They call him the man with the golden arm ^
When asked about his track record of 1000+ blood donations, James Harrison simply says “An hour of your time is a lifetime for someone else.”
It’s true, especially for him. You see, Mr. Harrison is Rhesus negative, and his blood has been used for decades to combat a potentially deadly condition affecting babies born to Rhesus negative mothers. It comes in the form of a shot given during pregnancy or just after birth, typically referred to as RhoGAM in the United States and Anti-D in other parts of the world.
So what exactly is RhoGAM, and when should it be used? ^
When I picked up a copy of Anti-D in Midwifery, written by Dr Sara Wickham PhD, RM, MA, PGCert, BA(Hons), I hoped to discover black and white answers to those questions. What I walked away with instead is a deep respect for the choices that Rhesus negative women must make, and the desire to see more (and better) research in this area. In this post I’m going to share what I’ve learned so far – I hope you find it helpful!
Please keep in mind that – as I wrote in my posts on the Vitamin K shot, Glucola and being GBS positive – “Best Boo-Boo Kisser South Of Puckett’s Gas Station” is about as official as things get for me professionally. I am not a doctor, this is not medical advice, and your decision is completely up to you. If you need some convincing on this, read my full disclaimer where I say it over and over again.
Special Note: Normally posts like this draw from many different sources. This one is unique because it relies mostly on Anti-D in Midwifery, with just a few updates based on research that became available after it went to print. If you are a midwife or birth worker, I highly recommend investing in her book. There is so much valuable information covered on best care practices that will not be covered in this article.
Also, both British and American spellings are used in this article depending on whether I am quoting Dr. Wickham or sharing my thoughts. Feel free to read quotes from Dr. Wickham with a lovely accent – I do!
- They call him the man with the golden arm
- So what exactly is RhoGAM, and when should it be used?
- What does it mean to be Rhesus negative?
- What is Rhesus D incompatibility?
- What if my baby is also Rhesus negative?
- Can I find out if my baby is Rhesus negative before he/she is born?
- One test said I was rh-positive and another said I am rh-negative. What happened?
- I am rh-negative. What happens if I become sensitized?
- What are some potentially sensitizing events?
- How can I know if a sensitizing event has occurred?
- Can I request a RhoGAM shot if I suspect I have experienced a potentially sensitizing event?
- How does Rhogam work?
- Does rhogam really work?
- What are the risks of RhoGAM?
- Are there any additional risks related to receiving RhoGAM while pregnant?
- What are the risks of not using RhoGAM?
- Is there anything I need to know about studies on RhoGAM?
- What is the optimal dosage?
- What is the likelihood that I will need RhoGAM?
- Has there been any research on the long-term health effects of anti-D for mother or baby?
- Do I need RhoGAM during my first pregnancy?
- Do medical interventions increase the likelihood of fetomaternal hemorrhage?
- Are there any ways I can reduce the likelihood of becoming sensitized?
What does it mean to be Rhesus negative? ^
You already know about the four blood types, right? Well, in addition to being A, B, AB or O, we’re all also either rhesus positive or rhesus negative. What this means is that some of us have rhesus proteins in our blood (which makes us positive) and some don’t (making us negative). Of the rhesus proteins, the D factor is the most common. That’s what we’ll be discussing in this post.
Caucasians are the most likely to be rhesus factor D negative (RhD-). About 15% of the population lacks the protein.
Some people believe that the lack of rhesus D factor is an indication of alien heritage. I’m personally going with the genetic mutation theory. 🙂
What is Rhesus D incompatibility? ^
Though normally the blood of a mother and baby do not mix during pregnancy – the placenta acts as a mediator that transports nutrients and waste without intermingling – problems can occur if blood does mix when a woman is Rh-negative.
If the baby is RhD-positive, the mother’s immune system will react to the presence of the rhesus D protein by creating antibodies against it – a process called sensitization.
What if my baby is also Rhesus negative? ^
If your baby is Rh negative there is no risk of sensitization.
Can I find out if my baby is Rhesus negative before he/she is born? ^
If your husband is also Rh-negative your baby will also be Rh-negative. You can request a blood test to find out his Rh status.
Also, Sequenom Laboratories recently released a fetal Rh D genotyping test that is 99% accurate when performed in the first trimester. The test is performed using just the mother’s blood, and the only downside is that additional analysis is sometimes needed if you’re having a girl, which means that you’ll know the sex of your baby if you require additional testing. I’m a fan of surprises, but I personally would ask for this test if I was Rh-negative.
One test said I was rh-positive and another said I am rh-negative. What happened? ^
Here’s the deal: The D antigen is composed of many parts which have been historically referred to as a mosaic. Some people have parts of the mosaic but not all – these individuals are said to have “partial D” expression. If an individual with partial D status encounters the blood of a Rh D-positive individual, their immune system will react to the parts of the mosiac they don’t carry in their blood.
On the other hand, some people who are classified as rhesus negative actually have the full mosiac, only in smaller quantities than typical Rh D-positive individuals. Theoretically, these individuals should not make anti-D since they possess all parts of the mosiac. (source) In the past individuals with weak D were considered functionally Rh-positive, but recent changes in guidelines have re-classified them as negative as a precaution. This is because there is a very small chance they could have a reaction. However, the only published report I could find of a weak D individual having a reaction to the rhesus D protein was in the case of autoimmunity. In other words, they were reacting to their own proteins, not someone else’s. (source)
I am rh-negative. What happens if I become sensitized? ^
If sensitization happens during the birth process, any future rhesus-positive babies the mother becomes pregnant with will be affected. This is because “the antibodies are able to cross the membrane at the placenta (even though the actual blood cannot) and may attack the rhesus proteins in the baby’s blood. This can cause a wide 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.” (Wickham p.4)
Firstborn children are not usually affected unless the mother was sensitized prior to the pregnancy through a blood transfusion or pregnancy loss. However, if sensitization occurred early in the pregnancy for some reason and was not treated, rhesus disease can occur.
What are some potentially sensitizing events? ^
- The birth process (Birth interventions may significantly increase the rate of sensitization. More on this later.)
