Managed Third Stage and Rhesus Status - Advice Please!

Yes Linnet they tell you your rhesus factor. You are given a card with your group and rhesus factor on it. In fact when you are O negative you are begged to come back. O negative blood can be given to people with any blood group, so it is vital for emergency situations where blood is needed when the person's blood group is not known or if they have run out stock of the known group.

Just out of interest Am I right in thinking that if dh went along and donated a pint of blood they will be able to tell him if he is rh neg/pos? I know they can tell you what blood type you are i.e a,b etc but don't know about the rh factor. If not we'll go to the dr anyway and get them to check.

You're welcome AliP

AliP - out of interest, do you know your DP's blood group? If he is RhNeg you do not need anti-D anyway.

Mears - thanks so much for all your input, it's very much appreciated

Linnet - he could kill 2 birds with one stone and become a blood donor That way he will find out his blood group for nothing and will be helping out the low blood stocks in the NHS.

Alternatively you could ask the GP to do it because you want to know if you will require prophylactic anti-D. If you don't you will be saving the NHS money.
If the GP won't do it (can't think why not though), The hospital can do it at an antenatal visit. That was where they took my DH's blood. He already knew his blood group through donating but they wanted to know the chances of our babies being rhesus positive because of my antibodies. The test showed he was homozygous positive - see gingernuts posting below - which means we can only have rhesus positive babies. Heterozygous means that the father may have positive or negative babies. That will not be helpful to you though so just the blood group and rhesus factor is enough. Let us know how you get on.

Hi everyone, me again. Having talked over the RH- situation with dh he has said that he is more than happy to have his blood tested to see if he is rh- or +. To be honest since he's actually agreed to this next baby he has confessed that he is worried about things going wrong. I think he's thinking along the lines of we've managed one healthy child will we manage it again.
Does anyone know if we should discuss this with our GP first or should we just go ahead and set up an appointment for blood to be taken by a nurse and explain that we want it checked for the rh factor? And does anyone know if we would have to pay for this blood test since we are asking for it to be done and it's not a medical necessity?
thanks gingernut for explaining about the rh gene. I realised after I'd replied that there could still be a chance, I was thinking back to genetics lessons in biology and realised that without actually knowing his blood type there could still be a chance. silly me.
thank you to everyone for your help and advice, this is a great website and I'm so glad I've found you all.

Linnet - yes you could refuse injections if you want. Get your dh's blood group checked. If he is RhNeg then you will never need anti-D as long as he is the father of your babies. I believe the injections should be given if there is an indication such as bleeding, pain etc.

Gingernut - once you develop antibodies you are not given anti-d prophylaxis because the damage is already done.
Ds no.2 got phototherapy for a few days after birth. Ds no.3 required was delivered almost 5 weeks early because of rising antibodies and he needed a blood transfusion aged 6 weeks because my antibodies made him anaemic eventually. My last dd was 3 weeks early and needed 3 exchange transusions. She was bright orange at 1 hour old.
I subsequently got sterilised as each pregnancy gets worse. With my dh's blood group we could only have RhPos babes

Mears - sorry, I've just re-read your post and see it was your last pregnancy where your baby needed transfusions. I've been on the wine I'm afraid

Mears - thanks for all the information and the website. I shall go and have a look at the NICE stuff - forewarned is forearmed!

BTW, sorry to hear you had such a difficult time during your 3rd pregnancy - it must have been an anxious few weeks for you. IIRC you went on to have a fourth. Did you have to receive rhesus prophylaxis throughout that pregnancy?

Linnet - if your dd is Rh- it does not necessarily mean your dh is. There are 2 types of Rh gene, Rh+ and Rh-. Rh+ is dominant over RH-. Everyone has 2 Rh genes. If a person has one Rh+ gene and one Rh- gene, then their blood type will be Rh+ (because the Rh+ gene is dominant). If they have 2 Rh- genes then their blood type is Rh-. And 2 Rh+ genes make an Rh+ blood type. Your dh could therefore have Rh+ blood but have an Rh- gene. He could have passed on this Rh- gene to your dd. Alternatively, he could have Rh- blood (as you do) in which case he would have 2 Rh- genes.

Mears,thanks for the information. I assume that my dh is RH- since we didn't have any problems when dd was born, but I may find out about him getting his blood checked as a precaution.
To be perfectly honest I don't feel very comfortable about having RH blood given to me on the off chance that I might need it. I would much rather wait until after the birth to see if I'd need it.
Is it possible to say that I don't want the anti d injections at 28 weeks and 34 weeks, or will they over rule my objection since these are the new guidlines?
My pregnancy with dd went very well, to well some people say giving the delivery I had but hey ho. I know that another pregnancy could be totally different but I'm not very keen on needles as it is and if possible I'd rather avoid these extra injections if I could.
I haven't yet looked at the web site that you gave the address for but will do it later when I have more time.

I had routine anti-D injections during my pregnancy in 1996. After her birth, DD's blood was tested and she is Rh- so I didn't need the injections anyway.

It was about 3 or 4 years before I found out that anti-D was a blood product - how naive I was. I was very worried, not just for myself but also because I am a blood donor and had donated a few pints in the intervening time. Although I was always questioned on all sorts of things, having had anti-D wasn't one of them.

I asked the Blood Donor Centre who told me that it wasn't a problem and allowed me to donate again.

Also the guideline does say if you want more info visit the NHD Direct website

www.nhsdirect.nhs.uk

I can guarantee it will not contain my sentiments

Sorry about that misplaced 'they'.

By the way the most evvective place for it to be administered is in the deltoid muscle of the arm. However, more often than not it is in the bottom or leg where absorption is less effective. Is it any wonder that sometimes women develop antibodies in the first place?

