Have you been told you need, or have been given the RH immune globulin during, or after pregnancy, and are planning to have another squish? Are you being faced with it in the future, but not sure where you stand? Are you completely for, or against it? On the fence? If so, you may want to keep reading...because this topic is *not* one that should be delayed until further research is done. Momma should be 100% confident in her decision *before* the time of apparent need.
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I have O- blood, and my husband has A+, so this is a topic I've studied extensively. After having 3 children and spending several years researching, I am very confident in the knowledge I've obtained regarding this very different shot, so I'd love to pass it on. Now, I don't vaccinate my children. They're healthy as can be, and hardly ever get sick. They have no chronic health issues. I also don't get any vaccines for myself any more, either...but this shot is different. It needs CAREFUL consideration. I'm here to give you the facts, so you can make the best informed choice for you and your baby, as well as all of your future babies.
# The Basics
When a mother has RH negative blood type, but the baby has RH positive blood type, and the blood mixes, the mother's blood will create antibodies to attack the RH positive blood, because they are incompatible blood types, causing rhesus disease, (RH disease,) in the baby. This can be mild to severe, so I encourage you to research [RH disease,](https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P02498) so that you know exactly what you're dealing with to help make an informed choice. The RH immune globulin, when used correctly, actually can be something in which the benefits outweigh the risks, unlike other routinely given injections. The RH immune globulin is *not* a vaccine, it's a blood product; blood from a mother who is already sensitized. When you're sensitized, your blood has made an immune response to the positive blood in your system because it's a foreign substance, so next time you get pregnant with a baby of a positive blood type, there's a chance that baby will get RH disease...**_if_** your blood crosses to the baby and attacks it's blood. Mom and baby's blood don't typically mix during pregnancy. However, it's quite possible during a rough delivery, as well as just about every intervention typically and routinely done by doctors, (go figure). It's *most* likely to happen if there is physical trauma causing bright red bleeding. (Not **all** bright red bleeding means there's a possibility of mixing blood...during one of my pregnancies, I had a UTI that made me bleed bright red. In a case like that, there's no risk of blood mixing, because it's coming from the urinary tract. I never took the immune globulin after that, and no sensitization occurred).
Giving the immune globulin makes your blood temporarily sensitized. It's foreign blood, so it breaks down over time because your body recognizes that it's not your blood, but a foreign invader to attack. While it has you sensitized for the first few days, your body will not deem it necessary to build an immune response that would be permanent, because it's already done so for the moment. Same reason why vaccines don't give a lifetime immunity...it's a weakened version of the real thing.
# What You Need To Know
I'm all about informed choice, especially when it comes to pregnancy and birth. Your babies are *your* responsibilities, mommas. Don't just agree to do things to them simply because the doctor says so, or the doctor assures you that the practice is "safe". You should **always** know what's being done to your babies, what could affect your babies, and how...even if you have full trust in that doctor. They are only human, and can make mistakes or skip over research if the boss says it's good, to save their busy schedule.
In any case, this is what you need to know when you are faced with this decision:
* If you have immune thrombocytopenia (ITP), the immune globulin can actually kill you, or cause *severe* damage to vital organs. Here is an [insert for WinRho](https://www.fda.gov/downloads/ApprovedProducts/UCM198717.pdf) and [general information on the globulin from Drugs.com,](https://www.drugs.com/cdi/rh-d-immune-globulin.html) outlining the risks.
* If the father of the baby is a negative blood type, **no shot is ever needed!** The baby will always be negative in this case; negative blood won't fight negative blood.
* The immune globulin is a blood product. While it's not a vaccine, it still carries risks. There are preservatives, which can have adverse health effects. There's also the chance of the blood containing ailments that are not included in the screening tests. They can't check for everything.
* The prenatal (28 week) dose is risky and unnecessary. There's a good chance the baby is negative, and in that case, there's absolutely no need, and it's only providing risks.
* There's a small chance that the prenatal shot can actually cause the disease it's trying to prevent. If you aren't sensitized, and you take it without any issues present, the shot temporarily sensitizes your blood. If you have trauma that causes bright red bleeding within 72 hours of the dose, then your blood is "sensitized" already, which means that it's going to attack the baby's blood right away, threatening to cause RH disease.
* This shot, no matter what brand, is a category "C" pregnancy drug. This means that animal studies show adverse effects to the baby, and that there's no adequate or controlled studies on humans. By agreeing to take the 28 week dose, you're agreeing to use your baby as a study subject...a guinea pig. *They don't know* what it will do to your baby...and since widespread use isn't controlled, any adverse effects are not recognized or reported; instead, they would be passed off as something unrelated.
* After the birth of your beautiful, perfect baby, request a blood type test for your baby, and a sensitization test for yourself. For me, if I'm not sensitized and my baby is positive I accept the shot, because it's no longer exposed to my baby, and while I'm reluctant for my own health, it saves me from becoming permanently sensitized and risking future babies. For you, weigh the risks and benefits. I would still suggest doing those blood tests, because if baby is negative, or you're sensitized already, it's 100% unnecessary. If you're not sensitized and baby is negative, same thing. Unnecessary.
