# Refusing Rhogam and doctors



## cdk (Jun 17, 2007)

Hi,
I'm new here and I'm so glad I found you guys! After doing some research, I've decided I am not going to get the prenatal rhogam shot. I am only 17 weeks but so far I have had no spotting etc...

I am currently seeing a OB doc/practice. How hard is it to refuse the shot? Are they going to refuse to keep me as a patient and fight me on it?

My Dh is O+ but his mom was Rh-. Does that give him a better chance of passing on a negative to the baby? Does anyone know about the blood tests he could have to find out? Or the Du? test for me?

Does the doctor check you at 28 weeks to see if you are sensitized?

I have a feeling my office will freak..should I bring it up at 24 weeks?

Sorry so many questions, I'm just so confused!

Thanks,
Cheryl


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## Crisstiana (Jan 18, 2007)

Hi, Cheryl:

Is this your first pregnancy? If so, the chances of a problem even if your baby is Rh+ and you are Rh- are very slight.

If this is not your first pregnancy, there may be a problem. With your husband being positive and your status unknown, it would be possible for anti-D antibodies to have formed to damage your baby's red blood cells. If it turns out that you are Rh-, the chances are only slightly smaller that your baby also would be Rh- with an Rh+ husband.

If this is your first pregnancy, you could talk to your doc about declining the shot due to the reduced risk. If it isn't, you could get tested for a better estimation of risk and then discuss your concerns with your OB.

Congrats on your pregnancy!


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## applejuice (Oct 8, 2002)

Quote:

Does the doctor check you at 28 weeks to see if you are sensitized?
NO. You are given this shot as a matter of protocol and it only protects your next child, not this one. If you refuse it, you may be required to sign something (you cannot be coerced) or fired.

AFAIK, titres are not drawn at this point to see if you have been sensitized.

Use the search button at the top of this forum. There are lots of posts and threads that address the Rhogam dilemma.

FTR, I have four children born at home and I never had the shot. I am RH- with a DU factor. Ask your doctor about that one. See if he knows.


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## 2Sweeties1Angel (Jan 30, 2006)

I didn't get the Rhogam until I was about 37 weeks with my last pregnancy. I wasn't going to get it at all, but DH wrecked the van and it wasn't driving so well but I had to drive it. I was afraid something would happen in the stupid thing that would cause the blood to mix. Looking back, I probably shouldn't have gotten the prenatal shot at all but oh well. What's done is done.

I was without an OB or midwife for weeks ~20-35 because I was planning a UC. When I started going to a family practitioner at 35 weeks because my BP shot up, I just told him I didn't want the Rhogam and explained my reasons. He was fine with it and didn't say anything about it until I told him I wanted to go ahead and get it at 37 weeks, then he wrote out the prescription. No big deal. I did see an OB before I went to him who tried to force the RhoGam on me and it ended up being this big thing that ended with me calling him a quack to his face







The reaction just depends on the doctor.

I don't know if this has anything to do when I got the Rhogam or birth method or what, but I thought it was weird. My first 3 were c-sections and I had the Rhogam right on "time" around 28 weeks. They were ALL jaundiced to some extent. My 37 week Rhogam VBA2C baby wasn't even remotely jaundiced.


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## Collinsky (Jul 7, 2004)

My CNMs when I got prenatal care (my first 2 pregnancies) were fine with me not getting the prenatal RhoGam. The first one even went and looked up the DU factor (which I asked her about and she admitted she didn't know what it was) and was very cool about it, even commended my researching. They both tested during my pregnancy for sensitization, I assumed it was pretty standard for all Rh- mamas. Even if it isn't protocol, they might be willing to do it. They like to do tests. However, it won't tell you much of anything that is useful - the point of the RhoGam is to prevent any sensitization; once you are sensitized, then there is nothing that you can really do to reverse that. I would argue that RhoGam isn't the only way to prevent sensitization, but then again, OBs hate people like me.

If you have a feeling that your caregivers will freak, you are probably right. It really does depend on your OB or midwife's personal feelings about it, how hard they push the protocol. The shot is not to protect *this* baby, but any future Rh+ babies you might have; the prenatal shot offers a very slight benefit that is nearly negligible and you should be able to reason your way out of it.

