#211 | Declining RhoGAM: A Conversation with Two Rh-Negative Women

May 3, 2023

RhoGAM or Anti-D is a blood product offered to pregnant women with an Rh-negative blood type who have conceived with an Rh-positive father. The use of RhoGAM is said to significantly reduce the chances of the mother becoming sensitized to a future baby if the current baby she is carrying has an Rh-positive blood type. The RhoGAM injection is routinely offered to all Rh-negative  women, despite that it is not always needed, comes with certain side effects, and isn't 100% effective. 

In this episode, we hear from two women: Kelsey and Emily, both of whom are Rh-negative mothers. Kelsey and Emily each had RhoGAM in the past: Kelsey had it with her first baby, and Emily had it when she miscarried. Both of them had some degree of side-effects from the shot. In Kelsey's second pregnancy and birth, she declined RhoGAM entirely, and Emily (currently pregnant) is open to getting RhoGAM after her baby's birth. In this roundtable-style episode, we learn about the thought processes leading to their respective decisions. 

If you are struggling to determine if RhoGAM is the right choice for you, this episode will give you the statistics and factors to consider if and when RhoGAM or Anti-D is necessary and the right choice for you and your baby.


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View Episode Transcript

So I messaged the nurse back and I said, we're gonna get my my husband's blood type tested, we don't know, and to determine if I need the shot or not. And the nurse replied to me and said, we still recommend, even if your husband is negative that you get rogram, because we don't know that he's the father.

And it's really important for mothers to know that there are this is not like a black and white. Just because you're negative doesn't mean you have to have the shot there. There are a couple of different places along the way where you can check in and determine if this is even a relevant conversation for you.

My when we went in the morning to get my DNC, I brought it up to the nurse, I said, Hey, I have this rash. I think it's from program I'd like to talk to the doctor about it. And she, the OB at the time said, we have no evidence that this is from a program. We've never seen that I don't think it's related and she downplayed a reaction to the shot that was listed on the insert.

Why ever given in pregnancy and face those risks if it can be given postpartum? What am I missing here?

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Podcast. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

Kelsey and Emily, thank you both for being here with me and Trisha today to talk about your respective choices around the RhoGAM shot. This episode was precipitated by an email that Trisha and I received from Kelsey after Episode 188, which we released in fall of 2022, in which we featured a mom who did have roe Gam, and in her case, the shot did not prevent sensitization. And her baby did become sensitized. So Kelsey shared some really, we felt very valuable research with us and part of her own thought process. And with her decision. So anyway, we just start with each of you introducing yourselves. And then we're going to hear each of your thought processes and why one of you opted against the shot and one of us opting for it. So Kelsey, would you start by introducing yourself?

Sure. Thank you for having me. I'm Kelsey, I am a mama of two little ones. I have a three and a half year old daughter. And my son is about to be six months. So I'm six months postpartum, I received rogram, during my first pregnancy, during pregnancy and after birth. And then with my most recent pregnancy, I did not receive rogram at all during pregnancy or after birth.

Hi, my name is Emily. Thanks for having me. And this is my technically third pregnancy, I've had two miscarriages, and I did receive RhoGAM with my first miscarriage, not with my second and then I am currently pregnant 34 weeks, and I declined. I declined the RhoGAM shot in pregnancy at 28 weeks when it was offered. And at this time, after baby's born, we plan to test baby's blood type, see if they're positive or negative. And if they are a positive blood type, I'm going to opt to get to get the RhoGAM shot.

Okay, great. Thank you, Kelsey, why don't you just kick it off by telling us about your first pregnancy and your choices around getting the shot and then your second experience and how you came to your decision?

Sure. And yeah, I think it's important for me to speak about my first pregnancy because that ultimately led me to my decision and my second pregnancy. So my first pregnancy, around 12 weeks, I had some spotting. And my midwife at that point, suggested roe Gam, I was a little bit familiar with Roe Gam because my sister was also pregnant and had to also make this decision just a few months prior. So my husband and I did some research and not too extensive. But you know, we did question it, read the insert. And after that spotting incident, I did decide to receive the shots. And before I go on, just to explain to listeners what RhoGAM is. So my blood type is O negative or RH negative and my husband is O positive. What this means is my baby could possibly be RH positive. If that were the case, if I were to, if I were carrying an Rh Positive fetus and our bloods were to mix, my body would then Then create antibodies. And then you know, kind of we can say, attack the baby in the next pregnancy. And I don't know, Trisha, if you can explain a little bit better, maybe Western medical terms, no. Or you said you said it exactly right. Basically, when a mother and baby have a different positive versus negative blood type, if they are not the same depending on what the Father is, then what happens in pregnancy is that there is a potential not a guarantee by any means. It's a small number, and we'll talk about that more potential risk for the mother's body becoming sensitized to the baby's blood and reacting in a way that can cause a lot of damage to a future child to a future pregnancy. Yeah. Thank you for that.

