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#1 of 36 Old 02-27-2011, 03:45 PM - Thread Starter
 
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I'm rapidly running out of time to decide if I want the 28 week Rhogam shot. The last time I spoke with my midwife about it she said she understood my hesitation and she assured me that not doing it would not negatively impact this pregnancy at this point. Up until that conversation I had been severely sitting on the fence about it and half-hoping she would tell me it could somehow positively affect my current pregnancy just I could feel like the decision would be made to get it at that point.

DH and I would like to try for one more child, so if my little one is born Rh+ I will have no issues with getting the shot postpartum. He is very supportive about the whole thing, but I think would prefer if I just got the shot "just in case." My issue is that it seems like getting the 28 week shot would definitely negatively impact my baby, and all for a bunch of ifs. IF she's Rh+ and IF I have some kind of unlikely blood exchange with her and IF I am even able to get pregnant again in the future (we struggled with infertility for 3 years before gettingbpregnant due to my PCOS and his male factor issues.)

There is a knee-jerk frightened part of me that just wants to get the shot because all the studies say its relatively harmless and I'm terrified I would say no and end up having problems with future pregnancies. I cannot reconcile that part with the bigger part of me that is antivax, anti-medical fearmongering.

Plus, the 28 week mark just seems so utterly arbitrary. If I have a definite trauma issue, they would recommend another shot then anyway. I don't really understand the whole passive immunity claim, or why it magically lasts 12 weeks.

Sorry this is so long, but it has been preoccupying me a lot lately. Anyone have any experience/advice/info?
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#2 of 36 Old 02-28-2011, 11:03 AM
 
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I don't have any useful advice but I didn't want your inquiry to go unanswered. Super dumb Q, but your dh is RH+ right? It was such a relief finding out dh was rh neg (I am as well so I avoided the whole thing). I know there's a super rare recessive gene that 'could' have made our first dc positive, but nope, neg too so we don't have to worry about it.

 

I would be likely to skip the 28w and get the shot pp if you choose.

 

Hope others weigh in with their experiences.


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#3 of 36 Old 02-28-2011, 12:54 PM
 
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There was a long thread in the Unassisted Childbirth forum on RH-.


Annabelle Catholic wife to Jeff '92 and mom to Makaley 19 Arden 19 Anniston 17 Taegan 14 Balen 12 Kellen 10 Ellery 8 Innish 6 Eiley 4 Finnian 3 Esca 2 our 8th uc.jpghomeschool.gifwaterbirth.jpgIHhbac.gifbftoddler.gifvbac.gifand expecting sweet pea January 2014.

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#4 of 36 Old 02-28-2011, 01:19 PM
 
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I've been doing some research on this myself, and I'm currently leaning towards skipping the 28 week shot and waiting until after birth. There isn't any information that proves that the 28 week shot reduces the chances of being sensitized to the baby's blood, and I've been told it's only really necessary if you have an accident or something that could cause baby's blood to mix with yours prior to birth. If that were to happen, they would give you another shot of Rhogam then anyway.

 

Having the shot administered within 72 hours of birth lowers your chances of becoming sensitized to 2% (from 10-16% without a shot at all). Like I said, I haven't seen any proof that the 28 week shot will bring those chances any lower.

 

I'm mostly concerned about the thermosol content and the fetal exposure to mercury, which I'd like to avoid if it's not absolutely necessary.Mercury crosses the placental barrier and the unborn baby receives 30 times the concentration level of the mother. Who knows how this could affect the baby long-term?! That's a scary thought!

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#5 of 36 Old 02-28-2011, 05:55 PM
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Rhogam has been mercury-free since 2001.

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#6 of 36 Old 02-28-2011, 09:30 PM
 
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Oh wow, okay! Thanks, I had no idea. The info I have says it's still in there. Must be seriously outdated... yikes!

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#7 of 36 Old 03-01-2011, 05:45 AM - Thread Starter
 
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Thanks for the responses. Baby's father is indeed Rh+. How I envy you for dodging that bullet. smile.gif

I think there are still some versions of Rhogam out there with Thimerosol in them. Their website wasn't helpful. I had my midwife look and the one she stocks in her office is clearly labelled Thimerosol free. if you get yours, just ask them if you can see the box.

The more I think about it and research the more I think I'm going to skip the 28 week shot too. I just haven't seen any proof that there is any benefit to having it. If it was the magic answer I'm not sure why I would need another shot if I did have some sort of trauma/injury in addition to it. Maybe that is naive of me.

