Tag Archive | rh negative

Oops my doctor thinks I’m a wackadoodle…

I don’t know if I’ve ever mentioned it before, but in “real life” (because…my words on the internet aren’t real life?) I’m a researcher.

I work at a university, I have a masters degree and I began my doctorate but deferred my studies when my ex-husband left me in 2014. Eventually I hope to go back, finish my PhD, and become Doctor Sadie. Yes Doctor Sadie – because in the world of pseudo-anonymous online blogging, there are no surnames…

The fact I was born with the ability to conduct rigorous academic research in my sleep has been both a curse and a blessing over the past few years.

It’s meant I was always fully capable of arming myself with cold hard facts during fertility treatment, IVF, surgeries, miscarriages, and all the other fun stuff us infertiles get to deal with on the daily. I always bypassed the anecdotal evidence available in copious amounts on Google, and went straight for the good stuff in peer reviewed academic journals.

And every time my hairdresser would say something like “Oh well my sister’s best friend’s cousin’s accountant was doing IVF and she started drinking Pepsi Max and fell pregnant straight away.” instead of rushing out and buying Pepsi Max by the carton I would think hmmm I wonder if there have been any clinical trials conducted on the effects of aspartame in infertile women under the age of 30.

But on the flip side, it’s also meant a lot of sleepless nights for me. Too much knowledge can be dangerous. Too much knowledge leads to anxiety, depression and sometimes mild hysteria. Knowing risk factors, knowing the research, the statistics, the likely outcomes…is not always a benefit.

But now I’m pretty sure my current obstetrician, Doctor Eminem, thinks I’m a wackadoodle. Why? Well I’m glad you asked because I’m going to tell you.

I attended my 28 week appointment yesterday. I’m actually 29 weeks but due to scheduling issues, we had the appointment a little later than usual.

First up I was given the news that I don’t have gestational diabetes. This absolutely shocked me, to be honest. I’m carrying a huge-ass bump out the front of my person. Like I mean people are already stopping me in the street and asking if I’m overdue. And don’t get me started on the old “is it twins?” jaunt. Why do people think it’s okay to ask that question? I don’t go up to random strangers and ask them why they’re so damn fat.

Plus don’t forget that PCOS puts me into a high risk category for GD (hello years of metformin!), I have a family history, I’ve stacked on way too much weight (already up 12kg – or 26 pounds – by 27 weeks, though this can likely be chalked up to emotional eating due to stress) and I fainted at work the other week.

So I was fully expecting the news that I would be replacing my Snickers bars with celery sticks. But all rejoice! The Snickers gets to stay!

Next up we did some measurements. My fundal height is now 31 weeks. This is no surprise to me as like I said, I’m carrying big. My tilted uterus makes me look even bigger than 31 weeks so I was just glad he didn’t say I was measuring 36 weeks or something!

Next up, I got my ultrasound. In Australia, in the private health system, you get an ultrasound every 4 weeks. At my last ultrasound (which you’ll know was at 24 weeks if you can count backwards in denominations of four ;)) my fatso baby was measuring at 25+4.

This time, her tummy is measuring 30+6, her legs 30+5 and her head 31 weeks. So that’s pretty much perfectly consistent with my fundal height of 31 weeks. Is it because we don’t know when I conceived and I’m actually 31 weeks along? Or is she just a monster baby?

She weighs approximately 1500 grams (3.3 pounds) which is 400 grams more than she should weigh at 29 weeks but spot-on for 31 weeks. Hmmm….

After the scan was done, Doctor Eminem tried to convince me to schedule an elective c-section to protect my pelvic floor from my monster baby. I am absolutely against this for a number of reasons.

I told him that firstly I want to be able to experience vaginal birth as this is likely the only time I’ll get to do this. Secondly, I want to be able to get up and move around straight after I give birth. Thirdly, the short-term recovery is better for vaginal births.

Lastly (and most importantly) I want the dump of hormones and chemicals after a natural birth that lowers a mother’s risk of postnatal depression. Given I’ve had multiple miscarriages and I’m still going through prenatal depression, I’m already in a very high risk category for PND. I don’t want to increase my risk any further by having an elective c-section.

