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?
Alma
Thank you for posting on this subject! I’m O- while my husband is AB+, so our blood types are quite mismatched, even though our hearts are not… These articles are really helpful for preparing for our first pregnancy.
Do you have any resources on ABO incompability?
Nicole
Thank you for researching and exposing this! I wish I had known what I know now when I was pregnant.
Bliss
I had an abortion some years back and wasn’t given a Rhogam shot. I found out i have O- blood type.
Is it possible I have a child with my partner who is O+?
Adelaide
http://www.bibliotecacochrane.com/PDF/CD006672.pdf
This cochrane review shows reduced perineal trama (tearing or episiotomy) with the use of warm compresses during second stage labor as compared with a hands off or no warm compress approach.
Your article has a few good pieces of info, but it also seems to contain a lot of stuff that is not supported by science at all. Normally I enjoy your well researched articles, but this one falls short with its single source which promotes some stuff bordering on quackery.
I am Rh- and have researched this subject extensively. There is a lot more good scientific info if you are willing to dig around. I have not read the book you are referencing, but to be honest it sounds like it falls short of being the resource it set out to be.
Heather
Hi Adeliade, thanks for your comment. This article actually references a few different sources, including this study on the effect of red raspberry leaf during labor: http://www.ncbi.nlm.nih.gov/pubmed/10754818
Dr. Wickham’s book is one of the most technically challenging I have ever read, and in my opinion she is about as far from quackery as they come. While I agree that there is a lot of good scientific info out there, most of it pertains to the RhoGAM shot specifically. I covered that research here, but wanted to bring up topics that deserve further discussion in this post. As mentioned in the article, research on subjects such as how bioflavinoids affect outcomes in sensitized women were being conducted before RhoGAM, but where abandoned when it was discovered. It is likely that they were thought to be unnecessary or less profitable, but for many women that information may still be important.
If there is something specific mentioned that you feel was not well-supported I would love to hear what it was and why. Thanks again for your comment!
Adelaide
http://www.glowm.com/section_view/heading/Alloimmune%20Hemolytic%20Disease%20of%20the%20Fetus%20and%20Newborn%20%28Erythroblastosis%20Fetalis%29:%20Diagnosis,%20Management,%20and%20Prevention/item/201#1408 If you look here you will see that ABO incompatibility with a negative mama and positive baby gives some level of immunity dropping sensitization rates from 16% to only 2% without Rhogam. This piece of info seems to be far more relevant than many of the general health recommendations and certainly more scientific than the potentially dangerous practice of eating placenta. The health recommendations aren’t bad but they do have the possibility of creating a false sense of security in forgoing rhogam. Those things maybe might help in a minimal way, but most of them are just general advise while pregnant.
I have drunk raspberry leaf tea with all of my pregnancy, but the study you referenced is pretty bad. It is a retrospective cohort study including all of the women who delivered at a single hospital over a 6 month period. It proves nothing but correlation, and a fairly predictable correlation at that.
There is more solid info on risks of Rh sensitization if you really dig. It is a complex issue and one that certainly deserves more consideration.
Angie
I’m curious why you have said that placenta consumption is potentially dangerous?? I’m considering encapsulation to help prevent PPD as I already have anxiety and am prone to depression but need some more information. My last babe was born with hemolytic disease even after receiving rhogam. He’s my second child but first positive baby (different dads). Antibody test was positive 3 months postpartum but I’m 26 weeks with #3 and so far all my antibody tests have been negative.
Becky
I am rh negative and my daughter is rh positive. I did placenta encapsulation with her birth and also refused the rhogam shot. We both are extremely healthy and I would highly recommend consuming your placenta. I had almost no postpartum bleeding or emotional issues because of the encapsulation. I refused the rhogam shot because I previously had a blood transfusion where the blood was not tested for antigens and I developed Kell antibodies which threatened my pregnancy with my daughter. I do not trust blood products to be safe. To this day hospitals do not test for these antigens unless you demand “clean” blood. This is an issue for all women who might want to have a child someday.
Melissa
I’m also an Rh- mama who has never received Rhogam, and I have consumed my placenta after the birth of my 3rd and 4th babies, now pregnant with my 5th. I also would highly recommend it – I consumed mine raw/frozen in smoothies and both times stopped bleeding on day 2 post partum as soon as I started taking it. I was very pleased by the amount of energy I had. All my births have been at home with very little intervention, I have great nutrition, don’t use fluoride…. I think I’m living proof that everything mentioned in this article is not quackery.
Lauryn
Thank you for writing this, helps get the word out about other alternatives. I am O- so I got the rhogam shot. I wish I would have taken the time to research it out more, but I was young for having my first (22 when I had her, 24 now) so I felt like I didn’t have a choice. I did encapsulate my placenta, more to the fact of preventing depression, and didn’t feel like I had any negative reactions. However, thinking back the stretch marks I had became super itchy and inflamed about a week after delivery and curious if it had anything to do with the shot. My baby was O+, so I’m wondering if there is anywhere that will allow me to not receive the shot anymore. Midwives are hard to come by where I live (Louisville, Ky) and doctors in hospitals can be very pushy, as we all know. But I will definitely be doing more research before the next baby (whenever that is 😉 )
Adelaide
It is not abnormal for stretchmarks to itch. That being said it is always your right to refuse any medical treatment you don’t want. Listen to your care providers, but remember no matter what they say you have a choice. I would encourage you to at very least have your blood tested for significant mixing with your baby’s blood immediately postpartum. This is standard to adjust Rhogam dosage in the case of significant mixing. A future pregnancy with another O+ baby would put you at significant risk of sensitization.