I feel a little bad telling hubby I just want to roll the dice with this, since it could potentially impact future pregnancies, but I feel like the percentages are so small and the "proof" that the 28 week shot has any positive impact just isn't there. I know he will support my decision either way, but it's still a litle scary that I could be responsible for future disaster.
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#8 of 36 Old 03-01-2011, 08:00 AM
 
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I don't think you're at a crossroads.  28 weeks is the standard time to give prenatal Rhogam, but it's not like you explode if you have the shot at 33 weeks.  Your midwife probably wants to know what you want to do so that she can order Rhogam if you want it, and that's reasonable.  But so long as you understand that there's some lead time involved, you can get the shot at any appointment, if you decide that you want it.  Sometimes taking the pressure off a decision provides a clearer perspective - maybe if you weren't thinking now or never, you'd be able to get a better sense of how you feel about this and what you want to do.

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#9 of 36 Old 03-01-2011, 08:59 AM
 
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I'll be getting a Rhogam shot at 28 weeks or thereabouts, and again after I deliver. From what I've read, the point of the 28-week shot is to provide a buffer in case of any occult bleeding that might cause sensitization but go unnoticed. A dose of Rhogam must be administered within 72 hours after an incident where baby's blood may have mixed with mine, but the effects of a prophylactic shot last for 12 weeks. I'm not comfortable rolling the dice and hoping my LO is negative, because there's no going back if I'm wrong and something happens and I become sensitized.
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#10 of 36 Old 03-01-2011, 10:02 AM
 
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I'm Rh- and DH is Rh+. This is baby number 4 for us, all my other kids are Rh+ so I took the Rhogam shot postpartum. BUT I just thought I'd let you know, I'm now living in Europe and it's not even standard practice here to give Rhogam at 28 weeks. They give it to you if you've had some trauma or a bleed and then after the birth if baby is Rh+.

 

Best of luck with your decision.


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#11 of 36 Old 03-01-2011, 10:07 AM
 
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With my baby #2 and baby #3, I chose to skip th 28-week prophylactic shot. After testing the placenta blood, we found my babes were positive, and I got the shot within 3 days post-partum.

If I had been in a car accident, or some other potential reason to mix our blood, then I would have chosen to get the 28 week one.

Just a thought about your post .... "they" say a LOT of things are perfectly safe ... and MDC-mamas question a lot of it....

Good luck with your decision!
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Quote:
Originally Posted by veganyogamomma View Post

Oh wow, okay! Thanks, I had no idea. The info I have says it's still in there. Must be seriously outdated... yikes!



There are still some scary websites out there claiming that Rhogam has thimerosol.  The manufacturer's website (http://www.rhogam.com/Professional/PlasmaSafety/Pages/ManufacturingProcesses.aspx) states that Rhogam has been mercury-free since 2001.  WinRho, the Canadian version, has always been mercury-free.  

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Originally Posted by mumofmak View Post

 I'm now living in Europe and it's not even standard practice here to give Rhogam at 28 weeks. They give it to you if you've had some trauma or a bleed and then after the birth if baby is Rh+.

 

Best of luck with your decision.


Just to throw another data point out there, giving Rhogam is standard here in Germany. I'm getting it at my next appointment, which I think is @ 29 wks. I also got it during my miscarriage in 2008. For me, the hypotheticals about the risk of shot additives don't outweigh the risk of my immune system attacking this and future babies. I'm really good at worrying. 

 

Good luck to you! 

 


hi!

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#14 of 36 Old 03-01-2011, 07:18 PM
 
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Originally Posted by veganyogamomma View Post
 
the unborn baby receives 30 times the concentration level of the mother.


Got a source for this?

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#15 of 36 Old 03-03-2011, 11:17 AM
 
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Quote:
Originally Posted by mumofmak View Post

I'm Rh- and DH is Rh+. This is baby number 4 for us, all my other kids are Rh+ so I took the Rhogam shot postpartum. BUT I just thought I'd let you know, I'm now living in Europe and it's not even standard practice here to give Rhogam at 28 weeks. They give it to you if you've had some trauma or a bleed and then after the birth if baby is Rh+.

 

Best of luck with your decision.



after i did a ton  of research during my 1st pg i decided to so the same. this is how i'm treating this pg as well.


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#16 of 36 Old 03-03-2011, 11:36 AM
 
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This is kind of a stupid question, but it's never been expressly stated to me. To be Rh + is to have a "positive" blood type, correct? If I were to have a positive blood type, like A positive, then the shot would not be required, right?


