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Rhogam shot

post #1 of 13
Thread Starter 

So I know Rhogam is not technically a vaccine because of how the product works but I am clumping it in because I'm pretty sure that all the preservatives etc. are the same. That's really the big concern (for me) anyways.

 

So here is my dilemma. I am Rh- DH is Rh+ homozygous so this baby is def. going to inherit his blood. I have refused the Rhogam shot during pregnancy and am still up in the air about whether or not to get it post-partum. Well last night I started having low cramping, back aches, and increased discharge. 

 

I'm still waiting for a call back for my midwife and have just been taking it easy. Are any of these symptoms a cause for concern for blood mixing? I read conflicting things that I'm either A) going through pre-term labor, B) completely fine and everything is normal, or C) could be a situaton where I would require rhogam. Bleh.

 

I am planning on asking when I get the call back but I know her opinion is that I should get it and there are absolutely no adverse side effects. I take that "no side effects" with a huge grain of salt. I don't buy it. 

 

so thoughts? What would you do? 

post #2 of 13

There have been numerous threads about this very question over the years. Have you done a thread search? I'm sure you would find loads of info.

 

Personally I would never get this while pregnant. Post partum - if absolutely necessary maybe.

post #3 of 13

I'm in the same boat. From what I understand, they can test your blood for antibodies. If you have no antibodies, you don't need the shot, if you do have antibodies, get the shot. 

If you don't get the shot, you may want to wear a medic-alert bracelet in case you're in an accident. 

FWIW, I think I'll be getting the shot for my second pregnancy. I didn't get it for my first and luckily nothing happened but I'm realizing now that the risks are more dangerous than I thought if something does happen. I don't like to use the carseat comparison with regular vaccines but in this case, it almost applies... would you not put your child in a car seat because you probably won't get in an accident? I know the argument is that the carseat doesn't put your child at risk to the list of things some people believe are linked to the shot, and the shot can be given up to 72 hours after the injury, but what if you don't realize there was an injury? The carseat analogy doesn't work in every respect, but in mosts respects it does.

post #4 of 13
Quote:
Originally Posted by Escaping View Post

I'm in the same boat. From what I understand, they can test your blood for antibodies. If you have no antibodies, you don't need the shot, if you do have antibodies, get the shot. 

 

 

I'm pretty sure that is backwards.  The shot is to prevent you from being sensitized.  If there are antibodies, then you are already sensitized so it's too late and the shot would not do any good.  

post #5 of 13
Quote:
Originally Posted by pers View Post

 

I'm pretty sure that is backwards.  The shot is to prevent you from being sensitized.  If there are antibodies, then you are already sensitized so it's too late and the shot would not do any good.  

 

You're right... for some reason I was under the impression that if the antibodies were still low, the shot would still be effective... apparently not. 

post #6 of 13

I agonized over the Rhogam topic too...  How far along are you?  If you are close enough for it to be pre-term labour, these symptoms on their own don't sound too terrible.  I remember lots of back pain and discharge... especially toward the end.  PLUS, if you are very close to delivering and you DID have some kind of trauma to cause blood mixing now, it is highly unlikely to be the worst consequences to your baby.  Maybe some jaundice... but the really bad consequences would happen if there'd been blood mixing much earlier in the pregnancy and you hadn't realized it.  Then it would be present through the development of all the critical bits... 

(People correct me if I'm way off here but this is what I recall from my reading when I was going through it...)

 

My situation was trickier as I lived my life believing I was Rh+.  Then, as I was in labour with my first, they told me I am Rh-. They tested twice; negative twice.  Keep in mind, I am IN LABOUR and they are telling me that there is a risk to my baby because I didn't get the shot and it's possible my baby could have all kinds of problems as a result.  Nice.  Baby is delivered and they test ONE more time... positive.  They tell me it was all just a testing issue (I stupidly didn't ask what the issue was, was kind of tired and on a baby high I guess) and so no post-natal shot for me.

 

I lived my life and never give it a second thought.

 

Then in my second pregnancy... first bloodwork comes back Rh-.  Now I'm flustered.  I had to do my own internet research to learn that there is a such thing as a weak positive... essentially just such a low level of antigens that if the test isn't sensitive enough, it will record me as a negative.  It was AMAZING how little the nurses knew and just kept telling me that it wasn't possible to have a test show neg one time and positive another.

