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My Rhogam crossroads. - Page 2

post #21 of 36


 

Quote:
Originally Posted by erigeron View Post

Quote:



Got a source for this?


It's in the printed paperwork that I got from my midwife.

 

post #22 of 36

I wonder where they got it. I've noticed several statements like that lately and they seem to be founded on a faulty understanding of how drugs and other substances distribute in the body. A fetus could get an amount of exposure to a substance that is proportionate to its size as the overall quantity of the substance is proportionate to Mom's size. It's not possible for the fetus to get an exposure that is manyfold larger than the mother's. The placenta does not act to concentrate chemicals in the fetus.

 

It's like if you fill your kitchen sink or other large vessel with water, then dump in some salt, mix it up, and then remove a cup of water. The cup you remove (representing the fetus) will have the same concentration of salt as in the sink itself (representing the mother). It's concentration that exerts an effect, not absolute amount.

post #23 of 36

This is timely!  I have been debating this myself.  Last pregnancy, I CALLED the RhoGAM company and asked for information.  They faxed articles showing the studies that have been done on Rhogam.  They told me that there was no longer mercury in the shots, etc.  We didn't even get my husband's blood tested because all three of his family members have O+ blood.  I got the 28 week shot from my midwife, but when our daughter was born with A- blood (like me), I obviously didn't get the second one.  So we DID get my poor husband the blood test (he hates needles) and he is O+, just like his parents, although obviously a RH- carrier.  The studies I read showed how the tests prevented women from being unable to have subsequent RH+ blood children.  The way the body can attack a future baby is pretty awful.  It also showed that when women were given a shot at 28 weeks instead of only after birth, it cut down chances of creating the antibodies against RH+ blood to around 1%.   I don't know about limiting shots to once every seven weeks either, because they said that if you had to receive a transfusion of RH+ blood, they would have to give you several shots to compensate.  When I asked about why this isn't done sooner in the pregnancy, they told me that it had to do with the amount of blood the baby had to cross over, although it might be a good idea to have one after a miscarriage or other early birth trauma.

 

Anyway, since then I've read articles saying that it is a dangerous mixture of things to have shot into your system while pregnant and it doesn't make THAT much of a difference.  I am now feeling a bit undecided.  Add to the fact that there is a 50% chance this baby will be RH- and the shot costs around $500 and I am feeling a bit MORE undecided.  I am supposed to get the shot tomorrow.  I guess it is true that if I am going to see my midwife in two weeks anyway (from now on we are supposed to meet twice a month), it wouldn't hurt to make the decision at week 30, unless I fall or get in an accident, at which point I have 72 hours to request one.  And the two week buffer may not hurt if I go over my due date a bit or something.  But still, I wish I knew what to do now.

post #24 of 36
Thread Starter 
Wow, the shot is only 200 for me. I went to my last Midwife appointment and told them I wouldn't be needing them to order the shot for my next appointment at 28 weeks. I believe I'm going to have to sign something to the effect that it was offered to me but refused.

I guess what ultimately helped me decide is that I feel like at 34 with infertility issues, I owe more to my current LO that I am carrying than to the slim possibility that there will be another future child I could be negatively impacting. Since I've been assured that at 28 weeks any future blood exchanges would not trigger enough of an antibody response to negatively impact HER, and since the shot will definitely a) attack and kill some of her red blood cells and b) expose both her and I blood borne pathogens that in some cases are not able to be screened out (the manufacturers site discusses CJD as a possibility) and c) has been shown to depress the immune system of the mother and baby, I am just going to wait until we find out her blood type and then go with the postpartum shot if necessary.

Thanks for the statistics AND the info re: some countries skipping the 28 week shot altogether. It was added reassurance.
post #25 of 36
Thread Starter 
Oh, and I should add... If she is born Rh+ and I have the PP shot, is there a test I can do before we TTC #2 to be sure I haven't been sensitized? I thought i remembered reading something about it somewhere.
post #26 of 36


 

Quote:
Originally Posted by JosieAK View Post

This is timely!  I have been debating this myself.  Last pregnancy, I CALLED the RhoGAM company and asked for information.  They faxed articles showing the studies that have been done on Rhogam.  They told me that there was no longer mercury in the shots, etc.  We didn't even get my husband's blood tested because all three of his family members have O+ blood.  I got the 28 week shot from my midwife, but when our daughter was born with A- blood (like me), I obviously didn't get the second one.  So we DID get my poor husband the blood test (he hates needles) and he is O+, just like his parents, although obviously a RH- carrier.  The studies I read showed how the tests prevented women from being unable to have subsequent RH+ blood children.  The way the body can attack a future baby is pretty awful.  It also showed that when women were given a shot at 28 weeks instead of only after birth, it cut down chances of creating the antibodies against RH+ blood to around 1%.   I don't know about limiting shots to once every seven weeks either, because they said that if you had to receive a transfusion of RH+ blood, they would have to give you several shots to compensate.  When I asked about why this isn't done sooner in the pregnancy, they told me that it had to do with the amount of blood the baby had to cross over, although it might be a good idea to have one after a miscarriage or other early birth trauma.

