Rh- mamas, are you getting the Rhogam? - Page 2

[phaeon]

I voted no, b/c DH is also RH- so there is no need. I don't understand why they don't test the dads before peddling MORE meds... Seems like an obvious i$$ue to me....

[Myboysmom]

I am negative. Ex is positive. I got it prenatal and postnatal with all three, and all three were postive.

[Collinsky]

This is such a confusing topic for me... our plan this pregnancy is to do what we did with the last two: no prenatal RhoGam, test baby's blood after birth and if Rh + then I will get the shot. Fortunately my girls are both O- so it hasn't happened that way yet, but the odds of all my children being Rh- are pretty slim so I'm sure I'll have to get the shot eventually. I REALLY feel very leery of it.. it just doesn't seem natural. And since most blood mingling is caused by external factors (cord traction, early cord cutting, fundal massage, augmented/induced labor, etc) then ther should be no reason for me to even worry since I won't be having any of that in my birth. But I want many many children, and don't want to in any way jeapardize that... that old "what if" that pops up.

I have heard about changing from Rh - to + through diet... but honestly I don't want to... I feel like I was born this way and that it's no more "wrong" to be Rh - than it is to be O blood type. That thought alone makes me think that the RhoGam isn't necessary in a natural, unmanaged birth.

[Pariah]

I've got two questions that my midwife didn't answer...if anyone here know some answers, please share your knowledge with me!

-- I spotted at 9 weeks, and was given Rhogam in the ER. Would this be a reason for me to get Rhogam at 28 weeks, or am I sufficiently protected from the dose I got at 9 weeks?

-- Blood mixing and becoming sensitized would only happen if a traumatic event occurred, right? Car accident, bleeding, some sort of injury... So would it be logical to skip the 28 week Rhogam and only get it if I happen to be in some sort of situation like that?

We're currently waiting to see if my husband is Rh-, but we're pretty sure he's +. My midwife wants me to come in this week to get a blood test...if I decide not to get the 28 week Rhogam, is the blood test necessary?

I'm upset...I had a list of questions typed out that I gave to my midwife at my last appointment, and she just picked and choosed which questions she would answer. That is not satisfactory to me...would anyone else feel that way, too? I'd at least liked to have been told "I don't know" instead of just not getting any sort of answer... She didn't answer the questions I posted, along with whether or not I would be able to get mercury-free Rhogam.

[loudmama]

Its not an issue for us. Both DH & I are A-. Because he's a regular blood donor, he even carries proof with him. Astounded the nurse when I was pregnant with my first.

L

[Collinsky]

[/QUOTE]
-- I spotted at 9 weeks, and was given Rhogam in the ER. Would this be a reason for me to get Rhogam at 28 weeks, or am I sufficiently protected from the dose I got at 9 weeks?[/QUOTE]

Ths shot only protects for 12 weeks, so no, you wouldn't still be covered at 28 weeks.

[/QUOTE]-- Blood mixing and becoming sensitized would only happen if a traumatic event occurred, right? Car accident, bleeding, some sort of injury... So would it be logical to skip the 28 week Rhogam and only get it if I happen to be in some sort of situation like that?[/QUOTE]

Yes, blood mixing is very rare - during pregnancy it can occur if there is an abdominal injury or invasive procedure (amniocentesis)... I believe that placenta previa can also cause it. During birth itself blood mixing can occur if there is any cord traction, fundal massage (anything that "encourages" the placenta to dislodge), early cord clamping, and it is possible that things such as induction/augmentation and epidural can also contribute.

[/QUOTE]We're currently waiting to see if my husband is Rh-, but we're pretty sure he's +. My midwife wants me to come in this week to get a blood test...if I decide not to get the 28 week Rhogam, is the blood test necessary?[/QUOTE]

It is most likely that he is Rh+, as only 10-15% of the population is Rh- ... As far as getting the blood test to see if you are sensitized, discuss with your midwife your options and how a positive result might change your decision. I personally would not get the test, but that is because I would not get the shot prenatally regardless.

