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rhogam help

post #1 of 41
Thread Starter 
Mods - please move if this is in the wrong place.

Can someone please explain the theory behind the rhogam shot to me or at least point me in the right direction.

I'm 22 weeks and due to get this thing in a few weeks. I've had the shot with all 3 of my previous pregnancies, never thinking to question it. Now, the red flags are really going off in my head regarding this shot. If I do consent to this shot, I will insist on the mercury free version, though I do understand that there are other dangers and concerns regarding this shot.

One more thing. Is the book "Anti-D in Midwifery" by Wickham worth the read to a completely non-scientific mind or would it be over my head?
Thanks so much!
post #2 of 41
Hi there,

Well, start looking at the thread in my siggie for a start.

I guess the other question is how many more pregnancies you're planning...if you're getting near the end of your baby days, there is less reason to get it (the main goal of it is to prevent sensitization in future pregnancies).

The worst that can happen if you don't get it is that you get sensitized. I got it 3 times during my first pg and was sensitized anyway and now I'm on my second sensitized pregnancy. So, being isoimmunized does not mean the end of childbearing.
post #3 of 41
I got the mercury filled version when pregnant with DS and suspect it has a link to his autism. I declined the 28w shot with DD and did take the postpartum shot, since I was planning one more child. I am declining the 28w shot again and am not 100% sure on the PP one this time. This is my last child, but you know....I plan, god laughs and all that.
post #4 of 41
If you look at the rhogam insert, there is a 0.5% difference in sensitization outcome between getting the shot at 28 weeks and postpartum and just postpartum. I refused at 28 weeks and will receive it after the baby is born if he is +.
post #5 of 41
I had the exact same concerns as I am supposed to have RhoGam at my next appt as well. Check this link: http://www.vaccinetruth.org/rhogam.htm. I decided to not have it during my pregnancy and if I do end up with an Rh+ baby then I'll have the thimerosol-free vaccine AFTER baby comes.
post #6 of 41
Thread Starter 
Quote:
Originally Posted by japonica View Post
Hi there,

Well, start looking at the thread in my siggie for a start.

I guess the other question is how many more pregnancies you're planning...if you're getting near the end of your baby days, there is less reason to get it (the main goal of it is to prevent sensitization in future pregnancies).

The worst that can happen if you don't get it is that you get sensitized. I got it 3 times during my first pg and was sensitized anyway and now I'm on my second sensitized pregnancy. So, being isoimmunized does not mean the end of childbearing.
Great link, thank you so much!
post #7 of 41
Thread Starter 
Does anyone know how long rhogam stays in the mother's system? I had it after my last child's birth, which will be 3 years ago at the time this baby is born. Does it make sense to find out HER blood type (I can't remember offhand) or will the antibodies have cleared my system?
post #8 of 41
Thread Starter 
Quote:
Originally Posted by mama_in_PA View Post
I had the exact same concerns as I am supposed to have RhoGam at my next appt as well. Check this link: http://www.vaccinetruth.org/rhogam.htm. I decided to not have it during my pregnancy and if I do end up with an Rh+ baby then I'll have the thimerosol-free vaccine AFTER baby comes.
From my reading so far, looks like I may be coming to the same decision as you. Thank you for the link.
post #9 of 41
Quote:
Originally Posted by EENS View Post
Does anyone know how long rhogam stays in the mother's system? I had it after my last child's birth, which will be 3 years ago at the time this baby is born. Does it make sense to find out HER blood type (I can't remember offhand) or will the antibodies have cleared my system?
It's a passive immunity thing - they specifically want to prevent you having an immune response. So the rhogam antibodies would have been cleared by you in a few weeks.

