Rh- mamas, are you getting the Rhogam? - Page 3 - Mothering Forums

View Poll Results: If you are Rh-, are you getting the Rhogam?
Getting it prenatally and after birth if baby is + 26 33.77%
Not getting it prenatally, but will get it after birth if baby + 33 42.86%
Not getting it before of after birth 13 16.88%
Other 5 6.49%
Voters: 77. You may not vote on this poll

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Old 01-23-2006, 01:55 PM
 
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Originally Posted by FreeSpiritMama
Anti-D in Midwifery by Sara Wickham arrived last week and I read it this weekend, thank you for recommending it Amy its a MUST READ for any RH- mama
I'm so glad you enjoyed the book.

And thank you for posting this, it is such an incredible read, and truly a must read for any RH- mama, preferably, before pregnant, but not necessary. I got so much out of it, and I know if others read this book they will be able to make informed decisions based on research and information instead of coming to a decision from a place of fear.
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Old 01-23-2006, 09:19 PM
 
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Originally Posted by AmyD
Wow, you sound like a walking advertisement for rhogam If I didn't know any better, I would think you worked for them, or something
Hmmm. Riiight. I work for the Rhogam people. I wish I had a job with ANY people, right now!

I took all information into account and made what I thought was the most reponsible decision. I think it's important to question *ALL* information- including the one book people seem to be pushing on here like crazy. I don't think it's good to only have one source of information, and I think my midwives are very well balanced about that. (Midwife, not OB.)

If it were legal in my state, I"d probably have a homebirth, and I don't want medication during labor/eyegoop/early vacc/vitk/ you name it, in case I need to impress some "credibility" to these boards, which seems to be important to certain people. To me, however, the benefits of the Rhogam shot (what else are we supposed to call it?) outweighed the negatives, because hemolytic disease is so terrible. Everyone can make their own decisions about this, but it's important to consider all sides- including what happens when something goes wrong. If it were possible to have some indication of small tears/abruptions, I would wait to get the shot only if needed. But, it's not possible to have this information, and that's why I made my decision. My decision WOULD HAVE BEEN DIFFERENT if it still had mercury in it. That changes the risk balance, to me. There *is* evidence that small number of women who only get a post-natal shot still get sensitized. This is what I considered.

It's important to question all sources of info, not just those on the "don't get it!" side. There's blatantly incorrect and outdated information on the web also- it's hard to get real information, of course. For example, the blanket statement that "Europe doesn't give the 28-week shot" is plain wrong. Where are people getting this from? The book? What countries in Europe? (which is not just one big country!) They do it in Austraila. The incidence of Rh factor in Africans and Asians is less than 1% (while it is aorund 15% in North America and Europe), so that may explain why it is not used as often in those countries.

An interesting recent (2003) document, establishing standards for the NHS (UK) suggests the 28-week shot. You can find the (large, interesting) document here:

http://www.rcog.org.uk/resources/Pub...natal_Care.pdf

Here's an excerpt:
Guidance on the routine administration of antenatal (here this means pre-birth) anti-D prophylaxis for RhD-negative women has been recently issued, which recommends that anti-D is offered to all pregnant
women who are RhD negative. [292]

RECOMMENDATIONS
Women should be offered testing for blood group and RhD status in early pregnancy. [B] It is recommended that routine antenatal anti-D prophylaxis is offered to all non-sensitised pregnant women who are RhD negative. [NICE 2002]

As does this book chapter from a UK book:

http://www.intl.elsevierhealth.com/e-books/pdf/321.pdf

The UK is actually a lot better about additionally testing the blood of pg women for antibodies than the US is.


So, why does hemolytic disease still exist? Some women never get the shot. Some women that only get the postpartum shot still get sensitized. The theory is that they got sensitized in the last 12 weeks of pregnancy. This is why the 28-week shot was started.

