Rhogam shot...is it necessary?

Question

Is the Rhogam shot necessary? I have read stories from mothers who a negative RH factor and still give birth just fine. I have also read that it can cause infertility issues. Anyone heard of this? I am Type O negative and my husband is O positive. Since our first baby we have had a hard time TTC #2. Our first baby was type O Positive.

Answer

Hey 👋🏻 I’m actually pretty knowledgeable about this as I am A Rh- and DH is O Rh+ and we’ve explored a range of options. 🙃
It really depends on whether you’ve already been sensitised to Rh positivity. If you have, there’s little that can be done apart from watching your pregnancy more closely to make sure your baby doesn’t suffer from rhesus disease. Your doctor will talk to you about treatments during, and after, your pregnancy if this is the case. The chance is a little higher because you say you’ve had a previous pregnancy by a Rh+ man, but the test will confirm. 
One of the first things that gets checked in any pregnancy is the blood type of the mother and whether she has been sensitised to Rh positivity, so you’ll find out much sooner than later. It’s not the vaccine that affects your fertility, it’s whether or not you have been sensitised as this increases the chance of pregnancies developing rhesus disease. 
The other concern about the vaccine is that it is a blood product, made from human donor plasma. Because of this, there is a very small likelihood that having the vaccine could infect you with something. Of course, these days donor screenings are much more rigorous than they used to be, but there’s always that very small chance. Mothers interested in holistic pregnancies will likely be concerned about this. 
Further to that, there is also a chance of having an allergic reaction to the vaccine. In the worst case scenario, these reactions can be extreme and can cause anaphylaxis. This is why, in many countries, midwives are not permitted to administer the vaccine - it has to be done by a trained doctor. 
But it’s not all doom and gloom! Very recently, breakthrough testing on foetal Rh factor has been made available. Before, you’d be given the vaccine regardless of your baby’s blood type, resulting in many, many pregnant mothers receiving a blood product vaccine when they didn’t need it (if, for example, at birth the baby’s blood was tested and it turned out they were Rh- as well!). This is (was) because testing the baby’s blood type during pregnancy was not standard and, in the past, required taking blood via amnio - a procedure with a small miscarriage rate, so many mothers and doctors rather chose to take the risk of having the first vaccine instead. Then, they would wait until the birth to test the baby’s cord blood to see whether a second dose of the vaccine was necessary. 
Why two doses? The first is to prevent the small likelihood that, if you’re not already sensitised, you might become so during your third trimester. The chances of this happening are low, but many mothers don’t want the risk. The affects of the first vaccine only last until birth, when a second vaccine becomes necessary. This is a headache for mothers planning home births in countries where the midwife is not permitted to administer the vaccine - they end up having to travel to hospital directly after the birth anyway. 
Or, of course, mothers only accept one vaccine, and wait until the cord blood has been tested at birth. Therefore they only receive one blood product, but take the risk of becoming sensitised during the third trimester. This decision is up to the mother. 
But, getting back to the real point of this long post, there is, these days, a completely non-invasive way of testing the baby’s blood type by NIPT! This way there is no risk of miscarriage by amnio and the mother gets to discover her baby’s rhesus status as early as 12 weeks, rather than at birth. This test is fairly new, you might have to fight to get it or call around the houses for someone who offers it, but in the UK the test is already standard on the nhs. In Germany, it costs about 150€ to do it privately. 
We’re in Germany. We didn’t know the test existed til I was 31 weeks along. I hadn’t had the first vaccine yet because my midwife advocated taking the risk of only having it done after birth. We weren’t too happy with that idea because my mother has the same blood type as me, and she was sensitised to Rh positivity by an abortion she had when she was young. She has no idea of the consequences and went on to have many miscarriages and a stillbirth in her marriage. We, obviously, wanted to avoid this. So we had another test at 31 weeks to check whether I had been sensitised since the beginning of my pregnancy and, luckily, I hadn’t. So then we had another NIPT to test baby’s rhesus status. It came back that our baby was, in fact, positive. If it had come back negative, however, I would never have taken the donor plasma vaccine!
So I decided to take both vaccines, first and second. Knowing our baby’s status means we can psychologically and logistically prepare for a trip to the clinic soon after giving birth, so I can get the second dose. It might have come as an emotional shock if we’d waited til birth to test the cord blood, after going through everything to have a home birth, only to be told that mummy now needs to leave newborn baby and get to the hospital asap.
Sorry for the long post, but I hope all this information will help you make the most informed decision you can! And good luck! 🍀

Rhogam shot...is it necessary?

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