Can I make an important distinction? Yes. So it only the different blood type only matters if the mother is negative, and the baby is positive? 100%? Yes. If if the mother is positive, carrying a baby with a negative blood type, that doesn't matter those right that yes, that doesn't create that same reaction. So that that is the important distinction.

This is only relevant to mothers who are A, B O or AB negative, if that's your blood type, if it's negative, yes. And if the partner is positive, if the baby's Yeah, if the baby is positive, okay, so you can proceed now.

So at that point, you know, doing some research, read the answer, I decided to get it for about like a month after I just remember being so sick, sinus infection, I got like a double ear infection. Now, I am not saying at all that, like I know, Rogen because this there was just like this intuitive feeling that Hmm, that's strange. So I just kind of like made mental note of that, then 28 weeks came around, and that is when you know, the routine administration of Roe Gam is recommended, at 28 weeks. At that point, I decided, no, I got it once during this pregnancy, I'm not going to get it going to get it again. And then fast forward to birth I had an uncomplicated birth at home, you know, no interventions, delayed cord clamping, water, birth, and baby was healthy. And I decided to get RhoGAM after pregnancy. So you have to get it within 72 hours of giving birth. And I got it at that point. This is also the factor of the next baby and my husband and I knew that we were going to have most likely a second child. Now fast forward a few years I get pregnant with my son. And I again, had spotting. My second pregnancy actually started with like a week of spotting whether it was implantation bleed? I'm not sure I know. There was a sub chorionic hemorrhage. Is that correct? Trisha? Yeah. Yeah, so there was a small hemorrhage that we found an ultrasound. At that point, no row Gam that was just like the very beginning of my pregnancy, like I was five weeks when I had just taken the test at 16 weeks. And my second pregnancy, I had the spotting again. Now when I'm saying spotting, pretty, very light, but enough for me to you know, tell my midwife at 16 weeks when I told her I was spotting, she said, Okay, we need to have the conversation of rogram. So I knew it was coming. And this time, I had definitely done a little bit more research. In particular, I was pretty concerned with injecting ro Gam, because it is a blood product. It is made of cooled plasma, so not just one person's blood. It is right pooled blood. And I researched and researched and dug to see if I can, if I could find out if the blood or the plasma in row Gam is from donors who have received the COVID shop. And I did not find an answer. But for myself, I was like, I'm sure that they're not turning people away who have the COVID shop. But I've never found there. They're not differentiating when they're pulling blood, they're not separating, you know, yeah. COVID people from non COVID Yeah. But can you explain for a second why your midwife recommended this at 16 weeks given that you had had RhoGAM after your first birth, which is meant to then prevent census sensitization in your subsequent pregnancy. So why, why the need at 16 weeks?

Because of the spotting, right they call it like a A potentially sensitizing event. Correct.

But but does she give you any information on what the incidence of that is given that you already had Rogen?

No. And to be honest, it was kind of a learning journey for her as well.

She was recommending it, basically, because this is the routine recommendation.

Yes. Okay. Yeah, definitely. I think I was one of the first under her care who had questioned it or declined it. So she kind of dove into the research with me. And it led us to a lot of Sarah Williams work to her book anti de explained.

Can you share some of that research? Kelsey?

Sure. Yeah. So, you know, that is one of the resources I use. It's called anti de explained Sara Wickham. She's a midwife out of Australia.

I would say that Sara Wickham is the leading expert in the world on regram. She's done the most research on this topic. So you went to the right place.

So yeah, I mean, to just like big stats that I took from her book were that 85 to 93% of Rh negative women who give birth to a positive baby did not become sensitized. Which means what does that sensitize you, you don't want to become sensitized, because it means your body has created these antibodies, that will then recognize that there's a fetus in your womb with positive blood, then it will recognize it as like an invader.

