Holistic Care For The Rh-Negative Mama

Bubble Wrap

When raising kids, sometimes it seems like the best option, you know? Last week we had a family photo shoot scheduled, so naturally my toddler gave himself a black eye the night before. (This has happened to you, too, right?

As parents, we do everything we can to keep our kids safe and healthy. Unfortunately, in some cases there is no clear cut path, and we have to trust ourselves to make hard decisions. Take, for example, the RhoGAM shot.

While it’s now possible to determine with 99% accuracy whether the baby you are carrying is Rh-negative or positive, questions still remain about what to do if baby is positive. According to the FDA, RhoGAM has been shown to have adverse effects on the fetus in animal studies and has not been adequately studied for safety in humans. (source) No studies have been conducted on potential long-term effects.

On the other hand, if a child develops rhesus disease it “can cause a range of problems, from mild jaundice to severe rhesus haemolytic disease, which in the worst cases can result in the death of the baby. Although a far greater proportion of babies suffering from rhesus disease survive nowadays as a result of advances in care, they may require blood transfusions, early delivery or intensive care.” (Anti-D in Midwifery, p.4)

In my previous post I discussed many of the factors parents might consider in deciding what approach to take, along with thoughts on how certain obstetric/birth procedures may increase a mother’s risk of sensitization. Today I’m going to keep the promise I made at the end of that post and discuss dietary and lifestyle choices that some midwives believe may reduce the likelihood of sensitization.

The idea is that these choices “work towards maximizing the physiological potential of the woman’s body” and therefore increase her chances that potentially-risky interventions will not be necessary. (Anti-D in Midwifery, p.101)

As always, please keep in mind that I am not a doctor, this is not medical advice, and your choices are completely up to you. If you need some convincing on this, read my full disclaimer where I say it over and over again.

Now, in order to understand why maximizing physiological potential may be key, we first need to discuss…

The Labor Trifecta

As you probably already know, there are three stages of labor. The first is where you put curlers in your hair and lip gloss on because you are going to do this thing with style, the second is after you’ve passed through the puke vortex, hallucinated a few smurfs, stomped around like an elephant, asked your husband to draw a bullseye on your bottom, and are ready to push that sweet little babe out.

The final stage of labor, of course, is when you look at your midwife/doctor and say “WHY CAN”T I JUST BE DONE NOW??” when they remind you that you still have to deliver your placenta.

Placenta Physiology 101

As it turns out, many midwives consider the third stage as the period in which interference with the birth process carries the most risk of sensitization. In most cases of normal physiological birth, the placenta will go through a specific detachment process that is believed by some experts  to offer some protection against fetomaternal hemorrhage. Basically, there are two sides to a placenta – the mother’s has her blood and the baby’s has his/her blood. The mother’s side is responsible for detachment, not the baby’s. When the mother’s side initiates detachment it bleeds slightly. Unfortunately, improper detachment may cause bleeding on they baby’s side of the placenta, which could cause the baby’s blood to enter the mother’s bloodstream.

That’s the short version, of course. Here’s a detailed explanation from Dr Sara Wickham PhD, RM, MA, PGCert, BA(Hons), author of Anti-D in Midwifery.

“The placenta is a complex and intricate organ which is designed to act as a ‘buffer’ between maternal and fetal circulations, allowing oxygen, carbon dioxide, nutrients and waste substances to pass between the two without the mixing of blood itself. This is achieved by the development of villi, tree like protrusions formed in the placenta which sit next to the maternal vessels, allowing the substances to cross via specialized cells and membranes . . . The placenta plays an incredible role in the growth of a baby, and remains in situ until after the baby is born, when it then separates from the uterine wall and is itself ‘birthed’ during what has become known as ‘the third stage of labour.’

…Once the baby is born, the uterus reduces in size and the placental site is also made smaller. This causes the placenta to be squeezed, and some of the maternal blood in the placenta moves into the uterine veins, causing the uterus to become tense . . . At the same time, some of the fetal blood in the placenta is passed to the baby, enabling the placental wall to thicken further in preparation for separation.
As uterine contractions recommence, a few of the congested maternal vessels burst and the small amount of blood which is released causes the placenta to become detached from the uterine wall. This maternal blood causes the spongy lining of the placenta to separate from the uterine wall, and the ‘living ligature’ effect of the uterine fibres seals the maternal vessels and begins the process of healing. The blood that is lost is maternal; midwives will confirm from experienced that the newly born placenta does not bleed from the attachment site.” (p.87-88)
She adds that:

“The physiology of the third stage itself also offers clues to confirm the protective nature of this process. Not only does the physiological mechanism prevent fetal blood from being released from the placental site, but the maternal blood may also act as a cleansing mechanism to prevent transplacental haemorrhage. Any fetal blood which had seeped from the placenta may be washed away (through the cervix and vagina) by the maternal blood, thus adding a further protective mechanism against transplacental haemorrhage.” (p. 90) Unfortunately, according to Dr. Wickham, deep tears or an episiotomy may negate the “washing away” protective mechanism.

How can I encourage optimal placental separation?

If it were me, I’d avoid the interventions listed in this article, since they may increase the risk of sensitization. In addition, I would:

• Do everything possible to avoid an episiotomy, including discussing my desires with my care provider, doing perineal massage prior to birth, and considering a water birth. (Some studies suggest it may reduce the likelihood of tearing. It’s unclear why, but it may be because the water softens the perineum and allows it to stretch more easily.) (source) I also loved Jamie’s approach shared in the comments of my previous post, which was that when the baby crowned, she waited and let “let everything stretch out instead of tear.” (Thanks, Jamie!)