I'm a twenty-something Canadian girl married to my sweetheart and due in June with Baby #1
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#17 of 36 Old 03-03-2011, 11:51 AM
 
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We have four kids but I only had the shot with the first two and no prenatal shot with the others and no problem here. I think you really are at a 'crossroads'. If you wait to have the shot prenatally then you might not be able to have it after the baby is born. There is, I think a seven week waiting period before a second could be given. Unless you have some reason to think blood may have mixed, like you were in a car accident, then I don't see a reason for it. Few other countries do a prenatal one and do not have significantly higher rates of sensitization. Giving it at 28 weeks is just a random time to give it. It will reduce your risk of being sensitized if and only if you have blood mixing prenatally, which is fairly uncommon unless there in an accident. Postnatally rhogam brings your risk from about 8% down to 2%, those are the numbers I've found. Keep in mind that higher sensitization rates are only seen in mothers where the birth had many interventions, such as internal fetal monitoring or a c-section. Also, higher rates are 'seen' in studies funded by rhogam manufacturers. 

 

My big concerns are not only the ingredients but how it's made. It a human blood product. The blood is PURCHASED from men who are sensitized. What motivation do they have to say they are at risk for a disease when they would loose money? Some of these men became sensitized via sharing dirty drug needles. Not someone I want a blood product from and all the blood is pooled before making the rhogam. There are no *proven* cases of mothers (and their breastfed babies) contracting diseases but there have been many accusations. They haven't been proven because there is absolutely no way to prove how a mother and baby got hep a or another disease, they can blame it on the mother. 

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This is kind of a stupid question, but it's never been expressly stated to me. To be Rh + is to have a "positive" blood type, correct? If I were to have a positive blood type, like A positive, then the shot would not be required, right?



Correct. 

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#19 of 36 Old 03-03-2011, 12:03 PM
 
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We have four kids but I only had the shot with the first two and no prenatal shot with the others and no problem here. I think you really are at a 'crossroads'. If you wait to have the shot prenatally then you might not be able to have it after the baby is born. There is, I think a seven week waiting period before a second could be given. Unless you have some reason to think blood may have mixed, like you were in a car accident, then I don't see a reason for it. Few other countries do a prenatal one and do not have significantly higher rates of sensitization. Giving it at 28 weeks is just a random time to give it. It will reduce your risk of being sensitized if and only if you have blood mixing prenatally, which is fairly uncommon unless there in an accident. Postnatally rhogam brings your risk from about 8% down to 2%, those are the numbers I've found. Keep in mind that higher sensitization rates are only seen in mothers where the birth had many interventions, such as internal fetal monitoring or a c-section. Also, higher rates are 'seen' in studies funded by rhogam manufacturers. 

 

My big concerns are not only the ingredients but how it's made. It a human blood product. The blood is PURCHASED from men who are sensitized. What motivation do they have to say they are at risk for a disease when they would loose money? Some of these men became sensitized via sharing dirty drug needles. Not someone I want a blood product from and all the blood is pooled before making the rhogam. There are no *proven* cases of mothers (and their breastfed babies) contracting diseases but there have been many accusations. They haven't been proven because there is absolutely no way to prove how a mother and baby got hep a or another disease, they can blame it on the mother. 


Elus0814, I had three Rhogam shots over the course of my last pregnancy, each of them three weeks from the other (it was a complicated pregnancy with a lot of blood mixing, and I wore the shots out).  They'd have given shots more frequently if they thought I needed them.  There is *not* a waiting period between shots.

 

The risk of Rh sensitization (post-natally) is much higher than 8%.

 

Rhogam is a human blood product, but individual lots of blood are extensively tested and screened - they're not just dumping it all in one bucket and hoping for the best.  I don't think shared needles carry enough blood to trigger Rh sensitization.  If they did, I would expect that drug addicts would be highly to be asked to give blood after receiving treatment.  Most sensitization is the result of cross-type blood donations.

 

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#20 of 36 Old 03-03-2011, 01:50 PM
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Elus0814, where did you get your information about blood donations for Rhogam coming from IV drug users?

 

 

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#21 of 36 Old 03-04-2011, 04:03 PM
 
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Quote:



Got a source for this?


It's in the printed paperwork that I got from my midwife.

 

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#22 of 36 Old 03-04-2011, 04:18 PM
 
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I wonder where they got it. I've noticed several statements like that lately and they seem to be founded on a faulty understanding of how drugs and other substances distribute in the body. A fetus could get an amount of exposure to a substance that is proportionate to its size as the overall quantity of the substance is proportionate to Mom's size. It's not possible for the fetus to get an exposure that is manyfold larger than the mother's. The placenta does not act to concentrate chemicals in the fetus.