 

Anyway, since then I've read articles saying that it is a dangerous mixture of things to have shot into your system while pregnant and it doesn't make THAT much of a difference.  I am now feeling a bit undecided.  Add to the fact that there is a 50% chance this baby will be RH- and the shot costs around $500 and I am feeling a bit MORE undecided.  I am supposed to get the shot tomorrow.  I guess it is true that if I am going to see my midwife in two weeks anyway (from now on we are supposed to meet twice a month), it wouldn't hurt to make the decision at week 30, unless I fall or get in an accident, at which point I have 72 hours to request one.  And the two week buffer may not hurt if I go over my due date a bit or something.  But still, I wish I knew what to do now.


Josie, I think in this kind of position, where you're hearing different things, the thing to do is evaluate your sources.  For me, I tend to rank articles from peer reviewed scientific and medical journals and government statistics as the best possible sources, but you do have to read very carefully to make sure that you aren't imputing things that the articles and statistics don't actually say.  Articles in popular news media come in way lower, and articles published only on the internet, I generally want to trace the information back to its sources before I decide whether or not it's any good. 

 

I will say, however, that Rhogam does make a HUGE difference in sensitization rates for Rh- mothers with Rh+ babies.  From 1970 to 1979, incidence of Rh hemolytic disease of the newborn dropped by 65%.  Researchers attributed 30% of that decrease to changes in family size and structure, and 70% to Rhogam.  At the time, anti-D prophylaxis for Rh- women was not yet routine.  With better prophylactic coverage, numbers have continued to improve.

 

post #27 of 36

I am 28w and had the shot today, I couldn't come to a solid decision as to how I felt about it so I just went with it. All 4 of my other kids are positive and I have always

had the shot afterwards as well. Even though this is my last pregnancy I just can't get comfortable with not taking that shot.

post #28 of 36
Quote:
Originally Posted by moppet View Post

Oh, and I should add... If she is born Rh+ and I have the PP shot, is there a test I can do before we TTC #2 to be sure I haven't been sensitized? I thought i remembered reading something about it somewhere.


Yes, if you're Rh-, screening for sensitization is part of a normal early prenatal panel, and could be done before TTC if necessary.

 

post #29 of 36

Coming in from New posts-- I was freaking out about the Rhogam shot as well when I was pregnant.  I also gave birth in Germany and the doctor was very up front that Rhogam is basically non-negotiable in his eyes.  For what it's worth, he did not allow me to get the flu shot, swine flu shot or any other vaccines while I was pregnant (and this is when they were really crazy about everyone getting swine flu). He also recommended not getting dental work done while pregnant except for cleanings. I would most definitely get the shot if I were you. The risks do not outweigh the benefits. If your midwife recommends it and you trust her enough to give birth with her, why would you not do it? The only possible reason I would not get the shot is if you know this is your last child and your husband is getting a vasectomy.

post #30 of 36
Thread Starter 
Quote:
Originally Posted by Lauren31 View Post

Coming in from New posts-- I was freaking out about the Rhogam shot as well when I was pregnant.  I also gave birth in Germany and the doctor was very up front that Rhogam is basically non-negotiable in his eyes.  For what it's worth, he did not allow me to get the flu shot, swine flu shot or any other vaccines while I was pregnant (and this is when they were really crazy about everyone getting swine flu). He also recommended not getting dental work done while pregnant except for cleanings. I would most definitely get the shot if I were you. The risks do not outweigh the benefits. If your midwife recommends it and you trust her enough to give birth with her, why would you not do it? The only possible reason I would not get the shot is if you know this is your last child and your husband is getting a vasectomy.


I don't really think the negatives are easily outweighed by the positives - for the 28 week shot. Postpartum, I'm totally on board, just not the "preventive" shot at 28 weeks.

FWIW, my midwife was totally cool with my reservations. She said she completely understood my concerns and didn't disagree and that it was a personal decision. I believe signing the form is purely to cover her butt if I later showed up sensitized and said I wasn't offered the shot.

