What is the Rhogam Vaccine

It is recommended for all pregnant women who are Rh- to get a Rhogam vaccine during the second trimester of pregnancy and after birth. The reason they recommend it is if your blood happens to mix with the newborn’s blood, which may be Rh+ blood type, your body will build antibodies against (+) blood and may be a problem for future pregnancies. There are several things to consider when deciding whether or not to do this vaccine. One must look at the father’s blood type to see if he too is Rh- because then it is not necessary. Also look at the number of pregnancies, the quality of the pre-natal care, the type of birth previously had whether in the hospital, home-birth, natural or medically assisted, c-section delivery or other medical interventions performed in previous pregnancies. Also, the use of Rhogam during pregnancy has not been studies long-term and has only been done since the 1980’s. One must consider the vaccine ingredients the unborn baby will be exposed to. Although most physicians say the vaccine is safe, I encourage carefully examining all options and also read the package insert that comes with the vaccine. Make an informed decision.

What is the Issue

There are four main blood types. Each of the four blood types is additionally classified according to the presence of another protein on the surface of RBCs that indicates the Rh factor. If you carry this protein, you are referred to as Rh+ (positive). You are called Rh- (negative) if you do not carry this protein. Majority of people are Rh+. If a man is Rh+ and a woman is Rh- and they make a baby, there is a 50/50 chance the baby will be Rh+. Problems may arise when the blood mixes during labor or delivery for the next pregnancy. Rh incompatibility usually isn’t a problem with mother’s first pregnancy because, unless there’s some sort of abnormality, the fetus’s blood does not normally enter the mother’s circulatory system during the course of the pregnancy. This can happened however if the pregnant mother is in an accident and experiences trauma to the abdomen area. With natural vaginal birth, blood does not normally mix. With a hospital birth, the following medical interventions can cause mixing of the blood, setting the stage for problems with the next pregnancy:

  • Episiotomy- the practice of cutting the mother while on labor to speed up delivery. It is a surgically planned incision on the perineum and the posterior vaginal wall during second stage of labor. This unnecessary surgery will open up mother’s skin and she will bleed. Most are done for convenience for the doctor or when baby is showing stress. Then when the umbilical cord is cut, blood can mix.
  • C-sections- A planned surgery where they make an incision through the abdomen and the uterus to get a child out. There is the possibility of blood mixing during this delivery.
  • Premature cord cutting- It is known that after birth it takes a few minutes for the placenta to pump all the blood into the newborn. In hospitals, they often cut the cord before it is done pulsing. This is another way the blood can mix.
  • Placenta Previa- when the placenta begins to separate from the mother prematurely. This results in medical intervention which will increase the chances of the baby’s blood mixing with mothers.
  • Blood transfusions with Rh+ blood or miscarriages

Testing for Sensitivity

You can get a test in the early stages of pregnancy to see if you are Rh-sensitized, showing if your body is responding to the baby with Rh+ blood. If mother and baby’s blood intermingles, the mother’s body recognizes the Rh protein as a foreign substance and can begin producing antibodies (protein molecules in the immune system that recognize, and later work to destroy, foreign substances) against the Rh proteins introduced into her blood. If you show that you are not sensitive, there is no reason for worry. If you are Rh sensitized, your body has made antibodies against the (+) blood because they are foreign to your own. Your immune system keeps the antibodies in case the foreign cells appear again, even in a future pregnancy. This may cause concern for the unborn baby. After the birth, you can have the baby’s blood type done and again, you can re-test for any sensitivity. If the baby is Rh-, there is no reason for concern. If there is sensitivity, you may consider the RhoGam vaccine for future pregnancies.

Problems Caused From Rh+ Sensitivity

If you are Rh-sensitized during a pregnancy, you may have regular testing to see how your baby is doing. Often though, it is during this testing that the blood has a better chance of mixing with the baby’s! Many doctors want to do an amniocentesis or a chorionic villus sample.

Amniocentesis is an invasive procedure where amniotic fluid is removed for testing. It can test for genetic defects and Rh sensitivity. This is a puncture of the amniotic sack which may cause leakage or other issues such as miscarriage, fetal damage or infection. Carefully weigh the risks and benefits before doing this medical procedure.

Chorionic Villus (CVS) is a test for identifying chromosome abnormalities and other inherited disorders. It is a medical procedure where a thin catheter is planted through your cervix into the placenta and guided by ultra-sound. They also may go through the abdomen with a long needle to draw a sample of tissue from the placenta. Both are invasive and often not going to determine the outcome of the pregnancy. Depending on the results, you may want a doctor who specializes in high-risk pregnancies (a perinatologist).

Risks of the CVS Testing

Miscarriage is the primary risk related to CVS occurring 1 out of every 100 procedures. This also can cause added stress for the mother and possible mixing of body fluids. In the past, Rh sensitization was often deadly for the baby because it was not understood. Even so, for centuries, humans’ have managed to survive. Because of modern birth practices, the chances of blood-mixing are increased.

Post-birth Problems

When the baby is born and blood tests show that there are Rh issues, the baby is usually suffering with anemia, loss of red blood cells. It can be mild anemia or in some cases severe. Severe cases may require a blood transfusion.. Severe anemia can cause heart problems, enlarged liver, spleen issues and respiratory problems. Because of improved testing and treatment, most babies with Rh issues survive and do well after birth. This can be life-threatening if not addressed.