They *can* test your husband's blood type to find out if he is Rh ++ or Rh +-. If he is ++ then he can only pass on the +, and all your children will automatically be Rh+. If he is +- then each child has a 50% chance of being pos. or neg. I have three children so far, and the two older ones are both Rh neg. Our son we did not have tested but we assume he is Rh + simply because the odds are in favor of it.

We personally have decided against getting the RhoGam shot after the births as well, unless we have a reason to be concerned about blood mingling. There are certain risk factors for blood mixing that we avoid (such as induction, early cord cutting and fooling around with the fundus/placenta). In a hospital birth, it would be difficult to have enough control to ensure these things, so in that setting I would probably get the shot. It is something that they feel VERY strongly about and will not take "no thanks" as an answer.


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## Emmeline II (Feb 16, 2006)

Do you know your blood type; you didn't mention it? If you don't know, I would find out first.

With #1 I refused because dh is O- and I am B-; little Airman me had to stare down a Lt. Col who basically said mother's can't be trusted to be truthful as to who the father is. #2 was a home birth, so no problem there.

Rhogam Thread:
http://www.mothering.com/discussions...d.php?t=455838


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## User101 (Mar 3, 2002)

Moving to Birth and Beyond


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## cdk (Jun 17, 2007)

Sorry I didn't put my blood type. I am O-. This is my first child and I am 35.

As far as the testing of my DH's blood for +- vs ++, how do I get that done? Does he go to my primary doc for that? Does anyone know the actual name for it?

Also, the Duffy/Du factor, is that a special test? Or is it found out when you find out your rhesus status? If it is a special test, is there a different name for it and who did you go to to have it drawn?

If something happens this pregnancy where my blood mixes with the baby, is there anyway that can harm the baby or is it just that I may become sensitized for next?

Thanks everyone for your replies!


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## mwherbs (Oct 24, 2004)

so the thing is initial labs will be run and as far as I know a titer is done with initial labs-- and several providers I know do titers if a woman refuses Rh antibody shot .
As for how hard is it to refuse depends on the provider- and let me say this in all the courts in this country a provider is the EXPERT and an informed consent form signed by you is mainly tossed out- so a doc is going to work hard to clearly inform you about the risks - your job is to be aware of the risks and make an INFORMED decision -- so yes you will have to read and hear about all the scary and bad possibilities.
from what I have read because both you and DH have O blood one of the protections is gone because ABO incompatible tends to be protective and engages the immune system over the Rh factor-
chances are relatively low for prenatal exposure there is a recent study from one of the European countries- that give % difference- testing DH won't really give you much more info because there is still some possibility for the baby to be + no matter DH +-, ++.


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## cdk (Jun 17, 2007)

I will take the shot after delivery if the baby is positive. One of the "statistics" that really makes me not want to take it prenatally is the percentage difference which is right on the rhogam insert. It says there is less than 1% of a difference in efficacy in getting both shots vs just after delivery.

If something happened to cause blood mixing, I would take it also. Can't I explain that to my doctor?

Also, I feel who came up with 28 weeks. What if I had microbleeding at 20 weeks that was undetected? Getting the shot at 28 weeks would not help. I think providers should definitely check for sensitization before getting it because if you are sensitized the shot won't help.

Am I right on this???


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## liseux (Jul 3, 2004)

I am rh sensitized and have had 2 pregnancies before I got sensitized and 2 after. I was sensitized during a very traumatic birth that involved severe shoulder dystocia and a big pp bleed with manual extraction. I did have only pp rhogam, and it didn't work.