So sensitized is a bad thing, because if she gets pregnant again, the fact that she is sensitized, will now potentially have that attack response on the next baby like the baby. So there's this incompatibility, and it'll make the moms sponsz to the baby potentially create result in loss.

So when a woman who is Rh negative declines, rogram, she has a seven to 15% chance of developing antibodies, and then in her subsequent pregnancy, she would have a seven to 15% chance of being sensitized to that baby, which would then result in another percentage, I think it's 17%. But I'm not positive, you might know. percent chance that that baby would have a significant life threatening complication from the sensitization.

Yeah, what percent? Do not get sensitized? 85 to 93%.

Okay, so seven to 15% do get sensitized? And then this is the part I'm not clear on of those seven to 15%, who do get sensitized. Did you just say the percent that actually do have that response, that attack response with the next baby? Or do all of them have that response? If they are sensitized? That was the next thing you just explained? Right? So what percent of those women did you say? Well, it's now we're talking about the baby 17% of the babies will have a life threatening reaction to the sensitization. Okay, so we if we take 7% Cynthia likes to crunch the numbers if we take 7% times, what was it 17%? Right, then there's a point 01 2% chance so 1.2% chance that that would occur. And it would be double that if that were on the higher end of the range. So like a one to 2% chance of of that happening. And if that occurs, does that did you say that's the risk of loss?

That's the risk of like, significant impact on baby like, like hydrops, fatalis or loss or that there's a spectrum.

Okay. It's a small number, but it's not totally insignificant. Right. I think the shot means there is that one to 2% chance that in the next pregnancy, this can happen. That's Yes. This is not insignificant. No, it is tiny number but still, it's like definitely worth paying attention to it's still a heavy decision. Okay, so Kelsey, where do you go with the decision after that?

I just wanted to say one more thing about from Sarah Williams book. So of babies who now have, you know, where something happened because of the sensitivity sensitization, right. It's not inevitable that the sensitization leads to severe Rhesus disease. So some babies can have a mild form of it. And even the most severely affected babies have a pretty high chance of survival. Now, I'm not saying we wish that upon our babies at all, but I think it was Courtney in that last episode is a perfect example. Her baby had a pretty severe crest.

Yes. needed three intra uterine blood transfusions in pregnancy.

Yeah, I thought I thought it was wasn't it six or not? It wasn't. I thought it was six

two. It was great. And she did get the shot and the shot didn't work.

You did get wrong. Yeah, yeah, that's right. So I'm just pointing that out. Because, yes, of course, we don't want that. But with modern medicine, there are ways to navigate it, even if the baby does have more a more severe reaction. So I did not receive it during pregnancy, I did not receive it at the 28 weeks where you're supposed to get it routinely. And then I had my second home birth, no complications, no interventions. And I decided to decline rogram after my second birth after the birth of my son, I guess there is something to be said to in my research, that when having a birth, with no interventions, I think it definitely helps the outcome to not be come sensitized. There are certain things that may happen with certain interventions, cutting the cord pretty early, maybe some other examples that Trisha you could speak about, that could lead to a higher chance of being sensitized,

leaving the placenta to birth, physiologically not pulling, forcing a placenta. Exactly, livery. Yeah, that's a big one.

Yeah. So. So yeah, that was my decision with my second. And I am very happy with it. I'm six months postpartum. And just last week, I found out that I am not sensitized, fabulous.

So grateful.

So you, your three things basically led you to your decision. One, you didn't feel great after the RhoGAM shot and your first pregnancy. So just intuitively, you were inclined to avoid it. If you felt you could, too, you didn't feel total trust in the product, because you didn't know where the blood was coming from. And maybe the medical community finds it insignificant as to whether people had the COVID shop, but to those who didn't want the shot. That's definitely an aversion. And then the third is that you didn't feel it was necessarily a black or white situation, even in the worst case scenario, but you still felt optimistic you could stack the odds in your favor, despite declining was there any other reason? Or did I? Did I get them all?

You nailed it. Thank you, Cynthia. Okay.

Emily, tell us about your thought process.

