Rh negative drama

*** This is another older, previously written post.  Resolution at the end :) ***

My blood type is A negative.  Several of the women along my mom’s side of the family have also been Rh negative, a number of them far enough back to pre-date RhoGAM shots and to have tragically lost/nearly lost Rh positive babies to hemolytic disease of the newborn (Rh disease).  I grew up hearing these family stories and feeling so incredibly grateful that something existed to save any future Rh positive babies of mine from anemia and death.  Rh incompatibility is no joke, and RhoGAM has been a true life-saving miracle since its introduction in the 1960’s.

However.

My husband is AB negative.  He doesn’t just test negative serologically - he and I also both genetically test homozygous for the fairly common “European” deletion of the entire RHD gene that is responsible for 99% of Rh- phenotypes among Caucasians.  Although such is not always the case for two Rh- partners (there are some totally interesting genetics behind “weak D” phenotypes that sometimes erroneously test negative, serologically), there is no doubt that the only offspring my husband and I can possibly produce will also be homozygous for this fairly enormous (~60,000bp) gene deletion, and thus necessarily Rh- as well.  We can never have an Rh+ baby.  This fact makes me incredibly lucky, as it means that there can never be Rh incompatibility between my fetus and me and I will not need RhoGAM.  Ever.

Cue the aggro OB’s.

It is standard hospital policy across the US to give every Rh- woman three (THREE!!) RhoGAM shots during each pregnancy, irrespective of the partner’s blood type or the presence of any actual blood-mixing event between the baby and the mother.  The internet is full of tales of OB’s that refuse to treat you, nurses that sass patients with “Honey, no woman ever really knows who the father is,” and other examples of shaming that occur when dual Rh- couples try to refuse RhoGAM.  I am preparing us for the fight.

Why fight at all, you might ask.  I should just get the needless shot(s!) and forgo the stress, right?  Well, on one hand, I’m generally against totally useless medical intervention of any kind.  I’m the type of girl who simply couldn’t force herself to take the seven placebo birth control pills each month that are placed in the pack for the women who are too stupid to a) read the package insert to see what ingredients are in each color pill (i.e., NOTHING in the green ones) and b) remember to start taking the next pack again after seven days off.  Simply knowing that there were absolutely no active ingredients in the seven little green pills meant that there was no way I could force myself to take them.  I seem to be incapable of maintaining cognitive dissonance, I’m afraid.

The second reason is the big one, though.  RhoGAM is not a “vaccination” that introduces some kind of modified (i.e., killed) infectious agent to spur an immune response.  It’s an injectable antibody cocktail derived from the plasma of human blood donors.  This means that on top of the potential side effects (allergic reaction, immune system depression, etc.) of receiving any injection, there is also transmission risk for some blood-borne diseases.  The disease transmission risk is pretty low for name brand Rh immunoglobulin under the trademark RhoGAM^®, which depends solely upon a population of about 300 long-term plasma donors in New York, nearly all of whom are cute (and selfless!) little old ladies that lost babies/siblings to Rh disease and want to give back to the community to prevent such tragedy in the future.  Old women in upstate NY don’t exactly constitute a high risk group for carrying blood-borne disease.  

These days, however, lots of pregnant Rh- women don’t actually get RhoGAM^® - they get some crazy knockoff generic immunoglobulin, much of which is made in China from who knows what donor pool.  Nothing personal against the Chinese, but they simply don’t have the same level of government regulation and oversight that we have here (or in Europe).  And for all the great things our university-based health insurance does for my husband and me, the one thing they totally suck at is in covering name brand anything - you get generic or nothing.  So I have exactly two choices: 1) pay out-of-pocket for a very expensive name brand injection that is totally medically unnecessary (did I mention that this would happen three times?) and that has at least some possibility of negative side effects, or 2) simply refuse the shots outright.  Ah, now you see how I have come to my decision.

Although I anticipate having to both bounce around among a few care providers until I can find one who is willing to use common sense over rigid, data-blind hospital policy and also to get my husband’s blood type well-documented by whatever provider finally agrees to see me, I have hope that I will find someone open-minded.  Husband thinks that I’m over-preparing, and his money is on the outcome where they just say, “OK, no shot, no problem.”  Will keep you posted!

Outcome: Our midwife (we went with the CNM group at our university hospital) is 100% on board with our decision to refuse Rh immunoglobulin - and indeed, husband is AB negative by their blood typing as well :)  And as a fun side note, we are actually our midwife’s very first dual Rh- couple - and she’s been practicing for a while!