- Abdominal trauma, such as from a car accident or serious fall
- Abdominal surgery, such as a cesarean section
- Placenta abruptio or placenta previa, both of which can cause placental bleeding
- External version (breech repositioning)
- Obstetric procedures such as amniocentesis, fetal blood sampling, or chorionic villus sampling (CVS)
- Miscarriage, ectopic pregnancy, or in utero death after 8 weeks of fetal age (when fetal blood cell production begins)
- Partial molar pregnancy involving fetal growth beyond 8 weeks
- Blood transfusion (if blood is mismatched)
(source)
How can I know if a sensitizing event has occurred? ^
A flow cytometry test can be done to determine whether feto-maternal hemorrhaging has occurred.
Can I request a RhoGAM shot if I suspect I have experienced a potentially sensitizing event? ^
Yes, you can.
How does Rhogam work? ^
Rhogam is made from the blood of Rh-negative individuals who have intentionally “infected” themselves with Rh D factor in order to produce antibodies. The antibodies are then injected into the mother with the goal of neutralizing any Rh D factor that has leaked into the mother’s bloodstream. If caught in time, the Rh D will be neutralized before her immune system reacts.
Does rhogam really work? ^
Yes, but not in 100% of cases. Experimental models also suggest the possibility that in rare instances it may intensify a woman’s immune reaction instead of suppress it. (source)
What are the risks of RhoGAM? ^
RhoGAM is a Class C pregnancy drug, which means that “Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.” (source)
“The known and documented side effects listed by the manufacturers and pharmaceutical guidelines include local inflammation, malaise, chills, fever and, rarely, anaphylaxis. Some women have reported suffering an intensely irritating rash covering all or a large part of their body following administration of anti-D. Further concerns include those of immune system compromise and the issue of some pharmaceutical companies using a mercury-based preservative, which some women are actively choosing to avoid because of potential toxicity.” (Wickham p.7)
A note on mercury: In the U.S. all RhoGAM shots are labeled as mercury-free. However, as the FDA states here, vaccines labeled as mercury-free may still contain trace amounts. This is because companies use it in the manufacturing process and then filter out as much as they can. Though RhoGAM is not a vaccine, it is my understanding that it may contain trace amounts as well due to similar manufacturing processes.
“The second issue is that of blood-borne infections. Anti-D is a blood product, and as such as the potential to carry such infections. The risks of anti-D in this area are compounded by the fact that the blood used to make the product is pooled, so blood from one infected donor may end up in several hundred doses of the product. Several years ago, over 3000 women in Ireland contracted hepatitis C from infected anti-D (Miesel et al., 1995), and HIV has also been transmitted through anti-D (Dumasia et al., 1989). While both of these viruses are now screened for and would be rendered harmless by the purification processes involved, the most pressing concern relates to the presence of as yet unknown viruses, which may not be killed by current treatments. We can clearly only screen for and treat anti-D for those viruses that we know about and have the effective means to treat.” (Wickham p. 7, emphasis mine)
Are there any additional risks related to receiving RhoGAM while pregnant? ^
Possibly. This study suggests that in some experimental models, passive antibody treatments like RhoGAM have actually done the opposite of what they’re intended to do. In other words, they intensified the immune response upon exposure rather than canceling it out.
She also points out that “about 10 percent of the anti-D given to the mother will cross the placenta to the baby (Hughes-ones et al., 1971; Urbaniak, 1998). Studies have shown that this causes a portion of babies to test positive for antiglobulins (via a direct Coombs test) after they are born (Bowman and Pollock, 1978; Tovey et al., 1983; Herman et al., 1984). The few studies that have looked at this have suggested that, while babies may suffer some anaemia, this does not require treatment in the immediate postnatal period. Although Romm (1999) points out that the manufacturers of anti-D clearly state that this should not be given to babies, nobody has considered whether there are long-term consequences of this. It should be remembered that unborn babies will also be exposed to the risks that women face, such as that of virus transmission. Is it also possible that a baby could suffer the equivalent of an anaphylactic reaction? If this is a possibility, how would this manifest, and is there any way we would be able to treat it before it was too late?” (Wickham p. 45-46)
What are the risks of not using RhoGAM? ^
Sensitization “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.” (Wickham p.4)
Is there anything I need to know about studies on RhoGAM? ^
Yes. First, all of the clinical trials on rhogam were conducted during the late 60’s and early 70’s – a time in which birth was considered inherently dangerous by many, if not most, practitioners. Interventions such as induction, episiotomies, anesthesia, cord clamping, etc. were routine in many cases – a reality which some evidence suggests may have increased the rate of sensitization reported. We’ll discuss more about why later on, but first let’s talk about the studies themselves.
Of the nine major clinical trials conducted:
- We don’t know who paid for seven out of nine of them. Of the two we do know about, both were paid for by pharmaceutical companies. As mentioned in this article, funding bias is a well-documented phenomenon in which the outcomes of studies tend to support the interests of those who paid for it.
- Seven out of nine were not double-blind. Of the two that were, one did not have an appropriate number of subjects.
- Six out of nine were either not randomized or only quasi-random. This raises concerns that patients could have been cherry-picked to influence the study outcome.
This is not to say that RhoGAM isn’t beneficial in some instances – clearly it is. However, questions remain regarding whether the benefits were exaggerated (either knowingly or unknowingly) and whether a low-intervention birth might reduce sensitization risk. (Again, more on that later.)
What is the optimal dosage? ^
We don’t know. The standard dose in the UK, France, Ireland and Canada is about 100mg, while the standard dose in the United States is 300 mg. Other than France, most European countries give between 200-300 mg. At a lower dosage there are concerns that if the bleed is large there will not be enough RhoGAM in the bloodstream to cancel it out. At higher dosages there are concerns of increased anaphylactic and other reactions. (Wickam p.26)
What is the likelihood that I will need RhoGAM? ^
“Overall, the average rate of isoimmunization of women in control groups was 7.5 percent (186/2488), which implies that around 90 percent of the rhesus-negative women who give birth to a rhesus positive baby remain unaffected.” (Wickham p.17)
Or to “put it another way, any given woman has a 1 in 4000 chance of losing a subsequent baby from rhesus disease if she does not have routine antenatal anti-D. [For you non-British folks, this means routine RhoGAM shots during pregnancy.] This does not, of course, mean that [a routine RhoGAM shot during pregnancy] will offer her total protection from this outcome, just as the current postnatal programme offers no absolute guarantee.”