If you're sensitised the reaction just gets stronger with each exposure (ie, more antibodies more quickly)

If you got the shot after the birth, she'll be rh+, because they test before they give it. Early in this pregnancy they'll have tested your blood for rh antibodies so you'll know if you're sensitised or not.
post #10 of 41
Quote:
Does anyone know how long rhogam stays in the mother's system? I had it after my last child's birth, which will be 3 years ago at the time this baby is born. Does it make sense to find out HER blood type (I can't remember offhand) or will the antibodies have cleared my system?
Quote:
So the rhogam antibodies would have been cleared by you in a few weeks.
Just wanted to say that's not necessarily the case. I had my last winrho shot in August (03), when I had my first baby. When I was pregnant again, my prenatal blood work in April (8 months later) came back positive for anti-D (1:1). I asked the GP and he said, "Oh, it's probably just a residual from your last winrho shot." But he sent me to a peri for a consult just in case.

The peri saw me in May, looked at the 1:1 titer and said the same thing...residual antibodies from the shot. Turns out it was not just the residual winrho...I was actually sensitized, but both doctors assumed the winrho could stay in my system for that long. So, it must be possible.
post #11 of 41
I found the book "Anti-D" to be a fairly easy read. I am from a medical background though, I read it all while out for coffee one am. I did recently loan it to another mom who is from a non-medical background, and she enjoyed it as well.
post #12 of 41
The Rhogam is given at 28wks, IF mom shows negative for antibodies at that time, to prevent sensitization between then and birth. It is believed that the Rhogam is good for about 12 weeks, but NO ONE REALLY KNOWS, and it probably varies from woman to woman.

Often, Rhogam is given to any rh- mom after birth, without blood testing the baby to be sure it is rh+ after birth. Just because you got rhogam does not mean they blood typed your baby after birth.

Sensitization CAN OCCUR, even in women who faithfully get the rhogam. Why this happens is not certain; it may be because too small a dose was given to overcome the amount of fetal blood in the maternal circulation; it could be that rhogam simply doesn't work for all women. What is in an injection of rhogam is a particular amount of antibodies; more or less can be given tho there is a 'standard dose' which is 'generally applied' to cover 'average fetal blood amt in maternal circulation'. Problem being that maybe YOUR baby let MORE than the average amt of it's blood into your circulation--then 'standard dose' would not be large enough to disable the rh factor before your immune system responds by making its own antibodies.

How and why rhogam works is not a certainty. It is generally believed that by injecting the antibodies (harvested from rh- people purposely exposed to rh+ blood), one or both of 2 things may be occurring: one is that those antibodies will destroy all rh+ fetal blood cells that got into maternal circulation, BEFORE the mother's immune system has time to respond to the presence of the rh factor from baby's blood. And/or, that the presence of these antibodies basically 'tricks' mom's immune system into believing that it already has responded to the presence of fetal rh factor--so that it won't respond.

Whatever docs are saying to mothers like some who posted here is PURELY CONJECTURE.

There are specific blood tests that can be conducted during pregnancy and after birth to determine IF there has been a fetal-maternal transfusion, and if so, then HOW MUCH rh+ fetal blood cells are in mom's system. Only by doing these tests can you know for certain if you even need the Rhogam, and if so, then what dose is actually appropriate.

Kleihauer-Betke test determines presence of rh+ fetal blood cells in maternal circulation

Rosette test (or 'Sheep's Rosette') determines amount of fetal cells present.

These tests are rarely done because a) families don't tend to know about them and b) rhogam is considered so 'safe' as to be 'harmless' to a woman who doesn't actually need it (if there has been no sensitization from her rh+ baby; if she turns out to be carrying an rh- baby anyway). They also don't do these tests because most women do not get sensitized anyway--rhogam for all is to cover the need of a small %. And the docs figure that standard dose is good enough for the majority who do need it.

But you still need to understand that rhogam cannot provide any guarantees that you will remain antibody-free, or remain antibody free forever. It does work for most women, however.

If you can find Anne Frye's Understanding Diagnostic Tests in the Childbearing Year, there is lots more info in there.
post #13 of 41
Yup, sure seems to be a lot of uncertainty and conjecture re: rhogam...I think part of the issue is guesswork re: how this whole immune aspect works (oh, let's inject antibodies, hope for the best, it should work) and the other part of the equation is doctors who don't believe in rhogam failure (much in the same way they don't believe in vax failure). Up until my titers started rising in the second tri, I was continually told it was just a residual trace of the winrho tricking the bloodwork.

