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Is Rhogam still risky or is it now safe? - Page 2

post #21 of 38
Just a few notes and thought I'd chime in...

About the post with the possibility of rhogam crossing the placenta, it was written by MT who has decades of experience researching vaccines and the immune system. So, although what she postulates may go against what medical experts would like us to believe, I would not write her off easily. For me, the question is this. If rhogam is made from the plasma of donors, collected to produce enough anti-D to simulate an immune response in a Rh neg mother, and is meant to be identical to the anti-D that would be produced by the mother if she were sensitized, what would keep even those trace amounts of anti-D from crossing the placenta? Is the anti-D from the donors so different in form from the mothers'? Is this not theoretically possible?

Also, then why after having a rhogam shot, do we often test positive for sensitization...is the anti-D in the shot not the same as the mother's own anti-D? Regardless of quantity, I'm just asking if they are the same substance, can the anti-D in the shot then not act the same way as the anti-D produced by sensitization?

As for consequences for me with regards to sensitization, basically the same as the PP but I didn't have an issue with it. Yes, that meant no home birth, but I did birth in a hospital with a doula and very "midwife-friendly" OB who let me do what I wanted during labor. Yes, I did have more monitoring, but that came in the form of ultrasounds to check on the status of the babies. Again, not a problem for me. Family size limits...I've had 2 healthy babies. I'm even considering one more child since I have not had any complications in my sensitized pregnancies. I know sensitized moms who have had 5 children. Yes, they did have more complications with the latter pregnancies but they did not let their sensitized status stop them from having the large families they wanted.

I see rhogam from a different perspective...it is not foolproof and it carries some risks that need to be considered. It failed miserably for me and I also question very strongly its role in the death of my first baby. My first baby died at term of unknown reasons yet the pathology report on the placenta showed some strange immune reaction took place that gradually shut down all the blood supply in the placenta. Correlated with the IUGR and growth rates from my DD, this started happening right after my last winrho shot. Seeing as the manufacturer themselves states that their product may contain any number of unscreened for pathogens and viruses, who knows what may have been in there that affected us. I do know that looking back, knowing what I do now, I would never have consented to a prenatal shot...I would have at minimum waited until after birth to have my child tested for Rh status and then perhaps have done the shot then...

I don't want to make light of the risks of sensitization. They do exist. But I do want to ensure a balanced look at all the issues surrounding rhogam. I think the decision to use it should be made with careful consideration.
post #22 of 38
There was a very recent long and heated discussion on this very topic in the Pregnancy? forum.

Quote:
Originally Posted by japonica View Post
what would keep even those trace amounts of anti-D from crossing the placenta?
Nothing. It does cross the placenta. But the amount of immunoglobulin in Rhogam is only enough to address the minute amount of fetal blood required to cause an immune reaction in the mother. When and if it does cross the placenta, and if it does destroy fetal cells, there is not enough quantity to affect the fetus.

Quote:
Is the anti-D from the donors so different in form from the mothers'?
Yes, it is different enough. Rhogam works by hiding the fetal cells from the mother's immune system, not by triggering a subclinical immune reaction. Many sources report that this happens though destruction of fetal cells but the exact mechanism is not known. It may only coat the fetal cells to disguise them rather than destroy them outright.

Quote:
Also, then why after having a rhogam shot, do we often test positive for sensitization...is the anti-D in the shot not the same as the mother's own anti-D?
That's a good question. Even though the end product is not identical, Rhogam is made from maternal antibodies. The routine antibody screen is not sensitive enough to distinguish between real maternal antibodies and the antibodies that were used to make Rhogam, but a simple antibody ID test will easily distinguish between the two.

Quote:
Regardless of quantity, I'm just asking if they are the same substance, can the anti-D in the shot then not act the same way as the anti-D produced by sensitization?
Again, the confusion here is the assumption that they are the same substance when they are not. Maternal antibody production leads to sensitization while Rhogam prevents it.

I agree it is not foolproof, but like you I only want to provide balanced information which I find it often sorely lacking here. I don't want to make light of the risks of Rhogam, but more often than not I feel they are exaggerated on this board while the risks of sensitization are minimized.
post #23 of 38
Both pregnancies and my miscarriage I had rhogam, had to sign like ten papers telling me that there was human blood product etc.
post #24 of 38
Quote:
Maternal antibody production leads to sensitization while Rhogam prevents it.
Please put a qualifier in there. Rhogam is supposed to prevent it. I was given multiple doses by trained nurses and midwives, according to package instructions, at the right times during pregnancy, in the right amounts and it failed anyway. I have "met" many women online in a support BG who also suffered from rhogam failure even when it was given as directed. Vaccine failure exists. Rhogam failure exists, even when everyone does what they are supposed to.

