THE RH FACTOR
HOW IT CAN AFFECT YOUR PREGNANCY
If you are an Rh-Positive (Rh+) woman, there is no concern for you regardless of your partners blood factor. Just as there are different major blood groups, such as A and B type blood, there is also an Rh factor - a type of protein on the red blood cells. Most people have this factor and are Rh+ (Rh-positive); others do not have it and are Rh- (Rh-negative). A simple lab test quickly determines whether you are Rh+ or Rh-. The Rh factor does not affect a person's general health. It can cause problems during pregnancy, however. Being Rh negative simply means your blood does not insert the allele that instructs your body to put the RH positive antigen on your red cells. It takes two Rh negative alleles to make an Rh negative person, but only at least one to make an Rh positive person. Therefore there are a greater number of Rh positives. It is or soon will be possible to determine by laboratory test whether an Rh positive person has two Rh positive alleles or only one.
MoonDragon's Lab Information: ABO-Rh Blood Typing - EldonCard Method
MoonDragon's Lab Information: Blood Typing & Incompatibilities: ABO-Rh Blood Typing
The Rh factor causes problems when an Rh- mother and an Rh+ father conceive an Rh+ child. The mother can become sensitized. This means she produces antibodies to fight the Rh factor as if it were a harmful substance. These antibodies then attack the fetal Rh+ blood cells, in a subsequent Rh+ pregnancy. During pregnancy, although mother and baby have separate blood systems, blood from the baby can cross the placenta into the mother's system. This mixing of blood is most likely to occur if:
1. Someone pulls on the umbilical cord while delivering the placenta.
2. Clamps the cord early, before pulsations have ceased, leading to a backup of fetal blood into the mother.
3. Mixing of the blood can occur during amniocentesis or other intrusive tests.
Once formed, these antibodies do not disappear. In a first pregnancy with an Rh+ baby, the baby is usually delivered before the mother develops significant amounts of antibodies. In a second pregnancy with an Rh+ baby, the antibodies are more likely to cause hemolytic disease in the baby. This condition usually becomes worse in later pregnancies. It takes time for an immune response to be mounted, as the number of children increases; the chances of damage go up. Sensitization can also occur if an Rh- woman has:
1. Had a previous miscarriage.
2. Induced abortion or ectopic pregnancy.
Hemolytic disease can cause babies to develop jaundice, heart failure, anemia, brain damage or fetal death. In some babies it shows up in utero, in others it is characterized by jaundice in the first 24 hours and usually requires a transfusion and other intensive care measures.
MoonDragon's ObGyn Procedures: Amniocentesis
MoonDragon's ObGyn Procedures: Amniocentesis How To
MoonDragon's ObGyn Procedures: D & C
MoonDragon's ObGyn Procedures: Cesarean
MoonDragon's ObGyn Procedures: Chorionic Villi Sampling (CVS)
HEMOLYTIC DISEASE OF THE NEWBORN
Rhesus (Rh) hemolytic disease of the newborn (HDN) is a serious, often fatal disease caused by incompatibility between an Rh-negative mother and her Rh-positive fetus.[1-3] If prophylaxis were not available today - as was the situation prior to the introduction of RhoGAM Brand in 1968 - then the following statistics[1,2,4,5] would be true:
- 13% to 14% of Rh-negative expectant mothers could become alloimmunized during an Rh-incompatible pregnancy.
- 25% of fetuses would need immediate treatment to avoid kernicterus (a form of brain damage caused by excessive jaundice and associated symptoms).
- 25% of fetuses would develop hydrops fetalis and die.
- Only 50% of fetuses would be mildly affected and not require treatment.
Alloimmunization: An Rh-negative woman may become alloimmunized to the D antigen present on fetal red blood cells (RBCs) during the first Rh-incompatible pregnancy. Alloimmunization can occur during a number of situations, including fetal-maternal hemorrhage, bleeding that occurs during normal delivery, ectopic pregnancies, spontaneous or induced abortions, and abdominal trauma. The first pregnancy is rarely affected because the number of Rh antibodies produced by the mother during primary immunization is low and the antibodies are usually IgM in nature. Rh Hemolytic Disease of the Newborn (HDN): Pathogenesis.
Anamnestic response: When the mother is exposed to D-positive fetal RBCs during a subsequent Rh-incompatible pregnancy, the mother mounts an anamnestic, or secondary, immune response to the fetus' RBCs. A large number of IgG-class Rh antibodies are produced. The IgG antibodies cross the placenta and make fetal red cells susceptible to destruction. The fetal RBCs are then destroyed by the fetal immune system. Anemia develops in the fetus with a concomitant increase in unconjugated bilirubin. The anemia and unconjugated bilirubin levels can lead to a number of conditions.
The clinical manifestations of Rh HDN can range from very mild to death in utero or shortly after delivery.[1,2,4,5]
The fetal liver and spleen enlarge as they attempt to produce more fetal RBCs in response to hemolysis. Nucleated RBCs can be observed in the fetal blood due to the release of immature erythyrocytes (this gave rise to the name, erythroblastosis fetalis).
In the worst cases, severe anemia leads to hydrops fetalis, which is characterized by severe edema that develops sometime after 18 weeks gestation. Hydrops fetalis develops secondary to congestive heart failure and liver failure due to extreme hepatosplenomegaly (enlargement of the liver and spleen) and portal hypertension.
After delivery, jaundice may occur due to an increase in RBCs. The infant lacks sufficient amounts of glucuronidase and albumin to process the bilirubin, which was metabolized by the placenta and the mother before birth.
Kernicterus or bilirubin encephalopathy can occur as levels of unconjugated bilirubin increase. The bilirubin can accumulate in neuronal tissues resulting in central nervous system damage and developmental problems that can include:
- Dental enamel dysplasia.
- High-frequency nerve deafness.
- Athetoid cerebral palsy.
- Mental retardation, pulmonary hemorrhage.
1. Rubin E, Farber JL. Development and genetic diseases. In: Pathology. 2nd ed. Philadelphia, Pa: JB Lippincott Company;1994:256.
2. Prasad AS. Acquired hemolytic anemias. In: Bick RL, ed. Hematology: Clinical and Laboratory Practice. Vol 1. St. Louis, Mo: Mosby-Yearbook, Inc.;1993:391-396.
3. Turgeon ML. Hemoyltic disease of the newborn. In: Turgeon ML, ed. Fundamentals of Immunohematology: Theory and Technique. Philadelphia,PA: Lea & Febiger;1989:321-343.
4. Bowman JM. Antenatal suppression of Rh alloimmunization. Clin Obstet Gynecol. 1991;34:296-303.
5. Freda VJ, Gorman JG, Pollack W, et al. Prevention of Rh hemolytic disease - ten years clinical experience with Rh immune globulin. N Engl J Med. 1975;292:1014-1016.
MoonDragon's ObGyn Pregnancy: Rh Isoimmunization (Erythroblastosis Fetalis)
MoonDragon's ObGyn Pregnancy: Rh Isoimmunization - RhoGam Question
RhoGAM Ultra-Filtered PLUS is a sterile solution that contains antibodies to the Rh factor. The antibodies in RhoGAM Brand are derived from human plasma that has been carefully screened and processed for purity. When injected, the RhoGAM Brand antibodies circulate in the Rh-negative mother's bloodstream and prevent her immune system from making the sensitized antibodies that would threaten a baby with Rh-positive blood.
The mechanism of RhoGAM in preventing sensitization may be due to:
Clearance of antigen from the mother's system.
Blocking of the antigen brought about by the attachment of RhoGAM to the antigenic sites of fetal cells in the mother's circulation, or some sort of more central type (systemic) inhibition of antibody formation.
