unusual antibodies - effects on actual birth

[ursigurke]

This is probably going to be a bit long.
I've a very unusual bloodtype and seem to have built antibodies, probably through birth of DD. (It is not just Rh-, it's one of the small blood groups that no one normally knows off) Now, the level of these antibodies is very low and there seems to be no danger for the baby at the moment, so that is all fine.
But the transfusion departement who keeps checking my blood writes on every report that they need to know in advance if "the patient" needs a blood transfusion as my blood would not be readily available.
I didn't need one at the first birth, was quite easy so hopefully this one should go even easier, but you never know.
So I got various information from various midwives and one doctor, who all seemed to have no clue tbh. The range goes from I will have to donate blood for myself well in advance to they don't need mine, they just have to make sure that there is some available just in case, so need to know in advance (in which case I am not sure who is actually responsible to order it and when).

Today, the midwife told me that the birthing unit might refuse me as they wouldn't be able to deal with me if I was bleeding too much whereas the normal labour ward can take my blood when I come in (in labour), send it off and, if I need it, they can give it back to me.
I really don't understand or believe this. Surely they wouldn't take huge amounts of blood of a woman in labour as then I would have lost already a huge amount without even bleeding. And I would be less strong for labour. And what's the point of sending it off anyway, and where? I don't plan on having a long labour. I have asked the midwife but she didn't see to see my concern.

So I am wondering if there was anybody out there with a similar experience who could tell me how they dealt with it exactly.
Or who could I actually ask these questions? I do not know who is responsible for it and taking this decision. I do not mind to donate blood now if it is necessary but I do mind loosing blood at the beginning of labour just for nothing.

Thank you already in advance

[lostintransition]

Antibodies are only going to cause a problem in the unlikely event that you may need a blood transfusion. It just means the haematologist will have to cross match any blood you need carefully so you don't have a reaction.

It would seem sensible to have your blood taken at the start of labour (cross-match) and the haematologist match a couple of units for you just in case. Are you under a specialist team? They (the doctors) should write a clear plan in your notes so everyone is aware...hope this helps.

[ursigurke]

Not really under a specialist team. I was transferred to the consultant once, haven't even seen the one who is on my notes, only a young one who didn't really seem to have a clue.
Haven't thought of the cross-match. But as far as I understood they need to know well in advance as my blood type is not readily available (Lu(b-) if you have ever heard of it, according to some internet source, only 0.15% seem to have this characteristic)
So I am in deed wondering who will tell them and when exactly.
I have been talking to so many people already and no one seems to know anything or being the one who is actually taking decisions. I can only hope that things go well and I won't need anybody who has a clue

[breatheslowly]

They certainly aren't going to take a pint off you at the beginning of labour and then give it back to you if you need it later as that doesn't actually leave you any better off than not taking it in the first place. Nor do I imagine that they would expect you to donate your blood while pregnant. At 0.15% it isn't really all that rare - 1.5/1000 people have it, so they just need to source some which they could look to do nationally and have it in the right place. The main thing is don't let this rest until you are sure that someone has understood, decided on the right action, convinced you that they are correct in this action and personally taken responsibility for that action to be taken at the right time. It is really easy for these things to drift. Have you spoken to your GP? They seem to know hospital consultants well and can get you actually seen by a consultant rather than a registrar.

[stokiemum62]

What this means is that it is likely to be more difficult to cross match blood for you urgently should you have significant blood loss during labour or immediately after delivery and so it could take time for donor blood to be available.
So what can you do about it?

1. Make sure you start labour with the highest haemoglobin level possible so that there is lots to play with; iron rich diet lots of folate and supplements if necessary aim for a haemoglobin level of 13 or more.
   
2. Keep labour as normal as possible, the less intervention the less chance of bleeding
   

3.Strongly consider an active 3rd stage, have the injection to help deliver the placenta as this is associated with less blood loss and so less chance of needing a transfusion
4.Think hard about a birth centre delivery, it could delay requesting blood if needed and so add delay to delay. I think your midwife sort of got it right, in a main unit they could take what is called a group and save sample when you arrive in labour and send if off to the transfusion lab, this sample is then prepared so that in the event of things looking as if they are going a bit pear-shaped a phone call and they can start the cross-match process so they will be a good few hours ahead of the game. Depeding on your history they may even order a couple of just in case units of blood as soon as you start to labour to have on standby which can be sent back if not needed.

It would be very unusual to bank your own blood prior to delivery or at the start of labour, not heard of that being done. Ask if the unit you are planning to deliver at uses cell salvage, a way of sucking up blood lost at operation, washing it and giving it straight back to you. This can be helpful if donor blood is not available.

You need to speak to consultant/senior registrar at your next clinic so that a plan can be made that you are happy with.

[ursigurke]

breatheslowly, that is exactly what I thought. It wouldn't make sense. I had talked about it twice with the GP (to different ones), but at a point where I wasn't yet concerned.

stokiemum62, I've just done another iron-level test (at 34 weeks actually), hopefully it is still high. I thought too that I should try to keep it high, which it still was last time.
I was hoping for the birth centre to get the more normal delivery as I am worried that they start monitor too much in the consultant led unit which will then make me nervous. Although I have no problem to go there if there is a good reason for it (like the delay that you mention). In theory I know that I can give birth "easily" as I have done it before.

Interesting point about the injection for the delivery of the placenta. Last time I did it without. Why did no one tell me that?
I guess I really have to make sure that I can speak to the real consultant and not just some young unexperienced person without any responsability.
It just seems to be impossible to get through to the right person.
Whenever I tried to talk about my concerns I got reassuring words that everything is taken care of and that the consultant would have contacted me if there were any problems. I just don't believe it anymore.

[breatheslowly]

I think it is too easy for things to be missed - I wouldn't believe it either.