And just an anecdote about telling them apart (true maternal response vs. the rhogam shot), I had an OB, and two peris who did not believe I was truly sensitized. They kept writing it off a "a delayed reaction to the winrho shot" until well into the second tri when my titers started to rise. Pretty bad when professionals miss sensitization as well.
post #25 of 38
Just thought I'd throw this out there...my midwife told me that the shot that I was taking (here in Canada) is derived from the blood products of a colony of Amish/Mormon something or other in Manitoba. Don't know if anyone has heard anything like that. She is very reputable though so I don't think that she is ill-informed. She teaches at one of the biggest midwifery schools here in Canada.
post #26 of 38
Quote:
Originally Posted by japonica View Post
Please put a qualifier in there. Rhogam is supposed to prevent it. I was given multiple doses by trained nurses and midwives, according to package instructions, at the right times during pregnancy, in the right amounts and it failed anyway. I have "met" many women online in a support BG who also suffered from rhogam failure even when it was given as directed. Vaccine failure exists. Rhogam failure exists, even when everyone does what they are supposed to.
It is extrememly rare for a woman to become sensitized if she received the reccommended dosage. However, sure I even have heard of someone who was sensitized and did receive rhogam.

However, in her case, she received the rhogam 'too late' most likely. She was pregnant (but did not know it) and discovered that she was pregnant and her baby had passed in utero. They believe that the baby had passed on a while before they discovered the pregnancy and some blood mixing occurred at that time.

So, in some cases it does happen. However, in general women need to know all of the risks and weigh them carefully when making a decision.

Without Rhogam--10-16% sensitization
With postnatal Rhogam shot--2% sensitization rate
With antenatal and postnatal Rhogam. --0.1% sensitization rate

And, of course, each woman needs to determine what her individual risks are. For women who want non-invasive births, and who want large families the 10-16% risk may be too high for them. I know someone who declined the Rhogam here whose family was one and done (she was also 41 years old when she found herself unexpectedly pregnant) so felt pretty secure that she was not having a second, both because of her age and because she'd never actually planned on having children!

In my case, my desire for a large family and non-invasive births was very important to me, I did my research and decided to have the injections. And, I'm about as crunchy as they come in terms of low intervention.

There have also developed a non-invasive test to determine the baby's RHD genotype. I know that it is expensive, however perhaps some insurance companies would cover it. It can determine at around 15 weeks. If this was done, a mom could then know if they were carrying a RH- or RH + baby and have even more information about whether or not to receive the antenatal injection.

http://www.lenetix.com/html/rhd___sry_genotyping.html
post #27 of 38
Quote:
Originally Posted by japonica View Post
Please put a qualifier in there. Rhogam is supposed to prevent it.
Nothing is 100% foolproof, that understanding should be inherent when you read the statement. You say it as if it rarely works. I'm sorry it didn't work for you, but that doesn't mean it's not an effective treatment most of the time.
post #28 of 38
Quote:
Originally Posted by D&S Mom View Post
Just thought I'd throw this out there...my midwife told me that the shot that I was taking (here in Canada) is derived from the blood products of a colony of Amish/Mormon something or other in Manitoba. Don't know if anyone has heard anything like that. She is very reputable though so I don't think that she is ill-informed. She teaches at one of the biggest midwifery schools here in Canada.
hehe and i heard that winrho (the win being winnipeg supposedly) used to be from nuns near winnipeg
post #29 of 38
i gave the dr. an earful the next day. i waited until almost 48hrs post labour to get my winrho shot.

i said that not only did i not appreciate the attitude given that i had a preemie, but that my midwives supported my decision not to receive the winrho shot before giving birth, and that as primary health providers in ontario, that that doctor was in effect questioning the care of my midwives.

i then asked why it was that the doctors there couldn't tell me why my son was born premature (no medical reason) but that i should be questioned about not taking winrho at 28wks. then i angrily said, because you seem to have all the answers...never saw that dr again, and thankfully the rest of the staff were professional. yeah, don't mess with a woman who speaks her mind especially after a difficult birth!