A lot of OB's don't know much about rh issues b/c they send us mamas off to perinatologists now. Your OB should test your dp blood, they will do it themselves or send him off to a lab. What they are finding out is if he is heterozygous or homozygous for his blood type. If you have the du factor you don't really have to worry at all. They will take a titer before the rhogam shot is given, they take blood, check the titer & then give rhogam only if there is no titer. There is also some evidence that if both parents are the same blood type that that can also be protective--the anemia can be less severe. In my case, my first rh pregnancy my titer was 1:32 and in my second it actually dropped to 1:8. We are both O and neither boy was very affected: the one with the higher titer needed 7 days of lights---the second one came home with no jaundice at all. Its also not so much what the number is, its how much it changes during the pregnancy. Also, first sensitized pregnancies can be worse than second or 3rd. The good news is that there are great, noninvasive ways to test the baby for anemia in utero and great treatments if they so start to look anemic. This is one area in medicine that
has improved a lot!

The bottom line is that you should be able to request titer watching instead of prenatal rhogam, without any argument from your OB. Good luck!


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## SublimeBirthGirl (Sep 9, 2005)

I'd look at this from a broader perspective, and think about how hard it'd be to work with a birth team that would be difficult over your refusal of a certain drug. Perhaps if they do respond very negatively, it's time to shop around.


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## bryonyvaughn (May 4, 2007)

Quote:


Originally Posted by *cdk* 
As far as the testing of my DH's blood for +- vs ++, how do I get that done?

You don't have to get it tested. Your DH's blood is +- because his mother only had - to give him. That means there's a 50/50 chance your child with be rh- or rh+.

Quote:

Also, the Duffy/Du factor, is that a special test? Or is it found out when you find out your rhesus status? If it is a special test, is there a different name for it and who did you go to to have it drawn?
Yes, it's a special test. Our local hospital does the test but as it's a regional medical center, I don't know how easy it is for get at other hospitals.

The du factor isn't discovered in normal blood typing. Those that it will test rh- but function like a very weak rh+. Regardless of exposure to rh+ blood, they will not produce rh antibodies.

Quote:

If something happens this pregnancy where my blood mixes with the baby, is there anyway that can harm the baby or is it just that I may become sensitized for next?
Your are a universal donor so even if your husband were AB+, your blood wouldn't harm the baby.

If you aren't du+ and this baby is O+ and his blood mixes with yours, you could produce antibodies to rh+ antigens which could harm a future rh+ baby if your blood mixes during that as well.

I read about a few studies of rh- moms of rh+ children that showed 2% those given Rhogam developing rh antibodies and 13% of moms not given Rhogam developing rh antibodies. The best way to stay in the 87-98% group is to not let your bloods mix. During pregnancy this means no chironic villi sampling, amnios, and rough external versions. During labor avoid prostaglands and pitocin, cesarean section, and assisted delivery be it by instruments or fundal thrusts. Before the placenta births avoid cord traction, uterine massage (sounds MUCH nicer than it feels), manual removal of placenta... basically a managed third stage. Most hospital based birth attendants have very little experience with a hands off third stage, IMO, because 1) time is money and 2) they don't try to avoid mixing blood because Rhogam is such an easy plan B. Well, it's now a plan A but that's for another thread.









~BV


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## ASC (Jun 4, 2007)

Quote:


Originally Posted by *bryonyvaughn* 
...avoid...a managed third stage.

What about cord clamping? When my son was born, I wanted to delay cutting the cord but was told it had to be clamped right away since I was Rh-. (I got both Rhogam shots.) Is it possibe to delay cord clamping if you're Rh-? How does Rhogam factor into that?


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## bryonyvaughn (May 4, 2007)

Quote:


Originally Posted by *ASC* 
What about cord clamping? When my son was born, I wanted to delay cutting the cord but was told it had to be clamped right away since I was Rh-. (I got both Rhogam shots.) Is it possibe to delay cord clamping if you're Rh-? How does Rhogam factor into that?

Thank you for bringing this up. I just rattled off blood-mix risking interventions off the top of my head and missed that one.

You were right, not your birth attendants. Cord clamping can create back pressure causing a bleed between the placenta and uterus before the blood vessels naturally start sealing themselves off. It's always safest not to mix blood.

IMO having Rhogam handy means birth attendants don't feel obliged to abide by best practices. If you want an example of how far safe practices have slipped, talk to a nurse who was trained in sterile procedure BEFORE the era of oral antibiotics. You'll get an earful! Another idea is to have a frank "what would you do if" conversation with a L&D type including precipitous labor unattended, remote birth with Rhogam unavailable, etc. It would be interesting how many standard operating procedures they'd backpedal on.