# To Summarize
After all my research, I wrote a letter to my midwife, who was trying to get me to take the 28 week shot. I'll paste my letter here, which lays out the nitty-gritty of it. She did respond to it, saying that the one thing I had wrong was the 3 day efficacy...it just works best within 3 days of bleeding or 3 days after traumatic birth, and gets less effective as time passes. Everything else was right, though...she had to research for herself when I gave her this. She has since changed her approach, so I'm pretty happy about helping out all the mommas who see her now!
Here is my letter to her:
"**RH IMMUNE GLOBULIN;**
**REASONING FOR ROUTINE PRENATAL REFUSAL**
This print-out is to advise of my reasoning for refusal of the routine prenatal RH immune globulin. I have done a lot of reading and research on this medication, including speaking with health care providers and reviewing the manufacturer's package inserts and information, however, if you find from this print-out that I have anything wrong or confused, please let me know...I am very open-minded and always willing to learn. I would like to have a discussion with you regarding this, but out of respect for your time with appointments, I thought this would be the easiest and most practical way to get my points across. I respect that you've been in this practice for a long time now, and have seen things happen first-hand. I want to be clear that I'm not trying to undermine your knowledge or experience, nor am I just writing off your recommendation, just concerned about this routine practice. I feel these concerns should be addressed or put to rest, not just for my sake, but for other mothers-to-be as well. I also want be clear that I'm not refusing entirely....as I have done with my last birth, I will wait for results of my baby's blood type after birth, and if baby is positive, I will accept the immune globulin. Thank you for taking the time to go over this!
1) This is a pregnancy category "C" drug. From what I know of the categories, "C" means "Risk not ruled out: Animal reproduction studies have shown adverse effects on the foetus, and there are no adequate and well-controlled studies in humans." Literature on this drug category also states that it should only be given when there is a clear need, because it may be of benefit, despite the potential risks.
Just this information alone is shocking to me as to how and why it's given as a routine pregnancy drug...shouldn't the women this is given to at least be informed that there are no human studies for prenatal use? Why is this drug given as routine to every pregnant woman with this blood type without even knowing if it is actually necessary? After all, if the baby has a negative blood type, then there is absolutely no need for this medication, and in turn, only providing risks.
2) This is given at 28 weeks, because 92% of women who develop an anti-D do so after 28 weeks. Correct me if I'm wrong, but to my knowledge this drug has a 72 hour efficacy, and by it's design, it shouldn't last a long time, (as this could become counter-productive, because it's suppose to only temporarily sensitize the blood so the body doesn't do so permanently).
If it's recommended at 28 weeks, but the risk is 28 weeks and on until the pregnancy ends, what is the point of only one shot at 28 weeks? If this is important in case of undetected feto-maternal hemorrhaging after 28 weeks, then wouldn't the only way for it to be truly effective during pregnancy be for it to be given on a regular basis after that point? Or, if this cannot be done because of the lack of safety studies, why is it given at all?
*** I've also found a source, (http://www.archivesofpathology.org/doi/full/10.1043/1543-2165(2004)128%253C463%253ATCOMFH%253E2.0.CO%253B2?code=coap-site) (**_Edit to add that this site has moved the document since then, [this is the new web address](http://www.archivesofpathology.org/doi/pdf/10.1043/1543-2165(2004)128%3C463:TCOMFH%3E2.0.CO%3B2)_**) from Archives of Pathology and Laboratory Medicine, that has revealed another interesting point; that the chance of massive undetected feto-maternal hemorrhaging (which is the true risk factor, from what I understand,) is actually very insignificant. It states that this could happen to about 3 in 1000 pregnancies. That's 0.3%. If it is 92% of women who develop an anti-D during pregnancy, then that would mean 92% of about 0.3% of women are at risk. This is less than a 0.3% chance of undetected FMH. How is that enough to justify giving a drug, that is unstudied in humans during pregnancy and showing adverse effects to foetuses in animal studies, to all mothers with this negative blood type as a routine? Especially when this <0.3% chance is basically cut in half or more, because there is a 50% chance the baby will negative as well, even when the father has positive blood, and then there is no need at all. ***
3) This shot works by temporarily sensitizing the blood after trauma causes feto-maternal hemorrhaging or more commonly after birth, especially C-sections. What happens, then, if after receiving the prenatal dose while nothing is wrong, I have trauma causing FMH during the 3 days that my blood is temporarily sensitized, and the baby is actually positive? Wouldn't that cause the RH-disease that this drug is suppose to prevent?
Thanks again for taking the time to go over this! Please let me know of your thoughts on our next visit. I look forward to talking about this!"
I hope this helps some of you make an informed choice about getting the RH immune globulin!