Okay, so as I mentioned, the beginning, I had two miscarriages before this current pregnancy, and I did receive program with my first pregnancy. At five weeks in that pregnancy. We met with a nurse, I was actually I had care with an OB at the time. So we went to meet with her nurse, that was their process. And we did those initial labs. And that was when I found out that I was oh, negative, I did not know my blood type before that. And so in that nurse visit, the nurse had mentioned given me this pamphlet about rural Gam, she didn't go over it but just mentioned, when we get your results back, this might be something you need to read about. And so after my labs came back, I got a message from her saying, Hey, your negative blood type, you're going to need the shot in pregnancy, make sure you read that pamphlet that we gave you. So that kind of led me down the road of looking into it. And immediately, as I started reading about it, I learned that if I have a negative blood type, if if my husband had a negative blood type as well, there are 100% chance that our baby would also be negative. And if you're negative mom carrying a negative baby, you do not need rogram. There's no you cannot get sensitized.

Can I interrupt you, Emily? Sorry. But was that specified in the pamphlet that they gave you?

It was not specified in the pamphlet? It was I found that by looking online. And there's

the reason I asked is because we've heard from a number of mothers who are RH negative, and the husband or father is also negative, and they're still offered, routinely offered RhoGAM. I'll share an interesting story about that. So I messaged the nurse back and I said, we're going to get my my husband's blood type tested. We don't know, and to determine if I need this shot or not. And the nurse replied to me and said, we still recommend even if your husband is negative that you get RhoGAM because we don't know that he's the father. That's an unbelievably outrageous. And disrespectful. Yeah. I mean, not just the presumption, but you're telling them who the father is. And to say, You know what to say to your face, we don't know if you're telling the truth. And I can't work with you. There has to be mutual trust. Yeah. Unbelievable. Yeah.

And, I mean, I'm not a person that's, I am not a person that is easily offended. So I didn't think I wasn't upset about this comment, but I recognized how ridiculous it was at the time. And just ignored it. And so we ended up getting my husband tested, he was HIV positive. So we knew from there that we would have to make a decision about Rogaine at some point in pregnancy. So I started doing a little bit of research, but not much because I was thinking, Oh, I don't have to make this decision. Until 28 weeks, I have time. And then we ended up. It was a break between eight to nine weeks we were having we'd went in for a dating ultrasound to determine our due date, and found out that we had a missed miscarriage and there was no longer a heartbeat. And in that appointment, I asked the maternal fetal medicine specialist, do you recommend rogram at this time? And I looking back, I kind of regret asking the question, because obviously his answer was yes, you should get it. But he was very forceful. It was like, yes, you should get it and we will give it we will give it to you right now I will have the nurse go get it right now. And I that offended me. Because like Kelsey had mentioned, you have about 72 hours after you would start bleeding or after I would start passing the baby to make that decision. And I wasn't I had no bleeding, I had no spotting, I had no signs that the pregnancy had even ended. And so I obviously had time to make the decision. And I'm sitting there trying to process a miscarriage. And he's like shoving this, this shot down my throat. So it put a really, that really put a bad taste in my mouth about the shot, even though that his recommendation shouldn't do that. But that's just the way that it played out for me. We ended up waiting a little bit over two weeks to see if I would pass that baby. Because if I passed it naturally at home, I felt comfortable not getting the RhoGAM shot. If I passed it with no interventions at that early in pregnancy, I was going to decline the shot. And there was just no signs of that happening. And so we did, I did end up getting a DNC. And so because of the surgical intervention that we had in that pregnancy, I did opt to get the shot. And that was a really tough decision because I left that appointment that day. And I went home and I spent my entire afternoon on PubMed, researching roe Gam, and if it was needed in the first trimester, and basically everything that you will find on PubMed, all the studies say you don't need it with a first trimester loss or first trimester bleeding anything before 12 weeks. But ultimately, we like because of the DNC, I decided to get it. In that few weeks, I ended up switching from an OB to a midwife.

