RhoGam Risks - Part 1

Jeannine Parvati Baker, author, herbalist, midwife, and mother of 3 passed away last week. She had been very ill with Hep C, contracted from a contaminated Rhogam shot that she was given 25 years ago during the birth of her first child. In her honor, let's talk about the pros and cons of RhoGam.

Part 1: The reasons behind RhoGam

Blood Type 101: There are two major blood types that are talked about. One is the letter (O, A, B, or AB). The other is called the "Rhesus factor," or the Rh factor. That is the - or + that comes after the letter. So, O- is type O, Rh -. There are also many other minor blood factors, but they are less common and therefore less often talked about. If you are Rh+ (O+, A+, B+, or AB+), no worries. If you are Rh- (O-, A-, B-, or AB-), occasionally a situation can arise where your body views the baby inside as an alien invader that must be attacked and destroyed.

Rh Sensitization: When your body views the baby inside as an alien invader that must be attacked and destroyed, the medical and far less interesting term is that you have become "Rh sensitized." In order to become sensitized, blood must mix from a Rh+ baby with a Rh- mom. The vast majority of the time, blood does NOT mix between mom and baby at any time. But occasionally, a small amount of blood will find its way from the fetal into the maternal blood stream. It is only if that occurs that there is any risk of sensitization.

The following events will increase the likelihood of blood mixing during pregnancy:

amniocentesis
partial placental abruption (part of the placenta separates from the uterus)
car accident
domestic abuse
other trauma

The following events will increase the likelihood of blood mixing at birth:

agressive removal of the placenta - agressive cord traction or manual removal
Cesaraen birth
clamping the cord before it is done pulsing
any "traumatic" birth - forceps, vacume extractor, shoulder dystocia

Occasionally, blood will mix even at a normal birth.

After the mixing: If the blood mixes prenatally, and the mother becomes sensitized, the baby can become very sick, sometimes even die. If the blood mixes at the birth, and the mother becomes sensitized, that baby is already out and safe. But if she becomes pregnant again, and the next baby is Rh+, that baby will be attacked and possibly destroyed by the mother's immune system.

Next: Part 2 - The Why To's and Why Not's of RhoGam

RhoGam Update: Risks, Benefits, New Recommendations, and Wacky Internet Myths

To review how blood types work, what it means to be Rh negative, and all the benefits of how RhoGam works, read this post from long ago.

Now for the risks: 
Disease
There is still a small, very small, risk of acquiring a disease, as is the case with any blood product. The processing standards for the shot are so good at this point, and it has been so, so, so very long since anyone has been infected with anything as the result of receiving RhoGam, that I beleive this risk is almost entirely thoeretical at this time.

Mercury
The FDA reports that there has been no mercury in RhoGam for a decade now. Some people claim that independent tests show that there IS still mercury in RhoGam. I was not able to find a source claiming this who I felt was legit enough to provide a link to on his site. Anyone who feels concern about this should be writing to the FDA and demand testing. Until such time as we can show otherwise, I personally will be taking the word of the FDA.

Aluminum
I have written to Ortho to inquire about aluminum in RhoGam.  It has been two weeks, and I have received no response.  I believe that aluminum is something we should take very seriously until such a time as we know for sure what level of risk it poses, if any.  I would encourage anyone who is concerned about this to also inquire.  If I ever hear back from Ortho, I will share their answer here.  If any of you get an answer about this, please send it to me!

Side-Effects
The product information lists possible side-effects, I have never witnessed any of these. These side-effects are known to be very rare.

New Recommendations
The old recommendations were to give a full dose of RhoGam after birth and the "mini" dose at 28 weeks, or earlier in pregnancy if indicated due to risk factors.

The new recommendations advise the full dose from 13 weeks on, and the mini dose only if there are risk factors during the first trimester, or a miscarriage or abortion prior to 13 weeks.

I predict that in time we will see the mini phased out altogether in women who are expected to remain pregnant, and used only in cases of miscarriage or abortion prior to 13 weeks.

My personal recommendation is that the risks of sensitization outweigh the risks of the shot in almost all cases, and women should carefully consider all possible outcomes of declining this shot if they choose to do so.  

Bizarre or Just Plain Wrong Internet Findings
In researching for this update, I came across some downright inaccurate information on the web (shocking!), and also some bizarre claims:  

Internet Rh Myth #1: You can test for sensitization, or check your titer, and only get rhogam if your titer is high.

 That would be backward. Once you are sensitized, it is TOO LATE for RhoGam, and there is nothing you can ever do to make yourself unsensitized. Your titer is a measure of how sensitized you are. So, if you have any titer at all, you should NOT receive Rhogam, as it will be adding useless risks (small as they may be) without any benefit whatsoever.  

Internet Rh Myth #2: With the proper diet and herbal treatments, Rh negative woman can change their blood type to Rh positive.

Um, nope, you can NOT change your blood type with those methods. You can't really change your blood type with any home method. The only way to "change" your blood type is to get a blood transfusion of a different type than you own. This would only be a temporary change, the blood cells from the transfusion would get broken down and replaced by the blood your body makes, which would be the same type it always was.

Internet Rh Myth #3: Rh negative blood is the only blood type of the aliens who landed on our planet and bred with the humans. So if you are Rh negative, this means you are the descendant of aliens, and part of the hybrid alien/human race.

While I can't actually prove this isn't true, there is not a shred of evidence that convinces me that it is. But I do miss watching the X Files.

Internet Myth #4: Prenatal RhoGam is a "big money ploy" from the pharmaceutical companies that provides no medical benefit.

There are many things that I believe that above statement is true regarding, but this isn't one of them. The risk of sensitization during pregnancy is real, and when RhoGam is given prenatally, that number drops significantly.

It is thought that the small percentage of women who get sensitized even when given RhoGam at 28 weeks and at delivery is mostly the result of "high-risk" situations prior to 28 weeks that are not recognized as such. Of the two women I have known who were sensitized after their initial bloodwork in pregnancy but before 28 weeks, they both had toddlers. Perhaps "has toddler" should be considered a risk factor for sensitization, as it is nary a toddler I know that doesn't regularly make impact on their mother's abdomen.