Has there been any research on the long-term health effects of anti-D for mother or baby? ^
No.
Do I need RhoGAM during my first pregnancy? ^
According to Dr. Wickham, sensitization “will not affect a woman’s first baby unless iso-immunization has occurred previously (such as from a mismatched blood transfusion, or at the time of an abortion or miscarriage). However, if rhesus antibodies are produced, subsequent rhesus-positive babies may be affected because the antibodies are now able to cross the membrane at the placenta (even though actual blood cannot) and may attack the rhesus proteins in the baby’s blood.”
To clarify, firstborn children are not usually affected unless the mother was sensitized prior to the pregnancy through a blood transfusion or pregnancy loss. However, if sensitization occurred early in the pregnancy for some reason and was not treated, rhesus disease can occur. It’s very rare, though. Here’s the math:
As mentioned previously, the rate of sensitization in control groups is estimated at about 10%, meaning that 90% of Rh-negative women who gave birth to a Rh-positive baby did not experience an immune reaction. Of the 10% that were affected, 86 out of 100 experienced sensitization at birth. That means out of the 10% that may become sensitized, just 14% of those individuals will experience sensitization before the birth process.
Do medical interventions increase the likelihood of fetomaternal hemorrhage? ^
Certain obstetric procedures, such as amniocentesis, fetal blood sampling, or chorionic villus sampling, are known to increase the likelihood of maternal and fetal blood mixing. However, many midwives believe that other procedures may have similar effects.
When interviewing midwives for her book, Dr. Wickham found the following procedures were of concern:
Ultrasounds
“Ultrasonography was felt to be a risk factor for transplacental haemmorhage in two ways. The first concerns the potential trauma that may be caused to the placenta by the movement of the transducer over the abdomen. Midwives noted that a number of women have their placenta attached to the anterior wall of their uterus, which is where the transducer is moved during the scan. It was argued that the pressure applied to the transducer in order to visualize the relevant parts of the uterus, baby and placenta might in some cases cause a small part of the placenta to separate from the wall of the uterus, and thus cause bleeding from fetal vessels into the maternal circulation.”
As we’ll discuss later, normal detachment of the placenta during birth does not cause bleeding from the fetal side. Wickham also points out that bleeding may only occur if the placenta is not optimally healthy, but also suggests that a baby’s tendency to “jump around” or thrash during an ultrasound may increase the likelihood that a small amount of damage is done to the placenta or cord, which might result in fetomaternal hemorrhage. (Wickham p.79)
Synthetic Oxytocin (Pitocin)
Thoughts on how synthetic oxytocin might cause fetomaternal hemorrhaging are two fold. First, it tends to create unnaturally strong contractions, which may cause the placenta to separate too early. In most cases of normal physiological birth, the placenta will go through a specific detachment process that is thought by some to reduce the likelihood of fetomaternal hemorrhage. Basically, there are two sides to a placenta – the mother’s and the baby’s. The mother’s side is supposed to detach and bleed rather than the baby’s. Early detachment may cause bleeding on they baby’s side of the placenta, which would cause the baby’s blood to enter the mother’s bloodstream.
Second, Pitocin reduces a woman’s production of natural oxytocin, which facilitates placental detachment. The problem here is that if the placenta manages to stay intact through Pitocin-induced contractions, it may then have difficulty detaching at the appropriate time because the woman’s natural regulation of oxytocin has been disrupted.
Intrauterine Catheters
“It is logical that any instrument inserted into the uterus, even with extreme care, may cause slight trauma to the placenta; slight trauma may be all that is needed for fetomaternal bleeding to occur during birth.” (Wickham p.81)
Episiotomy
Episiotomies inhibit a woman’s natural production of oxytocin, which is vitally important for optimal placental separation.
Fundal Pressure
“Fundal pressure may occur either deliberately, where the attendants push on the fundus to attempt to expedite the birth of a baby or the placenta, or accidentally, where the woman is asked to adopt a position which puts unnecessary pressure on the top of her uterus. Again, midwives suggested that this could interfere with placental attachment and physiology, and potentially cause fetomaternal transfusion.” (Wickham p.82)
Directed Pushing
Unlike instinctive pushing, “non-physiological pushing is thought to lead to an increase in intrauterine pressure, which may in turn cause trauma to the placental site or possibly the rupture of small vessels. Directed pushing usually involves the Valsalva manouvre, where the woman is instructed to take a deep breath and push for as long as she can. The fact that the Valsalva manouvre was originally invented as a method for forcibly removing pus from the ear would support the idea that this could create enough force to cause trauma elsewhere in the body.” (Wickam p.82)
Local and Epidural Anaesthesia
Most anesthetics contain vasodilators, which cause blood vessels to widen. “These vasodilators may be carried through the body, potentially causing the dilation of vessels in and around the placenta. Dilation of these vessels may then lead to the escape of blood from fetal vessels,” especially if this occurs around the time the placenta is separating. (Wickham p.83)
The use of anesthesia also often increases a woman’s need for other interventions that may make her more susceptible to fetomaternal hemorrhaging.
Cord Traction
“The use of controlled cord traction was also seen as potentially harmful; again, the effect of an attendant pulling on the cord may be to cause parts or all of the placenta to separate before this would have occurred physiologically, with the same result. The pressure of an attendant’s hand on the uterus, a procedure routinely used with controlled cord traction to ‘guard’ the uterus from being inverted, may also affect the delicate physiology of placental separation or cause fetal vessels to burst.” (Wickham p. 90)
Cord Clamping
“Early clamping may force blood back into the placenta which increases the likelihood of antibody sensitization for RH negative mothers who have an RH positive infant.” (source) It has been suggested that even touching the cord to see if it has stopped pulsing may disrupt the delicate process of transfusion from placenta to baby.