Go ahead, and sorry, I just want to ask a question about that. Did you and your research discover why you don't need it. With babies under 12 weeks, I assume that it has something to do with the fetal development and the ID that lessens the risk of sensitization because there is yeah, it basically said, when the fetus is that small, there's just not a lot of blood. And so the amount of blood that would potentially mix is so small that it wouldn't be enough to create sensitization. That was the reasoning. But my midwife said, Whenever she has a fetus with a confirmed heartbeat, which we did, then she says that means there's blood pumping in the fetus, and that her is enough blood that could mix and she would recommend rogram. So she's going to give me the opposite answer to what I was finding in the studies. So that complicated my decision a little bit, but like I said, because we did the surgical option, we opted to I opted to get the shot at that point. And like Kelsey, I also had a bit of a reaction. So I got the shot, like on a Monday. And by Tuesday morning, I started develop this rash on my torso, it was very, very small. And it's not significant. It wasn't, you know, big or red or anything. But to me, I was like, I got this shot less than 24 hours ago, I'm developing this rash. If you read the insert or google anything about rogram, itching and rash are the top two side effects that you will see listed for the shot. And for me, it was just the ratchet rash. I wasn't itching at that point. But a couple more days went by my when we went in the morning to get my DNC, I brought it up to the nurse I said, Hey, I have this rash. I think it's from program I'd like to talk to the doctor about it. And she said, Okay, the doctor will look at it when you're in the operating room, which gives me I can't talk in the operating room, I'm under anesthesia. So I made sure my husband knew to ask her about it when she came out post op. And he did. And she the OB at the time said, we have no evidence that this is from a program, we've never seen that I don't think it's related. And she downplayed a reaction to the shot that was listed on the insert. So that put another bad taste in my mouth about it. And then within a few days of the DNC, I also started to get the itching. And so it's harder to say if that was the program or if that was maybe just my body detoxing some of the anesthesia or combination of all of it. But I had like full body itching for a good two to three weeks. I connected it to program. The OB didn't think it was related. My midwife didn't think it was related. No one wanted to acknowledge that it was related. So that was a little bit of a disappointing thing when I knew that they were possible. Those were side effects of it. So So anyway, so that's a little bit of a backstory and program where I started out with this really negative experience around the shot and the medical system, you know, being forceful and not acknowledging that I had some side effects to it. And then we went on to get pregnant again. like three months later, and I miscarried at around five to six weeks, like I had just found out, I was pregnant, and a week or two later, miscarried, and I just miscarried at home. And I knew that I was early enough, and it happened at home. So I didn't even consider rogram, my midwife didn't even suggest it. So that was it was nice to not have to make that decision, then. And then we got pregnant right after that. And it didn't, I never had any spotting. So didn't come up in pregnancy. But I knew that I was going to have to make the decision, obviously, at 28 weeks. So I had several months of just thinking about it, I'd read Sarah Williams book, I'd continue to do research. I was in a Facebook group, I was reading information, but I wasn't really thinking about it too much, because I just felt like I had done so much research before I needed to take some time away from it. And I ended up getting to 28 weeks. And based on the information in Sarah's book, I felt comfortable declining it at 28 weeks, because she talked about how the studies they did to determine that that women should get the shot in pregnancy at 28 weeks. They were I think she calls them retrospective where they basically pulled the medical records from women that had been pregnant. And they looked at the number of women that had silence as sensitization they call it where they seem to have gotten sensitized in pregnancy, and they don't really know why. But she pointed out that the reason she thinks this happened is because the studies just weren't, weren't very well designed. And it was moreso a failure of the RH program at the time where women were offered the shot at the right time. They didn't know about the shot, they maybe had a potentially sensitizing event like a car accident or a fall. And they didn't understand that they should be asking for RhoGAM in that situation. And so it led to those women getting sensitized because something happened. And so that's the problem with the retrospective studies because it's not controlled. And they end up with all these questions when they're looking at the data.

Right? Yeah, the the data is quite poor quality, but also not to mention that there is there's very little research on how rogram impacts the baby, the baby, right and that. The other thing she says is a row game is one of the only medical interventions that you give that we don't really know how it impacts it. There's no benefit to me getting it in pregnancy. And then there's this unknown risk or benefit to the baby in utero. So

based on that, you just said there's no benefit to you getting it in pregnancy to that baby. Yeah, that's how she explains it. It's, she explains it as to me, right.

There's no, there's the benefit to you getting in pregnancy is potentially still for a future user. Yeah, I can see, right, but no immediate benefit.

Right. There's no immediate benefit to me. And I am getting it to prevent something for another person that doesn't yet exist, right. So like, we plan to have more children. But that might not happen for us. We don't know. So I'm like doing this, this intervention for a baby that is not yet, you know, in my womb, so with an unknown risk, the baby that is currently in your womb.

Right, right. So sorry, I just want to jump in real quick. And in Sarah Williams book, she says that rogram does cross through into the placenta.

So it does reach the baby.

It reaches the baby.

Yes. Does that mean it has unknown risks? Or do we know what those potential risks are? We don't know.

