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This is a topic I was asked to discuss when I did my reader survey recently.    And it’s an important one.  Some women will be told that they need to have a Rhogam shot during their pregnancies.  Women need to understand what it’s for, the risks and benefits, and other issues associated with this shot.

First of all, the Rhogam shot is for women who have RH negative blood.  That is, for example, you have “O negative” blood type.  Being RH negative simply means that you don’t have this factor in your blood, while those who are RH positive do.  Getting RH positive blood mixed in a person who is RH negative can cause serious repercussions in pregnancy.  Blood mixing can potentially occur during pregnancy if a woman is carrying an RH positive baby and some type of trauma occurs.  The Rhogam shot was created to protect against this mixing and the subsequent illness that would occur.

But is it necessary?  Is it safe?

First of all, there is one situation in which a provider may recommend a Rhogam shot to you, but in which you should always say no.  If you are Rh negative, and your partner is also Rh negative — you do not need a Rhogam shot!!  There is absolutely zero chance of your baby being positive if both parents are negative, because it’s a recessive trait.  Your doctor may still tell you to take the shot (just in case, you know, you’re lying about who the father is; or maybe they don’t understand how this works), but just say no.  There is absolutely no risk to you in this situation.

But what about in other situations, such as when the mother is Rh negative, and the father is Rh positive?

Doctors would have you believe that you must get a Rhogam shot in this case, because otherwise you are in danger.  This isn’t quite true.  Up until a few years ago, Rhogam wasn’t always given to women pregnant with their first babies (unless trauma occurred) because if blood mixing occurred, it typically happened at birth.  The woman then produced antibodies against Rh postive blood, but since the baby was already born, it was safe.  A Rhogam shot was then recommended in subsequent pregnancies, so that the woman’s body wouldn’t reject the baby if it had Rh positive blood.

In a normal pregnancy, though, mother’s and baby’s blood does not mix.  The only danger is if this happens, and under normal circumstances, it will not.  Pregnancy is designed so that blood just doesn’t mix.  However, if the mother sustains abdominal trauma or birth trauma then it can happen. 

Situations that may cause mom’s and baby’s blood to mix:

  • Previous abortions/late miscarriages (after 8 weeks)
  • Amniocentesis
  • Chorionic Villi Sampling (CVS)
  • Trauma to abdomen (car accidents, falls, etc.)
  • Forceps
  • Vacuum extraction
  • C-sections
  • Pulling on the cord/placenta after birth, or manual removal of placenta
  • Cutting the cord before delivery of the placenta (dangerous to the baby anyway)

The vast majority of these are caused by generally unnecessary birth interventions.  To avoid problems, you need to avoid unnecessary tests during pregnancy, and unnecessary interventions during birth.  You may find that a birth center or homebirth are better options for you.  This is especially interesting because issues with blood type incompatibility were extremely rare before the 1900s, when we didn’t intervene with birth very often.  Suddenly, when we “medicalized” the birth procedure, this became a problem.

In one study, only about 14% of women who were not given a Rhogam shot ended up “needing it” later (there are no details given on why they needed it).  86% did not require it at all.  It is possible to do a titer check to see a woman has become sensitized to assess if she needs Rhogam.

The truth and bottom line?  Most women do not need Rhogam.  First time mothers do not need it.  A dose at 28 weeks is unnecessary unless a test shows sensitization has already occurred.  And if birth is trauma-free and/or if baby is type Rh negative (even the manufacturers of Rhogam agree none is needed if baby is typed Rh negative!), none is needed.  If, however, trauma does occur, sensitization is known to have occurred, and/or baby is typed Rh positive, it would be wise to consider this.  Please ask your doctor to share all known side effects and risks (which, by the way, are greater if given during pregnancy than immediately after) before making a choice.

 

Sources:

Prenatal Rhogam Shot (Unhindered Living)

Midwifery Today

Natural Childbirth

Rhogam Website

 

What do you think about Rhogam?  Are you at risk?  Did you/would you receive it?


This is the writings of:

Kate is wife to Ben and mommy to Bekah (6.5), Daniel (5), Jacob (3), and Nathan (1.5). She is passionate about God, health, and food. She has written 7 cookbooks and a popular book entitled A Practical Guide to Children's Health. She also recently released Healing With God's Earthly Gifts: Natural and Herbal Remedies, which teaches people to use natural remedies to keep their families healthy. When she's not blogging, she's in the kitchen, sewing, or homeschooling her children.

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18 Comments

  1. I have really appreciated this series. We are hoping to begin our family soon, and it has been nice to read about all the different options associated with pregnancy and child birth, especially the more natural, less mainstream ideas.

    A few years ago I learned about the RH incompatibility thing and started reading up on it (we have this problem, so I was pretty freaked out by it). From everything I've read, the purpose of the Rhogam shot is to prevent your blood from becoming sensitized. It is ineffective if your blood is already sensitized.
    (http://www.medicinenet.com/script/main/art.asp?articlekey=51717)

    Even your link to the Rhogam website explains that it needs to be given before sensitization occurs. If you know it's your last pregnancy, that's when you wouldn't need to worry about it. But if you're planning to have more than one child, it should definitely be considered.