Are there any ways I can reduce the likelihood of becoming sensitized? ^
Though there haven’t been any formal studies on steps that can be taken to reduce sensitization risk, some midwives suggest certain supplements and lifestyle changes that may strengthen the placenta and support the immune system.
Click here to read my follow-up post on their recommendations.
Did you/would you get a RhoGAM shot? Why or why not?
Marcella
wow I did not know that 3000 people in Ireland contracted hep c from Rohgam. I’m from Ireland and currently 38 weeks pregnant I was told I had to have Rohgam because I am O Negative. We put so much trust in people
Kathy Cockroft
Answer is NO! It ruins your life. Plenty of rh-people in the world and you can make more!
Brittany
Thank you for this article I’ll be eagerly waiting to the next 🙂
Missy
i have had a rhogam shot with all four pregnancies, and with my last one they took my blood a week before so they could make the shot from my own blood. Is this still mixed with a blood pool? Or does the whole shot now come from only my own blood, which then eliminates most diseases which I don’t have?
Jenya
I had to switch doctors because my doctor insisted I get Rhogam. After doing research I decided not to get it while I was still pregnant. After giving birth, I got the shot so my 2nd baby (if I have one more) will be protected.
Kari
I am 29 wks pregnant and would like to defer the shot until post delivery. Did u get sensitized by waiting for the shot until post delivery?
Madeleine
I’m currently pregnant with my first baby and also O-. I’m planning a homebirth and my midwife said she will administer the rhogam shortly after the birth. There is a 72 hour window after the birth that still allows the rhogam to work properly to prevent issues with future pregnancies, so this should be fine. That way, the baby isn’t affected by the shot, but I’m still protected for future babies!
Danielle
Hi! I am 6 weeks pregnant and I’m A-
After my first visit with a new Obgyn, she automatically told me that I needed the RhoGAM shot at 28 weeks. She didn’t ask me if I knew my husbands blood type, etc. she just jumped the gun.
I’m not against having the shot after I deliver, especially if I want more kids, however I am hesitant about getting the shot while pregnant. I did have light pink discharge once and she wanted to inject me right there and then.
Not sure how to proceed, but feel like the risks outweighs the positives with this shot.
My sister is also A-, (her husband is positive) and she had 3 healthy kids having the shot after each birth, not during pregnancy.
Can anyone tell me worst case scenario what happens if my blood is exposed to the baby during pregnancy? It usually only plays a part in subsequent pregnancies, correct?
Thanks!
Jen McDaniel
I have an A- blood type, and my husband is O+, so I had two RhoGAM shots during my first pregnancy in 2012. One at 28 or 32 weeks (can’t remember), the other within hours of delivery when it was determined that my son was A+. I used a midwife during my pregnancy and delivered at Vanderbilt UMC in Nashville and wasn’t given an option to opt out of the shot.
Morrigan
You are NEVER given an option. You have to know there is an option. Doctors works for you, not the other way around.
Elise
I am A- and my husband is not, so we had to decide with our 2 kids whether or not we’d do the shot. We ended up not doing it during pregnancy, which meant we did extra blood tests and I was very careful to not do physically risky tasks. We tested our babies’ blood right after birth and I had 72 hrs to get the shot if need be. Thankfully both babies were negative, and we had non risky deliveries, so I have not had to do the shot yet. If one was positive I believe I would. I believe the risk of the shot is greatly reduced post partum.
jamie
i am rh-. all three of my kid have been rh+. with the first two, i received a rhogham shot during and after pregnancies. with the third, we chose differently.
with as much research and conversations as i could have with trusted sources, we decided to forgo the rhogham shot during pregnancy. i had my blood tested and everything was there that was supposed to be there (i don’t know all the technical terms, sorry!). also, from what i researched it seems that in some countries (maybe certain european ones?), it is common practice to only administer the post-natal rhogham shot (if needed). after conversations with our midwife, we felt comfortable with that decision.
some things we did to help prevent blood mixing during birth:
– choose a home birth with little to no interventions.
– when the baby crowned, waited and let everything stretch instead of tear (so painful but worth it!).
– after the baby was born, wait to cut the cord until the placenta was completely birthed, and the cord was drained of blood naturally back into the baby.
postnatally both myself and our baby were tested for antibodies and blood type within 72 hours. there was no mixing of our bloods so it was not necessary for me to receive a rhogham shot postnatally. however, if it was necessary i would have taken that precaution for the sake of future pregnancies.
Evie
It’s interesting to actually read something about the Rhogam shot. I never got it until after I had a child who was positive. I’d do it again, though I do wish there was more information available. I didn’t realize that it was so rare! My mom is O negative (like me), so I’ve known about this shoot long before I needed it!
Holly S
Next, please consider doing an article about how being sensitized actually affects future pregnancies! Because that’s exactly where I am right now. I am rh-, my husband is rh+, and I am sensitized. I’m not sure if it happened after the birth of my son (I did have RhoGAM within 72 hours, after a peaceful, minimal-intervention homebirth, but it’s possible that I needed a larger dose than they gave me; I remember that I did bleed a good bit, although I was nowhere close to hemorrhaging) or during a miscarriage two years later (I was spotting blood for a few days before going in to the hospital, and I was already sensitized by the time they thought to give me RhoGAM). No matter how it happened, I am sensitized, and we’re starting to look into getting pregnant again. The ways sensitization can potentially affect my next pregnancy are a little scary for me.
Thanks for this article, though; I wish it had existed when I was pregnant with my son. I believe I still would have opted for the RhoGAM, but information is never a waste. Every woman deserves informed consent in all aspects of pregnancy, especially with big issues like this that can affect future pregnancies.