[/QUOTE]I'm upset...I had a list of questions typed out that I gave to my midwife at my last appointment, and she just picked and choosed which questions she would answer. That is not satisfactory to me...would anyone else feel that way, too? I'd at least liked to have been told "I don't know" instead of just not getting any sort of answer... She didn't answer the questions I posted, along with whether or not I would be able to get mercury-free Rhogam.[/QUOTE]

Your midwife probably didn't know the answers to the questions she ignored... did she take a copy of the list with her? If so give her a call and ask if she'd had time to find the info you needed. If she didn't, call or email her and repeat the questions to her, letting her know that you hope she can find that information for her. This lets her know you see her as a resource, and that you don't expect her to know everything about everything. Also, these questions you're asking are probably pretty uncommon ones, many people do not even ask. I personally think she should have answered with an "I'll get back to you on that one"... I also think that you should feel comfortable enough with her to let her know what you need from her. If you don't feel 100% comfortable with someone at a prenatal appt, that is NOT going to change when you're in labor which is when you really need someone you fully trust and feel safe with. You need that rapport! I'm not saying that she doesn't deserve a chance to develop that with you; but it is something to be aware of. At the next meeting, put at the top of your list your concern that she is ignoring your questions and you don't know if it is because she thinks they aren't important, or because she needs time to get more info. And maybe read the list to her, rather than giving it to her to read, so that she can't avoid any questions.

HTH!!

[jenny-g]

Originally Posted by reader

One more thing... if you decide to get the shot(s), triple check to make sure they are giving you the thimerosal-free version. Don't just take their word for it, ask them to open the box in front of you and hand you the package insert before it's administered.

All versions in the US are thimerosal-free now, as the expiration date on the last lots manufactured with it has passed. Not sure what the rules are in other countries, but here, it's okay.

[jenny-g]

Originally Posted by Pariah

I've got two questions that my midwife didn't answer...if anyone here know some answers, please share your knowledge with me!

-- I spotted at 9 weeks, and was given Rhogam in the ER. Would this be a reason for me to get Rhogam at 28 weeks, or am I sufficiently protected from the dose I got at 9 weeks?

-- Blood mixing and becoming sensitized would only happen if a traumatic event occurred, right? Car accident, bleeding, some sort of injury... So would it be logical to skip the 28 week Rhogam and only get it if I happen to be in some sort of situation like that?

We're currently waiting to see if my husband is Rh-, but we're pretty sure he's +. My midwife wants me to come in this week to get a blood test...if I decide not to get the 28 week Rhogam, is the blood test necessary?

I'm upset...I had a list of questions typed out that I gave to my midwife at my last appointment, and she just picked and choosed which questions she would answer. That is not satisfactory to me...would anyone else feel that way, too? I'd at least liked to have been told "I don't know" instead of just not getting any sort of answer... She didn't answer the questions I posted, along with whether or not I would be able to get mercury-free Rhogam.

I think others have given good advice here. If I were you I absolutely would get it due to the earlier bleeding- I had that as well, and got the shot, and will be getting it at 28 weeks as well. My midwives strongly suggest it (who are not at all pro-intervention, etc.), and since I know I will want another child, I am NOT going to play around with the risk of giving him/her hemolytic disease, which is a big deal. People seem to forget that and how awful it was when it somewhat routinely happened.

No Rhogam in the US has mercury in it anymore, and hasn't for about three years. You don't need to worry about that part. My midwives didn't know that either, and that REALLY irritated me. I was just lucky- they were like, "oh, I don't know why it would have had mercury", when it used to have quite a bit! And at 7 weeks pregnant, I think that would have been an unacceptable risk.

The idea of "changing" your blood type by diet is total bunk. Please don't put your kids at risk by considering this.

I think because you had bleeding, it puts you in a risk catagory where you can feel pretty comfortable getting the 28 week shot. I understand people who are very low-risk not getting it, but on the other hand, every labor is different, and I disagree that blood mixing is caused only by "invasive" non-natural things like picotin, massage, etc. I think the natural rigors of labor, in someone who is having a really hard time, can cause it too, and you never know if you're going to end up having some sort of an intervention due to an emergency. I just think, for myself, the risk of having complications due to Rh incompatibility way outweigh any theoretical risks of the shot. It's important to have full information about those, too.

[wasabi]

I don't really understand why early spotting which is often just a normal part of pg would be considered reason to get Rhogam either at that time or at 28 weeks. I did have a small amount of spotting with both my third and fourth pgs and no one suggested I get Rhogam. We don't do the shot until later because as rare as prenatal sensitization is it occurs more frequently later in pregnancy when the fetus has a sufficient blood supply to even cause a sensitization.

-- I spotted at 9 weeks, and was given Rhogam in the ER. Would this be a reason for me to get Rhogam at 28 weeks, or am I sufficiently protected from the dose I got at 9 weeks?

-- Blood mixing and becoming sensitized would only happen if a traumatic event occurred, right? Car accident, bleeding, some sort of injury... So would it be logical to skip the 28 week Rhogam and only get it if I happen to be in some sort of situation like that?

We're currently waiting to see if my husband is Rh-, but we're pretty sure he's +. My midwife wants me to come in this week to get a blood test...if I decide not to get the 28 week Rhogam, is the blood test necessary?

