Don't want rhogam - HELP!

[N2theWoods]

My midwife informs me that because my blood type is A negative, I have to have a Rhogam shot. She just sent me an e-mail about it & is ordering the shot. This is my first baby.

Everything that I've read says that this isn't an issue until the second baby because the antibody formation in the mother occurs mostly in the first few days after birth, in a response to the mixing of fetal and maternal blood at the time of the birth -- unless I've had a potentially bad blood transfusion, miscarriage or trauma in this pregnancy and I've never had a blood transfusion, miscarriage/abortion or any issues with this pregnancy.

I REALLY don't want to take a shot that I don't need - especially one containing human blood products.

I want to refuse the shot. Does anyone have any compelling reasons why I should/shouldn't refuse? Help!

[pamamidwife]

The idea behind Rhogam is to protect the second baby - although prenatal Rhogam is just a preventative in any pregnancy.

You can turn it down. You have the right to. I would do it soon, though, because if your mw is paying out of pocket for the Rhogam, it is pretty expensive and you will want to let her know (it has a short shelf life and needs to be refrigerated sometimes).

[Elphaba]

your baby hasn't even been born yet, so there's no way to know what his/her blood type is. could be negative, could be positive. why get a preventative shot for something that may not even be an issue?
FWIW, i'm A- as well and dh is A+. i refused the 28 weeks shot, but dd was A+ so i relented and got the shot. maybe it worked and maybe it didn't. i just lost a baby and i can't help but wonder if the rhogam didn't work on me and that's why.
if you don't want it, just say you'd prefer to wait and see what the baby's blood type is. my midwives were all displeased with me for refusing it, but oh well. my body, my choice.

[Carolinamidwife]

Here is some info for you:

http://www.thebirthsource.homestead.com/rh.html

You are correct in assuming that during a normal first time pregnancy there is little risk of blood mixing. That is the issue at hand with 28 week prophylactic RhoGam. As for postnatal RhoGam, Rh sensitivity tends to increase with parity and if you become sensitized you will fight off any future embryos like they were an infection.

I am not a huge fan of the prophylactic shot (I refused mine) but I do believe that anyone planning subsequent pregnancies should be very sure of their decision to decline the shot postnatally.

Amy

[N2theWoods]

Thank you everyone - and thank you Sheena for the link! It was great. My biggest fear right now is that they'll refuse to work with me if I refuse the shot and I'll have to give up my home birth. which would make me VERY unhappy. But, my husband and I don't even KNOW his blood type, so IMO assuming I'll need the vaccine is premature until we know for sure whether he's Rh - or +.

This is what I wrote to her:

****
Have been searching for information... Everything that I've read says points to this not being a prenatal concern until the second baby because the antibody formation in the mother occurs mostly in the first few days/weeks after birth, in a response to the mixing of fetal and maternal blood at the time of the birth (unless I've previously had a potentially bad blood transfusion, miscarriage, amnio and/or trauma in this pregnancy and I've never received a blood product in my life, or experienced any of the other risk factors.) In which case, I might be a candidate for the 72-hour postnatal injection, but shouldn't need the prenatal one at all.

I would REALLY like to avoid receiving a human blood product at all, and especially during my pregnancy unless there is compelling evidence that I need it. It sounds like, from what I have read, that I really am only in a position to need the post-natal shot and that only if the baby turns out to be Rh+. Also, I'd like a chance to determine Mike's blood type, as if he is Rh negative then there's no need for me to have either injection.

So, I know it's an expensive shot -- please don't order it until we have a chance to talk further. Can we have an Eldon card on hand at the birth to test the baby's blood when he/she arrives?

[moonshine]

My first step would be to check your DH's bood type. I am negative and we found out that DH is too. Seemed strange to me that the midwives wouldn't first ask us to check his blood type to find out if you even theoretically need the shot. I had to bring it up with mine.

[moonshine]

DD woke up b/w my reading the thread and posting my reply, and I missed yours.

I wonder if they now make Rhogam shots w/o mercury? I had heard they they don't.

[N2theWoods]

According to RhoGAM's website (http://www.rhoghamfyi.com), they stopped using Thimerosal in the Rhogam shot in April 2001. (I was concerned about that, too & looked it up.)

[Spark]

Margo -- here is a thread a couple weeks back that really has a lot of good info on it. http://www.mothering.com/discussions...ghlight=RhoGam

Personally, I would NEVER get the shot during pregnancy. I just don't think there is a need, unless you were in an accident and bleeding internally or some other strange occurance.

The midwife I use and myself, we both believe that Rho-Gam is not needed when birth is handled appropriately. You can read my post on that thread, but basically, you should know that my midwife has been assisting in births for over 24 years now. She has never used RhoGam and never had a woman sensitized. She never pulls on the cord, forces pushing, and in general leaves Rh- moms alone more to birth. Read more on that thread for more info.

Best wishes making your decisions. And, let's just hope your DH is - so you don't have to make any more decisions! That's always the easiest way!

[teachinmaof3]

With my third pregnancy (home/water birth) I didn't have the 28wk shot. From the research I did and talking to my mw, I discovered it isn't necessary. My mw came for a PP check a few days later and tested the baby's blood...she's + so I had the PP shot.