The 72 hour rule emerged from the original trials with Rh IG. Since it can take several weeks for the body to mount a full antibody response, it is possible that RhoGAM could be given much later than 72 hours after an exposure and remain effective. However, the parameters for how long it would be possible to wait are not known. Obviously, if it is known that an exposure has occurred, then it would seem prudent to give the RhoGAM as soon as possible. But in terms of your question, it is probable that if an unknown exposure occurred more than 72 hours prior to giving the injection at 28 weeks, and antibodies have not yet developed, then potentially that RhoGAM would offer protection against the development of those antibodies.
INDICATIONS & USAGE
PREGNANCY AND OTHER OBSTETRICAL CONDITIONS: RhoGAM Brand is indicated for administration to Rh-negative women not previously sensitized to the Rho(D) factor, unless the father or baby are conclusively Rh-negative. Appropriate uses include:
- Delivery of an Rh-positive baby irrespective of the ABO groups of the mother and baby.
- Antepartum prophylaxis at 26 to 28 weeks of gestation.
- Antepartum fetal-maternal hemorrhage (suspected or proven) as a result of placenta previa, amniocentesis, chorionic villus sampling, percutaneous umbilical blood sampling, other obstetrical manipulative procedure (e.g.,version) or abdominal trauma.
- Actual or threatened pregnancy loss at any stage of gestation.
- Ectopic pregnancy.
TRANSFUSION OF RH-INCOMPATIBLE BLOOD OR BLOOD PRODUCTS: RhoGAM Brand may also be used for the prevention of Rh immunization in any Rh-negative person after incompatible transfusion of Rh-positive blood or blood products (e.g., red blood cells, platelet concentrates, granulocyte concentrates).
PRECISE DOSING INSTRUCTIONS
Available in two dosage strengths:
- RhoGAM 300 µg - For antenatal and postpartum use, second- and third-trimester pregnancy terminations, or transplacental hemorrhage [1-3].
- MICRhoGAM 50 µg - For use immediately after first-trimester pregnancy termination [3,4].
WHEN TO ADMINISTER RhoGAM® Brand
- At 28 weeks gestation [5-8].
- Within 72 hours postpartum .
- Following spontaneous or induced termination .
- Following any event that could lead to transplacental hemorrhage (such as amniocentesis, chorionic villus sampling (CVS), percutaneous umbilical blood sampling (PUBS), or abdominal trauma) .
HOW OFTEN TO ADMINISTER RhoGAM Brand
RhoGAM Brand should be administered in 12-week intervals .
Severe systemic allergic reactions are extremely rare. .
1. RhoGAM® Ultra-Filtered PLUS Package Insert. Ortho Clinical Diagnostics.
2. RhoGAM® Ultra-Filtered Marketing Authorization Application: Part IB1. Summary of Product Characteristics. Ortho Clinical Diagnostics. November 2000.
3. Pollack W, Ascari WQ, Kochesky RJ, et al. Studies on Rh prophylaxis. 1. Relationship between doses of anti-Rh and size of antigenic stimulus. Transfusion. 1971;11:333-339.
4. Frigolette FD Jr, ed. Antepartum administration of Rh immune globulin: a guide to office procedure. Raritan, NJ: Ortho-Diagnostic Systems, Inc. 1983.
5. Bowman JM, Chown B, Lewis M, et al. Rh isoimmunization during pregnancy: antenatal prophylaxis. Can Med Assoc J. 1978;118:623-627.
6. Bowman JM, Pollock JM. Antenatal prophylaxis of Rh isoimmunization: 28-weeks gestation service program. Can Med Assoc J. 1978;118:627-630.
7. Baskett TF, Parsons ML. Prevention of Rh(D) alloimmunization: a cost-benefit analysis. Can Med Assoc J. 1990;142;337-339.
8. Bowman JM. Antenatal suppression of Rh alloimmunization. Clin Obstet Gynecol. 1991;34:296-303.
9. Mintz PD. Rh Immune Globulin. In: Mintz PD, ed. Transfusion Therapy: Clinical Principles and Practice, 2nd Edition. Bethesda, MD: AABB Press; 2005.
10. Freda VJ, Gorman JG, Pollack W, et al. Prevention of Rh hemolytic disease - ten years clinical experience with Rh immune globulin. N Engl J Med. 1975;292:1014-1016.
11. Prevention of Rh D Alloimmunization. ACOG Practice Bulletin. Number 4, May 1999. Clinical management guidelines for obstetrician-gynecologists. American College of Obstetricians and Gynecologists.
IMPORTANT RhoGAM SAFETY INFORMATION
RhoGAM and MICRhoGAM Ultra-Filtered PLUS Rho(D) Immune Globulin (Human) are made from human plasma. Since all plasma-derived products are made from human blood, they may carry a risk of transmitting infectious agents, e.g., viruses, and theoretically the Creutzfeldt-Jakob disease (CJD) agent. RhoGAM® and MICRhoGAM® are intended for maternal administration. Do not inject the newborn infant. Local adverse reactions may include redness, swelling, and mild pain at the site of injection and a small number of patients have noted a slight elevation in temperature. Patients should be observed for at least 20 minutes after administration. Hypersensitivity reactions include hives, generalized urticaria, tightness of the chest, wheezing, hypotension and anaphylaxis. RhoGAM® and MICRhoGAM® contain a small quantity of IgA and physicians must weigh the benefit against the potential risks of hypersensitivity reactions. Patients who receive RhoGAM® and MICRhoGAM® for Rh-incompatible transfusion should be monitored by clinical and laboratory means due to the risk of a hemolytic reaction.
The use of RhoGAM Brand and MICRhoGAM Brand is contraindicated in Rh-positive individuals.
The Official RhoGAM Site
CONVENTIONAL OB MEDICAL GUIDELINES
If father of the baby or donor is Rh positive or unknown, the patient is a candidate for RhoGAM prophylaxis in the following cases:
Micro RhoGAM - Should only be given if a pregnancy terminates before 13 weeks (TAB, SAB, Ectopic, Molar)
Full dose RhoGAM is given:
- Threatened abortion at any stage with confirmed pregnancy.
- Abortion, ectopic, or molar pregnancy at or beyond 13 weeks.
- Genetic amniocentesis.
- Unexplained first, second or third trimester bleeding.
- Abdominal trauma 2nd or 3rd trimester.
- Third trimester amniocentesis.
*If amnio repeated in greater than 21 days another full dose of RhIg should be given. *if amnio is performed and delivery is anticipated within 48 hours, administration of RhIg can be with held until after delivery and determination of the newborn to be Rh positive can be made.
- Antepartum prophylaxis at 28 weeks.
- External version.
- Post dates pregnancy beyond 40 weeks.
- 12 weeks since last RhoGAM, repeat antibody screen and administer RhIg.
*if delivery occurs within 21 days of administration of RhIg and examination of maternal blood sample does not reveal an excessive amount of fetal RBC's additional RhIg is not needed.
If delivery is anticipated within 48 hours, administration of RhIg can be withheld until after delivery and determination of the newborn to be Rh positive can be made.
If patient elects not to receive RhoGAM at 28 weeks, repeat antibody screen every 4 weeks until delivered.
If at any time the patient's antibody screen is positive obtain MD consultation.
Obtain cord blood for blood type, Rh and direct coombs.
Postpartum (if Newborn is Rh-Pos). If newborn is Rh positive, have RhIg given to the mother within 72 hours of delivery. (Current recommendations is one vial if fetal RBC's less than 25 ml and two vials if 25-50 ml and so forth.)
If direct coombs is positive obtain cord bilirubin.