Doctor Eminem worked out pretty quickly I wasn’t going to budge on that one, so then he started talking to me about elective induction instead. He actually gave me some copies of some studies conducted recently that show women who have elective inductions between 38 and 40 weeks gestation have a 19% lower risk of emergency c-section and their infant mortality rate was less than half that of women whose babies are born after their estimated due date.

The studies he provided me with are quite compelling but I’m not entirely convinced because I know that on the flipside the epidural rate is 20% higher in inductions (and of course an epidural will also prevent that dump of happy hormones after birth) plus I also don’t like the idea of being stuck to an IV drip and not being able to walk around during contractions.

I’m also looking at studies that show when a mother’s brain signals that it’s time to start labour (yes we spell labour with a “u” in Australia – deal with it) the baby’s lungs are coated with an extra large dose of a protein called surfactant that helps the baby to transition to breathing air after they are born.

Surfactant coats the baby’s lungs from around 32 weeks gestation onwards, however right before birth they receive a large and crucial dose. That dose is never provided to the baby during an induction because the process is artificial so the mother’s brain misses the signal, and this is why induced babies are more likely to suffer respiratory problems as newborns.

So with regards to the induced labour I have some more research to do and some decisions to make.

But then I was all like “Hey Doc, while we’re talking about medical studies I’d like to raise a few questions with you.”

He was all like “Oh okay Sadie sure.”

And then…I hit him with the wackadoodle!

“As you know,” I began. “I’m Rh negative and due now for my first shot of anti-d” (that’s a Rogam shot for you Americans)

“Yes.” said the doctor. “You’ll receive your first anti-d injection today.”

“Well, keeping in mind that I clearly understand why this shot is administered and I’ve happily had the shot after all of my previous miscarriages, I’d like to discuss the persistent assertion that women who have the anti-d injection are at an increased risk of having a child with autism.”

*silence*

“As a researcher I’m very aware that correlation and causation are two different things.” I continued. “I’m also very aware that a lot of the evidence that supports this claim is purely anecdotal. But a study was conducted which demonstrated a 62% increase of autism in the children of women who had the anti-d injection. Of course this could be a genetic factor linked to the Rh negative blood itself and the fact these women received the shots was just coincidence. Can you please debunk this theory for me so I can have a clear conscience when you administer my anti-d injection?”

*more silence*

And then I’m just looking at the doctor like oh crap please don’t think I’m crazy because honestly I’m happy to have the shot! I just really wanted some good medical studies to put my mind at ease.

I’m not a person who believes in woo-woo pseudo science. I’m not a person who believes that autism is caused by basically anything and everything including vaccinations, patting your head whilst rubbing your tummy or listening to Justin Bieber music (which, I’d like to add, is a well known use of torture in prison camps around the world).

But there’s a very strong genetic history of autism in James’ family. It’s across several generations but seems to be getting worse. In fact, James has a brother and a sister. Between the three siblings, they have had four children.

His sister’s son is far enough along the spectrum that he has to attend special school and both of his brother’s sons are also autistic. One nephew is severely autistic and non-verbal.

The only child in the new generation of his family not to have autism so far is James’ own son Isaac. So of course autism is something I’m very aware of, even with the understanding that the condition is genetic and cannot for the most part be avoided.

And if I do have an autistic child that’s totally fine and I will love her no differently and raise her to be a beautiful young woman. Just so we’re clear. I just don’t ever want to feel guilt for causing her autism through a decision I made. Get what I’m saying?

“You know what Sadie?” Doctor Eminem finally said. “Don’t have the shot.”

“But…but…I want to have the shot!” I spluttered. “I don’t want to risk my baby being Rh positive, my body creating antibodies and hurting the baby!”

“If you started bleeding would you agree to have the shot immediately?” he asked.

“Yes of course!” I answered.

“Well then the risk to your current baby is quite frankly nil.” he said. “Once upon a time, the anti-d injection wasn’t manufactured in large quantities so Rh negative mothers only received the shot once their baby was born. They didn’t get the shots at 28 and 36 weeks. And in all my years as an obstetrician, I’ve never once seen a woman develop antibodies. So we’ll wait until the baby is born like they did a few years ago, and give you the shot then. That way not only are your hypothetical future babies protected but if your current baby ends up having autism you’ll know it’s not because you got that injection.”