 

In the end I stuck to my instincts and didn't take the shot. My post-natal blood work... Dh+.  My son's test?  Dh-.  From two apparently Dh+ parents.  Sheesh. 

 

Long story to say that from my experience the medical staff I interacted with know nothing about this stuff and how it works... they can recite from the pamphlet and from their textbooks only.  It is good that you are here gathering insights from those who've been through it instead!

post #7 of 13

I, too, am RH- and my DH is RH+. I'm also at 31 weeks. I resisted the shot at 28 weeks and told my OB I wanted to wait till I delivered to have my daughter's blood tested at birth (they can test her cord blood so no prick!) If she is positive, then I'll get the shot to protect future pregnancies. I personally have had no incidents that warrant me fearing blood mixing thus far, and plan on a natural intervention free birth (where most blood mixing happens other than accidents, amnio, or other invasive testing) so I don't think I'm putting this baby at risk. My OB freaked out and told me she's seen babies DIE.yikes2.gif Trying to scare me into the shot. Too bad I'm informed and didn't fall for it. She also said if I have started to develop antibodies, but only a few, then I can still get the shot. (This is contradictory to everything I've read.) She had my antibodies tested and they were negative. That was the last time I saw her. I immediately switched to a midwife and she's totally fine with me waiting. 

 

Do what is best for you, but also don't think you have to get it because of fear. It is standard in Europe to NOT get it. None of our parent's generation routinely got it. To me, it's just a $$ thing unless you have a medical necessity to get it. 

post #8 of 13
Quote:
Originally Posted by Escaping View Post

 

You're right... for some reason I was under the impression that if the antibodies were still low, the shot would still be effective... apparently not. 

 

I think that's a pretty common misperception and one that even nurses still fall prey to as well. The amount of times I've had to tell people, even during my second sensitized pregnancy, that NO I don't need a rhogam shot because that ship has sailed...well, it was quite often. I had to talk a nurse through it once: "You want me to come in to get a shot. To prevent me forming Rh D antibodies. The antibodies I ALREADY have. For which you regularly fill out titer requests." [cue silence] Nurse replies..."Oh yeaaah. That doesn't make sense, does it?" LOL

 

To the OP: I'm a case of rhogam failure. My story is elsewhere here on Mothering and if you do a search for rhogam threads, then you'll probably see my name pop up quite a bit. I had a silent bleed with my first pg sometime between 32w and delivery that sensitized me. I also lost my first baby to full term stillbirth for unknown reasons but as an unhappy coincidence, I had chronic vilitis and a lot of inflammation in the placenta that shows that something akin to an immune reaction was taking place that gradually cut off all blood flow, and based on IUGR rates, it started in the third tri. As I tested negative for any known infections in subsequent postnatal b/w, we don't know what IT was. Something happened during my low risk, normal pg and things went wrong. Did I react to my 32w rhogam shot? No one can say. Again, no answers and unhappy coincidence for me, but it colours my view in that in hindsight, I'd go for a postnatal shot even with the higher risk of sensitization. But that's just my opinion based on my personal circumstances. Anyway, as I ended up sensitized anyway, I no longer required any rhogam shots.

 

I've had two successful sensitized pregnancies. Both kids made it to 37w before we induced and I didn't even require any IUTs during the pregnancies. The babies had pathological jaundice and required about a week each under double bilis, but no postnatal transfusions or any other care. My husband is also homozygous for D and we knew all future pregnancies would be affected. We chose to limit the size of our family based partly on this, as we figured we did so well twice, it was pushing our luck to knowingly pursue a large family. Others see things differently and I read a post from someone on an iso pg support board who is embarking on her third iso pg and with Kell antibodies too, which are a lot more serious. Everyone's view of risk/reward is different, right?

 

Perinatal care has come a long way with iso pregnancies in the past decade or more and although there are never any guarantees (I know of two losses due to complications from an IUT and/or the fetus not making it to 19w when they can start the transfusions), outcomes are generally fairly good. It is ultimately up to you to decide what you want to do, but it is worthwhile looking at all of the possible risks critically and that includes what future pregnancies might be like if you were sensitized. I've also found that there's a lot of misconception out there from women who have been told how dangerous and awful a sensitized pregnancy is supposed to be, but they aren't sensitized and have never experienced one. 