If mother is a RhoGAM candidate and is also Rubella Non-Immune, administer the RhoGAM and hold the rubella vaccine until 3 months postpartum.
Testing the baby's Rh factor is now available prenatally. For about 38 percent of women, this means they would not need the 28-week RhoGAM shot. RhD Genotyping from Lenetix.com. You will want to check with your health insurance first to make sure they cover the test fee.
Stephanie Stern, MS
Lenetix® Medical Screening Laboratory, Inc.
174 Mineola Boulevard
Mineola, New York 11501
Ph: 516 320-6375
Fax: 516 248-4436
HOW IS HEMOLYTIC DISEASE PREVENTED?
Hemolytic disease can for the most part be prevented if the Rh- mother has not already made antibodies against the Rh factor from an earlier pregnancy or blood transfusion. RhoGam is a blood product that can help prevent sensitization of an Rh- mother. It suppresses her ability to respond to Rh+ red cells. RhoGAM is not helpful if the mother is already sensitized. It is not 100 percent effective in all cases.
Interesting to note, midwives and home-birth health care providers, who delay clamping the cord until the blood has stopped pulsating, report an almost zero incidence of Rh problems.
A blood test, called an antibody screen, can show if an Rh- woman has developed antibodies to Rh+ blood.
Once a woman develops antibodies, RhoGAM treatment does not help. An Rh sensitized mother can be checked during her pregnancy to see if the baby is developing hemolytic disease. Delivery may be followed by a type of transfusion for the baby that will replace the diseased blood cells with healthy blood.
Prior to RhoGAM, somewhere between 10 to 16 percent of Rh- women became sensitized to their baby's blood. Traditionally, RhoGam is given within 72 hours of birth. This is a recommendation which arose from the fact that the researchers developing the protocols for giving RhoGAM postpartum used the 72 hour period because of the logistics of drawing blood from volunteers who were newly delivered and usually discharged by 72 hours. Since they had such a high success rate with this particular protocol, this 72-hour limit became sacred. However, immunologists know that immune response is not initiated until fetal cells are identified by the mother's spleen. This process can take weeks. Therefore, you can go past the 72 hours before administrating the RhoGAM vaccine.
RhoGAM is developed by injecting human volunteer donors (Rh-) with the positive Rh factor, then drawing their blood once antibodies have been formed. This blood is concentrated into a serum for injection. RhoGAM is a human-blood product and therefore, despite all government reassurances, may contain the AIDS virus. RhoGAM reduces, but does not eliminate the possibility of Rh sensitization.
RhoGAM joins a long list of medical interventions that once were considered to be beyond question but now are suspect. RhoGAM, like immunizations and silver nitrate in the eyes of newborns, has been a form of Holy Water in the Religion of Modern Medicine.
Since 2 percent of Rh- women still become sensitized even with RhoGAM, researchers, seeking to better the percentage, began to give RhoGam at 28 weeks of pregnancy. This is a relatively new procedure.
With prenatal RhoGAM, the future siblings are the ones who may benefit from the treatment, rather than the baby who is subjected to the risk. Tests on babies whose mothers were given RhoGam prenatally imply that the immunoglobulin reaches the baby in measurable amounts. No one knows what the effect might be on an Rh- female baby who later gives birth to Rh+ babies.
Because the baby's blood type is not ordinarily known during pregnancy, the standard of care among United States obstetricians has come to be that all babies of Rh- mothers, regardless of their blood type, are exposed to RhoGAM. This means that approximately 35 percent of babies are needlessly exposed to RhoGAM. Another group of babies needlessly exposed are those who will be their mother's last child. It is only future pregnancies that are affected by the mixing of blood between Rh- mothers and Rh+ babies.
A part that may cause problems, in addition to the AIDS question, is the preservative thimerosol, which is a mercury derivative. Mercury crosses the placental barrier and, within minutes of maternal exposure, the unborn baby receives 30 times the concentration level of the mother. (Note: RhoGAM is now available in mercury-free formulations in the US. If you are getting RhoGAM treatment, be sure to have your health care provider or midwife check to see if the RhoGAM is the thimerosol-free formulation.)
MoonDragon's Health & Wellness: Mercury Toxicity
The use of RhoGAM during pregnancy may be dangerous to the baby. Some mothers after receiving prenatal RhoGAM have had their babies die within a week of having the vaccine.
Due to the 30 micrograms of thimerosal in each RhoGAM shot, fetuses receive this high dose. Children who have high mercury levels (due to thimerosal in vaccinations) are at special risk. Children have undeveloped blood brain barriers and much of the mercury goes to the brain, resulting in significant adverse neurological effects, including autism, persuasive developmental disorders (PDD), Asperger's syndrome, obsessive compulsive disorder (OCD), dyslexia, ADD/ADHD, learning disabilities, childhood depression.
The woman is blamed for Rh incompatibility, and professionals refer to "Rh negative women and their babies", never to "Rh positive men and their babies", even though it is just as much the father's genes and the mothers that is the cause of the problem.
Rh- blood is good, so is Rh + blood. They are just different, as different as two different species of humans. That is why they do not "mix".
Rh- negative blood carries special antibodies that others do not. Some blood banks "buy" this blood on a regular basis; it has special antibodies that are used to help some very physically ill people.
85 percent of world population is Rh positive, leaving only 15 percent Rh negative.
More people who are Rh- have roots in Scotland, Ireland, and Peru-Basque peoples.
In the 90's, in Germany and also in Ireland, thousands of pregnant women of Rh- factor were given RhoGAM; this shot however carried a horrible disease, hepatitis. This happened two times, about three years apart. Women and babies became ill. Time went on and eventually these women went to court. It was learned and proven that it was known in advance and proven in court, that the blood they received was tainted with hepatitis.
**WHAT HAVE I DONE?**
One mother's experience:
"With my first pregnancy and birth, I had the blood test to test for sensitization (Why was this recommended with a first pregnancy?) around 28 weeks. After my son was born we cut the cord after a few minutes and collected blood into vacutainers to be taken to the lab to be tested. We refrigerated the vacutainers immediately; my husband took them to the lab the next day. When my son's blood type was confirmed RH+, I was threatened and scared into taking RhoGAM at 80 hours postpartum. They tested me for sensitization and gave me two shots of RhoGAM in the emergency room. I believe that the reason I was sensitized was due to the inadvertent pulling on the umbilical cord, when my son was handed to me through my legs.
With my second pregnancy and birth, I also took the blood test to test for sensitization along with some iron level tests, at around 28 weeks. The test came back with me not being sensitized. After my daughter was born, my husband and I watched the cord, and when it stopped pulsating, we cut it and collected blood into a vacutainer. We put this into the refrigerator to wait until we were ready to test the blood type ourselves. Later that night I tested the blood with a simple test on an Eldon card (you can order these through any birthing/ midwifery catalog, they are about $2.00 each). My daughter's blood type is RH-. So there was no RhoGAM decision to make. I did study more about RhoGam and being RH-, I even contacted the Jehovah Witness religious group, as they do not accept blood transfusions or any blood products. But I did not find any women who were RH- and struggled with the RhoGAM issue.
MoonDragon's Lab Information: ABO-Rh Blood Typing - EldonCard Method
With my third pregnancy and birth, I did not having any blood tests done (if I was not sensitized when I was pregnant with my daughter and she is RH-, there is no reason I would be now). I did use a syringe to collect some blood from the cord, without cutting it. I tested the blood for type, just for my own information. He was RH-. I would not of had the RhoGAM shot regardless of blood type.