Another problem is called Hemolysis which will lead to elevated bilirubin levels. This will look like jaundice (yellow skin, yellow whites of eyes) after 24 hours post-birth. A baby’s blood count must be monitored. This is common in all births but with these babies it can lead to severe jaundice. With severe jaundice, the newborn’s liver cannot keep up with the bilirubin build-up and does not break it down efficiently or eliminate it properly. As it gets reabsorbed into the body, it can lead to cerebral palsy or other forms of brain damage in some babies.

RhoGam Vaccine

Today, when a woman with the potential to develop Rh incompatibility is pregnant, it is recommended that she get a series of two Rh immune-globulin (vaccines) shots, one during her pregnancy around 28 weeks and one following birth. I have heard of women getting as many as three during pregnancy.

There are no long-term studies done to see how giving this vaccine during pregnancy can affect the unborn child or mother. According to Dr. Mark Geier, PhD in genetics, he said they decided to start giving pregnant women this vaccine with no safety studies. Previously when the shot was given post-birth, studies showed that 7% off all women who got the vaccine did not respond appropriately. The decision was made that all Rh- women were to get it with all pregnancies at 28 weeks gestation. He also discovered that all RhoGam vaccines contained 12.5 micrograms of Thimerosal, a form of ethylmercury until 2001 when they were ordered to reduce it. Some vaccines are still made with the mercury called Thimerosal but is filtered out in the end process leaving traces behind. There are plenty of studies showing the negative effects of mercury on the unborn child. (See article “What is a Trace?”)

Because this vaccine is made from donated blood product, the potential for contamination from blood-carried viruses and diseases is real. Each RhoGam shot contains the antibodies of several different donors pooled together which increases the liklihood of viruses slipping through undetected to the RhoGam recipient. It is virtually impossible to test and screen out all the various viruses that could be present in the donor blood!

The Vaccine Recommendations

The first shot is to be given around the 28th week of pregnancy and the second within 72 hours after giving birth. Rh immune-globulin acts like a vaccine, preventing the mother’s body from producing any potentially dangerous Rh antibodies that can cause serious complications for future pregnancies.

A dose of Rh immune-globulin may also be given if a woman has a miscarriage, an amniocentesis, or any bleeding during pregnancy. If a doctor determines that a woman has already developed Rh antibodies, then the pregnancy will be closely monitored to make sure that those levels are not too high. In rare cases, if the incompatibility is severe and the baby is in danger, a series of special blood transfusions (called exchange transfusions) can be performed either while the baby is still in the uterus or after delivery.

Exchange transfusions replace the baby’s blood with RBCs that are Rh-negative. This procedure stabilizes the baby’s level of red blood cells and minimizes further damage caused by circulating Rh antibodies already present in the baby’s blood stream. Sometimes, the mother’s body will reject the unborn child.

My personal Experience

I am Rh(-) and when I had my first child in 1980, I did not know much about this vaccine. I was planning a home-birth but ended up in the hospital. I was able to have a normal birth but without my knowledge or understanding what it was, I was given the RhoGam vaccine before leaving the hospital. It contained 12.5 mcg of Thimerosal. My next child, a son, was born 2 ½ years later. He was born very sensitive to dairy, noise, visual stimulus and had colic for several months and took a while to develop his immune system. Everything was more difficult for him the first 4 years of life. I believe now it was because he had some mercury sensitivity issues. I had researched aggressively, had a successful homebirth and my midwife did not recommend the RhoGam vaccine. She said there was no reason for it as we would take necessary precautions to not mix the blood. I ended up having 4 homebirths and never got another RhoGam vaccine.

I cannot tell parents what to do but I can tell you options. I encourage parents who want the shot to be sure to order a shot that is Thimerosal FREE. I am not absolutely sure that they are all Thimerosal free. If they reduced the Thimerosal, they most likely increased the aluminum. Aluminum is also a neurotoxin and not good to inject! Remember, you have up to 72 hours after the birth to take the shot. You must read the package insert to be sure you know it is mercury FREE. Ultimately, you need to do the research and make the decision.

Much depends on the birth process. If the baby is born natural vaginal delivery, there should be no blood mixing. Most midwives are really careful to make sure the placenta pumps all the blood into the baby before cutting the umbilical cord and then they are very careful to do it after the placenta is birthed if possible. They are really careful to avoid mixing blood in any way. Hospitals are not as concerned or careful. With all the medical procedures that may be involved, it is more likely to happen.

No doctor can make you do the Rhogam, it is your decision. You can get tested to see if you are making antibodies against positive blood to eliminate any fear. If you decide to not do the shot, they may not like your decision and may try to scare you into doing what they want. Be firm in your decision and present them with some facts as to why you may not do the shot or why you may wait until the baby is born and blood is tested.

Ultimately, the decision must be made between mother and father. If you are not planning any other children, then a RhoGam is not necessary. There is no law written that says that you must do a RhoGam vaccine while pregnant or even after. Talk with your doctor and know your rights or you are no different than a slave.

This is general educational information only and is not to be construed as medical advice. Please consult the physician of choice for further information.