Rhogam

[boigrrrlwonder]

For Rh- mothers who have Rh+ babies, did you choose to get rhogam? How did you make that decision?

[Science Mom]

I am Rh negative and my husband is Rh+ and our babies' blood wasn't typed prior to leaving the hospital so I received Rhogam.

SM

[ripcurlgirl26]

I did with my first, both the prenatal and post partum dose. I actually had a sore butt and walked with a limp for a week due to the first shot.

This time around, I'm not getting the prenatal for sure, and probably not the post partum one b/c this is my last child.

[CortLong]

With my first pregnancy I got it at 28 weeks and then postpartum (dd was RH pos)

With my second pregnancy I got it after my miscarriage.

With my third pregnancy I only got it postpartum (dd was RH pos)

With my fourth pregnancy I got it postpartum and only took a half dose (ds was RH pos)

With this pregnancy I'll get it postpartum if I feel necessary. Definitely not prenatal.

[Pariah]

I got it prenatally (9 weeks, had random spotting) after receiving completely incorrect information from a doctor. I refused the regular 28 week dose, but I did get it postpartum.

[EENS]

THere is a thread on Rhogam over in the "beyond birth" forum I started. Lots of good information there.

I'll try to link it.

http://www.mothering.com/discussions...d.php?t=805214

I'm rh - with a + husband. I've had it all 3 pregnancies. This pregnancy, I'll be declining the 28 week shot and getting the post partum shot if the baby is rh +.

[CanidFL]

I got it after DS was born. It was mercury free according to my midwife.

[MsLondon]

I refused it. I said I would take it postpartum incase I was going to have another baby but I didnt need to in the end because DD was also rh neg.
So Im glad I went with my instincts and refused it.

[mama_in_PA]

I had questions about this too and discovered that there really isn't a whole lot of research available on RhoGam. I had it with my other 2 babies because I didn't know any better. This time, however, I did some research and discovered that the RhoGam only reduces the chances of fetal autoimmune hemolysis by 1-2%. I really didn't feel that was significant enough to subject my unborn baby to the potential risks of such a vague vaccination. Rather, I chose to have a thimerosol-free RhoGam vaccination after the baby is born providing the baby is Rh+ but NOT during my pregnancy.

[jest]

With my first, I did not get the prenatal shot. I had them test my baby's cord blood after birth and he is RH- so I also did not get the postpartum shot.

I will do the same this time: no prenatal shot at all but I'll get the postpartum shot ONLY if the baby is RH+

[Serenity Now]

I am rh sensitized to anti E. There's no rhogam for what I have, it's just one of those things.

I was sensitized during a pregnancy. We're not sure when, since there were no signs of bleeding or anything. At the begining of my pregnancy I was not sensitized, and in the delivery room they discovered that I was. The Coombs (think I spelled that right) showed that my ds was not affected, but he stil had a billi level of 21 at 3 days of life.

I am now being monitored very carefully by my OB and once my titers get to 1:4 I am risked out of our small hospital and will be seen at a large medical facility. The ACOG strongly recommends that all rh sensitized pregnancies not go past 38 weeks, and after reading the literature I agree. The risk of sudden death in utero go way up, and it's rare for a 37 weeker to die. My son was a 37 weeker, BTW, and was a totally healthy newborn.

Depending on my titers, I will need to get u/s towards to end to check for edema and other signs of hemolysis. If that doesn't look reassuring, then an amnio is the recommended course of action, and if that looks bad they will either deliver immediately, or try an in utero exchange transfusion, but the risks of death with that are very high.

Things aren't over once the baby is born, however. I am guaranteed a 3 or 4 day hospital stay because of jaundice. Both my kids, who were not affected by rh sensitivity had billi levels over 21 at 3 days of life. We were able to take them home with a blanket, but that won't happen this time. If the lights can't take care of the billi, an exchange transfusion may be in order, and for some reason that drs aren't sure of, babies with born to sensitized mothers are at a higher risk of kernicterus (think I spelled that wrong) at the same billi levels as babies born to mothers who aren't sensitized. Then of course there's an increased risk of hemolytic disease of the newborn, death, and edema, but I'm sure you knew that.

In short, it becomes a medically managed nightmare, not just during pregnancy, but also after delivery. I don't mind all of the extra tests I have to go through, but it breaks my heart that my little one will have to be laying alone under lights for several days instead of being at home in my bed being snuggled by my husband and myself.

And for what it's worth, it is illegal in my state to give a vaccine with thimerasol in it. I really wish rhogam would have been an option for me, but it wasn't, and now I'm stuck dealing with something I never thought I would have to.

[japonica]

Serenity Now: I'm sorry you've had such a bad iso experience but I wanted to post and say that not all iso pgs are this way.