Lina
So if you don’t allow anyone to touch the baby, you, or the cord, are you the one to hold the baby to your chest and try yourself not to disturb the cord? I don’t see how that is possible.
Mandy Dugas
Hey!!!
I really like this post! Im rh-negative (blood type is A-) and I got my placenta dehydrated into capsules that I took everyday for months. And I swear it helped 100%, from keeping all my hair to not experiencing any postpartum depression. From healing fast (down there) to getting my body back, it all went so smoothly! I had tons of energy and it made me bond with Kyri so much due to all the hormones and nutrients. I loved it! I totally recommend it to any woman who is thinking about it.
From Mandy @ MandysHealthyLife.com
GG
Was your baby RH + or – ?
This would be a big deciding factor, for RH- mamas, in choosing to consume your placenta, right?
Dana
Perhaps I interpreted this wrong but it sounds like they would be able to tell from looking at the placenta whether it detached properly and in which case whether there may have been no blood exchange from the baby? If this is true then why do they routinely/automatically give you a second shot of rhogam after your baby is born and confirmed to be rh+? Why dont they just check the placenta first?
Thanks for the article. I wish I had read it while I was pregnant. I’m antivax and somehow this never even occurred to me to research. How I was blindsided, I can only guess it was the way it was presented to me. The research I did was all about understanding the blood issue and the consequences. It didnt even occur to me to research how nature prevents it from happeening and in what percentage it actually happens. Sigh.
GG
“While it’s now possible to determine with 99% accuracy whether the baby you are carrying is Rh-negative or positive.”
How? What is the test? My ND and Midwives are completely unaware that this is possible.
Carol
The company “Sequenom” offers the SensiGene RHD maternal blood test. It can be done as early at 10 weeks gestation according to their website. I think it’s expensive and it must be ordered by your provider. Not sure if there are other companies that offer a similar test.
Ella
Thank you for this article.
I Am pregnant with my first baby and just found out that I am O- and was told by my midwife that I would need a shot of antidote if the baby will be Rhesus +.
When I asked her why, what is it and what’s in it she could only tell me ‘it’s okay, it’s no big deal’ as if I were asking because I was afraid of needles.
So I have to research myself. Is this something I can do orally instead of being injected?
Is this a vaccine and are there other alternative ways to get the ‘antidote’?
TC
I don’t know about this, but I do know a little boy with severe cerebral palsy due to blood-type incompatibility resulting in jaundice. His case might have been preventable with early detection and a blood transfusion, but it would very likely have been easily prevented by Rhogam shots in this and previous pregnancies. I have O- blood and I’m very glad to have been offered this shot. (Here in Finland they routinely do a test, using the mother’s blood, that tests for the blood type of the baby in utero, so the shot is only administered in case of incompatibility.) I’m not an expert, but those are my two cents, based on personal experience.
Rachel Pierce
I am RH-, and pregnant with my second. I refused Rhogam with my first little girl, I wasn’t comfortable with the risks, and also was worried about the mercury and or polysorbate 80 ingredients.
My Mom incapsulated my placenta for me, which I took daily for 6 weeks postpartum. I had been very emotional during pregnancy and I think the Placenta helped that postpartum, I also healed quickly and had lots of energy. I am planning to do the same for this one.
Kari M.
I appreciate the time you took to offer alternatives and explore other options. Although this article could be more fluid and in depth, I appreciate it in a world where we have access to the internet, which we assume is unbiased, but are finding out how truly biased the websites are and how rare it is that both sides of an issue are offered. I am O- and my husband is O+. I remember trying to find information, but was provided almost nothing from medical staff who seemed uninformed on the history, usage, risks versus benefits or where I could go to find information. I still breastfeed my 3.5 year old, and now seeing this, I definitely will continue until 4 when 2nd babe will be born (whether or not it has an effect, it cannot hurt). I am 85% sure I am done with injections and the lies and coverups of the vaccine industry that has exploited my body and my daughter’s with little to no informed consent on alternatives or risks versus benefits or even an ingredient list (I know vaccines have also done much good, but I am exhausted of it all at this point). I am currently reading Schoenfeld’s textbook “Vaccines and Autoiummunity.” I am still open to some vaccines if proven to have a greater benefit than risk, but I am very tired of hearing it’s “safe” with no mention of alternatives, and I am floored by how many fetal cells I injected into my daughter without informed consent. The MRC-5 cell line is from the lungs of a 14 week gestation baby boy from 1966 and is used in the Hep A, MMR Quad and Varicella. I know the Rhogam is made using human blood and I do not believe it is of fetal origin, and I do honor that for some, it could save a life! But I also realize that for healthy Mamas who do the extra hard work of proper nutrition and alternative treatments, there should be another way beside an injection that crosses the skin and gut barriers straight into the body, and whose adjuvants may cause autoimmune flareups or potential harm to baby that one would almost never be able to prove. I realize it could also save a baby, and each Mama can make that decision for herself, and I would need to read about actual cases that showed there weren’t other ways to prevent adverse outcomes beside a quick and easy injection. I need to read the book “Anti-D in Midwifery” and wish anyone in my family had had knowledge of an alternative before I received this shot (actually 3x since I had two different providers and I forgot I had already had it and as well in a previous miscarriage). I have had enough unexplained autoimmune issues. I am ready for au natural if I find my research leads me to conclude I can do it safely, and am willing to put in the hard work.