Well your protection from the 9 week shot ends at 21 weeks so there's a gap there anyway and I doubt anyone is going to suggest that you need a shot at 21 weeks to tide you over. The whole timing is just because 28 weeks plus 12 weeks gets you to 40 weeks when you will theoretically deliver and yet no one insists that people get another shot if they go past their EDD. Most countries do not do the prenatal shot and doing so here did cause health problems. Just something to consider why the US considers it necessary while other countries don't (hint pharmaceutical companies like to make money). All that said I think that theoretically if you had been exposed to mixing at 9 weeks the shot should have combated it. You would not be protected if you were to have a new exposure but I don't believe the blood from 9 weeks is still hanging around in you waiting for your shot to wear off. So I believe that threat has basically been dealt with and you are not currently at any higher risk without a trauma of some sort. If you decide you are absolutely not getting the shot then there's no need for a blood test. For that matter if you have the blood test and they find that you are sensitized then Rhogam can't help at that point so I don't know that it does matter in your decision as far as whether you get the shot or not. Also someone else was asking about the timing and there seemed to be a bit of confusion over the duration of the protection the shot gives and the timing of the shot. The US gives everyone a shot around 28 weeks however that will only protect you if you have not been exposed yet or have only been exposed in the last couple of days. If you have an exposure between 2 and 27 weeks that has no outward sign then getting that shot at 28 weeks is not going to do anything for you.

With my first two I had the prenatal shot. With my first I knew the father was negative so I was quite annoyed that they insisted I get it. No postnatal shot since the baby was of course negative. With my second we didn't know now-DH's bloodtype so I had the prenatal shot and then a postnatal shot when she was positive. I also had a shot after an extremely early m/c which was almost definitely totally unnecessary since I don't think the baby even had its own blood type then. I didn't even know Rhogam was a blood product until partway through my third pregnancy. So much for informed consent! I can't remember if I'd already had my prenatal shot by then or not but I did get it and then a postnatal shot when DD#1 was positive. The 4th time around though I did my research. After discovering that my risk of prenatal sensitization was less than 2% even if I was in a trauma I decided there was absolutely no reason for me to get myself injected with all these chemicals and expose my baby for an extremely low risk of problems. Besides that I know there is research indicating that most prenatal sensitizations are so low that you would need 12 incidences before the 13th baby had a problem. Most of us don't have 13 babies so not a huge issue for us. And if my risk is 2% over my entire pg what are the odds that my microbleed would play nice and only occur within 27w3d and 28 w? I know all Rhogam is now mercury-free (which my midwives did not know! When I first started asking they said they'd have to find out if they could even get the mercury free version) and that was a huge concern of mine due to the high correlation of autism with Rh- moms but even without it it just wasn't something I wanted my baby exposed to for no reason. My midwife felt I was very informed and was comfortable with my decision. We agreed that if I were to be in a car accident or a serious trauma and experienced late term vaginal bleeding without a cause that I would get the shot. That never happened so I didn't get the prenatal. DD#2 was positive again and so I did get the postnatal shot. I'm not entirely sure that it's necessary and I lean towards the idea that it's not. However I'm more willing to take a risk with myself to give (theoretically) protection to any future babies I might have. So far my blood tests have always indicated I do not have sensitization. So anyway there's my $20 on the subject. :LOL This link had a lot of good info as well and there's a book out there that goes even further. Good luck deciding.

http://www.*********/a/rhogam.html

[nmm2112]

Lucky me! My DH is A- ( I'm O-) sooo as far as Rh goes --- no worries about ever having a + child!

[liseux]

"I am NOT going to play around with the risk of giving him/her hemolytic disease, which is a big deal. People seem to forget that and how awful it was when it somewhat routinely happened." Jenny-G

I wanted to comment real quick. I actually am a rhogam failure who got sensitized. Rhogam wasn`t enough after a very traumatic delivery. I had my first sensitized pregnancy 2 years ago & these days it is not such a huge deal to be rh sensitized. I want to reiterate, AVOID it if you can, but nowadays the knowledge and monitoring of an rh sensitized pregnancy is hugely improved.

As recently as 5 years ago, rh pregnancies were managed by doing amnios every other week, if the baby started to become anemic, a transfusion was done in utero, as many as needed to get the baby to 32 + weeks, Now, these pregnancies are managed by a very specialized type of ultrasound that measures the velocity of blood flowing through baby`s brain. My son had a bunch of these ultrasounds and never needed an intrauerine transfusion. He did have rh related jaundice for a month after birth and was watched closely. The transfusions have been done for almost 40 years now and are very safe when done by perinatologists.