Depending on my titers, I will need to get u/s towards to end to check for edema and other signs of hemolysis. If that doesn't look reassuring, then an amnio is the recommended course of action, and if that looks bad they will either deliver immediately, or try an in utero exchange transfusion, but the risks of death with that are very high.

The risk of death from IUTs is not "very high." It is how iso pgs with hydropic babies are managed. I'm on an online support group for iso moms that has been going strong for about 3 years now. At least half of the 50 or so moms have had IUTs and there have been no direct identifiable deaths from the procedure. Some have had more than 3-4 transfusions each during the pregnancy. And some have had three or more iso pregnancies! The risk of death is higher to leave an extremely hydropic fetus as is. Also, after 33 weeks, most peris won't transfuse any longer and prefer to deliver. Finally, the monitoring is more usually done after 22 weeks (not later on) or so when IUTs are possible--depending on titers. The monitoring consists of MCA (mid-cerebral artery) dopplers, done every 2 weeks (or more often if titers are higher). During my first iso pg, my titers stayed 1:2 until third tri and then went to 1:8 and they only started dopplers around 30 weeks. This time, my titers are 1:64 and I'm starting them a lot earlier.

I am now being monitored very carefully by my OB and once my titers get to 1:4 I am risked out of our small hospital and will be seen at a large medical facility.

Your doctor and hospital must be very cautious. Most of the literature I've read doesn't even consider monitoring unless titers reach 1:8 or 1:16 or more.

Things aren't over once the baby is born, however. I am guaranteed a 3 or 4 day hospital stay because of jaundice. Both my kids, who were not affected by rh sensitivity had billi levels over 21 at 3 days of life. We were able to take them home with a blanket, but that won't happen this time. If the lights can't take care of the billi, an exchange transfusion may be in order, and for some reason that drs aren't sure of, babies with born to sensitized mothers are at a higher risk of kernicterus (think I spelled that wrong) at the same billi levels as babies born to mothers who aren't sensitized. Then of course there's an increased risk of hemolytic disease of the newborn, death, and edema, but I'm sure you knew that.

Yup, my DD spent a week under the lights (2 of them at once!), but she made it through this fine and is the healthiest kid I know today. The week with her in the hospital was difficult, but for us it was a means to an end and not any hardship for us. Again, of the moms on the BG, very few have had any lasting complications with the rh disease, the worst I can think of now is issues with baby making his/her own RBCs in a couple of cases, but it was managed and after the antibodies clear the system at the 3 month point, they did fine.

Like I said, sorry you have to deal with all this. I'm on my second iso pg--due to rhogam/winrho failure--so even getting the shots are no guarantee. And I had the blessing of both my OB and the perinatalogists before I got pg. If you'd like to PM me, I could pass along the support group link so you have a group of women to talk to who have all been there too...we have anti-D, anti-C/cs, anti-E/es, anti-S/s, you name it. Iso pregnancies aren't easier on the stress levels but they can be managed appropriately and have good outcomes.

[Spark]

I am Rh- and my partner is Rh+. We've had three children and I'm currently pregnant with my 4th babe. I am NOT Rh sensitized despite NEVER receiving the RhoGam shot.

I believe that sensitization has more to do with modern birth practices than with getting RhoGam. I mean, look at the history of RhoGam, first women got it post partum. Then, that wasn't working well enough, so they started getting it during pregnancy. That still isn't working well enough, so now they recommend getting RhoGam with any bleeding, and 1-2 times routinely during pregnancy and then again postpartum.

I think avoiding the following modern medicine tendencies would result in MUCH less sensitization even without RhoGam:
Rushed 2nd stage labor
Forced pushing
Cord clamping before natural delivery of placenta
Rushed 3rd stage labor
Episiotomies
Lack of knowledge in how to prevent tearing

[liseux]

Serenity Now, I am also sorry to hear that you're dealing with a challenging ISO pregnancy.

Japonica said it so well though, these days it is the best time to have such a pregnancy.

I have had 2, anti-d iso pregnancies, first was born at 36 weeks and did 7 days on lights. The second was born at 38 weeks and did no lights and went home with me. Its hard to say how a baby will do or even if/when the antibody will "see" the baby. I definitely agree with getting them out as soon as its safe. Also, I don't have experience with anti-e, but where I am even 1:8 is not considered very high risk. I only had 1 MCA at 22 weeks and then one at 34, 36 & 38 weeks. The only reason I had to have an MCA at all was because it was my 2nd ISO & statistically they can get worse each time --although not always.