They don't really unknown. Yeah, they've tried to study it. She talked about that a little bit in her book, I'd have to go back and read it specifically. But nothing was very conclusive about it. It's just a very unknown thing.

Okay, so you had all this on your mind that you don't know if you're gonna write Okay.

Go ahead, Trisha. Well, did anybody also we're talking about all this potential risk to the baby. But again, this is this is only an issue if you're carrying a positive, baby. So did anybody talk to you about the possibility of checking your baby's blood type before making this decision?

Okay, yeah, that was the part I missed. So I had read about the Unity test in a Facebook group, which is basically the NI, PT, non invasive prenatal testing that you would do, typically around 12 weeks, I think, if you opt for it, and it is that testing and it's something you can add on to that testing that would test the baby's Rh factor their blood type. And I asked my midwife about it, I thought that this testing was like across the board, like everyone would have access to it. So I did ask about that at 12 weeks in my pregnancy when we were doing some initial labs. And she said, No, the NI PT testing that we do does not have blood type. And so we opted out of Ni PT at that time, we chose not to get it because it didn't have the blood type. And that was all I cared about. So I just thought it wasn't an option for me. I kind of forgot about it and didn't look into it anymore. And then as I got closer to 28 weeks, that kind of started to come back into my Mind and so I looked it up again. And it is an option. It's just not available everywhere, but it is available in the United States. And so I reached out to the company for unity tests, I just sent in their contact form and said, I don't need that IP testing, I just want the Rh factor testing. Can you tell me how much it costs like I will pay for it out of pocket, I don't care about insurance. And they said, they don't offer it as a standalone test, it has to be with their ni PT testing. And you also have to order it through a provider. And so they asked for my providers information the clinic I was at, or the birth center that I was at, so that they could potentially have my midwife be able to offer that test to patients.

Yeah, that's a really important point. Because if a mother is negative, she needs to know that she has this option to get this test by at 12 weeks, because then you can completely eliminate this decision making process.

And it's not talked about I mean, my my I got this test, and my midwife and I had to really dig to find it, and to get it. Because it's

much easier to just give rochem. Yeah, to everyone that says so much right there. They're going so far as to question who you say the father is not just going that step to say, Oh, by the way, we can just test this and see if you even are at risk. It's yeah, doesn't make sense.

Anyway, I ended up obviously, the early testing wasn't something I was interested in, then because I didn't want to get the whole NFP testing at 28 weeks, like we were past that point. So I accepted that I was just going to have to wait until after we have this baby to get their blood type tested. So I declined a shot at 28 weeks, my midwife was totally fine with that she did give me the caveat that, you know, if I had a car accident or a fall or some sort of trauma, then she would recommend we talk about that and consider Rogaine at that time. And I was okay with that decision. And so now, I'm 34 weeks, No, nothing's happened. And so our plan at this point is to have the baby, test the baby's blood type after birth, if the baby is positive, I've decided to get rogram. And if they're negative, I don't need to get it. But ultimately, I had a lot of the same concerns that Kelsey had about the blood being pooled people with the COVID shot, I obviously had a reaction to the shot before. And those things all made it really difficult to decide on this. But for us, it came down to, I felt comfortable declining the shot at 28 weeks. So that meant one less dose that I had to receive. And that felt like a positive thing for me. This is our first child. And we know that we want to have more. And as we've talked about, and you talked about in that first episode, you guys did unreal game. If you do get sensitized and that baby, you know it, it leads to high it can lead to a high risk next pregnancy. And that's just something that I think I would like to avoid. Because having a pregnancy after two miscarriages was a pretty stressful thing for me. And so I can't imagine the stress of having a high risk pregnancy and having to have blood transfusions in utero. And just having to deal with all of that, I just think that would be a lot. So that was a really big part of it was the risk of sensitization and the rest of the baby with that is very serious. And so I think that ultimately was what kind of made our decision for us. And then, the last thing that really helped was that in talking with my midwife, and I also reached out to a functional medicine OB that I had worked with in the past about my concerns of getting blood from someone with the COVID vaccine. And we don't have any proof that this is true, but it makes logical sense. And they both gave me a similar answer in saying, when you receive a vaccine, the COVID shot or another vaccine, your body's going to make antibodies against that virus or that illness. And eventually, the vaccine ingredients should break down in your body or you should detox them or get them out of your body, but those antibodies are going to stay. And so she basically said, it's likely that if you did receive blood from someone that had the COVID vaccine, you would receive antibodies against COVID. But you might not actually receive the ingredients from the COVID vaccine. And I thought that that made logical sense. Like I said, we don't know if that's true, but it did make me feel better.