Quote:
Originally Posted by applejuice View Post
It has traces of thimerasol.

It is a human blood product and as such, does carry the possibility of AIDS and CJD and other viruses and disease.

No medical treatment is risk free. There is always a balancing act with each on.



Would he have mocked you if something did happen? I would report this. You have the right to make an informed decision regarding your own health and your baby's health.
post #30 of 38
Thread Starter 
Thank you for all the replies, they've been very helpful.

I recognize there is a small risk in not taking the prenatal rhogam, but I think I've decided to wait for the postpartum dose. I'm already 30 weeks so I think it's too late to look into the prenatal testing for the baby's blood type...i should have had the shot already.

I'm thinking if I give the prenatal shot, I am definitely putting this baby at risk (that risk might be small, but I am still accepting to put something into my body that could negatively affect this baby).

If I don't take the prenatal rhogam, this baby won't be at risk at all. Future pregnancies might not be at risk at all (if this baby is negative), or there is a 2% chance that future children would be affected. We would like to have 1-2 more children after this one, but there is no guarantee we will get pregnant again. So I feel like we'd be putting the baby that we do have at risk for future babies that we are not guaranteed to have.

this has been such a hard decision, and I'm still not 100% sure....sometimes i think i am just overreacting by questioning a decision that is considered safe and is part of standard medical procedure. My mom is a nurse and I haven't even told her that we refused the prenatal rhogam (and I don't plan to tell her) because I think she would view us as being foolish and I don't really have any studies to cite that rhogam could be harmful.

I really wish I was just positive myself and didn't have to worry about this!!
post #31 of 38
Quote:
hank you for all the replies, they've been very helpful.

I recognize there is a small risk in not taking the prenatal rhogam, but I think I've decided to wait for the postpartum dose. I'm already 30 weeks so I think it's too late to look into the prenatal testing for the baby's blood type...i should have had the shot already.

I'm thinking if I give the prenatal shot, I am definitely putting this baby at risk (that risk might be small, but I am still accepting to put something into my body that could negatively affect this baby).

If I don't take the prenatal rhogam, this baby won't be at risk at all. Future pregnancies might not be at risk at all (if this baby is negative), or there is a 2% chance that future children would be affected. We would like to have 1-2 more children after this one, but there is no guarantee we will get pregnant again. So I feel like we'd be putting the baby that we do have at risk for future babies that we are not guaranteed to have.

this has been such a hard decision, and I'm still not 100% sure....sometimes i think i am just overreacting by questioning a decision that is considered safe and is part of standard medical procedure. My mom is a nurse and I haven't even told her that we refused the prenatal rhogam (and I don't plan to tell her) because I think she would view us as being foolish and I don't really have any studies to cite that rhogam could be harmful.

I really wish I was just positive myself and didn't have to worry about this!!
Sounds like you've made the decision, difficult as it may be, that sits right for you...and I know what you mean about wishing you were positive...I wished that too after what we went through and I also wished DH was heterozygous for D (i.e. that we had a chance of a baby who would not be affected by my antibodies) but that was out too...

best of luck to you...((HUGS))

Quote:
i gave the dr. an earful the next day. i waited until almost 48hrs post labour to get my winrho shot.

i said that not only did i not appreciate the attitude given that i had a preemie, but that my midwives supported my decision not to receive the winrho shot before giving birth, and that as primary health providers in ontario, that that doctor was in effect questioning the care of my midwives.

i then asked why it was that the doctors there couldn't tell me why my son was born premature (no medical reason) but that i should be questioned about not taking winrho at 28wks. then i angrily said, because you seem to have all the answers...never saw that dr again, and thankfully the rest of the staff were professional. yeah, don't mess with a woman who speaks her mind especially after a difficult birth!
Yeah! You go, girl!
post #32 of 38
Quote:
Originally Posted by whalemilk View Post
The main consequences for me were:

1. No more homebirth. At first we were going to comanage with a perinatologist, but insurance won't cover both so I switched to CNMs in the peris hospital...and then my titers went up (meaning the odds of it affecting the baby went up slightly too) and I got entirely sent to the peris, who are very conservative. This has a lot of ramifications for what kind of birth I'm going to end up having.