If I have another baby I will refuse both b/c it will be our last child.

[Chelly2003]

I'm on my third baby with a + man, I'm -
Both my children are - as well, and I've had my blood tested and I don't have any antibodies.
My baby's cord blood will be tested this time, and only then will I get the shot if this baby is +
You have 72 hours to get the shot after the birth....

Good Luck

[georgia]

Chelly, I have two - babies, too with a + daddy! From what I understand, the 72 hour thing is only an assumption, based on a protocol that was used on female prisoners in an old research study....if I remember correctly. I was worried about the timeline, personally---but fortunately, it's not like a stopwatch starts the minute the baby is born If baby turns out to have + blood on two different Eldon cards, mom can choose to have the shot, if she plans on having more children in the future. If my memory also serves, there was a non-human blood product, maybe WinRho? I had BayRho (no thimerosal) on-hand at my birth---and ended up getting the shot several days later (whole 'nother story). I would most definitely have baby's dad blood tested first and foremost. It seems really premature to start talking Rhogam w/o knowing if it's even an issue. Rhogam shots are PRICEY, too----and getting them can be a hassle---esp. for those of us who don't like dealing with the "medical establishment" ---and who does???

Best wishes,

Amy

[applejuice]

There was a thread about rhogam a few months ago either here or in vaccinations.


Rhogam is a blood product, and as such, does carry the danger of carrying the AIDS virus.

Your DH's blood type is important. Have they drawn titres on you looking for a problem?

I am O- with a DU factor, which is a compensating factor. Ask about this. My DH was O+. I had four babies without rhogam. My doctor, Ettinghausen, has a website about his management of homebirth and the rhogam question.

He would draw blood and take a cord sample at birth and then give rhogam if necessary within 72 hours of the birth.

[N2theWoods]

My doctor, Ettinghausen, has a website about his management of homebirth and the rhogam question.

Was looking in my library for his books, but they seem to be out of print & I can't get my hands on them. Do you have the website address? I did an internet search, but couldn't find it -- would love to read what he has to say about it!

Will also ask my midwife about testing for the Du factor -- she's researching the Rh negative thing now -- I actually suspect she doesn't know as much about it as she should.

Margo

[pamamidwife]

Hey, Margo, I would also suggest two Eldoncards just in case. Over the years, I have stopped using them due to incorrect results. Now, I just send the blood over to the lab (which they'll need anyway if Rhogam is necessary) - the typing at the lab is around $10.

[mum2lillie]

I'm the one who started the previous thread about RH sensitization that Sparklin' suggested reading. I agree with pamamidwife totally about testing the blood with a lab and using 2 eldon cards. It was really stressful wondering if the eldon card we used pp was correct. I never doubted it until I was already pregnant with the second baby and had not gotten the rhogham after dd was born because the card said she was negative. There were plenty of chances for cross contamination during the 3rd stage of labor and had she been +, I would have probably shown antibodies. In the last month, I've spent $130 to make sense of this all. Thank goodness, the antibodies test came back negative so dd is probably - like me.

This pregnancy we will not be ordering a shot. I am going to labor and birth alone so that there will be the minimal risk of cross contamination if the baby I'm carrying now is +. The very small amount of research on the subject shows that if a woman is left alone, especially during the 3rd stage, the rh+ blood won't pass through the placenta.

Just to give you a little tidbit about the blood that goes into the rhogham shot. My father is rh- as is my mother. He tried to donate blood, but he was honest with them about having TB and they said that he couldn't because it would pass through. There are so many diseases that aren't tested for when they mix the blood for the shot. Can you imagine all of the people who aren't honest about what they've had in the past? Imagine getting that shot into you just after you've had a baby. It's not just a risk of AIDS or mercury poisoning.

[girliemama]

How do you know you haven't had a miscarraige? Most women probably have, but it just happened like a normal period. I would take the shot.

[N2theWoods]

Thanks everyone! I had a nice chat with my midwife, who admitted that she isn't as informed as she could be about the whole thing. She said a presentation was given while she was in training about how the US treats rh negativity too aggressively, and meant to look into it further and hadn't had the time. Well, I forced the issue for her, so she's been investigating too!

I do have to sign an "outside of standards of care" waiver, but she agrees that this baby is in no danger (I am 9 weeks before my due date,) and that any shots given would be given to protect the next baby, and not this one. She also agrees that my husband needs to get tested (he's got a requisition from his doctor and is going in next week,) and the baby as well.

We met with our pediatrician last week and she will be ready to do a blood draw and test the baby at our first visit.

My biggest fear was that my midwife would drop me, which she is not going to do, or that she would be offended that I refused the test, which she is absolutely not. In fact, she's glad that I forced the issue and made her learn more on the topic.

Thanks so much, everyone, for your support & advice - it helped enormously to have this resource - I was so stressed!!

[pamamidwife]

you don't have to draw blood from your baby - you can just get cord blood using a syringe before the placenta is born. No pokes for baby that way.

Glad to hear that things are going well and your wishes are being respected.

[Elphaba]

girliemama, if a miscarriage occurs before 8w, rhogam is not standard protocol. in the cases where women have had m/c and not been aware, it certainly would have been before 8w.