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#1 of 24 Old 03-21-2008, 11:55 PM - Thread Starter
 
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To have another baby after refusing antenatal and post partum rhogam? I refused Rhogam last week because in the trauma and chaos following my delivery I was *positive* I would never want another baby ever.

Now I am horrified I made that choice because obviously I am way past 72 hrs and I feel I have locked out my option of having another baby.

How serious is this? Is it a total impossibility for me to have a healthy baby after no rhogam and delivering a ++ baby?

Mama to nine gorgeous babies, with finale #10 due April'14.
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#2 of 24 Old 03-22-2008, 12:08 AM
 
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has your DH/partner been blood typed? If he's also rh- you have no worries.

if he's rh+, you can be tested to see if you have developed antibodies before deciding to get pregnant again.

it is nowhere near a total impossibility to have a healthy subsequent pregnancy. your chances would be about 50/50 that you developed the antibodies.

DD1 7/13/05 DD2 9/20/10
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#3 of 24 Old 03-22-2008, 12:09 AM
 
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It completely depends on whether or not there was any blood cross contamination. If there was no blood crossing, then you won't be sensitized. You can be checked to see if you're sensitized.

-Angela
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#4 of 24 Old 03-22-2008, 12:10 AM
 
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Originally Posted by bri276 View Post
your chances would be about 50/50 that you developed the antibodies.
Do you have a link to the 50/50? I'd never seen that stat before. I would think it would matter greatly what kind of birth it was and how much blood there was.

-Angela
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#5 of 24 Old 03-22-2008, 12:36 AM
 
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ibelieve there are post partum treatment options as well if you had an rh+ baby. i don't know too much about it though b/c i never thought about refusing the rogham until the two littles were already born.... i might need to know this for the next one though.... b/c if i can get by w/o it next time i'd like to
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#6 of 24 Old 03-22-2008, 12:47 AM
 
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I was told by more than one birth professional ( cnm and cpm) that they 72 hour time suggestion is just that, a suggestion ( well usually interpreted as more of a law) because the original tests for the rhogam were set using a randomly selected time. One of the mws even mentioned that she had read reviews of the study and that the women used were incarcerated and they were only available to be tested up to 72 hours after birth. I am not sure of the absolute truth of this but I was assured in the hospital after my last child when there was a misunderstanding about his dob that they do routinely administer the rhogam shot after the 72 hours. All of the mws that I have used agreed that they would still be comfortable if I came in a few days, more like 4 or 5 after the birth to get the shot as long as there was no traction on the cord or any weird bleeding for me.
I think I remember threads about this from last year...
I will look in a few minutes when the kids get quieter...
Laura

laura, dh Brian, ds Rory 14, dd Ellie 13, ds Caelan 11, ds Seamus 9, ds Finn 7 and Penelope 2 !!!!

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#7 of 24 Old 03-22-2008, 09:12 AM
 
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The rhogam might still be helpful. Also it is possible that you were not sensitized, even though you did not have the rhogam. I believe that the raw statistics are that 15% of women will be sensitized after giving birth to a + baby and not receiving rhogam.

If you were sensitized, your next pregnancy might not be all that complicated. They can follow you with ultrasounds to see how the baby is doing -- many first babies after sensitization don't need much therapy. For many sensitized women, though, the reaction gets stronger with each subsequent pregnancy. My mom and all of her sisters and her mother and her mother's sisters are rh-. For the ones who gave birth in the pre-rhogam era only the ones who had 3 or more children had problems.

Stacia -- intrepid mama, midwife, and doula. Changing the world one 'zine at a time.
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#8 of 24 Old 03-22-2008, 09:30 AM
 
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The percentages of the baby having a problem if you have a baby with the opposite blood type are:

13% if you had no shots with the last delivery
1.5% if you had only the postpartum shot
.5% if you had the 28 week and the postpartum shot
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#9 of 24 Old 03-22-2008, 09:54 AM
 
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Yes to what STacia said--

Also, not sure how long it's been since your birth, but it may be possible for you to request a Kleihauer Betke test to see if there are baby blood cells in your bloodstream. You might want to talk to a lab that does the KB, and find out how many days after birth they might still be able to accurately assess presence of baby's blood in your circulation. If it is believed that the KB test would still be helpful at this point, that is one way to find out if sensitization occurred (whether or not antibodies have been made yet).