Elaine
I know this is an older comment by wanted to thank you for writing this! I am very invested in herbal medicine, homeopathic remedies, and the importance of nutrition and activity, but decided to get the RHOgam shot a couple of days ago at my 28-week appointment with my second child. Even my husband said he was surprised that I was getting this shot. But, as your situation points out, there are some things that cannot be planned for, such as spotting in the final days of pregnancy or being hit by an inattentive driver. RHOgam is not the same kind of issue as vaccination against specific diseases, over which there is some control, like breastfeeding, strengthening your child’s immune system with what goes into their bodies, practicing good hygiene, and avoiding certain people or places (though, of course, you can never guarantee avoidance of a disease). Though sensitization is very rare, it cannot be prevented by my choices. For me, with my current readings and research, the risk of potentially compromising every single future pregnancy is much worse than the risk of the unknown affects of the RHOgam shot. I’m extremely naturally minded, but this is one of the rare times I’m choosing to use modern medicine. I believe it is to my advantage and to the advantage of the many future children that I hope to mother. In the meantime, I’m sleeping a lot, hydrating a lot, taking liquid chlorophyll, drinking herbal teas, and eating very, very clean to help my body recover from an intramuscular injection with some “nasties” in it. All the best to you mothers trying to make the same difficult decision!
Marina
I Was required to get it for two out of three pregnancies. I Have to say I found it rather odd that they didn’t have my partner tested for blood type in either case. Turns out they give everyone with a negative blood type the shot in case the mother is lying about who the father is. Not that I blame them. In my mother’s case, it was a good thing that she was regularly tested for stds because it turned out that her partner was receiving oral sex from someone, and he infected her. So she was able to get treatment before giving birth to my baby sister. This time I have a midwife, and I know my partner is rh negative. So no shot for me ☺️
Marina
Well, I know it seemed like a tangent. But I meant ob/gyn policies can be beneficial.
Sherry
I am rH- and had the shot after both of my pregnancies. I was not sensitized just before the delivery of my second, but even though I got the shot, I ended up sensitized. So, it didn’t work for me. I am very concerned about it being made of human blood product, as my health has not been the same since. I have been diagnosed with lyme, EBV, micoplasma, etc etc. My grandma was rH neg as well and never had any shots…all of her kids were positive and she never had a problem, so I personally regret it for myself. I can’t have any more kids (doc says I’d be high risk) AND I have a chronic illness.
ally
Sherry- I also have never been the same since having the shot. Still trying to figure out what’s wrong with me. Chronic fatigue, muscle weakness, calf pain, neuro symptoms..it’s awful. I’m being tested for Lyme soon as well. Is this what would make another pregnancy high risk for you?
Jessica
How did you end up being diagnosed with Lyme after RhoGam? I declined it after my first baby was born Rh+, and my second was Rh-, but I had a unexpected miscarriage at 12 weeks and didn’t have enough time to think about it and decided to get the shot (which I totally regret – my baby was only about 8 weeks). Anyways, I haven’t noticed any weird symptoms, except that I am tired all of the time, but there is also a lot of stress in my life.
Eb
Omg… I got the Rhogam shot and I have been diagnosed with Lyme disease as well… It’s so weird I read your comment, because I just was thinking “I wonder if I received Lyme infected blood” … I have already decided that for my next pregnancy I would not do the Rhogam shot. just lots of nettle tea and prenatal yoga!!
Cara
I started having gastrointestinal symptoms including bleeding (OB said it was probably just internal hemorrhoids) right after my RhoGam shot in 2005. Things only got worse and I was diagnosed with Ulcerative Colitis in 2006. It is an inflammatory bowel disease and considered an autoimmune disease. I was previously healthy.
I’m not saying don’t get the shot, but it is not without risks. The lack of any studies on long term effects is a terrible disservice to all of us.
If I could go back in time I would absolutely not get the shot. I wish I would have known that I could have tested my first son’s blood in utero.
I had 2 more babies and did not get the shot with them. My midwife did the blood testing post birth and all was fine.
Tai
I did as much research as possible when I found out I was rh negative. I also read wickhams book. I have had an overwhelming gut feeling the whole time I was pregnant not to do the shot. So far I haven’t met anyone else that has completely refused the shot. I did even though my baby was rh positive. I’ll know in a few weeks if I developed antibodies. According to what studies where done, odds are I will be fine.
Christina
This is a great article Heather. Thank you for your thorough research and easy to digest regurgitation! Sure you should be Mamabird?
I have rH neg blood, my husband is rH positive, I have birthed 5 babies and have refused the rhogam shot each time. My midwives weren’t concerned about the first couple of babies, and even at the fourth, we did NOT do a antibody test, even though my first child is rH Positive. We did do the antibody screen during the late second trimester of my fifth child – it was NEGATIVE.
My husband is a homeopath and I have been treated homeopathically for 11 years. I think this has helped.
Also, my husband wants to add that he has treated at least five babies who’s mothers HAD developed antibodies and the babies had symptoms like jaundice, anemia, etc. Homeopathic treatment resolved their issues within a few weeks. Several of these babies were followed into teen-hood. They never had any residual problems with their livers or with their bloodcounts.
Homeopathic treatment CAN help with any incompatibility issues that develop in the child.
Also want to tell you about a friend of mine who was also rH negative. During her “wild years” as she called them, she had five abortions. She was given cervical rhogam shots each time. By the last one, she had almost become completely debilitated with chronic fatigue and fibromyalgia – her doctor said it was FROM THE RHOGAM SHOTS and he had other patients who’d had the same problems. Back then, they were full of mercury, but he said it was also from the immunosuppressive nature of the shots…
savannah
Would you mind sharing what types of natural treatments he used for the babies who did develop the symptoms due to the mother being sensitized? thanks 🙂
Wandia Mom
Hello Christina!
I’m a fellow homeopathy believer and would love to know which remedies your husband recommended during your pregnancies to prevent sensitization. I am pregnant with my second child, I am O-, my husband is O+ and our first child is also O+. I was not sensitized during my first pregancy according to the blood tests and didn’t receive any Anti-D shots. I would love to boost my health so that everything goes as smoothly as possible for this pregnancy as well. I would be very grateful if you could share what helped you ! Thanks again for sharing your very positive experience!
Lila
Hi, do you know if your friend got the rhogam shot after her last abortion? And did she go on to have children? Wondering how abortions effect rh negative woman with future births after getting Rhogam/ as well as not getting it?
Verna Nolt
Hello Christina
I find it very exciting to hear that someone knows of natural treatments for Rh incompatibility! I would be very interested to learn about this!