 

It's like if you fill your kitchen sink or other large vessel with water, then dump in some salt, mix it up, and then remove a cup of water. The cup you remove (representing the fetus) will have the same concentration of salt as in the sink itself (representing the mother). It's concentration that exerts an effect, not absolute amount.

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#23 of 36 Old 03-10-2011, 06:44 PM
 
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This is timely!  I have been debating this myself.  Last pregnancy, I CALLED the RhoGAM company and asked for information.  They faxed articles showing the studies that have been done on Rhogam.  They told me that there was no longer mercury in the shots, etc.  We didn't even get my husband's blood tested because all three of his family members have O+ blood.  I got the 28 week shot from my midwife, but when our daughter was born with A- blood (like me), I obviously didn't get the second one.  So we DID get my poor husband the blood test (he hates needles) and he is O+, just like his parents, although obviously a RH- carrier.  The studies I read showed how the tests prevented women from being unable to have subsequent RH+ blood children.  The way the body can attack a future baby is pretty awful.  It also showed that when women were given a shot at 28 weeks instead of only after birth, it cut down chances of creating the antibodies against RH+ blood to around 1%.   I don't know about limiting shots to once every seven weeks either, because they said that if you had to receive a transfusion of RH+ blood, they would have to give you several shots to compensate.  When I asked about why this isn't done sooner in the pregnancy, they told me that it had to do with the amount of blood the baby had to cross over, although it might be a good idea to have one after a miscarriage or other early birth trauma.

 

Anyway, since then I've read articles saying that it is a dangerous mixture of things to have shot into your system while pregnant and it doesn't make THAT much of a difference.  I am now feeling a bit undecided.  Add to the fact that there is a 50% chance this baby will be RH- and the shot costs around $500 and I am feeling a bit MORE undecided.  I am supposed to get the shot tomorrow.  I guess it is true that if I am going to see my midwife in two weeks anyway (from now on we are supposed to meet twice a month), it wouldn't hurt to make the decision at week 30, unless I fall or get in an accident, at which point I have 72 hours to request one.  And the two week buffer may not hurt if I go over my due date a bit or something.  But still, I wish I knew what to do now.


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#24 of 36 Old 03-11-2011, 09:23 AM - Thread Starter
 
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Wow, the shot is only 200 for me. I went to my last Midwife appointment and told them I wouldn't be needing them to order the shot for my next appointment at 28 weeks. I believe I'm going to have to sign something to the effect that it was offered to me but refused.

I guess what ultimately helped me decide is that I feel like at 34 with infertility issues, I owe more to my current LO that I am carrying than to the slim possibility that there will be another future child I could be negatively impacting. Since I've been assured that at 28 weeks any future blood exchanges would not trigger enough of an antibody response to negatively impact HER, and since the shot will definitely a) attack and kill some of her red blood cells and b) expose both her and I blood borne pathogens that in some cases are not able to be screened out (the manufacturers site discusses CJD as a possibility) and c) has been shown to depress the immune system of the mother and baby, I am just going to wait until we find out her blood type and then go with the postpartum shot if necessary.

Thanks for the statistics AND the info re: some countries skipping the 28 week shot altogether. It was added reassurance.
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#25 of 36 Old 03-11-2011, 09:26 AM - Thread Starter
 
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Oh, and I should add... If she is born Rh+ and I have the PP shot, is there a test I can do before we TTC #2 to be sure I haven't been sensitized? I thought i remembered reading something about it somewhere.
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This is timely!  I have been debating this myself.  Last pregnancy, I CALLED the RhoGAM company and asked for information.  They faxed articles showing the studies that have been done on Rhogam.  They told me that there was no longer mercury in the shots, etc.  We didn't even get my husband's blood tested because all three of his family members have O+ blood.  I got the 28 week shot from my midwife, but when our daughter was born with A- blood (like me), I obviously didn't get the second one.  So we DID get my poor husband the blood test (he hates needles) and he is O+, just like his parents, although obviously a RH- carrier.  The studies I read showed how the tests prevented women from being unable to have subsequent RH+ blood children.  The way the body can attack a future baby is pretty awful.  It also showed that when women were given a shot at 28 weeks instead of only after birth, it cut down chances of creating the antibodies against RH+ blood to around 1%.   I don't know about limiting shots to once every seven weeks either, because they said that if you had to receive a transfusion of RH+ blood, they would have to give you several shots to compensate.  When I asked about why this isn't done sooner in the pregnancy, they told me that it had to do with the amount of blood the baby had to cross over, although it might be a good idea to have one after a miscarriage or other early birth trauma.