There is sensitization and sensitization...that is, not all sensitization is equal. Some women's immune systems react 'more' than others in terms of creation of antibodies...especially w/a first baby following sensitization (as S has said). Along with u/s to check on the next baby, there is also the option of serial antibody tests for you during a next pregnancy (having the antibody test every few weeks during pg, to determine if count is rising). Although there are no hard and fast rules about how a baby will be impacted by the presence of maternal antibodies, there are some rules of thumb concerning the number of antibodies present in mom's bloodstream during a pregnancy.

Skipping the details here, basically the serial antibody tests can help you figure out the degree of risk for your baby: low antibody count most always means little to no harm comes to baby, high or gradually increasing antibody count indicates increasing risk. However, there really ARE no hard and fast rules--a high antibody count does not always mean that baby will be harmed. NOt only do women react differently/individually to sensitization, so do babies. HIgher antibody counts *might* mean more harm to baby....and might not. This is where u/s comes in, to help see if baby is growing properly. There is a midrange of harm, as well--some babies are anemic and jaundiced at birth due to the antibodies' attack of their red blood cells (which impacts their intrauterine growth), but can be effectively treated for those things without too much ado after birth. Being sensitized, and baby being effected, in other words, does not always mean 'the worst'.

It may be too soon now to use the antibody test to determine if blood mixing occurred--yes, early studies were done on incarcerated women who stayed in the hospital routinely, for exactly 3 days. Based on studies of their antibody status in that time, it was determined that it takes 'more than 3 days' for maternal antibodies to form. No one really knows HOW MUCH LONGER than 3 days--it is assumed medically that if RhoGAM is given by the end of 3 days, then it will be effective in preventing sensitization.

However, you might get an antibody screen in a few months, or maybe later, at the point when you feel you are ready to ttc again. Knowing you are clear of antibodies will certainly clear the way for ttc, right? If you are making antibodies, then knowing how many are circulating can help you to determine how high is the risk to another baby. While there is no way to know in advance whether or not your antibody count will climb (or climb drastically) during pregnancy, at least with a prenatal screen you see if it is already high or not.

So...maybe investigate whether or not the Kleihauer Betke is still an option--and don't wait to find out, do this now. Otherwise, the antibody screen at some point later will probably help you in decisions about ttc when you are ready.

ANd remember that it is quite possible that you were NOT sensitized at all!

Sorry that your birth was chaos and trauma for you! Best wishes in sorting this out--and in having a better birth if there is a 'next time'.
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#10 of 24 Old 03-22-2008, 11:38 AM - Thread Starter
 
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Thanks everyone. They havent typed the baby, but DH is ++ and I am --. It was a c/s delivery after a failed attempt at VBAC, I have no idea if that would mean more or less risk of contamination. I am going to go to my OB today and get the RHogam and ask about that test and etc. I really appreciate all the help.

Mama to nine gorgeous babies, with finale #10 due April'14.
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#11 of 24 Old 03-22-2008, 11:39 AM
 
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Quote:
Originally Posted by MommyMidwife View Post
The percentages of the baby having a problem if you have a baby with the opposite blood type are:

13% if you had no shots with the last delivery
1.5% if you had only the postpartum shot
.5% if you had the 28 week and the postpartum shot
No, those are the rates of sensitization, not the rates of complications with subsequent babies.

Sometimes babies born to sensitized mothers have mild jaundice or no symptoms at all. It depends on how severe the sensitization is. On the opposite end of the spectrum, some severely sensitized mothers will have repeat miscarriages and not be able to carry a pregnancy long enough to have a viable baby. But that USUALLY does not happen in the first baby after sensitization. MsBlack does a good job of explaining it all.