Rebekah
The Rhogam shot was one of the hardest decisions of my pregnancy. I hated thinking of the possible side effects. I hated the fact that I was rH negative.
I did NOT get the the shot during pregnancy, as I didn’t see any reason to (no trauma or previous miscarriages).
I did have the Sequenom Lab genotyping test done which confirmed that our son was rH+ like his dad.
I did get the shot after birth. It was an emotional, but I think there’s been no side effects, and I am praying that it worked.
Thank you for posting this article. I find your research and blog inspiring!
K Bottch
How did you go about getting the genotyping done? Did you have to go outside of your normal health plan or was that available through your doctor? Thanks so much for posting about this, its so helpful! I am 25 weeks with my second (first was RH- but I’ve gotten a lot more pushback this time from nurses about refusing the shot during pregnancy) and trying to do more research!
Beth K.
I’m A- and have an autoimmune disease, and my husband is O+. Both our daughters (2 months and 3 years old) are also O+. First daughter was a planned home birth that turned into an emergency C-section because she was breech and very stuck, and external version would not turn her. Second daughter was a successful planned HBAC. I chose to have Rhogam once after each birth. Though I was unaware of all the risks of the shot, I think I would still choose to have it again if God blesses us with another baby. None of us had a reaction that we know of, and I’ve had enough “sensitizing events” that I would feel better getting the shot.
However, I did realize while reading this that because of the way the shot is formulated, it would be possible to get a blood-borne illness (especially Lyme, of which I am terrified), so thank you for including that information. It is a tough decision.
Katheirne
I chose not to get the Rhogam shot during pregnancy. My first was RH+ like her Dad but my second was RH- like me. I did get the shot within the 72 hours after my second but it was very difficult to make that choice. It felt like that was the best choice though, if we ever have another child. I was lucky to have a midwife and home births but I wished there was another way to deal with the RH- issues besides a shot. In general, is not our preferred choice when it comes to matters of health.
Thank you for giving light to this issue which was a very difficult decision to make.
Grace
You never need rhogam when the baby is Rh negative. Did you mean you got it after your first delivery?
Jennifer Burgess
There 20+ other antibodies for which there is no treatment. I am sensitized to one of them so every pregnancy for me is high risk. I am choosing to have no more children (we have 3, but wanted 6) because of this and I also have precipitous births that are so scary. I found during my sensitized pregnancy that when I removed inflammatory foods from my diet that my antibody level went down and ultimately my baby was unaffected by the S-antibody problem. I wish there were research on how diet effects response to pregnancy and auto-baby-immunity.
Nichole
I am o- and husband is +. I got tested multiple times while I was pregnant if I had any antibodies and I never did so I didn’t get the shot while pregnant. Ended up my baby was – too so I didn’t get one after birth either. I will do the same thing if I have another baby and would probably get the shot after the birth if the baby was +… just in case we go for 3 🙂
Sienna
Hi – I’m sorry, but when you’re actually faced with this decision during pregnancy and have already lost a baby, there is no question at all about whether to get the shot or not. There is nothing to figure out. If you need the shot, you get it. I’m RH negative and my husband is postive. When I was pregnant, UCLA Medical Center required me to get the shot on a schedule. One before birth and one right after. There was no debate or question about it on either end. It was a medical necessity. And I’ve never heard or read of any controversy about it. It’s easy to interpret this as another version of vaccinations when you’re an observer – and especially if its never happened to you. Reading a long article about the science behind it is a waste of time for pregnant women who have more important things to read and less clear-cut decisions to make. This is on the verge of fear-mongering. Too much information is not always a good thing.
Heather
Hi Sienna, I am so sorry for your loss. However, I disagree that sharing information is fear-mongering. As I covered in the article, it is now possible with 99% accuracy to determine a baby’s Rh-status in-utero. Furthermore, many women opt to find out if their husband is Rh-negative before deciding about the shot, because if he is negative it is completely unnecessary. This article is not about whether the shot is good or bad – clearly it is helpful in many cases – but about determining when it is indicated and when it is not, as well as understanding the risks on both sides.
Alayna
What is the blood test called that can be done to determine if the baby is rh negative or postive? When can it be done? I am 24 weeks now and have to make a decision before my 28 week appt on whether I want to get the shot or not.
April McMillan
I’ve had two miscarriages and I have been very conflicted about this shot. I am thankful to have found this article and appreciate being able to access more information to make a choice rather than have someone else make this choice for me, when it is my family that lives with the outcome, not theirs. Everyone is wired and processes things differently, and some of us need to wade through detailed information in order to find a place of resolution about a big decision. Actually, not having enough information to answer our questions— and sensing there is more behind the curtain— that produces more fear for me. It saddens me that all of this kind of info has to come from blogs and documentaries instead from my doctor.
Rachel
After much research, including reading Wickham’s book, I refused the shot completely and opted for intervention-free births. So far so good with two healthy children of unknown blood type, and we’re praying for many more.
Cori
With my son I was very uninformed about the choices that I had and received a RhoGam when I was pregnant unfortunately! I had a long hospital birth ending in pitocin, epidural and directed pushing but he ended up being Rh negative, so I never even needed the shot! Grr.
Seven weeks ago my daughter was born gently and naturally at home by my Midwife. I didn’t get the RhoGam with her because I decided not to get ANY vaccine (or medication)while pregnant. She is Rh positive and I was not sensitized so I decided to get the RhoGam even though I hated it. I plan on several future pregnancies.
I prayed while I was getting it and doubled up on FCLO that day.
Not sure if I’d do the same thing again.
Melanie
Hi Cori,
thank you for sharing. just wondering waht FCLO means;) thanx
Jen
fermented cod liver oil
Kathryn
Hello. Why did you get the shot after the second pregnancy if you were Not sensitized?
Kristie
Great article! There is a lot of good info here to chew on. I, too, am Rh(-) and my hubby is (+). All 5 of our children so far have been Rh(+) like Daddy, and I’ve had RhoGAM with all five of them, and now with #6 as well. I’ve had no side effects or pregnancy difficulties from it. The only real issue for me, which I still struggle with, is the fact that the shot is made from other people’s blood. Ew. Please, Father, don’t let me catch a disease!!! HalleluYah!!!!