I read in 'Polly's Birth Book' by Polly Block, that there are a number of women who had begun their childbearing years RH-. When they had continual problems with pregnancies, they began seriously to build their blood and their general health. In each case physicians, not the mothers, discovered a change in their RH status. They were now RH+. The doctors were astounded and called for additional tests and reports. They could not understand why a mother who had been RH- for years was now RH+. These women all shared something in common. In each instance, these women had concentrated on purifying their blood by changing their diets so they had exceptional nutritional intake. They ate fruit for one week. Then they ate fresh, raw, homegrown foods or organic foods. They eliminated sugar, coffee, alcohol, and soft drinks, as well as white flour, prepared foods and refined products from their diets. They used herbal lower bowel tonic and had occasional enemas to keep their bowels evacuated thoroughly during body cleanses. They used herbs to cleanse and build the blood. Several of these mothers gave Periwinkle special credit. They ate foods that built blood: Grape juice, molasses, beets, etc. No one knew how long it took to bring about the change in RH status, as there are no records.
I found that all very interesting. I never knew it was possible to change your RH status. But then again- "all things are possible". I just thought I would share this with you."
POLLY BLOCK'S METHOD OF BLOOD CLEANSING
FOR RH-NEGATIVE MOMS
A good way to cleanse your blood (from Polly's Birth Book):
Drink plenty of cups of Red Raspberry leaf tea.
Take Herb: Organic Raspberry Leaf, Caffeine Free, Kosher, Traditional Medicinals, 16 Tea Bags
TakeHerb: Raspberry Leaf, Woman's Female Support, Yogi Tea, 16 Tea Bags
A tea made from Red Clover blossoms, Chaparral, Licorice root, Poke Root, Peach Bark, Oregon Grape Root, Stillingia, Cascara Sagrada, Sarsaparilla, Prickly Ash bark, Burdock root and Buckthorn bark.
A few capsules of: Goldenseal root, Blessed Thistle, Cayenne, Cramp Bark, False Unicorn root, Ginger, Red Raspberry leaves, Squaw Vine and Uva Ursi.
NuFem, 100 capsules
And a few capsules of: Black Cohosh, Sarsaparilla, Ginseng, Licorice, False Unicorn root, Blessed Thistle (Holy Thistle) and Squaw Vine.
Changease 100 capsules
BOOKS BY POLLY BLOCK
I wrote the following to a woman wishing for more information so her daughter could "stand up" to health care workers regarding RhoGam.
I have been searching through my papers to find what you need, and alas I cannot find it. The information you need is the paper that comes with the vaccine itself. It lists the possible side effects and contents. The vaccine is anti-Rh (anti-D) antibodies immunoglobulin (a human blood product). My papers say that the long-term risks are not known at this time, and there is controversy as to the safety of this application. Your daughter should ask first for the prescribing information on RhoGam. She will learn that it is a human blood product that reduces, but does not eliminate the possibility of Rh sensitization. She will also learn that the manufacturer warns that no one knows whether when administered to pregnant women, RhoGAM causes damage to the fetus. After reading this information, she should then ask her doctors for scientific information that support the recommendations to use RhoGAM in her particular case.
For example, she would want to look for cases in which RhoGAM was administered during a first pregnancy. She then could ask the doctor if he/she remembers when sick newborns, not too many decades ago, were treated with blood administered intramuscularly. That led to Rh sensitization in female babies long before they became old enough to be pregnant. What does her doctor think of that medical mistake, and does he/she know the dangers today's RhoGAM shot may pose years later?
She needs to be sure the doctor shares information with her from the manufacturer that tells the AIDS status of the RhoGAM.
- Does the particular batch he/she wants to use carry the AIDS antibody?
- Does it carry the virus itself?
- What tests have been done to exclude the possibility?
- Are the tests accurate?
- How does he/she know?
RhoGAM is made by human volunteers who are Rh- and injected with positive Rh factor, causing antibodies into serum for injection. These antibodies in this pooled serum coat the blood cells of the Rh- mother who is injected. There is also thimerosol, a preservative in RhoGAM, which is a mercury derivative. This does cross the placental barrier within minutes and the baby receives 30 times the concentration level of the mother - which prenatally can push them over the brink- so to speak. The FDA "believes" RhoGAM carries no AIDS risks. Believes, but does not know for certain.
And RhoGAM is far from effective. Some women become sensitize in spite of being given RhoGam after delivery (9 out of 25). The best things to do is avoid procedures that might cause mixing of the mothers' blood with that of her baby's (amniocentesis, early cutting of the umbilical cord, pulling on the cord, etc.) and refuse the prenatal shot (you do not know if your baby is Rh+ or -). So question everything and if you are not given a satisfactory explanation or you feel uneasy, refuse!
1. If you and your partner's blood is RH-, you do not need to concern yourself about RhoGAM or blood sensitization. Your child's blood will also be RH-.
2. If your blood is RH- and your partners is RH+, ONLY if your child's blood is RH+, will you need to concern yourself with the Rhogam question. If your child's blood is RH-, you do not need to concern yourself at all.
3. If your blood is RH- and your partners is RH+; NOT pulling on the cord, waiting to clamp and cut the cord, and avoiding amniocentesis, taking bioflavinoids, a healthy diet - will all help you to not become sensitized to RH+ blood, as the blood will not have an opportunity to mix with yours.
A simple antibody (blood) test can tell you if you are sensitized, due to previous miscarriages, births, and abortions.
*NEW* There are two Thimerosal FREE shots available. They may take longer for the health care provider's office or blood bank to order, but they are available. They are Bayer's BayRHO and Cangene's WinRHO.
Anti-D in Midwifery Panacea or Paradox?
-- By Sara Wickham MA BA(Hons) RM,
This is a book available on the subject. Highly recommended.
PRENATAL RHOGAM: A COMPLICATED CHOICE
By Judie C. Rall & The Gathering Place
From The Gathering Place: http://www.angelfire.com/biz3/gatheringplace/rhogamalarm.html
It is well known that mother and baby have two distinct blood systems. Mother and baby often have two different blood types depending upon genetic contributions made by both mother and father. These two blood systems do not mix. The placenta allows nutritional components and hormones to enter the blood stream of the fetus, and of course, any drugs introduced into the mother. But the two blood systems do not mix.
For thousands of years, mothers have given birth unassisted by medical technology. There was never a problem with blood incompatibility. Now, in this new age of medical intervention, including surgical abortion, prenatal testing such as amniocentesis and chorionic villus sampling, and giving birth in hospitals where procedures such as cord traction and cesarean section practically insure there will be some kind of blood mixing, suddenly blood incompatibilities between mother and child have been discovered.
In 13 percent of the population, the mother happens to be Rh- and the father Rh+. This is not an emergency in and of itself. In the 1970's an inoculation was developed, made from the blood of Rh- mothers. This substance was to be injected into mothers to immunize them against the blood of their babies. When a mother gives birth naturally, without medical intervention, there is little risk of the mother and baby's blood supply mixing. They are two separate systems. But in a system of "managed" birth, where there are often interventions which can mix the blood supply, a case for this inoculation seems to have developed. You see, when you have amniocentesis or chorionic villus sampling, your womb is being invaded by a sharp tool which CAN cause bleeding. When a woman has abortions, the blood of the fetus can be mixed with her own. When a woman has a cesarean section, internal fetal monitoring, cord traction to remove the placenta, or scraping of the uterus to remove placenta pieces, this mixing can occur. These circumstances did not exist years ago. These kind of procedures were never performed. So the Rh- problem is a problem that has largely been created by modern medicine and its birth interventions.
According to the logic(?) of this, just as a person who is given blood that is the wrong type will have a reaction to that blood, the woman whose blood mixes with that of her child will have a reaction. Her body will sense the foreign blood and will make antibodies to destroy any blood cells like the ones detected. In other words, it makes antibodies to kill the blood of any future babies with that blood type.
