerosol free. if you get yours, just ask them if you can see the box.

The more I think about it and research the more I think I'm going to skip the 28 week shot too. I just haven't seen any proof that there is any benefit to having it. If it was the magic answer I'm not sure why I would need another shot if I did have some sort of trauma/injury in addition to it. Maybe that is naive of me.

I feel a little bad telling hubby I just want to roll the dice with this, since it could potentially impact future pregnancies, but I feel like the percentages are so small and the "proof" that the 28 week shot has any positive impact just isn't there. I know he will support my decision either way, but it's still a litle scary that I could be responsible for future disaster.

[MeepyCat]

I don't think you're at a crossroads.  28 weeks is the standard time to give prenatal Rhogam, but it's not like you explode if you have the shot at 33 weeks.  Your midwife probably wants to know what you want to do so that she can order Rhogam if you want it, and that's reasonable.  But so long as you understand that there's some lead time involved, you can get the shot at any appointment, if you decide that you want it.  Sometimes taking the pressure off a decision provides a clearer perspective - maybe if you weren't thinking now or never, you'd be able to get a better sense of how you feel about this and what you want to do.

[nikie23]

I'll be getting a Rhogam shot at 28 weeks or thereabouts, and again after I deliver. From what I've read, the point of the 28-week shot is to provide a buffer in case of any occult bleeding that might cause sensitization but go unnoticed. A dose of Rhogam must be administered within 72 hours after an incident where baby's blood may have mixed with mine, but the effects of a prophylactic shot last for 12 weeks. I'm not comfortable rolling the dice and hoping my LO is negative, because there's no going back if I'm wrong and something happens and I become sensitized.

[mumofmak]

I'm Rh- and DH is Rh+. This is baby number 4 for us, all my other kids are Rh+ so I took the Rhogam shot postpartum. BUT I just thought I'd let you know, I'm now living in Europe and it's not even standard practice here to give Rhogam at 28 weeks. They give it to you if you've had some trauma or a bleed and then after the birth if baby is Rh+.

Best of luck with your decision.

[HappyMommy2]

With my baby #2 and baby #3, I chose to skip th 28-week prophylactic shot. After testing the placenta blood, we found my babes were positive, and I got the shot within 3 days post-partum.

If I had been in a car accident, or some other potential reason to mix our blood, then I would have chosen to get the 28 week one.

Just a thought about your post .... "they" say a LOT of things are perfectly safe ... and MDC-mamas question a lot of it....

Good luck with your decision!

[stik]

Originally Posted by veganyogamomma 

Oh wow, okay! Thanks, I had no idea. The info I have says it's still in there. Must be seriously outdated... yikes!

There are still some scary websites out there claiming that Rhogam has thimerosol.  The manufacturer's website (http://www.rhogam.com/Professional/PlasmaSafety/Pages/ManufacturingProcesses.aspx) states that Rhogam has been mercury-free since 2001.  WinRho, the Canadian version, has always been mercury-free.  

[homestyle]

Originally Posted by mumofmak 

 I'm now living in Europe and it's not even standard practice here to give Rhogam at 28 weeks. They give it to you if you've had some trauma or a bleed and then after the birth if baby is Rh+.

Best of luck with your decision.

Just to throw another data point out there, giving Rhogam is standard here in Germany. I'm getting it at my next appointment, which I think is @ 29 wks. I also got it during my miscarriage in 2008. For me, the hypotheticals about the risk of shot additives don't outweigh the risk of my immune system attacking this and future babies. I'm really good at worrying. 

Good luck to you! 

Edited by homestyle - 3/2/11 at 12:44am

[erigeron]

Quote:

Originally Posted by veganyogamomma 

 

the unborn baby receives 30 times the concentration level of the mother.

Got a source for this?

[astar326]

Originally Posted by mumofmak 

I'm Rh- and DH is Rh+. This is baby number 4 for us, all my other kids are Rh+ so I took the Rhogam shot postpartum. BUT I just thought I'd let you know, I'm now living in Europe and it's not even standard practice here to give Rhogam at 28 weeks. They give it to you if you've had some trauma or a bleed and then after the birth if baby is Rh+.