Also, if for some reason I did end up sensitized even after having the postpartum dose, that would be it for us TTC. I would not risk HND knowing the possible outcomes.
post #31 of 36

I got the shot today and feel good about it.  I read the medical articles again and was convinced that it was for me.  Now I'm really sore. :(  Oh, and it is $250 for me, I guess $500 if I need 2 shots.  Thanks for all of the discussion ladies.  I wish I could get on here more often; I learn a lot from you all.

post #32 of 36

Hey there,

 

It seems like you already got a lot of comments from some very educated mamas! I just wanted to chime in with my personal experience and that of a friend (both of us are RH neg with RH pos hubbies). During my first pregnancy, I like you was very nervous about getting the 28-week shot. It just didn't seem necessary, and I didn't want to expose my daughter to ANYTHING unnecessary. I felt like having it after childbirth or immediately after trauma should be enough, but was I guess a little more terrified about something awful happening and then not being able to have another child without my body attacking it (or, I should say, having that be a possibility). In the end, I just got the 28-week shot and then got the shot after delivery as well. I am antibody free and my daughter is RH positive. She is the smartest, healthiest, most verbal little 20-month-old you could ever meet. 

 

I have a dear friend who also got the 28-week shot AND the post-delivery shot. She also took a very bad fall when she was about 34 weeks along but didn't get another shot because she SHOULD have been covered by the 28-weeker. For some reason, she STILL ended up getting sensitized, and is now facing an incredibly high-risk pregnancy if she even chooses to have another baby. Her docs think they must have not given her enough at the 28 weeker or that it leaked out or something, or that she had some additional trauma they didn't realize and she should have received more. My point in telling you about her is just so you can know how real sensitization can be, NOT to make the point that you could still be sensitized even WITH the 28-week shot. The docs say my friend's case is incredibly rare, and my midwife was shocked when I told her. I guess what I took from her story is that you don't always KNOW when you've experienced a trauma, so it really makes sense to get the 28-weeker to protect yourself and future babes. Also, that little baby in there is in the third trimester and not as vulnerable as when it's first forming. Those are just some thoughts that comfort me.

 

I myself am pregnant again and just had my 28-week Rhogam shot without any stress. It's important to weigh the risks of anything you put into your body, absolutely, but to me the risk of your body attacking a future baby is just too great, especially if you know you want another. 

 

Take all of that for what it's worth ;)!! I'm sure all will be well for you.

post #33 of 36

I will be getting the 28 week shot. I looked into it and feel comfortable with my decision. I would really like a large family and would be DEVASTATED if the very slight chance of becoming sensitized during pregnancy happened to me. Things happen that you can't always predict, you know? In an idea world, we wouldn't add a blood product to our bodies while preggo, but RH- and it's associated risks is a very real threat to the viability of future pregnancies. That slight risk is something that I could not personally live with. But this is something that's going to feel different for every woman and it's a very personal decision. 

post #34 of 36


 

Quote:
Originally Posted by moppet View Post



Quote:
Originally Posted by Lauren31 View Post

Coming in from New posts-- I was freaking out about the Rhogam shot as well when I was pregnant.  I also gave birth in Germany and the doctor was very up front that Rhogam is basically non-negotiable in his eyes.  For what it's worth, he did not allow me to get the flu shot, swine flu shot or any other vaccines while I was pregnant (and this is when they were really crazy about everyone getting swine flu). He also recommended not getting dental work done while pregnant except for cleanings. I would most definitely get the shot if I were you. The risks do not outweigh the benefits. If your midwife recommends it and you trust her enough to give birth with her, why would you not do it? The only possible reason I would not get the shot is if you know this is your last child and your husband is getting a vasectomy.




I don't really think the negatives are easily outweighed by the positives - for the 28 week shot. Postpartum, I'm totally on board, just not the "preventive" shot at 28 weeks.

FWIW, my midwife was totally cool with my reservations. She said she completely understood my concerns and didn't disagree and that it was a personal decision. I believe signing the form is purely to cover her butt if I later showed up sensitized and said I wasn't offered the shot.

Also, if for some reason I did end up sensitized even after having the postpartum dose, that would be it for us TTC. I would not risk HND knowing the possible outcomes.

can you explain what the negatives are in your opinion?
 

 

post #35 of 36

There is a great guideline, with statistics as far as risk of not getting the shot at all, not getting it at 28 weeks, versus getting it at various points.  It's the SOGC (Society of Obstetricians and Gynecologists) of Canada.  You can find it here:

http://www.sogc.org/guidelines/public/133e-cpg-september2003.pdf

 

Good luck with everyone's decision making! 

post #36 of 36

This DDC is now full of babies who are 2 months old or more, so this information comes a little late. Might want to post that link out in the main forums.

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