The best way to avoid blood mixing is to have a homebirth with no medical interference of any kind. If you allow your placenta to be expelled naturally, you will probably have a more heavy blood flow for a longer period of time in order to cleanse the uterus. At this time, any placenta pieces which may have been retained will be expelled. There is no need to invade and violate the inner sanctum of the uterus.
Reading the package insert on RhoGAM is a very educational experience. There are many risks to taking the shot, including anaphylactic shock. Damage to the immune system can also be permanent. RhoGAM is made from human blood products which can harbor viruses that cannot be screened out. With HIV and other harmful viruses out there, it is outrageous to think of exposing yourself to potential risk of getting it from a RhoGAM shot. It also is preserved in a mercury derivative, something that should never enter anyone's body. The package insert also says there are risks to the immune system of the mother or child if they have allergies. Who among us doesn't have an allergy to something?
There has been some research done which suggests that if one does NOT have amniocentesis or cesarean section, and births without cutting the cord until the placenta has delivered itself with no cord traction or pulling, this is the best way to prevent blood contamination.
Most physicians will tell you that you can never change your Rh- status. But there are some women who have done it by changing their diets and taking certain herbs. The women in question were known to be Rh- and when they went to the doctor for a routine test, it was found that they were suddenly Rh+. The doctor is the one that discovered this. It is not known how long it took for this change to occur, but the women were following blood cleansing procedures such as:
1. Changing their diet and eliminating all sugar, white flour, caffeine, sodas, processed foods, and alcohol.
2. Using a lower bowel tonic and occasional colonics to keep the bowel clear.
3. Use of herbs to cleanse the blood (such those outlined above under Polly Block's Method).
4. Also, included in the diet blood builders, such as grape juice, molasses, beets, and others.
I am simply sharing all this with you because I believe it is dangerous to take the RhoGAM shot. If you are tested and are told you need the shot, please do not rush into this decision. I believe that you have other options besides permanently damaging your immune system. They used to administer the shot within 72 hours after birth. Now, they want to administer it to all pregnant women who are Rh- without even testing them to see if they need it. I would not accept the shot without testing to see if I needed it. And if they said I did need it, I would do everything in my power to avoid it. Of course, if you refuse the shot, your doctor may refuse to attend your birth.
But there are other options for birth besides physician attended birth. Also, the hospital emergency room and the doctor on call on the labor and delivery floor are required to give you care if you show up.
What is the bottom line in all this? As we take a step further in technological advancement, we are getting farther and farther away from trust in our bodies, farther from the knowledge of how to have safe and healthy birth, and closer to permanently endangering our health and the health of our children. We do not know the effect these substances will have on the reproductive health of the children we carry while taking these drugs. But we do know that it is possible to have a health pregnancy and birth without taking the RhoGAM shot. I am personally acquainted with women who have not taken the shot, and have suffered no ill effects.
Exercise your right of informed choice. Do your own research, and do not be pushed one way or the other. Consult your inner wisdom, and only do what feels right to you.
By Midwife Archives
From archives at: http://www.gentlebirth.org/archives/postpart.html#Rhogam
If the baby is positive, then the mother's blood is tested to determine the amount of fetal cells. The blood bank usually does this. Then depending on the calculation of fetal blood that has passed to the mom, the Rhogam dose is adjusted. The test is called Kliehauer, but I have come across it named "fetal screen".
The test is a Kleihauer-Betke, and estimates amount of fetal blood cells in the mom's blood. One dose of Rhogam is considered sufficient to deal with 15 mg of fetal blood cells. Under most circumstances that's enough in a normal home birth. We weren't doing them for a long time because no commercial labs in the area were doing their own, and it would take 8 days to get the results back from wherever they sent them out. A bit late for our purposes. Now my lab does them in-house, so it has become do-able for us. I did labor support for a gal who had been sensitized because she was not given enough Rhogam after her c-sec. Kleihauer said 57 mgs fetal cells, which works out to 4 doses. They gave her 2, said "that's all we ever need". Wrong.
Her next 2 pregnancies were nightmares of interventions, multiple specialists, weekly amnios for bili levels, and one induction because they couldn't get at a pocket of AF to draw any at 38 weeks. Babies were Rh- , after all that.
just one little tidbit I learned a few years ago when attending a conference on prenatal issues were rhesus isoimmunization was discussed. The 72 hour cutoff which is normally touted as being the cutoff for giving RhoGAM is an artifact from the original study which was done on prisoners over a weekend. It is felt that it is safe to give RhoGAM up to about 2 weeks which is about how long it takes for the bodies immune system to respond.
By Cathy O'Bryant CPM
RhoGAM is the original Rh immune globulin. It was introduced in 1968. It is a specially prepared gamma globulin that contains a concentration of Rh antibodies. These antibodies suppress the Rh negative mother's immune response to the foreign Rh positive red blood cells that may enter her bloodstream during pregnancy or following an abortion or full term delivery. RhoGam is derived from Rh-sensitized moms or Rh- males that have been sensitized through blood transfusions.
I myself do not totally agree with this procedure. In my practice a routine antibody screen is done at the initial prenatal visit. I screen all my Rh- mothers, primips or multips. If they have a negative titer, I do not feel the antepartum injection is necessary. First of all, a primip would have not had any time to build up immunities. She does not need RhoGAM if she has not had any transfusions, abortions, etc. My biggest objection to antepartum RhoGAM is the fact that the baby can be born direct Coombs positive from the RhoGam injection itself. This is one of the contraindications, although rarely mentioned by the drug company or physicians. I have seen this scenario, where the baby had to be transfused after delivery because of antepartum RhoGAM.
After my deliveries, I type babies and if they are positive, then the mother is given RhoGAM. Some of my mothers refuse the RhoGam and I respect their decision. They have birthed 6-7 Rh+ children and have never received one dose of RhoGAM and they still test negative on their titer. On the other end of the spectrum, I worked with a woman who had a miscarriage early in her marriage and became sensitized - her healthcare provider didn't tell her about the chances of her becoming sensitized because of her Rh factor. She became highly sensitized 1:250 dilution or higher. She continued to have 7 Rh+ babies who all needed to be transfused. She has had two more children who were born negative.
RhoGAM can be a sensitive subject and each person needs to research the answers. As far as contracting HIV from RhoGAM, I'm sure that it has happened but within the last few years, the process of filtering the product has gone through major changes and it is micro filtered over and over again, one reason why the cost of RhoGAM has risen from $25 from when I first started practicing to over $100 on today's market.
Reprinted from Midwifery Today E-News (Vol 1 Issue 51, Dec 17, 1999)
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By Karen Blake
I am assuming that you are referring to Anti-D, given to rhesus negative women when the partner is rhesus positive, leading to a rhesus positive baby. There are associated dangers with this vaccination as it is made of human blood products, obtained from a pool of rhesus negative male donors. However, the risks far outweigh the benefits of the mother being prevented from developing antibodies and being unable to have any normal pregnancy with a rhesus positive baby. I am Rh neg and recently had an early miscarriage because it was prior to eight weeks gestation and I did not have the vaccine. This is usual practice in New Zealand as the placenta was not fully formed and no fetal blood cells would have been able to enter my system. A fabulous way of avoiding lots of these vaccinations is to avoid or minimize interventions during pregnancy i.e., amniocenteses.