Some homebirth midwives will see you even if you're sensitized (depends on the state and the mw's comfort level) but generally speaking if your titers increase, that's a definite risk-out because it often means some blood mixing is occurring again and/or that the fetus is at greater risk of being affected by the antibodies.

...
my midwives didnt even suggest that i should get rhogam prenatally or get antibody tests done unless i felt i should. they would not deny care based on me getting or not getting medical tests done, everything is my choice in my homebirth. maybe not all midwives can or do practice like this but i am choosing not to get the 28 wk shot and i did get a titer check once which showed i am not sensitized but i wont be doing this again during this pregnancy unless it seems i should due to some issue.
post #33 of 38
Quote:
Originally Posted by arismama! View Post
my midwives didnt even suggest that i should get rhogam prenatally or get antibody tests done unless i felt i should. they would not deny care based on me getting or not getting medical tests done, everything is my choice in my homebirth. maybe not all midwives can or do practice like this but i am choosing not to get the 28 wk shot and i did get a titer check once which showed i am not sensitized but i wont be doing this again during this pregnancy unless it seems i should due to some issue.
i was going to say something similar - i was cleared for a homebirth (was actually my heart condition that was the issue not the rh- status). that was until my footling breech baby decided to show up 6wks early. but they definitely were okay with homebirth and rh- status even though i refused the winrho while pregnant since you have up to 72hrs to take the shot after birth. my husband is rh+ and everyone in his family is so i knew i'd have an rh+ baby.

i refused the shot until after labour not only for my son's health, but i had a history of bad reactions to vaccines as a child (in the early 70s when we didn't get jabbed as much!) and didn't want to risk a reaction at the 28wk mark!

i had my titers checked almost every week from 28wks on. easy-peasy.
post #34 of 38
Quote:
Originally Posted by japonica View Post


Yeah! You go, girl!
thanks, i must have shook for several minutes after dr. ignoramus walked out the door from the emotion of it all...
post #35 of 38
I think you're misunderstanding what whalemilk is saying. She BECAME sensitized, and thus risked out of homebirth. No one is saying you can't have a homebirth and be Rh- that I can see.
post #36 of 38
Thread Starter 
Well i had another midwife appointment today and the midwife again tried to convince me to get rhogam. this is the 3rd midwife i've talked to about this (there are 5 midwives in the practice). They've discussed my situation with each other and with the OBs at the practice and i feel like they are all very concerned about getting us to change our minds.
On one hand, I'm tired of discussing this and their insistence makes me wonder if I'm overreacting by refusing the shot. I also feel like if I do end up getting sensitized, I would feel extremely guilty and remorseful for not getting the shot, since we do want more children. Also, there is a good chance we will be living in east africa again when we have another baby and would not have access to all of the medical technology to deal with a sensitized pregnancy.
So I have an appointment to get rhogam tomorrow. i'm still not very comfortable with it but i'm tired of fighting the midwives and i really don't want to be sensitized. I've also stressed over this so much that i don't want to have to think or worry about it anymore.
i hate this - i have very little faith in the american medical institution and it's so hard to know what is the best decision for my baby. of course my key concern is to do what is best for this baby or future babies but i just don't know what the best thing is.
post #37 of 38
What exactly is your concern about getting the Rhogam? The risks of either decision are small, but the risks of getting Rhogam are infinitesimal compared to the risk of sensitization.
post #38 of 38
I'm sorry you're feeling pressured. That's really stressful, and not the way I think midwives should act. For any medical decision, I think care providers should help you get access to as much information as possible, then stand back and respect your decision.

Maybe you can take a while to really think this over. I would try sitting down and actually writing out all the pros and cons. There may not be enough hard evidence to feel secure about your knowledge, but if you know that you have all the available information, at least, you can think things over with a clear mind and make a decision you can be happy with. Then don't let anyone else influence you, unless they provide new information.

Once you've made your decision, there's no point worrying about it, so try to relax. In my first pregnancy, I got three doses of rhogam - the regular two, plus an extra one after my external version. I wasn't as informed as I could have been, but I was doing the best I could with the information I'd been able to find. My baby was just fine (super smart and happy, actually). He was slightly jaundiced (needing no treatment besides sunshine), but that's almost surely from the bruising from a long pushing stage, not from the rhogam.

I'm a lot more informed now than I was then. I'll still probably get the rhogam prenatally. This time I'll look into the Kleihauer-Betke test first, though.
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