 

As for preservatives in the rhogam, I think since they "removed" the thimerosal, there's a trace left. For me, the bigger issue was the one of unknown/unscreened for infectious agents considering the large pool of donors. That has to be balanced against the knowledge that if you refuse and become sensitized, you might end up needing blood products anyway for IUTs. That's also something to consider. Good luck with whatever you decide.

post #9 of 13
Quote:
Originally Posted by Blt178 View Post

I agonized over the Rhogam topic too...  How far along are you?  If you are close enough for it to be pre-term labour, these symptoms on their own don't sound too terrible.  I remember lots of back pain and discharge... especially toward the end.  PLUS, if you are very close to delivering and you DID have some kind of trauma to cause blood mixing now, it is highly unlikely to be the worst consequences to your baby.  Maybe some jaundice... but the really bad consequences would happen if there'd been blood mixing much earlier in the pregnancy and you hadn't realized it.  Then it would be present through the development of all the critical bits... 

(People correct me if I'm way off here but this is what I recall from my reading when I was going through it...)

 

 

Just chiming in...

 

Most OBs run a titer for sensitization at the start of a new pregnancy. So, if someone were sensitized early (more likely at the end of the last one, I'd say) then it would appear in the initial bloodwork. From what I recall, blood mixing in the first tri doesn't come into it until after the placenta has formed and I believe that's around the ninth week. That's probably why most physicians probably would not be sounding the alarm over spotting around week 4-5 but would possibly recommend coming in for a rhogam shot for spotting at the end of the first tri. That was my experience.

 

Also, suppose you were sensitized early (as in my case, already sensitized at the end of the last pg and with a 1:1 titer at the start of the second pregnancy), it's not a given that any "bad consequences" would happen. OBs would wait and retest to see if it's genuine sensitization or the remnant of the rhogam shot. If true sensitization is established (usually when the titer starts to rise), then OBs will monitor with regular titer draws until the level reaches 1:8 or 1:16 (depending on the antibody and rate of rising) and then send the mother off to the MFM physicians to start the MCA dopplers. But it may take a while for that to happen in a first sensitized pregnancy. My titer was 1:1 in the first tri, 1:2 through the second, and jumped to 1:8 by the third and even though my OB normally didn't send patients over until they hit the 1:16 mark, I asked to go early because of my previous unexplained stillbirth and figured any extra monitoring and care they could give me wouldn't go amiss. So, it took about 25w for my titer to even get to 1:8 and once we started the scans, the peris weren't that concerned at all. Things looked fine. Being sensitized through two pg, with all the development of their "critical bits," didn't make one iota of difference. My titer was 1:32 at the start of the pg with my son, so even that higher titer had no effect on his development. Both of my children turned out healthy and well. The first tri is not generally the big issue for us sensitized mothers. For those of us with moderate to higher titer levels, it's the period between from about 10w (when the placenta is formed and our antibodies can start crossing over to the fetus) until 19-20w when we can receive IUTs if our baby needs them. That's a nine week period of a lot of praying and crossed fingers. We didn't even start the MCA dopplers on my DS (second sensitized pg) until 19w because I guess the peris feel there's no point until then as not much can be done. 

 

There's a vast amount of difference between someone who is newly sensitized with a low titer compared to some of the other mothers I've met online who have a titer in the thousands (yes, thousands) who are just hanging in there, trying to get to 19w to start IUTs, using whatever means they can (IVIG etc). That's a night and day difference.

post #10 of 13
Thread Starter 

Japonica- Yes, I do remember reading your story on an older thread. I'm so sorry that you had to go through that. It's hard because it seems so sketchy. Yes, there is a 1% chance that there could be blood mixing even if there are no traumatic experiences present.

 

But what is considered a traumatic experience? I've read a lot of things both on and off Mothering arguing about Rhogam but I haven't come across a list of things to look out for/be aware of. It seems to either be "get the shot! It's super necessary!" Or "It's unneeded and all about the money!" I'm sure there is some sort of middle. The owner of an herb shop not too far from here (about an hour) told me that you will have symptoms if you had blood mixing. He asked me if I was feeling sick or had any other sorts of complications. I tried looking this up online but could find no information of warning signs.