Best of luck with your decision.

after i did a ton  of research during my 1st pg i decided to so the same. this is how i'm treating this pg as well.

[Spinnerette]

This is kind of a stupid question, but it's never been expressly stated to me. To be Rh + is to have a "positive" blood type, correct? If I were to have a positive blood type, like A positive, then the shot would not be required, right?

[elus0814]

We have four kids but I only had the shot with the first two and no prenatal shot with the others and no problem here. I think you really are at a 'crossroads'. If you wait to have the shot prenatally then you might not be able to have it after the baby is born. There is, I think a seven week waiting period before a second could be given. Unless you have some reason to think blood may have mixed, like you were in a car accident, then I don't see a reason for it. Few other countries do a prenatal one and do not have significantly higher rates of sensitization. Giving it at 28 weeks is just a random time to give it. It will reduce your risk of being sensitized if and only if you have blood mixing prenatally, which is fairly uncommon unless there in an accident. Postnatally rhogam brings your risk from about 8% down to 2%, those are the numbers I've found. Keep in mind that higher sensitization rates are only seen in mothers where the birth had many interventions, such as internal fetal monitoring or a c-section. Also, higher rates are 'seen' in studies funded by rhogam manufacturers. 

My big concerns are not only the ingredients but how it's made. It a human blood product. The blood is PURCHASED from men who are sensitized. What motivation do they have to say they are at risk for a disease when they would loose money? Some of these men became sensitized via sharing dirty drug needles. Not someone I want a blood product from and all the blood is pooled before making the rhogam. There are no *proven* cases of mothers (and their breastfed babies) contracting diseases but there have been many accusations. They haven't been proven because there is absolutely no way to prove how a mother and baby got hep a or another disease, they can blame it on the mother. 

[MeepyCat]

Originally Posted by Spinnerette 

This is kind of a stupid question, but it's never been expressly stated to me. To be Rh + is to have a "positive" blood type, correct? If I were to have a positive blood type, like A positive, then the shot would not be required, right?

Correct. 

[MeepyCat]

Originally Posted by elus0814 

We have four kids but I only had the shot with the first two and no prenatal shot with the others and no problem here. I think you really are at a 'crossroads'. If you wait to have the shot prenatally then you might not be able to have it after the baby is born. There is, I think a seven week waiting period before a second could be given. Unless you have some reason to think blood may have mixed, like you were in a car accident, then I don't see a reason for it. Few other countries do a prenatal one and do not have significantly higher rates of sensitization. Giving it at 28 weeks is just a random time to give it. It will reduce your risk of being sensitized if and only if you have blood mixing prenatally, which is fairly uncommon unless there in an accident. Postnatally rhogam brings your risk from about 8% down to 2%, those are the numbers I've found. Keep in mind that higher sensitization rates are only seen in mothers where the birth had many interventions, such as internal fetal monitoring or a c-section. Also, higher rates are 'seen' in studies funded by rhogam manufacturers. 

My big concerns are not only the ingredients but how it's made. It a human blood product. The blood is PURCHASED from men who are sensitized. What motivation do they have to say they are at risk for a disease when they would loose money? Some of these men became sensitized via sharing dirty drug needles. Not someone I want a blood product from and all the blood is pooled before making the rhogam. There are no *proven* cases of mothers (and their breastfed babies) contracting diseases but there have been many accusations. They haven't been proven because there is absolutely no way to prove how a mother and baby got hep a or another disease, they can blame it on the mother. 

Elus0814, I had three Rhogam shots over the course of my last pregnancy, each of them three weeks from the other (it was a complicated pregnancy with a lot of blood mixing, and I wore the shots out).  They'd have given shots more frequently if they thought I needed them.  There is *not* a waiting period between shots.

The risk of Rh sensitization (post-natally) is much higher than 8%.

Rhogam is a human blood product, but individual lots of blood are extensively tested and screened - they're not just dumping it all in one bucket and hoping for the best.  I don't think shared needles carry enough blood to trigger Rh sensitization.  If they did, I would expect that drug addicts would be highly to be asked to give blood after receiving treatment.  Most sensitization is the result of cross-type blood donations.

[stik]

Elus0814, where did you get your information about blood donations for Rhogam coming from IV drug users?