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rhogam?

post #1 of 58
Thread Starter 
I do not know if this is the best forum for this question, but here it goes...

I just read an interesting article about Rhogam in BestFed.com - an article by Kim....

Those of you who are Rh- mothers w/ Rh+ partners...what did you do?

Rhogam is a human blood product. It contains mercury and the package insert says it can cause anaphylatic shock.

But little information is shared by health practitioners w/ their patients regarding how this 'vaccine' works and if it is really necessary.

So,...what did you do?:
post #2 of 58
I was ignorant and got the shot - TWICE.

BUT the next time I won't - it will be my last baby, and my two children are both Rh- as well - so there is not much chance of me having any antibodies at this point.

TTC#3

post #3 of 58
I'm not very knowledgable about RH- and +, but I think I would definitely research it before they injected me with anything like that.

I was concerned when I read in an article that they sometimes give this to PG women?! I'm really wary of vaccines right now, but even if I thought it was necessary I wouldn't do it when pg!
post #4 of 58
It's only needed if you are Rh-, your partner is Rh+, you already have a Rh+ child, and you want another child. In that case, your body has built antibodies against the child (to prevent your immunity system from destroying it at an early stage).

It's okay to live with the antibodies, it's only a problem when you're pg again and your body attacks the new Rh+ embryo.

I don't see why it's necessary to do the shot right after or even before birth. Why not when you ttc another child, and after the Rh-factor of child1 has been verified? But I don't know for sure. I bet they do it so early "so nobody forgets." Oh, and as far as I know, having a second Rh+ baby who would be a "rh-child" if you hadn't had the shot, is pretty nasty business. It really affects the child.
post #5 of 58
Thread Starter 
It is considered good practice to give the rhogam shot at twenty-six weeks gestation. Why this is the magical point I do not know. I also know that most practitioners draw titres on all pregnant women who are Rh- regardless of what their partner's Rh status is as a routine.

The idea is that all women are, of course, promiscuous,(sp?) so who knows who the father of this child is anyway?

I am Rh-. My dh, the father of all of my four children, is Rh+; I never had rhogam, because I have a DU factor in my blood which compensates for the missing Rh factor.

Has anyone's midwife/OB ever discussed this w/ them?

I guess that I was lucky to have someone take the time and explain it to me.

I tried to explain it to someone else who shouted me down and called me an idiot when the explanation became too complicated.
post #6 of 58
I will take a shot at explaining....

Antibodies are drawn on ALL pregnant women, whether rh- or + because even rh+ women can develop antibodies against other blood types...it is relatively rare, but it has occurred (occurred in our practice just two months ago, actually). It has nothing to do with thinking that we can't trust women to be honest about who the father of the baby is.

Our rhogam does not contain mercury (I know, I looked on the package).

I can't tell you why you get it at 26-28 weeks. It's a secret.

Actually, I don't know off the top of my head. My good maternal nursing book is at work, and I can't look it up right now. I have an idea in the depths of my brain, but I can't pull it out well, so I'll just leave it at that for now.

Rhogam prevents the development of antibodies, which is why it is given right after birth. There is a small chance of a blood exchange between mother and babe, giving mom the opportunity to develop a sensitivity. Thus giving the shot after birth. But, if the babe is negative, then there is no reason to give the shot.

All rh- women should have their partner tested, for it is true, rhogam is a blood product, and carries with it the risk that other blood products carry. So if your partner is negative, there is no sense in exposing you or your babe to the very small but real risk. However, if I were rh- and my partner was positive, at this point in my life and learning, I would get the shot. Just my opinion.

I will look up why the injection is given at 26-28 weeks and let you know. I don't go back to work, though, until next Monday. Maybe before then someone will come up with the reason.

I hope this has been helpful.
post #7 of 58
Thread Starter 
Dear Lorijds:

Thank you for your input.

Do you test for and/or consider the D or DU factor in the blood when you draw the titres on the blood?

I am forever grateful to my midwife for explaining the D and DU compensating factor to me.

How would you explain the fact that I have never been sensitized despite the fact that I am Rh- and my DH Rh+, and had four children?

I know about A,B,AB, and O incompatibilities. I know that these are rare, yet when this does happen, it is really bad.
post #8 of 58
Hey applejuice;


Okay, it gets complicated from here on out, and I don't understand it all exactly, but I'll do my best. I have never heard of a DU factor, and I can't find it in any of my books. Yes, we take antigen D into account, because that is the most important of the Rh antigens. They are the ones that are usually involved in the incompatibilities between mother and babe. My diagnositc tests book says "After ABO compatibility, Rh factor is the next most important antigen...The major Rh factor is Rho (D). THere are several minor Rh factors. If Rho (D) is absent, the minor antigens are tested. If negative, the patient is considered "Rh negative" (Rh-)."