    I recently had an early miscarriage, and perhaps I didn't really need the shot, but the doctor recommended it, so I went for it. I want to make sure my body doesn't attack my next baby. After your post I will definitely do more research about the pros and cons of having it at 28 weeks. The doctor said they would test the baby's blood once it is born, and if it has RH positive blood, I would have the shot then for sure.

    Reply

  2. i'm liking this healthy pregnancy series! and interesting timing on this post, because i was just reading about how consuming the placenta after delivery may help prevent the mother from forming the antibodies to her baby's antigens, since the placenta contains an abundance of estrogen & progesterone which can "suppress the immunological processes involved in tissue rejection". this was mentioned in a study on placentophagia, but i'm not sure how much more it has been researched. i'm currently studying to become a placenta encapsulation specialist and i'm learning all kinds of interesting stuff!

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  3. So what ARE the risks of getting the shot? I was given it more than once during my pregnancy….

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  4. Very interesting! This is the situation I would be in if we have children. This is also the situation my mom was in! So it's neat to read this perspective because I just assumed I would have to have that shot…but now I see that there's more to it than that! Thanks!

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  5. I am O- and my husband is a positive blood type. Before both of my girls were born, I researched legitimate sites about the risks and dangers of taking the Rhogam shot vs not taking it and concluded that it was worth taking. There is only a very very very slight potential risk from taking the shot and a much greater potential danger to my baby and future babies if I didn't take it. There is a MUCH greater chance that I will be in an accident while pregnant or have unforeseen complications than that any harm will be done by the shot.

    I also want to caution women that if you choose not to get the shot and something does happen that causes the mother to build up antibodies to rh+ babies, the shot will not help after the mother has been sensitized. If the mother does not miscarry future babies, they will almost always require a blood transfusion after birth.

    Your comment that these sensitivities did not not happen before 'modern' medicine is also inaccurate. Traumatic births were common (hence the reason for high mother and infant mortality rates during that time) and many women suffered from rh incompatibility. They just did not have a name for it then.

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  6. As another rH- mother, I did decline the RhoGham shot. The point to note is that this was my first pregnancy, and I would have had no way to be previously sensitized. As the shot is made from blood products, I was not willing to risk my baby's health on the possibility that he *might* have been rH positive. Second point to note is that the shot is considered to be "effective" for 12 weeks, which is why it is typically given at 28 weeks. As I carried to 42 weeks, it would have been useless all the same, and made me complacent when my son was born via section. When my son was born, we had his blood tested. As he came back rH+, I accepted the RhoGham shot in the hours following his birth. Had I had the shot prior, I would not have thought to have it again, nor would the hospital have thought to give it to me. This would have further compromised any future rH+ children.

    The shot was absolutely not for me. However, I wouldn't hold an informed decision against anyone. That's the point, isn't it? To have all the information available to us, and then make the best decision we each can based on the facts and our comfort levels?

    Much appreciated article, thank you.

    Reply

  7. Thank you for this article. I am rH-, as is the father of my fetus, and met resistance from my nurse midwife when I suggested there would be no need for this shot. She went as far as stating that "sometimes the father changes." I will now be sticking to my guns on this one. Thanks again!!

    Reply

  8. I am rh-negative and my husband is rh-positive and though I am on my seventh pregnancy I have only had rho-gam twice! Once was with a miscarriage at 12 weeks and the other was with my only positive type baby so far and after she was born. We always decline the 28 week shot and I have never had any trauma or bleeding problems during pregnancy. It is true as someone else mentioned that the rho-gam shot will not do anything for you if your body has become sensitized already and if that happens your body will attack any positive type babies that you have in the future.

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  9. I would like to know if I’m 6 week pregnant and I’m O NAGATIVE blood type if I do an abortion should I have the rhogam shot?

    Please I need help!!

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  10. I have had 8 shots and I am very upset because I just found out there’s other peoples blood in these shots and that against my religion to have human or animal blood. Also no one ever checked my husbands blood and when we asked his doc at kaiser they said they were not allowed to tell us ! That’s illegal right? I am trying to not get the shot and my doc told me that kaiser will fine me if I try and have my baby at home! And that they have no controll over the delivery and can’t promise to let me have an all natural birth and to let the placenta come out by it self! I feel like the system is against me and trying to break me down! It’s making me want to leave kaiser

    Reply

    • Hi Porschr,

      They can’t fine you for having your baby at home, at least not in any area I’m aware. And they also can’t force you to do anything in the hospital against your will — you simply say “I don’t consent” and unless it’s an emergency they have to follow that. They may still bully you (unfortunately, since they’re already doing that), but they legally cannot MAKE you do anything. What area are you in? If you are outside the U.S. I am not sure of the laws.