 

Anyway, since then I've read articles saying that it is a dangerous mixture of things to have shot into your system while pregnant and it doesn't make THAT much of a difference.  I am now feeling a bit undecided.  Add to the fact that there is a 50% chance this baby will be RH- and the shot costs around $500 and I am feeling a bit MORE undecided.  I am supposed to get the shot tomorrow.  I guess it is true that if I am going to see my midwife in two weeks anyway (from now on we are supposed to meet twice a month), it wouldn't hurt to make the decision at week 30, unless I fall or get in an accident, at which point I have 72 hours to request one.  And the two week buffer may not hurt if I go over my due date a bit or something.  But still, I wish I knew what to do now.


Josie, I think in this kind of position, where you're hearing different things, the thing to do is evaluate your sources.  For me, I tend to rank articles from peer reviewed scientific and medical journals and government statistics as the best possible sources, but you do have to read very carefully to make sure that you aren't imputing things that the articles and statistics don't actually say.  Articles in popular news media come in way lower, and articles published only on the internet, I generally want to trace the information back to its sources before I decide whether or not it's any good. 

 

I will say, however, that Rhogam does make a HUGE difference in sensitization rates for Rh- mothers with Rh+ babies.  From 1970 to 1979, incidence of Rh hemolytic disease of the newborn dropped by 65%.  Researchers attributed 30% of that decrease to changes in family size and structure, and 70% to Rhogam.  At the time, anti-D prophylaxis for Rh- women was not yet routine.  With better prophylactic coverage, numbers have continued to improve.

 

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#27 of 36 Old 03-11-2011, 01:10 PM
 
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I am 28w and had the shot today, I couldn't come to a solid decision as to how I felt about it so I just went with it. All 4 of my other kids are positive and I have always

had the shot afterwards as well. Even though this is my last pregnancy I just can't get comfortable with not taking that shot.


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#28 of 36 Old 03-11-2011, 01:51 PM
 
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Oh, and I should add... If she is born Rh+ and I have the PP shot, is there a test I can do before we TTC #2 to be sure I haven't been sensitized? I thought i remembered reading something about it somewhere.


Yes, if you're Rh-, screening for sensitization is part of a normal early prenatal panel, and could be done before TTC if necessary.

 

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Coming in from New posts-- I was freaking out about the Rhogam shot as well when I was pregnant.  I also gave birth in Germany and the doctor was very up front that Rhogam is basically non-negotiable in his eyes.  For what it's worth, he did not allow me to get the flu shot, swine flu shot or any other vaccines while I was pregnant (and this is when they were really crazy about everyone getting swine flu). He also recommended not getting dental work done while pregnant except for cleanings. I would most definitely get the shot if I were you. The risks do not outweigh the benefits. If your midwife recommends it and you trust her enough to give birth with her, why would you not do it? The only possible reason I would not get the shot is if you know this is your last child and your husband is getting a vasectomy.


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#30 of 36 Old 03-11-2011, 03:00 PM - Thread Starter
 
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Originally Posted by Lauren31 View Post

Coming in from New posts-- I was freaking out about the Rhogam shot as well when I was pregnant.  I also gave birth in Germany and the doctor was very up front that Rhogam is basically non-negotiable in his eyes.  For what it's worth, he did not allow me to get the flu shot, swine flu shot or any other vaccines while I was pregnant (and this is when they were really crazy about everyone getting swine flu). He also recommended not getting dental work done while pregnant except for cleanings. I would most definitely get the shot if I were you. The risks do not outweigh the benefits. If your midwife recommends it and you trust her enough to give birth with her, why would you not do it? The only possible reason I would not get the shot is if you know this is your last child and your husband is getting a vasectomy.


I don't really think the negatives are easily outweighed by the positives - for the 28 week shot. Postpartum, I'm totally on board, just not the "preventive" shot at 28 weeks.

FWIW, my midwife was totally cool with my reservations. She said she completely understood my concerns and didn't disagree and that it was a personal decision. I believe signing the form is purely to cover her butt if I later showed up sensitized and said I wasn't offered the shot.

Also, if for some reason I did end up sensitized even after having the postpartum dose, that would be it for us TTC. I would not risk HND knowing the possible outcomes.
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