IMO in the vast majority of cases it's best not to clamp the cord. If you're in one of those rare situations where you really need to cut the cord, you can clamp the cord baby side, cut it mother side, then let the cord hang over a bowl to drain. That way you'll avoid the back pressure problem.

~BV


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## jocelyndale (Aug 28, 2006)

Quote:


Originally Posted by *ASC* 
What about cord clamping? When my son was born, I wanted to delay cutting the cord but was told it had to be clamped right away since I was Rh-. (I got both Rhogam shots.) Is it possibe to delay cord clamping if you're Rh-? How does Rhogam factor into that?

My OB said he would only want immediate cord clamping in case of emergency (resuscitation or hemorrhage), but that Rh factor didn't matter. The cord wasn't clamped until I gave the go ahead. It had stopped pulsing for several minutes and was white.

My DS is B+, and I was not sensitized. I only consented to postnatal RhoGAM.


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## Collinsky (Jul 7, 2004)

Quote:


Originally Posted by *ASC* 
What about cord clamping? When my son was born, I wanted to delay cutting the cord but was told it had to be clamped right away since I was Rh-. (I got both Rhogam shots.) Is it possibe to delay cord clamping if you're Rh-? How does Rhogam factor into that?

Early cord clamping is actually one of the things to avoid if you're Rh - and trying to avoid sensitization. So you were right.

What is possible in a birth is dependent on your attendants willingness to allow you say - hospital protocol affects a lot of things but cord clamping should be flexible... however many OBs are NOT flexible.


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## bryonyvaughn (May 4, 2007)

Quote:


Originally Posted by *jocelyndale* 
My OB said he would only want immediate cord clamping in case of emergency (resuscitation or hemorrhage), but that Rh factor didnn't matter. The cord wasn't clamped until I gave the go ahead. It had stopped pulsing for several minutes and was white...

Unless the bleed is from the cord or placenta itself, clamping/cutting the cord would only be for the convenience of staff working on the mom.

I think need for resuscitation is the time when immediate cord clamping and/or cutting is most contra-indicated. If the baby's blue, limp, and not breathing cutting off his oxygen and blood at best seems reckless.

~BV


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## japonica (May 26, 2005)

I'm loving this thread and all the info. I wish I had known about the cord clamping when I was sensitized (anti-D) at the birth of my first DD. And that was despite 3 prenatal shots of winrho during the pg.

liseux...nice to meet another iso mom at MDC. Sorry about the sensitization, but congrats on your great pregnancies and healthy babies. I had my second DD (1st iso pg) back in 2004 and we're TTCing for a 3rd this year. My titers are at 1:32, so we'll see how things progress. I know checking for titers is pretty useless in a second iso pg and we'll be relying on the MCA dopplers, but it kinda gives me an idea of where I'm starting at titer-wise.


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## wannabe (Jul 4, 2005)

If your husband's mother is -ve, he's certainly +-, which gives a 50% chance of your baby being -ve too.

The prenatal rhogam takes you from something like 1.2% chance of sensitisation to 0.6 or so. And given you've got a 50% chance of a -ve baby, your original risk is ).6, dropping to 0.3%.

I'd also take into account how many kids you want to have. If you want a dozen, I'd get the rhogam, but if you only want 2 or 3, then there's less risk of sensitisation messing up your plans.

I think a fair few people probably refuse prenatal rhogam, it's a blood product after all.

Quote:

Your[sic] are a universal donor so even if your husband were AB+, your blood wouldn't harm the baby.
This pregnancy, it's the next pregnancy where the damage could happen from anti-D antibodies crossing the placenta.


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## mwherbs (Oct 24, 2004)

I wanted to pass along this risk assessment page on Rh factor quite a bit of medical info

http://www.obfocus.com/high-risk/Rh_..._diseasepr.htm


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## wannabe (Jul 4, 2005)

Thanks, mwherbs, that page is fascinating. I had no idea it was not a simple autosomal dominant/recessive trait.


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