By Dianne Oliver
I am Rh negative and my husband Rh positive, therefore the RhoGAM injection was an issue for me. With my first pregnancy, I did not give it too much thought until after the nurse gave me the injection of RhoGAM at 28 weeks. After receiving the injection it was as if a light went off, and I realized I had just received a *blood product*! Foolishly I had not read up on RhoGAM nor asked to read the package insert before the injection. My concern was HIV.
So I did some investigating to see whether or not my concern was justified. What I discovered from calling the American Red Cross, inquiring into the procedure used to make Rhogam and speaking with other people who had some background in blood products is that, first of all, there has never been a documented case of HIV transmission from RhoGAM, and RhoGAM has been around for quite some time (I want to say 30 years or so, but I am not certain.) Second, if I remember this correctly, RhoGAM is made from blood plasma, not the whole blood product. And third, the plasma used to make Rhogam is heat treated which would, in theory, kill any HIV present.
This is the information as I recall it. I would advise you to double-check this information with a knowledgeable source in case I have recalled something incorrectly.
Two suggestions I would make to any pregnant Rh negative woman:
1) Have the baby's father's blood type checked before submitting to the RhoGAM injection. If the baby's father is Rh negative, there's no need for RhoGAM.
2) Type the baby's blood after birth (cord blood). If the baby is Rh negative (like the mother), there is no need for the postpartum injection.
Reprinted from Midwifery Today E-News (Vol 1 Issue 48, Nov 26, 1999)
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ANOTHER MOTHER'S PERSPECTIVE ABOUT RHOGAM & RH SENSITIZATION
I stand behind the message in this post with every fiber of my body. I know that many women are concerned for the health of their unborn children to the point of letting the fear ruin their lives and I am so sorry for them that they have been so traumatized by people they trust. I have Rh negative blood and my husband has Rh+ blood and my oldest son has Rh+ blood, yet I defied the odds and had an unassisted birth with my 6 month old son David without the prenatal RhoGAM innoculation and without the RhoGAM shot given in the first 72 hours following his unassisted free birth. Many women will be confused as to my motivation in taking this action. Some will see me as fool hardy and many others will view this action as neglectful or ignorant. It was a decision that my husband and I arrived at following many months of research and soul searching. It was not something we entered into lightly, and I stand firmly behind my decision to have a second child without RhoGAM. I can not tell others what decision to make and I will not assume responsibility for the decisions or consequences others will bring about in the decisions they will make to refuse RhoGAM or accept this human blood product. All I can offer others is an attempt to explain why I chose to give birth without medical intervention in my home without RhoGAM. I studied Mechanical Engineering in college, not genetics, so my comfort level discussing the mechanics of genetics is not as so great as it would be of discussing a strengths of materials topic or proving a mathematically based theory. Furthermore, I took Biology 12 years ago in college and brushed up on it for the purposes of understanding these RH theories for my own personal knowledge, but I do not claim to be an expert on this topic.
I would like to tell you that I have nothing to say about RhoGAM or Rh-D factors except that I am more confused and puzzled by the conflicts that are occurring between what should be happening to women and what is really happening in their bodies then I would ever imagined possible. I have met women in "real" life and on the internet who's case histories have defied every rule that I previously thought and that I presently read that is presented as fact, and the more I come to know about this issue, the more I come to find that we are in the dark about all the facets of the complex issues that affect our bodies where these blood factors are concerned, and the contrasting case histories I have stumbled upon can only indicate that there are unknown pieces of the puzzle that we have not yet come to understand. I have found my journey to be circular, in that I am always being brought back to the question - what are the facts besides the obvious that all women need to do their best to prevent the circulatory system of their unborn children from being disrupted or tampered with.
Further, I think we have alot to learn about these issues, and I would like to establish a world registry of women with Rh-D blood factors for the purpose of trying to learn more about when these true Rh blood incompatibility incidents are arising in their children. I have written up a questionnaire for Rh-D moms to fill out and would like to keep track of these case histories in a confidential manner in an attempt to find some absolute truths. Please e-mail me at firstname.lastname@example.org for a questionnaire. If you would like to receive a e-mail newsletter devoted to the these RH issues please indicate your desire. If you do not have internet or e-mail access, please indicate your need to receive the newsletter through the postal service. An RH- mom, Jennifer VanLaan Smit will be updating her web page with information at http://www.geocities.com/heartland/woods/2924/index.html.
If are a woman and you have Rh- blood type, (A-, B- AB- O- etc), then you probably want to know how this, and the birth choices you make, can and will effect your unborn child and subsequent children. I would like to stress that 13 percent of the population has the occurrence that the mom happens to be Rh- and the dad Rh+. I strongly believe that this is not an emergency or any cause for alarm in and of itself. There are not so many terrible occurrences of problems with children of these parents that we should be terrified about this situation and misled into thinking that we need to all run out and get tubal litigations or to be afraid for 9 months that our children are dead or soon will be. In other words, don't let the situation ruin the beauty and enjoyment of your pregnancy for you.
Here is my amateur attempt to pass along the genetics information that I retained from Biology 101 in college. Human beings have 26 chromosomes. They get 13 from their mom and 13 from their dad. Our blood types are either negative or positive. For instance, I am A- in blood type. My mother has A+ blood and my father has A- blood. When my parents jointly contributed to my genetic makeup, My father gave me one A- gene. My mother is A+ but she is heterozygous for her blood type meaning that she had the ability to pass along to me either a A+ gene or an A- gene. As my blood type is A-, I got two negative genes. So I am homozygous for A-, having two A- genes. This indicates that I lack the + gene.
To further complicate the matter, this A- blood type is one of more that a dozen other genes affecting my blood typing that I have inherited. So this well known A- factor that I have been tested for is called Anti-D. of the dozen other factors there are many other blood factors that go untested everyday in the millions of pregnant ladies around the world.
Also it is interesting to know that this Rh-D factor is not the only gene determining the genetic implication of the child. There is another gene referred to as DU. DU is a factor that overrides the Rh-D factor. You can be tested to see if you carry the DU gene. If so, the DU is said to trick your immune system into believing that you are RH+D, so that your immune system will not create antibodies against your unborn children.
However, an unassisted birther in New York state by the name of Patty Kohl, featured in a 1996 issue of the New Nativity II magazine available by snail mail from Valarie Nordstrom by contacting Val at email@example.com for $10 per year), lacks the Rh-D factor as well as the DU factor, has seven beautiful healthy Rh+D children and still without RhoGAM for the last few pregnancies and births and defies all the theories and rules of this Rh- game by having NEVER created antibodies against her children's blood type. Go figure.
This common negative factor I and you will be tested for is the little D factor. This factor is said and commonly believed to cause severe anemia in infants carried to term my Rh- moms with Rh+ dads. However, it is not as commonly known that a more extensive genetic evaluation leaves most of the population at risk for one of the other dozen plus genetic risk factors.
Why then is there this huge concern and analysis being done on the blood of pregnant ladies around the world who test negative for Rh-D factor blood? The most obvious reason is that an innoculation was created in the early 1970's using human blood from Rh- moms who had created antibodies against the Rh+ babies they carried in their bodies. This blood product is manufactured using donor blood of these Rh- ladies who have developed these "cell killing" antibodies in an attempt to save the world from babies being born with said severe anemia that was believed to be caused from the pregnant mother's immune system creating antibodies to protect itself from Rh+ blood contamination. The theory behind this being that just as people have severe life threatening consequences if they are intravenously injected with the wrong blood type, the blood streams of pregnant Rh- moms will be invaded by the Rh+ blood cells of their unborn child. The woman is believed to be in danger of this blood contamination during birth and some have even contended that a serious risk is present to the mother during pregnancy. Here is where I am in objection to the common practice of inoculating all Rh- mothers with RhoGAM.