It's also really interesting that there are other blood factors that can cause this disease- the one Rhogam takes care of (D) is most common, but there are like three others that are slightly more common, and more that are really rare (they talk about this in the NHS document). Perhaps that was what the other poster was talking about, when two "negative" people still had a "postive" baby- perhaps it was positive for -c or one of the other factors? -j
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Old 01-23-2006, 11:09 PM
 
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I believe I was the one who mentioned the Europe shot...and I believe my post said something about it not being the case now (that they do give it). I think I should have said UK as it was based on info I had gotten from moms in the UK who'd had babies within the last 10 yrs. They told me it was not common practice to get the antenatal shot but the post partum shot was always given when needed.

Yes, there is evidence that getting the antenatal shot reduces risk somewhat. Just getting the post natal shot (lemme go find the actual numbers...) you reduce your risk to 1.8%, getting the antenatal as well makes your risk about .1%. BUT you have to balance that by the risk inherent in getting any kind of shot, especially a blood product. Even the manufacturer of Rhogam states (in their labeling that only the doc sees unless you ask to see it):

Quote:
RhoGAM is made from human plasma. Products made from human plasma may contain infectious agents, such as viruses, that can cause disease. The risk that such products will transmit an infectious agent has been reduced by screening plasma donors for prior exposure to certain viruses, by testing for the presence of certain current viral infections and by removing certain viruses during the manufacturing process. Following fractionation, a viral clearance filtration step is incorporated in the manufacturing process. This filtration step removes viruses via a size-exclusion mechanism utilizing a patented Viresolve 180 ultrafiltration membrane with defined pore-size distribution. The filter is inert to the product. This virus removal process has been shown in laboratory spiking studies to reduce the level of some viruses ranging from 18 to 200 nm in size, including enveloped viruses as well as non-enveloped viruses.4 Despite these measures, such products can still potentially transmit disease. There is also the possibility that unknown infectious agents may be present in such products.
(emphasis mine)
and:

Quote:
Pregnancy Category C
Animal reproduction studies have not been conducted with RhoGAM. It is also not known whether Rh o (D) Immune Globulin (Human) can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity
and:

Quote:
The physician should discuss the risks and benefits of this product with the patient
That's my favorite, because really, DO doctors discuss the risks? I've seen several different OB's and midwives in my various pregnancies and not ONE of them has ever mentioned any possible risks.

I just think there are risks and you have to make an informed decisions. If that informed decision (like you made Jenny) is to have it then by all means get it! I'll never say "no one should get this shot" I just feel too many people/care providers focus on the scare tactics about the risks of developing antibodies when there's usually NO discussion about possible risks from the shot.

And my other pet peeve is that just because a woman develops antibodies and she hadn't got the prenatal shot, that doesn't automatically mean the prenatal shot would have stopped it. Maybe the shot didn't work post birth. We just don't know. It's not fair to assume that she would have been free of antibodies had she just got that shot.

C ~ mama to (16), (13), (9) (5)

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Old 01-24-2006, 08:17 AM
 
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Originally Posted by maybebaby
I believe I was the one who mentioned the Europe shot...and I believe my post said something about it not being the case now (that they do give it). I think I should have said UK as it was based on info I had gotten from moms in the UK who'd had babies within the last 10 yrs. They told me it was not common practice to get the antenatal shot but the post partum shot was always given when needed.
You're info is right I'm in the UK and the introduction of the Anti-D shot (Rhogam is a product name and not the one used here) at 28weeks is very recent. In my area it was introduced about 18months ago. My first pregnancy 4years ago I was not offered routine Anti-D during pregnancy, I did regularly have my bloods monitored for antibodies and I was offered the shot post partum.


Quote:
Originally Posted by jenny-g
I think it's important to question *ALL* information- including the one book people seem to be pushing on here like crazy. I don't think it's good to only have one source of information, and I think my midwives are very well balanced about that. (Midwife, not OB.)
I agree it is important to question all information and read more than one source which I personally have done. Whats so wrong with wanting to recommend a (imo) good source of information to other mamas? Personally I have not found Drs or hospital midwifes here to give balanced information.
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