I had to admit, Doctor Eminem’s logic was sound. I wasn’t aware that up until recently women only received the shot once their babies were born. That made me feel a lot better.

Plus…let’s be honest…the chance of Miss Infertile Australia spontaneously falling pregnant twice in her lifetime is slim to nil. So future babies are unlikely to be a factor to stress about…

“Right.” I said. “Let’s move on to the whooping cough vaccination.”

*silence*

*crickets chirping*

*tumbleweed rolls past the doctor’s desk*

“Vaccinations don’t cause autism.” Doctor Eminem blurted out, a wild look in his eyes.

“I absolutely agree.” I said ardently. “I’m a very strong proponent of vaccinations and my child will be fully vaccinated. I am fully vaccinated. I had a whooping cough booster only two years ago! Every single person who will be coming into contact with the baby in her first few weeks of life including James, my parents, his parents and my grandparents have been given a booster since I fell pregnant.”

“Okay so what’s the problem?” he asked.

“Well I just want some evidence of the safety of administering the booster whilst pregnant.” I explained. “The Boostrix vaccine insert recommends the shot not be given to pregnant women. I understand this is because vaccine manufacturers routinely exclude pregnant women from their clinical trials and I’m not questioning this. But from what I can see, the only clinical trials that have been conducted for pregnancy have been trials of rabbits and mice. There was one very small study conducted on humans in Europe, but the study population was tiny and I wouldn’t think it overly reliable. I am wary of allowing myself to be injected with a vaccine whilst pregnant, before rigorous clinical trials are conducted on humans. Your thoughts?”

“My thoughts?” asked Doctor Eminem. “Well…um…my thoughts are that you shouldn’t get the booster during pregnancy.”

“But Doc!” I gasped. “Australia is in the middle of its worst ever whooping cough epidemic! And by administering the booster shot to pregnant women between weeks 28 and 32 of their pregnancy, they pass partial immunity to their baby! I need the shot!”

(As you can see…it was like I was playing devils advocate with myself and my doctor was merely along for the wackadoodle ride.)

“Yes it’s true that the booster does provide partial immunity for the baby.” the doctor agreed. “But you personally are already protected by your recent vaccination and everyone in your family is protected. If you plan to isolate the baby prior to her first round of shots when she’s six weeks old then don’t even worry about it. That’s a good level of protection. Then you won’t have to worry about the validity of the research into administration of the vaccine during pregnancy.”

So basically…I went into the appointment hoping my doctor would debunk my concerns regarding the anti-d injection and the whooping cough vaccination, and instead I technically won both the arguments and the end result was no shots for me. And the truth is that was not the outcome I wanted! I really want the shots! I just wanted him to prove me wrong! Argh!!

I’m still pretty certain I’m going to go ahead and get the whooping cough booster shot. I don’t like the idea of her being exposed, even if I keep her at home. I guess I have a few weeks to decide.

And now I’m going to ask for some of that anecdotal evidence I try so hard to avoid!!

Did you get the anti-d (rogam) injection whilst pregnant? Did you ever worry about it affecting your baby?

Did you get a whooping cough booster whilst pregnant? Did you feel safer knowing your baby had partial immunity?

Oh oh! And can anyone share a story with me about elective labour induction? Or just induction in general? What was recovery like? Were you able to move around? Did you need an epidural? Did your baby have breathing problems?

Hit me with your lovely anecdotes!!

Lots of love,

Sadie xx

p.s I think this post definitively proves I’m basically incapable of writing anything less than 2000 words even when I’m not moaning about my stressful life. #sorrynotsorry

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Anti-D, Anti-Everything

Last week Shirley, one of the nurses at the clinic, phoned me and told me that I had to come in at 7am the next morning for a blood test and an anti-D injection.

For those who aren’t aware, Rhesus Immune Globulin (anti-d) is an injection that is used to prevent the immunological condition Rhesus disease. I need to get these injections because I am Rhesus negative but around 85% of the population is Rhesus positive, including my husband. When I am pregnant there’s a high chance my baby is also Rhesus positive like Doug, because most people are Rhesus positive and my babies already have a Rhesus positive parent. You all with me so far?