However, there was an article that appeared in the San Francisco Chronicle by a Dr. Jagger who posed the question - is the nurse who draws your blood at risk for Rh-D antibody production if she draws blood from a Rh+ patient, and accidentally sticks herself with the needle thus contaminating her circulatory system with Rh+ cells. This is a great question and I did run across a Rh- mom who was a nurse and did have Rh-D antibodies before she was ever pregnant. This is a very interesting incidence and one that could have very serious implications - perhaps it could be said that Rh-D nurses and doctors should not be drawing blood. A very interesting and important contention that I hope would be investigated.
It has been said by a Dr. Mendelsohn, author of "Confessions of a Medical Heretic" that the need for RhoGAM inoculations came about to combat another iatrogenic (medical practitioner induced complication or harmful) occurrence when the natural process of giving birth and carrying our children and miscarrying our children, when unfortunately but necessarily it does occur, is disrupted. It is said to be the intention of our creator that the circulatory system of the mother is distinct and different from the circulatory system of her child while she carries him in her womb. The placenta is placed in the womb in such a way that the child develops its own system of circulation independent from its mother and that their blood does not mix, unless the delicate system is interrupted by an outside source. Such as if a needle were inserted into the mother's abdomen puncturing the amniotic sac and the baby were accidentally stabbed by the doctor's needle spewing blood from the baby's body through the hole in the amniotic sac once the needle is removed (as the needle would leave a hole in the amniotic sac) and the child's different Rh-D blood factor cells would leave the child's placenta entering the uterus of his mother and further more spewing the child's blood into the abdominal cavity of the mother.
It could be easily seen where this type of blood contamination could also take place in other medically mis-managed areas of pregnancy, miscarriage, birth and post partum. Anytime the blood system of the child is invaded by a doctor's scalpel or a midwife's overzealous attempt to separate the placenta from the uterine wall of the mother prematurely or to pull the placenta out the birthing mom by yanking on the cord, this blood contamination takes place and as Dr. Mendelsohn points out RhoGam would now be used. In a D & C (dilation & curettage) the uterine wall of the mother is scraped with a sharp instrument thus creating the situation described where the mother has an open wound that would readily accept the blood cells of her deceased child. Also it is common for doctors and midwives to forcibly scrape the mother's uterus to expel extra pieces of placenta. They believe that any pieces left intact in the uterine wall are likely to cause the mother to hemorrhage thus creating a life threatening situation. However, many women (myself included) have carried placenta pieces around for a week or two and expelled them over time with patience and lack of hemorrhage.
For those who do choose to give birth without the uterine scraping of the doctors or midwives or the D & C surgical procedure in miscarriage, these ladies often do have a heavy flow of blood for a longer period of time. So it is important to know that when the new mom or the woman who recently miscarried has a heavy flow that this is a natural and normal part of our body's ability to cleanse the womb. Care would need to be taken to be certain that a great deal of blood should not be lost in a short period of time, but an awareness that a gradual and heavier amount of blood is normal when the uterus empties itself on its own and in its own time.
Getting back to my Biology lesson. I have Rh- blood and I married a man who has Rh+ blood for the little D factor. So my husband is either heterozygous (one + and one - factor) or homozygous (two + genes). My son has Rh+ blood and he could have only received the + factor from Ron, so I still do not know if Ron will always pass the + factor on (being homozygous) or if only 50 percent of the time the baby will get the factor (thus heterozygous). I did have a cesarean section and that surgical birth and immediate cord clamping and cutting definitely left lots of potential for my son's + little D factor from backing up into my circulatory system. At the time, I did not know of the damage that could occur in my immune system from this blood product, or to my son's, or about the risks that a blood product like this harboring human viruses could expose me to. Note: Read the package insert on RhoGAM and these risks and the risks of anaphylactic shock are well documented. I reminded the doctor to give me a second shot in the hip with this RhoGAM product and felt I was safe from developing antibodies.
Second pregnancy I get tested at four months to see if I developed antibodies in spite of the RhoGAM and I test negative. Still the recommendation to accept another RhoGAM innoculation at 26 weeks of gestation with the second pregnancy. I declined. I refused to accept the risks of the viruses or the risks to my immune system or my unborn child's immune system. The package insert describes the risk to the immune system being significant if the mother or unborn child has allergies or is prone to develop them. I have also read that the immune system damage is permanent. Knowing that my pregnancy went well and that my child's circulatory system was not pierced by a needle, and that I gave birth to him freely in a gentle way vaginally allowing the placenta to deliver itself and without severing the umbilical cord until after 8 hours following his gentle birth when baby David's blood was completely out of the cord and in his veins, I did not take RhoGAM. I have not conceived again and will likely not for a few years due to lactational amenorrhea (natural and normal cessation of menstrual periods or conception times due to demand breastfeeding and exclusive nursing) so I can not document a healthy child after a RhoGAM free birth, but I feel confident that my future children will be healthy.
To recap the points I have made earlier, there seem to be many factors that contribute to the rare incidence of blood contamination of RH- moms and RH+ babies. First off, if your blood is typed negative (AND IF AND ONLY IF your husband is RH+), then many doctors and labs around the country are doing a second test to see if a weaker RH factor (called DU) is present in your blood. This blood typing indicates if a RH- mom indeed has a DU+ factor in her blood or not. If the mom is indeed RH-, but DU+, then she is in fact NOT a candidate for RhoGAM injections as the DU+ factor in her blood means that she will not develop antibodies against the baby's blood if a maternal-fetal bleed does occur. If the DU scan comes back negative, then the mom is assumed to be in fact a true RH-, and many doctors are suggesting that the RhoGAM innoculation be taken in hopes of preventing the formation of maternal antibodies in the event that a maternal-fetal bleed does take place. Furthermore, the baby's cord blood can be cultured at birth to test for the RH factor of the child. If the baby is indeed RH+ (having inherited that RH factor from the father, and the mother is concerned that a maternal-fetal bleed did occur), then RhoGam could be taken.
How much of a dosage of RhoGAM to give the mother is said to be indicated by a blood screen of the mother's blood after the birth of the baby to see how many RH+ fetal blood cells are present in the mother's blood. Depending upon the results of the fetal blood screen of the mother's blood, the dosage of RhoGAM will vary. It is said to be rare that a larger dose of RhoGAM would be needed. This fetal blood screen is called the "Maternal Kleihauer" blood screen. I personally know two couples in their 60's who stopped having children after one child, because they were so terrified that their next kids would die or be terribly sick. These couples both wanted more kids and it was an unfortunate and sad fact that they were misled into thinking that their Rh status meant that they couldn't have more kids. Hundreds of millions of couples with Rh- moms and Rh+ dads have produced healthy children without a hitch and we need to focus on that fact.
If your blood is Rh negative. Then your husband's blood type needs to be determined. If you decide to have him tested to see if his blood is of a positive type, that is not enough information to let you know whether your child will be of a positive blood type or of a negative blood type even if your husband is positive - as there are recessive genes for passing the Rh blood type and dominant genes (the husband's genetics pick this - not yours). I think IMO that the most important fact that we Rh- moms with Rh+ dads need to focus on is how can we prevent the blood of the mother from mixing with the blood of the baby.
