Monday, December 15, 2008

Negative Talk at Birth Circle

Rh negative talk has become a hot topic at Birth Circle. Tonight marks the second meeting in a row where the routine treatment of RhoGAM for Rh negative mothers came up. Two months ago I hadn't met a woman who was questioning the protocol for being Rh negative and now I know four. FOUR women questioning a medical norm in two meetings, 4 weeks apart. I am excited for this group to start discussing their choices of treatment with me so I can pass on this wisdom to others out there. It seems like yet another support group in the making. Rh negative women should know they are not alone in questioning their treatment.

One thing that became clear is that Rh negative women do not feel they have enough information about the latest treatment, Rhophylac (and other preservative-free RhoGams: BayRho-D® Full-Dose; BayRho-D® Mini-Dose; MICRhoGAM®; RhoGAM®; Rhophylac®; WinRho SDF®). The traditional treatment of RhoGAM got lots of attention with its possible negative side effects to the baby so you can see why these women want answers.

I have to admit, I did not know much about this treatment because I am Rh positive and even if I were negative, I had my first baby at a teaching hospital in 2003. Perhaps they were already using a preservative free-RhoGAM and the controversy had calmed down?

Thimerosal, the preservative that is 49% Mercury, was removed from RhoGAM in 2001. Women in 2009 are hunting for studies and data to help them make hard decisions.

I have learned a few things that I think all Rh negative women should know:

1. If the father of the baby is Rh negative, you have virtually nothing to worry about. Care providers rarely ask what the father's blood type is.

2. If the baby is Rh negative, also nothing to fear. Women rarely hear about their chances of birthing an Rh negative baby.

3. Childbirth is designed to work. In a normal birth, baby's blood should not cross to the mother. The small risk of this happening is not discussed with women. Interventions increase the risk of baby's and mom's blood mixing so guess where most of these women are choosing to give birth....that's right, at home with midwives.

4. If the baby is Rh positive, you have a 72 hour window to give the mother the post-natal treatment. It isn't some sort of sudden panic at birth, you have three days to manage this situation.

What seems to be a common thread is more women questioning the traditional treatment at 28 weeks gestation. Women do not trust that the preservative-free RhoGAMs will not have some side effects to their babies or to their own bodies. These women want studies and they also want community. They want to see how other women proceed given different situations.

I would love to know what, if any, recent studies we have to cite for this topic. Please comment away if you have any perspective on this subject at all.


Jeff said...

Have you read "Autism's False Prophets: Bad Science, Risky Medicine, and the Search for a Cure" by Paul A. Offit? I've heard good things about it. There's a copy at the Downtown library so I might check it out later.

Rebecca said...

I am RH negative and I declined the 28 week dose for my 3rd pregnancy. I did receive the post partum dose because we didn't have the blood typing card needed to verify baby's blood type so weren't sure he was also negative. My first two had positive blood and my fourth does too, but I've yet to find out my third baby's blood type. lol
Anyway, I had planned to also decline the 28 week dose with my 4th, but complications cropped up requiring it so I had it both at 29 weeks and after he was born just 4 weeks later.
However, under normal (healthy) circumstances I feel perfectly comfortable declining the 28 week dose. I do prefer to get it after birth if the baby's blood is positive, but I know those who also choose to decline that one. It's all in the weighing of risks. There needs to be more research done on this issue though!

Sheryl Rivett said...

All four of my babies were RH positive. It wasn't until my third that I was told about pregnancy doses of RhoGam. I found it strange the change in protocol, given that there were no issues with the old approach. I knew immediately that I wouldn't opt for a pregnancy dose (and luckily i had a lay midwife who respected my judgment). With four homebirths, I usually found my way to a doctor by day 2 to receive my shot. I wasn't crazy about getting the treatment with the questionable ingredients. However, I felt grateful to live in a time when I could have four children with my husband. I don't many RH negative mamas - amazed to hear about so many in Charlottesville!

Megan said...

I am RH negative and had the shot with both children. I just said "okay", never asking what was in the shot or even why I needed the dose. This post has opened my eyes! I don't even know my children's blood type. Lord I am embarrased!

Rixa said...

I highly recommend "Anti-D in Midwifery: Paradox or Panacea?" by Sara Wickham. Her books is the most comprehensive examination of all aspects of Rh- issues. I just read it a few weeks ago.