I normally would with most vaccines, but the COVID vaccine actually isn't a vaccine and the CDC changed the definition of vaccine to meat what that product is. So it might be true, but I think there's just too many questions around the COVID injection as to how it really worked and the impact in the body.

What you're what you're saying to those by the time the person donates their plasma. If they got the COVID vaccine six months ago, a year ago, those vaccine ingredients have already been detoxed from the body. So your concern was that those adverse ingredients that we don't want injected into our body would be coming through the program. shot. And we're saying no, because the person whose plasma you're getting has already detox that from their system. That's that's the assumption.

Kelsey, what about what are your thoughts on that?

I mean, similar to what you said, it's not a vaccine. So it works differently than a vaccine. Because it's the mRNA.

You guys are talking about two different things. Kelsey, is you're talking about the potential of getting the spike protein from somebody else's plasma. Whereas, Emily, you're talking more about the risk of aluminum, mercury, whatever other preservatives are in the vaccine that would potentially have already been eliminated, but the spike protein would not be.

And I mean, I was concerned about the spike protein too. But it's, it's, it was just a question that we will we will never have any answer to nobody's going to do that research. The

ingredients are definitely the first thing that come to mind. Okay, so um, yeah, I have a question. Why would anyone? Why is this being recommended in pregnancy, when it can be taken within the first couple of days postpartum, irrespective of the fact that we can test babies postpartum? Why ever given in pregnancy and face those risks? If it can be given postpartum? What am I missing here?

Because sensitization can occur in pregnancy, not just at the time of birth, the chances of it are much smaller. But so the highest risk of sensitization is at the time of birth, that's when it most often happens.

So are you saying, if a woman if a woman gets sensitized in pregnancy, then getting the shot after the birth doesn't help her? She's already been sensitized?

Yeah, but they'll still give it to you anyway. Yeah.

That's interesting. But that, but I have that. Right. Right. I mean, the idea is that once she sensitized you can't get rid of it by getting the shot postpartum. But of course, that's a rare risk, you'd have to have a really heavy bump or something to jolt, right. That's what it sounds like they were saying, or you could have the bleeding at 16 weeks anything after 12 weeks, if you have any type of bleeding in pregnancy, it doesn't have to be from a traumatic event or injury, then you have the risk of sensitization, but the risk of sensitization is, do you guys remember the silence sensitization risk is really quite a bit smaller than the risk at birth.

What does the silent one mean? It that means that you get sensitized in pregnancy, and you know, you don't know it without like a major, major event, like a car accident or something. I don't remember the number. But, you know, I think for anyone listening, I mean, obviously, both Emily and I really relied on Sarah combs book, and she talks about the whole history of Roe Gam and how it did become this routine recommendation at 28 weeks.

So whatever women decide you both recommend that book as your starting point, for sure. Right. 100%

I think she's about the only one talking about it. I think everywhere else, it's pretty much just like, oh, the thought process. And you heard this in our first episode that we did on this is just that program is so effective that why would we even consider not doing it? It's just so effective. And there we had somebody on the show who completely wasn't effective for but that is how medical providers see it. Yeah. 100%. So nobody's doing, nobody's doing the research, because it's like, it's just so good. We don't need to do the research on it. Who cares?

Even though the research is from the 60s and 70s, and it has not been updated at all. And the studies are such poor quality?

Well, that's really interesting.

The one thing that Sara Wickham said in her book that made me feel a little bit better about the shot was that she does recognize that it was when it was developed, it was very much like a life saving medical advancement at the time, and she was like, I'm not downplaying it. It is important. It does help women. She's like, but there are all these unanswered questions that we don't that, you know, they did that research in the 70s. And they said, okay, cool, this works. And then after that, they basically said, Well, now it's how they say study, it's like unethical to keep studying it, and declining, letting telling women they can't have rogram to be like in a control group. That's their reasoning for not studying it anymore. And she acknowledges that that is really a disadvantage to women like us that want more answers to those questions. And I still don't think that research is going to happen, but I think it's important to understand the history of the research that has been done. Yeah,

because we need to remember that there is about a one What did we say it was one in 1000 chance? No,

it was like 1.2%. It was like one and 100. And for the 15% category, it was more like two and a half percent. No, it's it was one in 100. Yeah,