And I did have a Kleihauer-Betke test...I recall reading on the autopsy/pathology report that the ME noted a "significant feto:maternal hemorrhage" and mentioned twice in the report that this was "of note" with an Rh neg mother. But the three doctors I saw afterwards, none picked up on this. Sigh. And folks wonder why I endlessly question and double guess doctors.
post #14 of 41
I just started reading the Anti-D in Midwifery book the other day. I come from a scientific background (engineer), but I'm finding it to be a little dense (maybe part of it is the language thing, too -- UK vs USA). It could also be because I'm chronically sleep-deprived . Anyway, I still think it's a very worthy read, and am amazed by just how little I knew about this (I've received the shot at least 4 times in my life, and am horrified that no one informed me of the risks ... or that I was even receiving a blood product!). I would recommend the book.

Quote:
Originally Posted by MsBlack View Post
There are specific blood tests that can be conducted during pregnancy and after birth to determine IF there has been a fetal-maternal transfusion, and if so, then HOW MUCH rh+ fetal blood cells are in mom's system. Only by doing these tests can you know for certain if you even need the Rhogam, and if so, then what dose is actually appropriate.
I am going to be tested soon to make sure I'm not already sensitized. Assuming I'm not, based on discussions with my midwife, I think it's likely I will decline the prenatal injection, and get tested for the presence of fetal blood directly after the birth. If none is present, I will decline the post-partum injection as well. If some is present, I may have the shot. Still have to finish the book and decide for sure, though.
post #15 of 41
I am also rh sensitized, I had too little rhogam after a huge bleed. I only did it pp, once baby's blood was typed. Now that I'm sensitized I know that my dh is heterozygous, we can only have rh+ kids.

"If you're sensitised the reaction just gets stronger with each exposure (ie, more antibodies more quickly)" wannabe

Actually, this is not always the case. My titer with my 1st sensitized pg was 1:32 and my second was 1:8--not considered a big deal around here. My first ISO baby had anemia and jaundice at birth & stayed on lights for 7 days, my 2nd went home with me.
post #16 of 41
i am rh neg and recieved rhogham. i am wondering; is it harder to get pregnant after recieving it?
post #17 of 41
Hi liseux *waving*
Quote:
Now that I'm sensitized I know that my dh is heterozygous, we can only have rh+ kids.
You mean homozygous, right? (Same as our situation). If your DH was heterozygous there would still be a chance every pg for a rh- baby.

Yeah, titers can go up and down (I wish mine would go down--LOL). I'm currently at 1:64 and going for my peri consult next week. With my first iso baby, my titers were only 1:8 by the end and she was still under the lights for a week. It's amazing to see so much variation with everyone's experience of this condition and even from pregnancy to pregnancy.

Arismama, I don't know offhand if it makes it more difficult to conceive. I imagine health care providers will say no, but maybe someone else has other stories to share.
post #18 of 41
Quote:
Originally Posted by arismama! View Post
i am rh neg and recieved rhogham. i am wondering; is it harder to get pregnant after recieving it?
Anecdotally... My rh- mother has four children. I'm not entirely sure how many shots she had. She always told me I'd have to get a shot in pregnancy since I'm negative as well, so I assume she probably had both the doses, unless they tested at birth before giving the pp one.

I hope it doesn't make it harder to get pregnant, since I had two or three doses - I don't know why it would, though.

I'm definitely going to be doing those tests next time.
post #19 of 41
Okay, I just read the thread in Japonica's siggy. I am - and dh is +. Can I still skip the 28 week shot? Sorry to butt in.
post #20 of 41
I am Rh- and really like this web site.
http://www.unhinderedliving.com/rhogam.html


My problem is not worrying about the 28 week shot because I KNOW I will not take it unless certain situations arise....

But My problem is after the birth... I am a homebirther and it is hard to find someone willing to give you a shot after you had a baby at home!

Anyways I did not get the shot at ALL during my last pregnancy because it was my *LAST* pregnancy:

Anyways I am 9 weeks now.. LOL
I did have my levels checked and I was not sensatised at all.. I attribute that to a patiend midwife and a good birth experience
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