According to my maternal nursing book, there are several antigens that have isoimmunization potential. Basically, three pairs of genes control the antigens of the Rh system. These are Cc, Dd, and Ee. There are many genetic combinations possible, like cDe, Cde, etc. The book states "Individuals who are homozygous for the D antigen (DD) or heterozygous (Dd) are Rh positive because the D antigen is dominant; those whose genotype is dd, homozygous for the recessive antigen, are Rh negative."

Now, I don't have Anne Frye in front of me, both her books are at the office (Holistic Midwifery and Understanding Diagnostic Tests in the Childbearing Year). I don't know what what she would have to say about it; she might have a different take, or at least do a better job of explaining it. I am going on Mosby's medical dictionary, Hole's Human Anatomy and Physiology, and Prentice Hall's Maternal-Newborn Nursing. When I get to work on Monday, I will look it up and see if she offers any additional insight.

Do you know what Rh factor your children have? If they are all negative, then you would not be isoimmunized. If they (or some of them) are positive, then I guess you have had no blood exchange between you and your babies. According to one of my textbooks, if an Rh- woman gives birth to an Rh+, ABO compatible babe, she has a 16% risk of becoming sensitized. My pathophysiology book states that about 50% to 75% of Rh- people develop the antibody to D antigen if exposed to Rh+ blood. I don't know if that is per exposure, of if that means that 25-50% of Rh- people don't ever develop anitbodies to the D-antigen if exposed to positive blood. Of course, the book doesn't specify. Perhaps the "DU" factor that your midwife speaks of is responsible? Based on the two stats, though, it would seem to me that there is around a 25-35% chance of clood exchange between mom and babe, resulting in a 16% of becoming sensitized. That doesn't factor in the DU factor, and goes on the assumtion that the second stat from above is a "per exposure" stat, not a lifetime stat. Is any of this clear? I'm not very good at explaining things sometimes!

Also, if you are Rh-, your genotype is (dd). If your husband is (DD), then all of your children will be Rh+. If he is (Dd), then there is a 50% chance either way for Rh- or Rh+ children.

Once again, I cannot comment on the DU factor, because I have never heard of it, and can't find it in my books anywhere. I wonder if your midwife can provide further information? I'd be curious to know what tests she does to determine this factor, and where she learned about it in the first place. I certainly can't find it in any of *my* books, but all I have here is nursing school textbooks. All the midwifery textbooks are at work, and they might have more information; or at least in the case of Anne Fye, they may offer some alternative therapies or philosophies from my mainstream nursing textbooks.

I hope this wasn't too much info...I find this really interesting! Thanks for bringing it up! That is what I love about these forums...some one asks "why" and I get curious about it and go and look it up and learn more. Who needs school?

If Anne Frye has anything different to say, I'll let you know next week, unless someone else looks it up sooner!

edited for typos and a vague attempt for clarity!
post #9 of 58
just a note to those who don't know - ANYTHING can cause anaphylaxis if you are/become oversensitive to it. anaphylaxis is a severe allergic reaction where your airway swells and you are unable to breathe. Any medication, food, or substance can cause it in a person with an allergy. If you look on the package insert of almost any medication you will see that warning.

-wolfmom
post #10 of 58
I am Rh-, dh is Rh+ and so is ds.
I had the shot at 28 wks cuz at that point in my life I was too unaware of too much. Didn't do enough research and I think it is a major contributing factor in ds's severe food allergies.
That being said, SIL had a very scary experience. She is also Rh- and dh was Rh+. SHe somehow managed to get exposed to pos. blood between the initial blood tests and the next round of tests at 26 weeks. Her body was already rejecting her baby. She managed to deliver at 35 1/2 weeks without any transfusions for baby. He was in intensive care for awhile while the bilirubin was eliminated.
Then, she unexpectedly got pg with #2 3 months later. This baby had complete transfusions every 2 weeks from about 18 weeks to delivery at 32 weeks. Had she received rhogam earlier, this may have been prevented, but it is such a freak thing, who coulda predicted it?
I plan to refuse the shot in the future and follow the precauions for Rh- mom's.
post #11 of 58
okay, now I'm real curious. I've not been asked about my blood factor and dh's. In fact, neither one of us knows what blood type he is as he's not been tested nor asked.