Gingernut - anti-D is sourced from blood donors who have antibodies themselves who can be men or women. It is bought from donors from the USA beause they do not have variant CJD. I was going to donate my plasma because of my antiboies but plasma is no longer collected in the UK because of 'mad cow disease'.

The guideline was issued in May 2002.

It is called 'Guidance on the use of routine antenatal anti-D prophylaxis for RhD-negative women'.

You will be able to see it at www.nice.org.uk

They

Mears with my first pregnancy I was given a leaflet which didn't really explain much at all (in fact i've learned more this morning reading your thread).However they did not offer the anti-d until ds was born in which case i did not need it.
My second time around i had placenta previa and had 7 bleeds (3 very large) and was given lots of anti-d.So the system worked for me.Except for the fact I now have pnd and every period i get taken back to that time.That's another story.

PS: mears - do you know how anti-D is sourced? I guess from Rh- women who have rhesus antibodies?

Thank you for that mears, it is very interesting. Do you know when the NICE guideline came out? I think they it be available on the web so I shall go Googling. I mentioned the 28 and 34 week anti-D injections to my GP when I was pregnant (i.e. did I need them?) and was told no, I would be monitored as I described (this was in 2001) and I was pleased that I would not be given anti-D unnecessarily. I hope that we shall have another child and would hope to receive the same monitoring (although I did have to be vigilant and make sure they took the sample for testing, and chase up the results later - just a warning to others!) rather than routine anti-D.

Linnet, I have had anti-D twice (once after m/c and once after birth of ds) and both times was given the jab in my bottom! I guess you would remember this . It is supposed to be given into a muscle so I suppose could be given elsewhere though.

Linnet - the precautions you mention are new national guidelines of giving all rhesus negative women anti-D at 28 weeks and 34 weeks (NICE guidelines).
The Royal College of Midwives has grave concerns over this and as a midwife, so do I.
The reason it is being done is to try and prevent women developing antibodies and therefore preventing life threatening complications for the baby. However, there are very few rhesus negative women who do develop problems and of them, many would not have developed a problem had the existing guidelines been followed in the first place such as the administartion of anti-D after miscarriage, bleeding during pregnancy, any invasive procedure such as amniocentesis, abdominal pain, and ofcourse post delivery if the baby is Rh Positive. Also the kleihauer test must be performed to ensure a big ehough dose of anti-D is given post delivery. There are still some places that do not do that.
The health risk of being given a blood product has been claimed to be negligible because of the safety in it's preparation. However, I think it is outragious that all Rh Neg women will be given a blood product that may have some, as yet undetected virus or other in it as has happened in the past. I have concerns that women will not be given all the information to make an informed choice as to whether they want it or not "just in case". I worry that this will just be given automatically and women will think that it is something they must have.
If I was pregnant again for the first time I would be finding out my partner's blood group. If he is Rh negative then there is no need to have anti-D at all (that is actually mentioned in the guideline but there is a worry that women will not want to admit that their baby is not their partner's).
The subject is very close to my heart because I myself have got rhesus antibodies and my last baby needed 3 exchange blood transfusions. However, I developed antibodies at 37 weeks in my second pregnancy. I actually had had an episode of abdominal pain at 34 weeks which lasted for a couple of hours then passed. I saw my GP the next day who said it was probably my 'lower segment forming'. I accepted that ( me a midwife too!!). Once I developed antibodies I realised that the pain had probably been a small abruption which is a bit of bleeding behing the placenta. That would have resulted in some of the baby's blood entering my bloodstream.
On the one hand you could say that prophylactic anti-D would have prevented that. On the other I believe it would have been prevented by anti-D being given as it should have been to a Rhesus negative woman with abdominal pain. Awareness raising would have been a better tactic to me than blind administraion of anti-D to everyone. It will be interesting to hear what information rhesus negative women are getting from the professionals.

thanks for your comments gingernut. I don't remember getting any injections after dd was born, I thought they may have done it in theatre and things are a bit hazy from then so I wouldn't remember if they had.
I have vague recollections of a midwife telling me my dd blood group but I don't remember exactly what she said. That was when she was about 1 or 2 days old.
I've spoken to my GP about having another baby and mentioned being RH- and she did tell me that their policy has now changed and when I'm pregnant I'll get an anti d injection at 28 weeks and 34 weeks, they apparently do this as a precaution now. Not sure if this is nationwide but that is what they do here.

Linnet, during my pregnancy blood samples were taken from me and tested for the presence of antibodies to the Rh+ protein. So although the foetal blood group was not known at that stage, they were checking to see if I was mounting an immune response to the foetus. If there is any concern about the antibody levels, treatment is by giving anti-D or by intrauterine blood transfusion (in extreme cases). I would imagine it is possible to ascertain the foetal blood group however, just that it is rather invasive so not usually done.

Mears' post below describes what happens after birth. If you need anti-D then it is given up to 72 hours after the birth. It would not usually be given immediately after the birth because it takes some time to check whether or not you need it.

You may not have received anti-D because you may not have needed it (e.g. if your dd is also Rh- you would not need it).

However, having said all this, practices may vary throughout the country and also may have changed in recent years because of concern over administering a biological (i.e. a product made from a human source) where it is not strictly indicated.

Just out of interest I have a question on the rhesus blood group, if you are rhesus negative do they give you the anti D injection just incase the baby is RH+ or is there any way they can know before the baby is born? I know this is a really dumb question but I always forgot to ask my midwife when I was pregnant a few years back now. I am RH- and assume I was given the anti d injection after the birth of my dd although it was all a bit of a haze, but that's another story. And do they test the baby after birth to see what RH type the baby is?
Thanks

pupuce - PHEW! - was trying to think how I may tell you gently your case had been mismanaged!