My point is just that there are advances in this area and its not an insurmountable problem to be rh sensitized, its high risk, but rhogam is not 100% and even though the odds of sensitization are low, its still happening.

[Collinsky]

Originally Posted by jenny-g

I am NOT going to play around with the risk of giving him/her hemolytic disease, which is a big deal. People seem to forget that and how awful it was when it somewhat routinely happened.

I agree, HDN is a very dangerous situation, and Rh sensitization does cause it. My cousin required transfusions at birth due to it. However, nearly all (if not all) the data we have on it was gathered in hospital births in the middle of the last century when births were highly interventive - mothers strapped on their backs, given drugs, and babies pulled out by forceps, immediate cord cutting and stringent placental management. And yes - it routinely happened in these births. It is possible that sensitization could occur in a noninterventive, gentle birth with a very hands-off caregiver --- however that would be extremely rare. Most sensitization is caused by something that is done to the mother. So while I don't downplay the danger and seriousness of HDN, one also has to take into account the danger and seriousness of the interventions that might lead to blood mixing and therefore sensitization.

(Just a note, this isn't in response to the previous poster who had a traumatic birth and got Rh sensitized - sometimes things do happen with no explanation so I certainly don't want to downplay your experience!! Just addressing the general topic.)

[jenny-g]

Originally Posted by reader

One more thing... if you decide to get the shot(s), triple check to make sure they are giving you the thimerosal-free version. Don't just take their word for it, ask them to open the box in front of you and hand you the package insert before it's administered.

All Rhogam in the US is thimerosal free. The expiration date for the last Rhogam to be made with it past in early 2004 or thereabouts, so this is at least one less worry (I don't know about other countries, though). It was good luck for me, as my midwife didn't even know they ever had thimerosal in them and basically assumed they didn't. I find my midwives very good at some things, and *terrible* at other things (like medications and chemicals).

[Kundalini-Mama]

I voted "other" b/c I didn't want to get the prenatal shot.

With my 1st pregnancy (I was much more sheepish), my medwives said come in for the shot, and I said, which arm? As my son was A-, it was unnecessary.

FF a couple of years and I read a ton. Decided that I would not not get the prenatal shot. But at 19w after sex, I started bleeding, quite a bit. My MW thought it was a low lying placenta, and that can cause sensitization. So I got an u/s (which I didn't want either), it was low-lying and I got the rhogam. My son was A+, and I decided to get the rhogam again, for future pregnancies as I want to continue to go UC.

All pregnant RH- women should read this book though before making any decision though. A great great great read.

Amy, who will still continue to read the package insert to see if it is mercury free, b/c you can't be too careful. And really, does anyone really and truly trust the vaccine industry

[MommyofPunkiePie]

I'm A- and DD's bio-dad is O-. My OB asked me for proof of bio-dad's rhesus staus, and I asked him repeatedly for it. I ended up moving to a different state at 6 months pregnant, and only then did bio-dad get a blood test from a lab for me to show proof that he was indeed O-.
I wasn't sure why, but I was dead-set against getting the shot. Now I know!!!

[alliei]

had no idea you could still get sensitized

I had a traumatic delivery with my son - I ended up needing a csection and lost too much blood afterwards. I am going to ask for a blood test to see if I have been sensitized at my next prenatal, just to be safe.

I will get the Rhogam shot prenatally and postnatally.

Allie

[georgia]

It was always my understanding that the 28 wk. shot isn't to protect mother from bleeds that have already occured, but rather to minimize the risk at birth.

This is a very interesting thread from gentlebirth about Rhogam.

[KittyKat]

My DH is A- so I have a better chance of having problems from the shot than of ever having a baby with Rh+ blood! Still my STUPID OB office with babies #2 and #3 insisted that I needed the rhogam. I know NOW that the reason they did this is because sometimes there are women who SAY that their DH/DP is the father but really the bio father is someone else. What a STUPID reason to pressure women with no need for the rhogam take a dose.

So I don't take rhogam anymore and I feel like a moron for taking it even though I had been told with my first pregnancy that it wasn't necessary.

Kathryn

[mimid]

I just found out today that I'm RH-. I'll have to check on dh because that would really make it easier all around. My doc did say that the 28 week one if I have an amino, there was some sort of trauma or I had heavy bleeding in the 1st trimester (which I didn't). I'll probably end up following his advice and asking my dad (ER nurse) and step-mom (NICU nurse) their opinions.

[chlobo]

Can anyone point me to some other resource to get my research started?

I had Rhogam with my first pregnancy (3 shots! Eek). I'd like to avoid the prenatal shots this time round if I can.