it was 1.2%. If it was a 7% sensitization, and it was 2.5 If it was a 15%. So the range is about one to two and a half percent, that sensitization can occur and result in an adverse outcome in the next pregnancy. Yeah, that's a high number. Yeah,

it's like we said it's not insignificant. It's a heavy decision. So there are risks on both sides. As with so many things, there's no right or wrong decision. But thank you both for sharing the hard work you've done in making your own decisions. And thank you for sharing why you came to each of your, your decisions, because that's what this is all about. It's these, we need individualized care. And we don't want anyone being told by rote what they're supposed to do with their bodies in making their decisions. And you both went through the effort of recognizing what the experience was like after you had the shot. And very thoughtfully and consciously deciding what to do the next time around, which we respect and appreciate so greatly.

And it's really important for mothers to know that there are this is not like a black and white, just because you're negative doesn't mean you have to have the shot there, there are a couple of different places along the way where you can check in and determine if this is even a relevant conversation for you.

And you know, I would just say really advocate for yourself because most most doctors oovs are not have not done the research on this. I forgot to even mention just real quick that I did get an ultrasound with some when I had that spotting event in my second pregnancy. And as soon as I went to the ER because it was a weekend and I got an ultrasound and the doctor said, okay, you've had some spotting, you know, how many weeks Are you okay, we're gonna give you real Gam, and he didn't even ask my husband's blood type. Right. So, you know, I had to really advocate for myself there.

I think something you guys also talked about in the podcast all the time is finding a provider that is supportive of what you want. And I found that to be true for me because I, I had an OB and a midwife, my first pregnancy. And then with this pregnancy, I've actually have a different midwife. I'm at a birth center now. And they were totally supportive of my decision to decline at 28 weeks, they were not forceful at all. And even when I brought up the conversation about after birth, and my last appointment, my midwife simply said, Well, are you going to get rogram it like, just her asking the question and putting the decision in my lap first, and offering some empathy about it, that was very meaningful to me, when I consider my first experience with it, with that maternal fetal medicine specialist, like basically trying to walk in the room with a needle and give it to me, the second I had a miscarriage, you know, it's like it was very forceful. And I felt like I had no say in that situation. And in this, you know, my current pregnancy, my midwives understand my concerns, and they sympathize with that. But they also, you know, they also know that there's risks and they do think that I should get it, but it's very much like a team decision for me right now. And that feels a lot more comfortable to me.

I was gonna say the same thing. My it felt like my midwife and I were a team, like tackling this decision, which felt really good.

You're a grown woman, you're capable of making your own decisions, the ideal provider is there to basically advise you consult with you, it is your own decision. And it's it's, it's so often we hear women feeling so grateful, when their providers give them the space to make their own healthcare decisions. But it's, it's the only way it should be.

That's where the virus should be. It you know, in both of your cases, though, in this situation, I think that both of you were giving your providers a lot of insight into this issue. So they were actually kind of like, you know, they were working with you because you were providing information to them.

Yeah, they do behave differently around empowered and informed women, whether, you know, they should treat everyone with the same respect, but they do start to change when they recognize you have some resolve around your own decisions.

So thank you both for coming on and sharing your stories. And having you know, two different perspectives on this is really helpful because this is, this is a decision that many mothers face, and most of them have no idea what the options aren't. I think we presented some really key points here about how to make this decision. And we hope that everyone out there listening can feel more confident now in their choice as to get RhoGAM or not.

Thanks so much for being here. Thank you. Thank you so much. Thank you

Thank you for joining us at the Down To Birth Show. You can reach us @downtobirthshow on Instagram or email us at Contact@DownToBirthShow.com. All of Cynthia’s classes and Trisha’s breastfeeding services are offered live online, serving women and couples everywhere. Please remember this information is made available to you for educational and informational purposes only. It is in no way a substitute for medical advice. For our full disclaimer visit downtobirthshow.com/disclaimer. Thanks for tuning in, and as always, hear everyone and listen to yourself.

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About Cynthia Overgard

Cynthia is a published writer, advocate, childbirth educator and postpartum support specialist in prenatal/postpartum healthcare and has served thousands of clients since 2007. 

About Trisha Ludwig

Trisha is a Yale-educated Certified Nurse Midwife and International Board Certified Lactation Counselor. She has worked in women's health for more than 15 years.

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