Am I negligent by not inquiring about this procedure.....?
post #12 of 58
Laila, Rh- is most common among northern/western Europeans and those with that heritage. It's pretty uncommon among east Asians and African Americans. If you or your dh is for example "full" Afr Am, chances that you're Rh- are very small ~ but how would your dr/midwife know what someone's heritage is just by looking? I think not asking is their negligence, not yours, and I'd have it checked if I were you. And let them know that you don't appreciate their negligence
post #13 of 58
When your routine labs are drawn, and they determine your blood type, at that time it is determined whether you are Rh+ or -.

For example, my blood type is O+. That means my Rh factor is +. If someone has a blood type like O-, that means their Rh factor is -. So if your doc or midwife drew routine lab work at the beginning of your pregnancy, they would know. ALso, if you have ever had your blood typed, you would know then, too, as your type and Rh factor never change. However, your sensitivity to other antigens *can* change, which is why they draw an antibody screen every time.

I'll bet they tested you for this; maybe they told you or maybe they just said "All your labs are normal." At your next appointment, definately ask. I know at my prenatals, unless I specifically asked, my doc NEVER surrendered any information. Just told me "everything looks normal!" Sometimes you have to get aggressive--think of it as "proactive"-- with these guys (and gals).
post #14 of 58
Don't have quite the technical knowledge of the previous posters, but I am Rh- and dh and both kids are Rh+. I have had two children and I have had a rhogam shot 4 times (at 26-28 wks with both babies and right after delivery - c-section with both) and neither I nor my babies seem to have any ill effects. I am planning to have at least one more baby and will have the rhogam injections with that child too (just in case I can talk dh into #4 later ).
post #15 of 58
Thread Starter 
I think the question that should be asked here is -

...Did your healthcare provider tell you that rhogam is a blood product and, therefore, however remote a possibility, may contain the AIDS virus?

...Were you offered an alternative or allowed to refuse the injection or made to sign anything?

...Did you get the lot number of the injection if you did get the injection of Rhogam?

...Were you offered any information on the injection other than "This is how we treat mothers who are Rh-."

...Did they test your dh or dp for his blood type?
post #16 of 58
Exactly, applejuice!
I was never led to believe anything other than it was absolutely safe. In fact, I had to cancel my appt that fell in week 28 and the nurse all but lost her smock! She freaked that I might wait another week to get "such a critical treatment that could save the life of my baby.": Of course, me being a first time mom, and not having found anyone who did anything different from the norm, I figured if I didn't get the shot I was doing something horribly dangerous.
Boy have I learned to question, question, question.
post #17 of 58
Like Chelly I was ignorant the first two times and got the shot both my boys were negative. This time I did not get the shot during pregnancy but did get it afterwards as DD is positive and we are not sure if she is our last. I would never get the shote during pregnancy.

Keri
post #18 of 58
I tried so hard during this pregnancy to get some straight talk on Rhogam and mostly failed! I am RH- which of course I never realized until I was pregnant with DD1 and they brought it up at my second prenatal. But no, I had absolutely no idea it was a blood product until this pregnancy. They just made it out to be "standard protocol" and therefore assumably safe. No risk to myself or baby were mentioned. So I had the shot at 28 weeks and after birth.

With this pregnancy I learned that Rhogam is a blood product and that the particular brand Rhogam is preserved with mercury, although there are other brands that are not. I did some looking around and found a reference to the DU factor - but of course my doctor at the time looked at me like I was nuts when I mentioned it - then again, she wasn't willing to have any part of our homebirth and was busy looking at me like I was nuts anyway... I also found some articles suggesting that contrary to popular belief, there ARE risks associated with Rhogam, especially during pregnancy. Not only because of the preservatives in the shot, but the immunoglobulin works by kind of taking your immune system offline so that you can't make antibodies. Apparently there have been some very rare cases in which the fetus' immune system was permanently damaged.

Our new doctor provides a brand of RhoD immunoglobulin which does not have preservatives of any kind. In order to decide if it was something I wanted with this pregnancy, I even went to the pharmacy that carries it for my doctor and went over the insert with the pharmacist. This type is called ProRho or something like that. ??? I decided to get only the postpartum shot since we weren't doing any interventions prenatally that would cause blood to mix, ie amniocentesis, villi sampling, etc. These are the justification for giving the shot at 26-28 weeks as far as I know. The other justification is just in case an edge of the placenta would separate or something like that. Anyway, I felt pretty comfortable getting the postpartum shot , although I didn't feel it would be necessary as we were planning a gentle, intervention-free birth.