Stacia -- intrepid mama, midwife, and doula. Changing the world one 'zine at a time.
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#12 of 24 Old 03-23-2008, 09:54 AM
 
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hmmm, they did NOT type the baby? That doesn't seem right at all! Why would they offer RhoGAM if they didn't know the baby's rh status? Actually, our local hospital is known to do just that, but it is NOT good/standard/ethical practice. I have been told by med providers on another list that labs have particular protocols they're 'supposed' to follow when it comes to Rh neg moms: blood typing the baby first; if baby is rh +, then giving mom KB test to determine IF there was blood mixing, and IF SO, then HOW MUCH baby blood is present in mom. If you don't know how much baby blood is in mom's bloodstream, you can't give the right dose of RhoGAM! And if you don't give the right dose of RhoGAM (if you give too little RhoGAM), it will not work to prevent sensitization.

And if the baby is rh neg, then you don't even need the RhoGAM, period. Sensitization could NOT have occurred, even if there was blood mixing.

If you have already gotten the RhoGAM, then this may be wasted words. But--on the one hand, if there was no blood mixing there would be no sensitization and it is presumed that 'unnecessary RhoGAM' is 'harmless' anyway. On the other hand, I hope you realize that if you WERE sensitized, it may be too late for the RhoGAM to have the desired effect. I guess if it were me, I'd still get an antibody count at some point---more than 3mos after the RhoGAM shot, because the RhoGAM itself can cause a positive result in antibody test for awhile. Actually, what research I've found on this is not real clear--no one seems to know just how long the RhoGAM itself will impact results of an antibody test, and of course this could vary from woman to woman.
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#13 of 24 Old 03-23-2008, 01:38 PM
 
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My bad - i meant that...saw it in my head...typed the WRONG word!!
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#14 of 24 Old 03-23-2008, 07:30 PM - Thread Starter
 
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No, they didnt type the baby. I have always had the Rhogam without the baby being typed...I deliver in hospitals BTW.

The NICU said the only reason they would ever type a baby is if it was in need of transfusion. It never occured to me to question that?!

Mama to nine gorgeous babies, with finale #10 due April'14.
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#15 of 24 Old 03-23-2008, 11:06 PM
 
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Both of my babies were typed (it is standard here it seems) and only after the type is known did I get Rhogam.

Megan Davidson, Labor & Postpartum Doula, Breastfeeding Counselor, Anthropologist, Mom to August (9) and Clay (4), Partner to Shawn.

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#16 of 24 Old 03-24-2008, 10:06 AM
 
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Interesting discussion. Thank you ladies. I am having my last baby at home and am just not really feeling this great need to bust my butt getting Rhogham. Since my MWs cant carry it. And its expensive. So I would have to go to a special pharmacy and pay $250+ out of pocket to have it on hand or go running around to a lab 3 days PP. Blah. We dont plan any more babies and DH is going to get snipped soon,so maybe I will just not worry about it. And even if there was an oops baby in there, it sounds like my chances of sensitization and further complications are pretty low. Thanks!

Jenn, perpetually tired mom to DS(9): DD(4.5): DD(2) :
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#17 of 24 Old 03-24-2008, 11:51 AM
 
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If your dh is ++, then they don´t need to type the baby, the baby can only be +.

I´ve had 2 sensitized pregnancies, after a big bleed & rhogam (pp only) failure. My first pg was actually worse, with a higher titer. Baby only did lights, he was born jaundiced. The second sensitized pg baby was born with no sign of jaundice or anemia at all. There were a lot of u/s with both, but that is a much less invasive way of checking for anemia than what they did just 8 years ago ----amnios every other week!