When the baby is on it’s way out of my body (either during miscarriage or labour – if I ever make it that far in a pregnancy!) there is a risk that a small number of the baby’s red blood cells can leak into my blood stream, allowing my body to develop antibodies against anything Rhesus positive entering my body in the future. If left untreated, during subsequent pregnancies if my baby is once again Rhesus positive my body may use those antibodies to attack and ‘remove’ it (yay!). Otherwise it can still cause lots of long-term problems for the baby including anaemia and jaundice. And nobody wants that. So basically I need to get an injection of anti-D to prevent this happening every time I miscarry and also at 28 weeks and 34 weeks pregnant (again, if I ever get that far in a pregnancy…).

The anti-d injection is produced from the blood of Australian Red Cross donors. I always find it fascinating when I’m injected with other people’s blood. Does that make me a weirdo? I know blood products from donors are also used to assist fertilization of eggs during IVF cycles and I’m also fascinated by that. I wonder if those donors have any idea they’re helping to create life rather than save life. When I imagine donating blood I see it going towards saving a car crash victim who is rushed into the hospital with an amputated leg and is bleeding out and close to death. I can see doctors running around the room and intubating the patient and shouting orders to each other. And I can hear the theme song to the television show ER. And I can see Doctor Green and Doctor Weaver, and definitely Doctor Ross. Oh hello, Doctor Ross. I have a fever would you like to do a full body examination? Oh…sorry…I think I just steered you all into one of my fantasies…

Back to the anti-d.

When I lost my first pregnancy in April I was with a large and impersonal clinic with unimpressive levels of patient care. I was never offered the anti-d injection, even though it should have been mandatory. Luckily when I was tested at my new clinic they found that Nemo’s blood cells had very kindly avoided my blood stream as he vacated the premises and I hadn’t developed anti-bodies. But I’d completely forgotten this time around that I would need an injection and was unpleasantly surprised to receive the phone call from the nurse.

Not only did I have to come in at 7am, I had to get another huge intra-muscular needle in my thigh. Why is it always in the damn thigh lately? And why always in the muscle? Give a girl a break.

After terminating the ectopic pregnancy I was looking forward to resting in the weeks coming up to Christmas. I was looking forward to not having to be up at the hospital most mornings before work for tests or scans or appointments or injections. I was trying to see the positive side to losing my little Peanut and/or Butters. But no! The inconveniences continued!

Five minutes after receiving the bad news, my phone rang again.

“Hi Sadie, it’s just Shirley again.” said the voice on the other end of the line. “We’ve changed our minds. Can you come in tomorrow at 7am for the blood test and then 7am the following day for the anti-d shot.”

Ugh. Seriously? Two days in a row? Just my luck.

“If the blood test comes back negative do I still need to get the shot?” I asked hopefully.

“Yes.” Shirley replied sternly. “And don’t forget the day after that you need to come in here for your first follow-up blood test following the methotrexate.”

Well…..damn. Apparently you can’t sleep in when you’re going through IVF, you can’t sleep in when you’re pregnant and you can’t sleep in when you’ve lost a pregnancy. You just can’t sleep in. At least not if you’re me. And I am me.

To be fair, the anti-d shot itself wasn’t too bad. It certainly wasn’t anywhere near as painful as the methotrexate. It sort of just felt like a regular FSH injection, except with a much bigger needle. I’m glad I had it done. Now I don’t have to worry about anything else going wrong next time we go through a cycle. Because let’s face it, not too much else can really go wrong for me at this point.

Now I’m just waiting for my next follow-up appointment with Doctor Vacation. Sorry, wait. I meant to say with Doctor B when she comes back from yet another holiday abroad. That will happen in the first week of December.

Now that everything is out of the way for this cycle, I can simply be “anti-everything” and just take a break from all the infertility stuff. At least for another couple of weeks. It feels so nice to just be away from it all. I can focus on other things now! I might even be able to catch up with a couple of friends for coffee and not bore them with fertility treatment talk. And I might even drink actual caffeinated coffee. I’m wild!

I can’t believe how positive I am being at the moment. I actually feel a little bit like a real human being!

You guys, I give it a week tops until I am back on here complaining about some other crisis or drama in my life.

A week.