According to Dr. Mendelsohn (author of the book "Confessions of a Medical Heretic"), there is a Dr. Doolittle who did a study on the effects of cutting the umbilical cord and forcing the separation of the placenta, amniocentesis (needle injected through the mother's abdomen while she is pregnant that causes the baby to bleed and the mother to bleed), and surgical birth on the Rh complications. (Mendelsohn published the article that I am referring to about Doolittle in a magazine that Laura Shanley - author of Unassisted Childbirth - mentioned to me.) The name of the magazine is "The People's Doctor". Anyway, the gist of Doolittle's work stressed that allowing the baby to remain in the womb without amniocentesis was absolutely needed. Then allowing the baby to be born - no cesarean section. Then birthing without cutting the cord until after the placenta delivers itself (no pulling or tugging on the cord or pressure applied to the mothers abdomen to force the placenta to detach prematurely) is the best way to prevent a blood contamination - as well as fact that the placenta detaches itself from the uterine wall fastest and easiest with the umbilical cord still attached (so this practice should be standard for all women IMO - in or out of the hospital). According to Mendelsohn, by preventing the contamination of blood between mother and child, the likelihood of an Rh antibody situation arising in subsequent pregnancies was 0 percent.
Next, I think we need to focus on the fact that even if the worst case scenario occurs and the mother develops Rh antibodies, like in the case of the nurse who had antibodies after needle sticks, she gave birth to four healthy children after her sensitization.
Next I would like to share with you some the personal accounts I have come to learn about. Some of these ladies have been referenced earlier. There is a mom who has her story of her Rh history published in Lynn Griesemer's new and upcoming book "Unassisted Homebirth." The mom's name is Patty Kohl, she is a registered nurse in NY state, and she has seven children - she stopped getting RhoGAM (the shot of gammaglobulin for Rh) after baby #5. Her husband is Rh dominant, so all 7 of her kids have Rh+ blood. the doctors will all tell you that this mom should have developed Rh antibodies after she stopped getting RhoGAM and continued having Rh+ babies, but she has taken the Rh titer and she never developed the antibodies that are said to attack the developing unborn baby. She never had a single of the "dreaded" complications from her Rh situation. She has indicated that there is a substance in our blood called DU, and she said that her blood has been tested and she does not contain DU. The DU if it were present would be the genetically determined substance in her own body that would trigger the Rh response. She was born without this Du substance, so she said that all the fear and worry she had all those years that her children would be born with these Rh problems were completely unfounded - she never needed a single dose of RhoGam. If you find a doctor who will test for Rh dominance in your husband or one who will test for DU in your own blood, let me know - all the doctors I talked to told me to shut up get my RhoGAM and stop asking questions.
There is a Rh negative mom from Hawaii, Jennifer Smit, a personal friend of Hygeia Halfmoon, who has a Rh positive husband, she chose to forgo the RhoGam shot until after the baby was born when she could determine for herself if she needed a shot at all. She delivered her own child at home, unassisted. She then cut the cord after it stopped pulsating, got out her Eldon test cards and tested for Rh+ blood in the baby. The son was her first child, he was Rh+ so she went and got a shot of RhoGAM within 72 hours of his birth at her local Emergency Room. The second child was a girl, she birthed her at home unassisted, got out her Eldon card, tested the cord blood, and she was Rh- (this means two things - her husband is Rh recessive (so each child has only a 50 percent chance of being Rh+ and that this child is Rh- so RhoGAM would have no purpose). A RhoGAM injection was not indicated and she did not get one. If you have more questions about this moms experience, I have Jennifer's e-mail and you can ask me for the address privately.
There is a test kit from Cascade Birthing Supply that you can order for under $15 to test your baby's blood once the child is born - the midwives use it all the time, and it is called an Eldon Card. Cascade's toll free number is 1-800-443-9942. Meanwhile, the Compleat Mother magazine published a couple of letters from moms in Canada who refused the RhoGAM inoculation there and they could be sources of information for both of us as they are doing their own research on the topic. I have their mailing addresses.
One of those moms, Catriona Campbell, wrote in to the magazine the following: "I'm happily breastfeeding my 3 month old son. I'm Rh-, he's Rh+. I refused the RhoGam shot on many grounds: the mercury preservative in it, the fear of anaphylactic shock, and not wanting a blood product. We're hoping to have another child soon, so any thoughts and information would be appreciated as soon as possible. I understand:
1. There is a 35 percent chance my next child will be RH-, so no worries.
2. There is a 10-17 percent chance of me developing antibodies, meaning there is a 83 percent chance of no worries.
3. Even if my child is RH+ and I've developed antibodies, it's not certain that my child will have problems.
I've met several RH+ women in their 60's who had multiple children, without RhoGAM, with no problems. As Catriona points out the RhoGAM injection is a made from human blood products, and the package insert clearly shows that many viruses are not able to screened for or eliminated, so you will catch the diseases of the blood donors - and they clearly tell you this right on the package insert. Finally, there was a study done just the past few years that showed that the RhoGAM injection caused permanent damage to the immune systems of the unborn children who's mothers had been injected at 28 weeks gestation with this damaging substance. I believe this to be true, as I was injected and my son was having anaphylactic allergic response to substances in his first year of life that are unheard of. I will never receive this or any other immunization while I am pregnant again, and this study recommended that no mothers should be immunized while they are pregnant.
Finally, Jeannine P. Baker is currently recovering from a serious elbow injury, so she will likely be hard to get a hold of, but she has published a paper on Rh and unassisted birth, the article is $3 and is called "RhoGam or RhoScam?"; I did not find it to be so important in the sense Jeannine might have intended as I don't relate to the strong power of positive thinking ideals that she has, but I found her article to have a half dozen excellent sources of information backing up the justification for not taking RhoGAM. It was important reading. I think that Jeannine's current e-mail is firstname.lastname@example.org. Jeannine's Bibliography includes:
- "Is Prenatal Rhogam Dangerous?" by Ina Mae Gaskin (Spiritual Midwifery author) in Mothering Magazine Fall 1987
- "More on Prenatal Rhogam" Letter to Mothering Magazine by Katie Simpson wherein she cites the mercury derivative thimerosol, a preservative in the RhoGam vaccine as her reason for not taking the shot anymore.
- "Is Rhogam Safe?" by Dr. Robert Mendelsohn, M.D. in the "People's Doctor: A medical Newsletter for Consumers" Volume 12 No. 1. Where Mendelshon states "My advice to every pregnant woman faced with a doctor's or a midwife's recommendation for a RhoGam injection during or after pregnancy is to ask first for the prescribing [package insert] information on RhoGam. She will then learn that RhoGam is a human blood product which reduces, but does not eliminate the possibility of Rh sensitization. She will also learn that the manufacturer warns that no one knows whether this serum carries the AIDS virus [or other viruses] or not... An Rh- woman who wishes to avoid the use to RhoGam altogether should avoid procedures that might cause the mixing of the her blood with that of her baby (amniocentesis, early cutting of the umbilical cord) RhoGam joins a long list of medical interventions that were once considered to be beyond question but are now suspect.
- "Childbirth At It's Best" by Dr. Nial Ettinghausen by Candor Publishing Company - Discussion of Rh reactions to RhoGAM injections.
- "American Medical Association News" October 9, 1987 - Ortho Diagnostic labs recalled serum that contained AIDS after a female army soldier and her newborn contracted AIDS. Lot RHG-636 has AIDS in it and it was still used by doctors even after the lot was recalled.
- "British Medical Journal" April 1987 - 8 out of 33 cases of Rh sensitization deaths were with RhoGam vaccinated mothers. In 1984, 9 out of 25 "failure of prophylaxis" in newborns whose mothers received RhoGam.
- "Childbirth Alternatives Quarterly" Summer 1988.
- "More on RhoGam" - From http://www.bestfed.com/childbirth/freebirthfaq/kim.htm
MOONDRAGON'S RELATED LINKS
MoonDragon's ObGyn Pregnancy: Rh Isoimmunization (Erythroblastosis Fetalis)
MoonDragon's ObGyn Pregnancy: Rh Isoimmunization - RhoGam Question
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