Postpartum Rhogam

Postpartum Rhogam is a vaccine that is recommended by the medical model to be given within 72 hours of birth to all women who have Rh negative blood type.

What is Rh negative blood?

Each person's blood is one of four major types: A, B, AB, or O. Blood types are determined by the types of antigens on the blood cells. Antigens are proteins on the surface of blood cells that can cause a response from the immune system. The Rh factor is a type of protein on the surface of red blood cells. Most people who have the Rh factor are Rh-positive. Those who do not have the Rh factor are Rh-negative.

A woman with Rh-negative blood has nothing to worry about if her baby is also Rh-negative, and a woman with Rh-positive blood need not worry at all. Problems arise only with Rh-negative mothers and Rh-positive babies. Usually the first pregnancy goes fine. It's a subsequent Rh-positive baby who may be at risk. The mother herself is in no danger.

Normally, maternal and fetal blood supplies don't mix during pregnancy, but during childbirth, some fetal blood may enter the mother's system. If this happens, and the mother is Rh-negative and the baby is Rh-positive, the woman's immune system responds with antibodies to the Rh factor. The chances of responding, and the strength of the response, increase with each Rh-positive pregnancy. In a subsequent pregnancy these antibodies cross the placenta and enter fetal circulation. If the next fetus is also Rh-positive, the mother's antibodies can attack fetal red blood cells. They break them down and produce anemia (the blood has a low number of red blood cells). This condition is called hemolytic disease or hemolytic anemia. It can become severe enough to cause serious illness, brain damage, or even death in the fetus or newborn.

Is there treatment for Rh sensitization?

Although treatments are available to save affected babies - including transfusing Rh-negative blood, sometimes even prior to birth - prevention obviously makes more sense.

How is Rh sensitization prevented?

The current medical recommendation is an injection of anti-Rh antibodies (widely known by the trade name RhoGAM) given to the mother soon after birth which prevents her immune system from responding to any fetal blood cells in her circulation. Subsequent pregnancies should be like the first, as if the woman was never exposed to the Rh factor.

Postpartum Rhogam is considered less controversial than prenatal Rhogam as there is no exposure of potential preservatives to the fetus.  Studies have proven it to be very effective in the prevention of Rh antibodies.

The trade name for the injection of mercury-free Rh antibodies is Rhophylac. This is the product that is available from our local blood bank.

Warnings and precautions listed in the package insert for this product are:

  • Allergic or hypersensitivity reactions, including anaphylactic shock
  • Exposure to viruses and other infectious agents that cannot be fully screened from this human blood product
  • Adverse reactions to the shot can include nausea, dizziness, headache, injection site pain, and malaise

 

How will I know if I need to consider Rhophylac after my birth?

If you are Rh negative, you will order a blood typing card with your birth kit.  After you baby is born and the placenta is delivered, we will obtain a sample of your babies blood from the cord.  We will type it at the birth and if your baby is also Rh negative, you will not need to consider Rhophylac.

How do I receive the Rhophylac shot after my birth?

Rhophylac is a controlled substance in Virginia and therefore is not something that we can provide to our clients.  Most women who want to have the prenatal shot obtain it through their primary care physician.  We can perform the necessary lab work at the birth that your physician will need to prescribe the shot.

Are there other ways to prevent Rh sensitization at my birth?

During the pregnancy, the best way to avoid sensitization is to have established a healthy placental bed. The health of the uterine wall at the time of implantation and the continuing health of placental tissues during its formation in the first 12 weeks of pregnancy can help it withstand the pressures of increased blood volume later in the pregnancy as well as allow it to separate easily after the birth.  This is primarily controlled through good nutrition in the childbearing cycle.

Drinking Red Raspberry Leaf tea is beneficial throughout the second half of pregnancy. It helps tone the uterus for labor. This will help keep blood loss at a minimum during and after birth. Drinking citrus juices and selecting vitamin C rich foods is believed to help keep the placenta strong and healthy.

Eliminating fluoridated water is also recommended as fluoride has been shown to interfere with collagen production. Collagen is what holds the placenta firmly attached to the uterus.

At the birth, the third stage of labor is possibly the most vital part of labor to keep natural. Waiting for the cord to stop pulsing before it is cut allows most of the blood to flow into the baby's body and prevents potential back flow of fetal blood into the placental site.

Allowing the placenta to separate naturally and be born gently is also beneficial. Waiting for strong contractions will help the placenta to shear cleanly off the surface of the uterus and continued contractions will seal off the blood vessels.  When the placenta has fully separated, it will generally deliver spontaneously or very gentle cord traction may bring it out.

Information compiled from the following sources:
American Pregnancy Association
Rhophylac™ package insert/website/Patient Fact Sheet
Prenatal Rhogam:  Examining Reality by Kristen Hart