Tammy
My exhusband and now all 4of our boys test A- but have the du variant. My firstborn is a girl and is A+. The next was a girl and O-. Three of my boys ended up under bili lights, but this was thought to be due to an abo incompatibility. I took the rhogam shot with all but the first. We didnt know my ex had the du variant until our daughter was born. No reactions to the shot.
Rusty
I was fortunate enough to be a part of the control study that created RhoGam. I have 3 positive children and without the shot would have only had one. I gave my blood weekly after giving birth which helped to create the shots for others. Feel blessed to have been in the program that has given RH neg women the opportunity to have as many children as they desire.
Katherine
i would have loved this info 4 months ago! I think we still would have made the same decision, but I just wanted to know why……since I apparently needed 12 shots after my rh+ baby was born and everyone wondered how sick we might be or if we had experienced trauma. I’m not sure any of the above fully explains why. The director of the blood bank in my city said he’d only ever seen 9 given safely. My doc had me take 6 one night and the other 6 the next day. I was a little light headed right after each set (like you feel if you haven’t eaten for a while) and I had a small rash on my hand in between my knuckles. But that seems to be the only noticeable side effects I have experienced. I do wonder if we’ve made a decision that might effect me 30 years from now. But, I trust my doctor and her decision. She had my blood tested umpteen times and when the hospital was ready for me to take all 12 before all tests were completed, she advocated for my blood to go to the blood bank for more tests and did not want me getting all shots at one time. It seems like she did as much as she could to make sure I was ok (physically and emotionally) and to help protect me and our future pregnancies.
Dianna
I developed anitbodies during my first pregnancy – discovered at 7 months. My son was a bit jaundiced, but fine. Does my “antibody” A- blood have any value to others? I would love to donate regularly if it would be helpful.
Amber Henderson
I am not %100 percent sure but since you are sensitized I think you can donate and your blood can be used to make rhogam? It’s worth looking into!
Nicki
I am Rh- and so is my husband. All three of my children are Rh- and yet I was told multiple times I needed the Rhogam (I declined each time). I think that nowadays it is just so standard that many practitioners are not using their head and over giving the shot to those who do not need it. My midwife’s policy is to only offer Rhogam if the baby test positive at birth barring another condition that may result in blood crossing, such as abdominal trauma. I hope that Rhogam will eventually be used wisely in only those that need it rather than being widely used on those who do not.
Nichele
I have two children. My first was negative like me. The second one was positive. I never took a Rhogam shot. I was never sensitized either but I did decide to quit after two kids. I didn’t know at the time if I sensitized or not. I did get tested five years later cause I thought about having another baby it was negative for antibodies. But I didn’t have anymore we adopted four children instead.
Pups
How did you go about asking your OBGYN for the test? Can they test you for sensitization if you are not pregnant? I am interested in getting the test and would like to do so before I get pregnant wasn’t sure how to go about it.
KD
What an interesting article. I am O-, got the shot after my son was born. At the time, there was no internet like there is today, none of the nurses or my doctor explained anything, never blood typed my husband or my son. Didn’t need a shot, as my son is A-, and I never had anymore children anyway. Wish I had had the level of information available now back then, I would have refused quite a lot of things the doctor/hospital did to me during pregnancy/birth. I did end up refusing quite a few things afterwards, as I was sick of all the poking and prodding when I was essentially in good health. I think most of the things they did were simply because I had good insurance, like wanting afterwards to cut pieces of my cervix out for “testing” when I had no issues that would require any testing. I changed doctors shortly afterward thankfully, it would have been a rocky career for him 😉
Jess
In some Eastern European countries, it is entirely the parents’ decision whether they take the shot or not. That’s because although it is theoretically free of charge and available to any Rh- woman on request, and covered by any type of insurance, Rhogam is not on stock in hospitals, so you simply have to buy it. It costs about half of the average monthly wage, so one thing’s for sure: nobody’s taking the shot just for the sake of it. Actually, many women do not even know about it, or about the consequences or becoming sensitized. Standard procedure for – mothers and + fathers (both parents are tested, always) involves testing the mother for antibodies al least twice during pregnancy (after 12 weeks, and again a few weeks before birth), checking the baby’s Rh immediately after birth and giving the shot (if the mother buys it) in the first 72 hours after birth. However, given the financial status of most families, when explained why they need Rhogam (that is, to protect subsequent babies) and being faced with the costs, in most cases the parents choose to simply stop having any more babies, and that’s that. The discusssion about the side effects of the shot, whether it’s good or bad, etc etc, is so far from the general concerns around here…
But there’s still a couple of us, like me, who are interested in finding out more, so I thank you, Heather, for the article. As far as I’m concerned, I got the shot after my first two pregnancies, because my sons were A+, and I’m 0-. Not to mention that after the first birth we couldn’t find the injection at all in the whole country (my husband eventually bought it from Germany; just imagine!). I’m hoping for a Rh- baby this time (I’m 36 weeks along), but that’s mainly because, honestly, the high price of the shot scares me more than the possible side effects. I know it sounds crazy, but that’s how things are around here…
Nidhi
I am currently 7 months pregnant and I am facing a severe blood group issue. I have got my blood tested multiple times. Majority of the times I have got it positive and sometimes negative. One of the hospitals considered me as weak D positive.
Iam currently at Qatar and the doctor iam consulting now sees me as a A+ve mother and is not giving me the rhogam shot. My husband is A+ve. The hospital where i have planned my delivery follows the WHO norms strictly and will not give me the injection even if I insist. Iam very much worried and confused.
Jessoca will
If you decode to get a Rho gam shot is here one brand better than another? One hospital offers Ortho Rho gam and the other offers rhophalac from another company
Alice
I had some health problems that led me sadly to need to end my pregnuancy due to complications to a copper IUD I expelled. I didnt know anything about my blood being RH negative or anything about the shot they needed to give me post procedure. There was never even any converstion about it I just got it injected. It was a scary confusing time in my life when I didnt have much information to go on. I would like to thank everyone for talking about what seems to happen often with out any options presented, for me I needed more information. Who knows maybe had I know about my A Negative 6% of the population blood issues id have made totally different choices having had some many terrible reactions to medical procedures.