The worst case scenario is that the baby looks anemic in utero & then the baby could need an intrauterine blood transfusion to go to term or stay alive long enough to be a viable preemie. This would be pretty uncommon in a first sensitized pregnancy, plus very recently there has been success in giving isoimmunized moms IVIG in pregnancy, that can help get a baby a lot further along and maybe skip a transfusion entirely. Also, time can help, I waited 2 & a half years before conceiving my 2nd rh sensitized baby and I think it made a big difference in lowering my titer. Also, my lower titer came after a c/s, so that won´t necessarily increase your sensitization--if it even happened at all.

Married Catholic mami : to 5 boys, : 9 6 3 : 5 mo. 5/6/02-6/22/02 (HIE)
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#18 of 24 Old 03-24-2008, 12:21 PM
 
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Originally Posted by liseux View Post
If your dh is ++, then they don´t need to type the baby, the baby can only be +.
No, this is not true. There is a greater CHANCE of your baby being + because of the - being a recessive gene (I have heard 70% but don't quote me, I don't know where). I am -, my husband +, and we have two darling RH- little girls who will also have to deal with this should they choose to procreate with an RH + man.

Those worst case scenarios are bad enough for me to want to hightail it out and do whatever it takes to get a dose of Rhogam PP were I to have an RH + baby. Fortunately my m/w had it on hand, was able to send cord blood off to the lab and get it typed fairly quickly, and I didn't need it anyway because my babies were - too.

Good luck OP with whatever you ended up doing. I'm sorry you had such a difficult birth.

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#19 of 24 Old 03-24-2008, 12:37 PM
 
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ok, I may be confused, if you're talking about DH having both ++ genes then sure I bet you're right. But I have never heard of getting that kind of typing done?? is that something you got because of your situation? Everyone I know just knows they're one or the other.

mama to 3 girls: Abigail 2.12.05, Eliana 8.26.06, Willa 1.9.09
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#20 of 24 Old 03-24-2008, 12:41 PM
 
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i read somewhere that even 12 days later is still good.
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#21 of 24 Old 03-24-2008, 01:38 PM
 
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¨ok, I may be confused, if you're talking about DH having both ++ genes then sure I bet you're right. But I have never heard of getting that kind of typing done?? is that something you got because of your situation? Everyone I know just knows they're one or the other.¨amiev

Yes, I did have to get more specific typing done. If the baby´s dad is homozygous positive he would have 2 positive alleles on his blood, so ++, but if he is heterozygous, he will have *-. The heterozygous guy could father a rh - baby. Of course my dh is homozyg for ´+, lucky me A man with 2 positives can only have a positive baby.

There are cool things like the du factor though that can make an rh negative woman unlikely to ever develop antiboides. There are any variations and weird things about this whole issue that they haven´t even learned yet. There are definitely worse problems than being isoimminuzed though!

Married Catholic mami : to 5 boys, : 9 6 3 : 5 mo. 5/6/02-6/22/02 (HIE)
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#22 of 24 Old 03-25-2008, 04:52 PM
 
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Interesting discussion!

More thoughts to add:

Having an indirect Coombs done on the maternal blood will determine the presence of antibodies in her blood. If positive, an antibody ID would then be done.

RhoGAM is thought to "cover" those with the anti-D (that is what it is given for), which most Rhneg people have, but doesn't protect moms (therefore babies) with other antibodies.

HTH,
L
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#23 of 24 Old 03-27-2008, 09:49 AM
 
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My children are both RH-negative, so I didn't need the rhogam after birth, but my grandmother is also RH-negative and had seven children without rhogam, including at least several who were +. She did not have a problem until the sixth child, who required a blood transfusion at birth but survived.
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#24 of 24 Old 03-27-2008, 01:53 PM
 
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Quote:
Originally Posted by AmieV View Post
ok, I may be confused, if you're talking about DH having both ++ genes then sure I bet you're right. But I have never heard of getting that kind of typing done?? is that something you got because of your situation? Everyone I know just knows they're one or the other.
It depends on where the typing's done. At some labs, they do check homozygosity. When my Dh was typed for Kell, they checked his homozygosity v. heterozygosity because for us it would make a difference.

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