A couple of thoughts on after the birth: The good news is that even affected/anemic infants (once they get treatment) go on to have a completely normal, healthy life. But it can be hard in the first few days/weeks. I have been there with my newborn being born with jaundice and being put straight on the lights, with doctors telling me its the super scary type of jaundice, not typical physiological jaundice. For me it was doubly hard b/c it was my first baby after a loss and I wanted to be in bed with him at home. What I did was have a sort of schedule where he was in my bed nursing until he fell asleep, then he slept under the lights. Then he would wake up and root & be brought to me before he cried. Then he would spend an hour in bed with me just eating until he slept & then back to sleeping under lights. He also had all of his jaundice-checking heel sticks done while he slept. I think not wounding a baby, no circ, no hep B, that helps them get their RBC's in order early on too.

With my 2nd, since he didn't have that instant jaundice I kept him with me from the start and stayed up the first night, all night giving him as much colostrum as I could. I kept that up the whole time in the hospital since colostrum is the best laxative & more bm's moves the jaundice out. He never did get jaundiced although he did test coombs +.

Also, there are new approaches like IVIG that are helping women with very high titers to avoid IUT's. I wouldn't have considered getting pg again until I read about IVIG, it can do amazing things for moms & babies.

Spark, I agree with your list, I would also add to avoid amnios & CVS. Unfortunately I tried for that approach to birth, everything went terribly wrong. I agreed to pp rhogam after a huge bleed & it didn't work. But, I think the chance of getting sensitized with no rhogam at all is 16 %, which could be an old number--but its pretty low & sensitization is fairly rare.

[wannabe]

I'm rh-, my husband is +ve, so I've had prenatal rhogam with both pregnancies, but both kids are -ve, so didn't need any after the birth.

Spark, before Rhogam, women had babies who died, then they had miscarriages. You can choose not to have it, but please don't pretend that it's not a real problem or cause of illness, death and heartache.

[Spark]

Originally Posted by liseux

Spark, I agree with your list, I would also add to avoid amnios & CVS. Unfortunately I tried for that approach to birth, everything went terribly wrong. I agreed to pp rhogam after a huge bleed & it didn't work. But, I think the chance of getting sensitized with no rhogam at all is 16 %, which could be an old number--but its pretty low & sensitization is fairly rare.

Oh, yes those would be very good additions for sure. I would have had RhoGam in your case for sure, too. I'm sorry it didn't work for you though. I think that number is either old or done using cord clamping, forced 4th stage, etc. I really disagree with it. I work with a MW who has been assisting in births for almost 30 years now. In that time, she has given the RhoGam shot a total of once. She's had many Jehovah's Witness women who were Rh- and partners were Rh+ and yet still, they all had as many babies as they wanted. I'm not a rarity for her practice, I'm the rule. That said, if I was in a car crash or had something go wrong at the birth, I'd probably do RhoGam.

I'm so sorry so many of you are dealing with sensitization, despite using RhoGam. It really is a problem on the rise from what I understand. And, yes, I have to agree NOW is the best time to be sensitized and be pregnant.

[Spark]

Originally Posted by wannabe

Spark, before Rhogam, women had babies who died, then they had miscarriages. You can choose not to have it, but please don't pretend that it's not a real problem or cause of illness, death and heartache.

Wannabe, I never said it wasn't a real problem or cause of illness, death or heartache. From what I understand this is a thread sharing our experiences. I do realize that my perspective is not main stream, but don't flame me for that.

[phathui5]

I'm Rh- and dh is +. I choose to skip the prenatal shot but I do get the postpartum shot with Rh+ babies (2/4).

[momtoafireteam]

So if it is our last baby, we do not need to get a post partum shot? I am so grossly uninformed on Rhogam, and I am angry at myself for having 11 shots (over 7 pregnancies) without knowing anything. But if this baby is our last baby, do I still need to do it?

Also, how do you know if you have been sensitized to it? Is that a specific test, or do you get signs that make it obvious?

[japonica]

So if it is our last baby, we do not need to get a post partum shot? I am so grossly uninformed on Rhogam, and I am angry at myself for having 11 shots (over 7 pregnancies) without knowing anything. But if this baby is our last baby, do I still need to do it?

Also, how do you know if you have been sensitized to it? Is that a specific test, or do you get signs that make it obvious?

JMO, but if it were my last baby, I wouldn't bother with the shot. And even if it weren't my last, I wouldn't have a prenatal one (hindsight's 20/20 for me too). Don't be too hard on yourself for past choices. Check with your MW/OB and see what they suggest but I bet an OB will encourage a shot anyway, even if it is your last one.

About getting sensitized, it showed up in my early pg bloodwork of my second pg (I was sensitized at the end of my first pg, sometime after 32 weeks). I had a titer of 1:1. Then there was the debate with the doctors as to whether or not I was truly sensitized or if it was the residual from the winrho shot showing up in the b/w. It wasn't until my titers started to rise in the second tri that they agreed I was well and truly sensitized. There's no physical signs of it...just what comes back from your labwork.