      If you feel you have few options, I’d look for a midwife quietly and then, when it comes to have the baby, just don’t show up at the hospital. Have the midwife there. If they were to actually try to fine you (which I have NEVER heard of), just don’t pay it. If you can leave Kaiser for something else…do it.

      And yes, it’s illegal for them not to tell your husband what his blood type is. They may not be able to tell *you* because of HIPPA laws, but he certainly has the right to know! I’d be looking for a new doctor, with all this nonsense going on….

      Reply

  11. Kate – thank you so much for this article. I recently found out my blood type is RH- and my husband’s blood type is RH+. I am not a fan of vaccinations so I was a bit distributed to hear that I would potentially need to take Rhogam. I had a miscarriage in November which required a D&C at that time I did not know my blood type was RH- so I didn’t have any knowledge of the need to take or not Rhogam. Fortunately I had a blood test recently which showed no antibodies in my blood.

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  12. I have had it 8 times and I feel weaker every time I get it, I am not taking it this time an want a home birth but kaiser is giving me a very hard time an most the docs won’t waste their time on me an referr me to another.
    I find it outrageous that they won’t take the time to listen to me and have completely ignored everything about my pregnancy. I’m in my third trimester and all that’s come up is rhogam, I think they think I’m crazy because I get to go see a counselor next week.

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  13. I’m A- and my husband is O+, so I was “at risk.” I had twin baby girls 19 months ago and they were both A+ They tested my blood right after the birth and said I had antibodies and only had 72 hours to get the Rhogam shot. I had been reading up on childrens vaccinations and we had decided not to vaccinate for many reasons, so when the Rhogam shot came up I refused it. I was lectured by the nurse, the doctor and they acted as if they wouldn’t let us leave the hospital. When I got home I did more research on it and once I found out it had human blood in it I was SO glad I had refused it. Anyhow… I got pregnant again when the twins were 12 months old and the Rhogam shot came up again. We had moved and I had a new midwife. She has been awesome! She explained why we should get the shot and had us sign a waiver, but treated us as thinking adults instead of children:) We now state religious and moral reasons for refusing the shot. I had to get my blood tested early on with this pregnancy, at 26 weeks and I’ll have to get it tested again. The results… My blood does not have antibodies in it! From what I’ve read it’s impossible, but it’s true. The results from after the girls birth shows my blood as testing positive for antibodies and 15 months later it tested negative for antibodies. I didn’t eat my placenta or really do anything other than eat a healthy traditional nourishing diet(lots of raw milk), and we prayed a lot.

    That’s my two cents. I would encourage women to research and dig deep with regards to every aspect of your pregnancy. Many shots and tests have become a habit for the medical world and we need to constantly be questioning and finding out the truth for ourselves.

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  14. I have a blog where I discuss similiar things, and was looking to update my RhoGam info, and came across your site. While I am generally supportive of what you are doing here (it is good to question the relevance and risks of medical treatments!), some of the information you are giving is just blatantly inaccurate.

    First off, RhoGam is USELESS once someone is sensitized. So checking titers first is a good thing to do before getting the shot, but you have the action backward: If you are sensitized, you should NOT get the shot. If you are not sensitized, that is when to consider getting it.

    Also, as a licensed health care provider (midwife), I always check the baby’s cord blood for the blood type, and I have had numerous occasions where both parents are negative and the baby is positive. Sometimes it is cheating, sometimes it is that the father was wrong about his blood type, sometimes there was lab error and the lab was wrong about the father’s blood type, and sometimes I don’t know why, but it just is. So even if both parents are negative, the baby’s cord blood should still be tested for the baby’s blood type.

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  15. Hello, I am an RH sensitized mother of 2 children. When I was pregnant with my first child, I was advised by my midwife to not get the shot at 28 weeks, but wait until after her birth to get the shot. I did my own research and based on the fact that it is very rare to become sensitized during the first pregnancy unless there is trauma AND my fears that the shot might be related to autism and other disorders, I refused the 28 week rhogam shot. At 39 weeks my blood was check and found to be positive for antibodies. I never had any trauma or bleeding. I was induced the next day and my baby was born blue and had to be resuscitated. She spent 4 days in NICU under biliruben lights. She is now a healthy almost 4 year old with no signs of autism or any other disorders. 15 months after my first birth, I was induced with my second child at 37 weeks, after a very closely watched pregnancy full of ultrasounds and blood tests. After he was born, he had a blood transfusion at 24 hours old and spent 5 days in NICU under biliruben lights. He is now a healthy 2.5 year old with no signs of autism or other disorders. I just wanted to share my story so that other moms in my situation will know that there are risks when you don’t get the shot. I do have a fear of having anymore children because of the damage the antibodies do.

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  16. What if d woman is negative n d hubby is positive n deir was trauma during her two pregnancies n she dint have shot of rhogam,what will happen to the subsequent pregnancies,will she alwys end up miscarring them?

    Reply

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