 

I'm 30 weeks so a bit early to be thinking about labor but I have a friend who got admitted into the hospital for pre-term labor at 26 weeks O.o thankfully they think that they can keep her baby  in until 34 or 36 weeks but it makes me sort of paranoid. I went in today and my MW is testing for a yeast infection, bladder infection, and something else that can cause cramps. She also is running a test of something I can't remember it's called but can tell if I am at risk for going into labor within the next two weeks. My cervix is closed and decently thick so she didn't seem to concerned. It seems that cramping  is one of those "it can be something or nothing" type things. I go back tomorrow for a follow up.

post #11 of 13

The question of what qualifies as a "traumatic experience" re: blood mixing is, as you rightly surmised, pretty vague.

 

FTR I had no symptoms of blood mixing. I don't think I'd even know what they are TBH. I had no indication whatsoever that anything was wrong and that included the sensitization bit and the whole inflammation/vilitis thing going on. I knew all of the so-called danger signs in late pregnancy to keep an eye on, but I didn't experience any of those. I would personally be sceptical, just from my experience, of anyone saying you should have physical symptoms of possible sensitzation. Obvious bleeding/spotting, sure. But not, "I think I'm forming antibodies now." I love herb shop/health food store workers too, but I'd really take what he said with a grain of salt. If nurses and OBs get info the wrong way round with the sensitization thing, then others easily do as well.

 

I guess it comes down to evaluating what your concerns are re: rhogam (I know you mentioned preservatives, any others) and doing the old vaccine risk-benefit analysis of outcomes, right? Now we also cannot assume outright that you will become sensitized if you refuse, but stats show it is more likely. So, you have to decide between the possible risks of the product vs. the risks of future sensitized pregnancies. Family size also has to be considered. I mean, it's a different issue for someone on their last child or second last, compared to someone just starting out, right?

 

Were you looking at doing rhogam postnatally anyway...I mean without the cramps and possible PTL factor? Perhaps that is the middle ground option for you.

post #12 of 13
Thread Starter 
Quote:

Originally Posted by japonica View Post
 

 Family size also has to be considered. I mean, it's a different issue for someone on their last child or second last, compared to someone just starting out, right?

 

Were you looking at doing rhogam postnatally anyway...I mean without the cramps and possible PTL factor? Perhaps that is the middle ground option for you.

 

Family size is a huge issue for me. This is our first child and both DH and I would like to have a large family.

 

I was looking into doing rhogam postnatally. Unless I have some sunshine and rainbows birth experience I will most likely get the short as that "middle ground" that you talked about. I'm much more OK with putting my own body at risk than my child's. How long does it take for antibodies to form? My husband's impression was that I be able to have a blood test done in the hospital before we leave to see if the shot would be benefitial but after this discussion I'm seeing how that doesn't make sense. =/

post #13 of 13
Quote:
Originally Posted by inconditus View Post

 

Family size is a huge issue for me. This is our first child and both DH and I would like to have a large family.

 

I was looking into doing rhogam postnatally. Unless I have some sunshine and rainbows birth experience I will most likely get the short as that "middle ground" that you talked about. I'm much more OK with putting my own body at risk than my child's. How long does it take for antibodies to form? My husband's impression was that I be able to have a blood test done in the hospital before we leave to see if the shot would be benefitial but after this discussion I'm seeing how that doesn't make sense. =/

 

True. The other issue is that if you get the shot postnatally as per most HCP protocol and then test in subsequent weeks, you'll most likely end up with a false positive from the rhogam. It takes a while to clear the system.

 

The literature cites a 72 hour window for administering rhogam from a suspect bleed/"traumatic" injury, amnio, m/c, birth etc. So, I'd imagine that declining and testing then waiting for the results might not be possible. I don't know how long it takes to run a titer. My routine ones were done on a Thurs or Fri and I'd get a call back by mid-week with the results. Of course, in hospital, they should have a quicker turn around time. Still, I guess the risk is that while you're waiting for the results and then deciding on whether or not to get the rhogam postnatally, you're taking a calculated risk. Knowing that you would like a large family and this is your first, you should make the decision that will best help you in that and reduce your risk of becoming sensitized. Like I said, many sensitized mothers go on to have two, three or four children, but they are not stress-free, intervention-free pregnancies by any means. Good luck. 

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