• Ask my care provider to allow me to catch my baby and not to touch me, the cord, or the baby unless absolutely necessary until I’m ready to deliver the placenta – and only then to catch the placenta. (Some midwives believe that even touching the cord while it pulses can disrupt blood flow from the placenta to the baby.)

• Ask that my attendants wait patiently for me to feel the urge to push out my placenta in whatever position is most comfortable for me. No fundal massage to “help” the placenta be expelled or directing me to push. Cut the cord after the placenta is delivered.

In addition, I would consider the following proactive self-care approaches. As with any pregnancy, sometimes we do all the “right things” and something still doesn’t play out like we’d hoped. However, it’s always good to take steps to optimize our health as well as our baby’s. Here are some ideas you may find helpful:

Nutrition

Obviously, right? According to Dr. Wickham, “Optimal nutrition during pregnancy was cited as being of benefit in strengthening the placental bed and reducing the chance of feto-maternal haemorrhage. Midwives felt women should concentrate on whole foods, fresh, raw vegetables, pulses and seafood.” Some evidence even suggests that healthy fats such as omega fatty acids may promote “healthy uteroplacental blood flow.” (Anti-D in Midwifery, p.105) Likewise, certain foods such as caffeine, food additives and alcohol may deplete the body of minerals needed to create a strong placenta.

I personally followed an adapted Weston A. Price pregnancy diet that excluded grains during my last two pregnancies. (The first included grains.)

Supplements

Before RhoGAM was developed, citrus bioflavinoids were “shown to strengthen placental attachment and increase strength of blood vessels (Jacobs, 1956, 1960, 1965). The research also showed that these substances could improve the outcomes of babies born to women who had already become isoimmunized.” (Anti-D in Midwifery, p.106) I personally look for whole-food forms of biflavinoids and vitamin C – you can find a list of what I use on my resources page.

Certain herbs such as red raspberry leaf are thought to strengthen and tone the uterus. In one study, mama’s who consumed red raspberry leaf had fewer birth interventions such as artificial rupture of membranes, forceps delivery and cesarian sections. They were also less likely to experience both pre and post gestation (source) I included it in my pregnancy tea recipe along with vitamin C rich rosehips and iron-rich nettle.

Magnesium was mentioned as potentially supporting placenta strength. Dr. Wickham also mentions few foods and supplements that may support optimal immune function, such as garlic elderflower and echinacea.

Avoiding Toxins

Fluoride

“While fluoride is accepted as being potentially toxic to all of us (Colquhoun and Mann, 1986; Hirzy, 1999), it is seen as a particular danger to pregnant women because it may interfere with the formation of collagen in the placental wall. The evidence collated by Hirzy (1999) suggests that fluoride has a negative impact on bone formation. While it has proven impossible to find studies that specifically report effects of fluoride on placental formation, women and midwives may feel that there are enough parallels between musculoskeletal and placental formation to warrant further consideration of rhesus-negative women’s fluoride intake during pregnancy.” (Anti-D in Midwifery, p.106)

Xenoestrogens

Chemicals that mimic estrogen in the body are thought by some to disrupt the delicate balance of hormones that ebb and flow throughout pregnancy. It may be beneficial to opt for glass containers instead of plastic wrap and homemade personal care products instead of store-bought ones that contain synthetic chemicals and preservatives.

I’ve put together a list of beauty recipes to get you started here.

Breastfeeding

Women are considered “immunosuppressed” during pregnancy, although some argue that it’s a selective adaptive response rather than the pathological form of immunosuppression we see in other cases. If that’s the case, some people believe that the hormones which facilitate breastfeeding extend this “immunosuppressed” state, thus possibly reducing her likelihood of forming antibodies.

When I first came across this idea I wondered if it contradicted recommendations for immune supporting herbs and such during pregnancy. Do we want to “boost” the immune system or suppress it? I think this is a great discussion to have with your midwife or doctor. Like naturally produced oxytocin vs. synthetic oxytocin, it may be about respecting the body’s ability to regulate itself and simply providing gentle building blocks that it may need along the way.

Placenta Consumption – A practice in need of more research

Also, one theory worth noting is that placenta consumption may modify a woman’s immune response in a beneficial way.
“A very interesting adaptive theory is that consuming placenta may actually affect the mother’s immune system, by suppressing her body’s inclination to create antibodies as a response to antigens present in the baby’s blood. As an example, women who are negative for the Rh antigen can have difficulty supporting a subsequent pregnancy if her first baby is positive for the Rh antigen. Her body can create anti-Rh antibodies, which then attempt to fight off the next pregnancy if the next baby is Rh-positive, mistakenly recognizing it as a threat. Placentophagia may actually cause a suppression of this response, allowing her to have successful subsequent pregnancies. Human women who are Rh-negative are often encouraged to get a shot of Rhogam, a vaccine that blocks the creation of high levels of these antibodies. Mammals may have adapted their own antidote over thousands of generations, simply by practicing placentophagy.” (source 1, source 2)
I personally do not think there is enough research on this subject and I am not certain that placenta consumption is safe for rh-negative pregnancy, but I do believe this subject deserves further research. I have read reports that thousands of rh-negative women have consumed their encapsulated placenta with no negative effects, but I have been unable to verify this independently through studies or primary sources. (If you have experience or knowledge regarding placenta consumption in rh-negative women please share it below!)

What would you add to this list?