Sarah
Thanks for this information! I am RH- and had already decided I would be refusing the shot due to it being made with blood plasma. For religious reasons I do not accept blood or products made with blood or its major factors. It’s nice to get a little more information in how it all works. This being my first baby if I were to develop the antibodies after birth we would decide to not have anymore children. There are plenty of babies out there to be adopted who need good homes.
Trisha
I was found to be Rh- at 32 weeks pregnant with my baby. I did TONS of research as I was NOT comfortable getting Rhogam knowing that it contains both mercury & aluminum and has been proven to cross over to baby in utero and/or through breastmilk and has been linked to autism as well. I discovered that WinRho would be a good substitute to getting the Rhogam as it does not contain mercury or aluminum. The only problem with WinRho is that it’s very hard to get ahold of, extremely expensive and I’m guessing a lot of drs. wouldn’t be willing to order it for their patients. I was blessed to work with a naturally minded dr. who was willing to order it for me.
mandy
thanks for the information
Chrissy
I’m o- and pregnant for the second time with twins. I got the shot right before I gave birth to my first child, right after and a year later after a miscarriage. Would I need to do the shot again for this pregnancy? Is there any way I can gets around it?
Lina
Of course I did it. I did my research and knew my priorities – I wanted to have kids and didn’t want to have any chance of becoming sensitized. My first child (good for her! was born A positive), so I am glad I had an option to get a rhogam. Thanks to it, I have 3 kids now. And all born totally naturally with no/zero interventions. But I still got rhogam and very happy they have this for mothers. I was born in Russia, where I knew so many women, mothers of my friends, my cousins who could not have more kids or had miscarriages because they got sensitized and never got rhogam shot simply because it didn’t exist in Russia.
For those who is scared that there is a trace of mercury product in it, well sorry, you get it also and even in higher amounts by eating wild caught salmon. Use common sense, especially if you want to have more kids.
Verna
I would love to know your natural treatments for sensitized Rh-mothers!
Thanks
Connie
My 7 children are between 25 and 45 now, plus 3 adopted from Haiti who are 44. I had 5 Rhogam shots, after the first 5 babies. With #4, the doctor wanted to give it during pregnancy but I refused because he couldn’t tell me if it was safe for the baby or even necessary. By the time I was expecting #6, I had read that if you have the baby in hospital, that because of all the interventions, you have as high as 35% chance of sensitizing your next baby, but if you have it naturally at home with a midwife, it’s more like 5% or less. Also, a doctor friend told me how the serum is made – mixing the blood of 50 prisoners (he said not all forms of HIV were testable) so I asked my doctor if I couldn’t just have my blood tested right after birth (I had baby at home with midwife) to see if I’d developed antibodies, and he said, “Hm, I never thought of that. OK.” The hospital didn’t want to do the test, but I pushed them and they did. Then I got a call from the lab at midnight saying they wouldn’t process the test, I needed to just go get the shot. I said no. So they did, and no antibodies. Next (last) baby I just didn’t even bother. They all had jaundice, but that didn’t seem any different from one to the other. I wish I’d known this stuff sooner, I would have foregone them all. I haven’t ever been well since. Chronic Fatigue, Lyme, NH LYmphoma, Conn’s. Might have been caused by something else, but I wonder.
Megan S. Alger
Thank you Connie!!!
I am pregnant with my 7th babe. More than likely will be a positive babe.
My only fear in not getting the shot and being blamed for getting sensitized, is that no midwife in my area will service me after that. I hate hospital births.
Jaundice does not seem like such a huge deal.
Did you do huge things in your diet once you stopped getting the shot???
I am really looking at never again getting the shot. I become more suicidal as my hormones go crazier and crazier after each babe.
Thank you so much for speaking up,
Megan A.
Connie
I didn’t do anything special with my diet. I’m so sorry your hormones are messed up, that is awful! Do you have a doctor that prescribes bio-identical hormone creams? That works for me, the other did not. Also, make sure your thyroid is optimum. There’s a book, Stop the Thyroid Madness that may help you. I exposed the babies’ skin to the sun as much as possible when they had jaundice. And nursed them a lot.
Diana
Hi Heather 🙂
My daughter is 6 months pregnant and wants to know if the Rhogam shot she is scheduled to receive in a few weeks because of her Rh negative blood would have the ability to transmit any component of the mRNA covid vaccine to her since it is made from platelets of a donated blood source that could have been vaccinated. She will absolutely not get the vaccine but is just worried about the blood supply. She already received one shot when first pregnant and then another when she was 8 weeks along because of spotting, but that was before the vaccine rollout.
We are very anxious about this and are trying very hard to get some answers to make the best decision for mom and baby. Thank you for any advise!
Taylor
Diana,
Did you ever find out any information or advice on this question? I have the same concern. I want nothing to do with the covid vaccine. I’m already leaning towards not getting the rhogam shot anyway, but the unknown from the vaccine may be what makes my decision final.
Diana
Hi Taylor,
We actually were able to speak to a doctor at the lab where they make Rhogam and she said that it takes about one full year to make the final product from collection to testing and that the plasma can then be frozen until it is used. The final product, however, cannot be frozen. It is mixed and then sent out in batches to be used within a certain time frame. She said the odds of all that happening within the past 6 months since the vaccine rollout would be near impossible.
My daughter has decided to forgo the shot at 28 weeks but get it after her son is born after they can determine if his blood is positive.
Hope this helps. It’s a tough decision one way or the other.
God bless!
Mary
Hi Taylor,
What did you end up deciding to do? I’m pregnant again and terrified to get the rhogam shot this time because of possible mrna transfer. I have no idea what to do and am so worried.
Mary
Hi Heather!
Thanks so much for all this info! Are you aware if there is any risk of MRNA from the covid shots getting transferred through rhogam? I am absolutely terrified of this being a possibility. I am 4 weeks along with baby number 5 but have had 4 losses as well. I have researched so many places and can’t find any answers. I’m very anxious to find out quickly since I have a history of losses and would need to know what to do sooner than later just in case. Thanks for any help!