I talked about this with my doctor but apparently we missed an important part of the communication because after Eli was born last week, I called my doctor to see about getting the shot. He wanted me to come get blood drawn for a Coombs test (I think) so he could see if I needed the shot. I would have been much happier to do this prenatally but as I said, we missed a beat in communcations, I guess. So I went in to his office, got my blood drawn, and decided to trust blindly whatever he said even though it didn't stack up with all the other things I'd read about Rh. I'll ask him next week... but I certainly didn't want to worry about it when I had my sweet 1 day old baby boy to get back to. Anyway, he called later and said I didn't need the shot... and I have no idea why at this point.
post #19 of 58
Well I just gotta throw my two cents in, as a Rh- woman with a Rh+ Dh, and a Rh+ dd....

When we were pregnant, we planned on having a homebirth with our direct entry midwife. I was still seeing a Dr though cause I had insurance and I hadn't decided on the Rhogma issue. Basically I saw the Dr too cause the MW had no reliable way of obtaining RhoGam for me if I decided I wanted it. So around the issue, my MW supplied me with lots of info and told me she would support my choice. MY Dr actually told me there were no risks... when I asked for the insert and showed her where it listed risks she blew it off !! I was pissed ! This was something I took very seriously... My own parents had endured the Rh- mama factor too, my big bro was +, they weren't sure if they would have a problem with me, but I turned out to be Rh- like mom. She had lost a baby before me, can't imagine why, but who knows ? (Rh incompatibility ?).

Anyways, My MW gave me some good info, Some was from Midwifery Today, some was from Mango Mama (is that gone now ? It also had info on DU fator, though I could never find any more about it.). I collected as much info as I could, and made my best choice. I calculated a slight statistical difference set as "safer" to get the shot at 28 wks... It was really a gut wrenching decision for me.

Then the birth took many twists and turns, and in hour 26, after 5 hours of pushing (standing, kneeling, all 4's, on toilet, in bed, in bed sitting up, sqatting, leaning, screaming, silent ,shitting, puking... and more...) ...with no progress and merconium leaking, we had to go to the hospital, eventually in surgery.

After dd was born they tested her cord blood (I believe, they didn't take it from her) and found she was Rh+. The tech came by to give me the shot... right after blood for a coombs test... I was like, well can't you test me and THEN tell me if I need the shot ? He said no, this is how they do it, they test you, but give you the shot, before they do the test to see if you need it :

And anyways, I knew I had likely been exposed to some blood in the c/sec birth, and that someday I might want another child, so I took the shot. In this case I felt it was warrented, ,what with by surgical exposure to + blood and wish for future child. And I wasn't pregnant anymore, so I wasn't exposing my baby to mercury (except, I was BFing but less risk).



Risk for exposure increases:

~When the cord is cut before it finishes pulsing and/or placenta is delivered

~During a surgical birth

~At any time where the blood could mix such as amniocentesis, villi sampling, surgery including c/sec birth, If the placenta were tol oosen from the wall prematurely (I forget the term just now )



Anyways, I wanted to say, find out all you can, talk to everyone, and make your best decision... It was hard for me to get the shot because I didn't want it on just about all levels, but I knew it was best for us. And I wound up with an exposure, so perhaps it has helped preserve my future fertility. It feels in retrospect like intuition took over when I made that decsion I haven't noticed any effects, thank goodness. My Dr was unable/unwilling to help me get the thimerserol free (mercury free) shot. She was such an A$$ about the whole thing.

It's not for everyone, but don't feel bad if you have to get it either. We all do our best.


And those time frames are probably mostly cause that is the times they studied in the studies on Rhogam. For instance, you are supposed to get the post birth shot within 72 hrs.... why ? They don't know if it works after that, but they studied up to 72 hrs and that timeframe works so they are sticking with it.


ABTW, and this will help you feel better if you do/did get the shot, the people who supply the human products for the shot are pretty consistent, they often "donate" (paid ? I dunno...probably) for years on end. My point is, their medical histories are checked and monitored more than, say, whoever walks in off the street into the clinic to donate blood for cash, KWIM ? Anyways it helped me feel better, my general basis being to avoid meddling in the human body in general..., well, I was uneasy to say the least.

Hey thanks if you stuck with me this post was incredibly long !!
post #20 of 58
Thread Starter 
Sounds like most of you have done your homework.
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