If, like me, you have a Rhesus (Rh D) negative blood type, you will be offered a prophylactic anti-D injection before your baby is born. What on earth does all that mean, you may be asking? In this post I cover what the anti-D injection is and explain why I chose not to have it.
**Please note, I am in no way advocating not having the anti-D injection. I just wanted to provide information for women in my situation who wanted to know what would happen if they did refuse. I could only find scare stories at the time.**
What is Rhesus negative?
You may or may not know your blood group before you find out you are pregnant. It doesn’t matter either way though. At your booking appointment with the midwife, one of the things they test your blood for is your blood group. Basically, all your red blood cells have little proteins on the surface called antigens and these make up your blood group. The ABO antigens give you the A, B, AB or O blood group (I am O), and you also are either Rh D positive or negative (I am negative). So my blood group is known as O negative.
If you are Rh D negative, that means you don’t have the Rh antigen on your red blood cells.
Why is the anti-D injection offered?
This information is important to know in pregnancy (which is why they test everyone’s blood groups even if you know them already—they have to make sure). If you are Rh D negative, but your baby is Rh D positive (because the baby’s father is positive), your body’s immune system can develop antibodies against the Rh D antigens. This only happens if the baby’s blood enters your blood stream and is known as sensitisation. Sensitisation can happen during birth or if there is a bleed or injury during pregnancy.
This is not usually a problem in the first pregnancy, but if you have a second baby and you have been sensitised, these antibodies can attack the baby’s red blood cells. This can lead to haemolytic disease of the newborn, which can be a serious condition.
Because of this, women who are found to be Rh negative are routinely offered prophylactic (this just means preventative) anti-D injection. The anti-D injection is an immunoglobulin that works to ‘mop up’ and neutralise any Rh D antigens so that the body cannot make antibodies against it. This means any future babies are protected, although it does have to be repeated at each pregnancy, as sensitisation could happen during each pregnancy.
You can also be offered anti-D injection after birth if the baby is found to be Rh positive.
So why did I refuse anti-D injection?
In my case, I refused to have the anti-D injection prophylactically. This may seem reckless, but in my case the risk was miniscule. My husband is also Rh D negative. This means it was almost impossible for our baby to be Rh D positive, as the baby couldn’t inherit the Rh D gene from either of us. I say it was almost impossible, because there is some talk of weird mutations causing it, but that’s so rare it’s not really worth worrying about. As it was my first pregnancy, there was no risk to the baby because I couldn’t have been sensitised before.
What’s the point in refusing the anti-D injection you may ask? Why not just have it? And it’s a good question. Because the anti-D injection is made using donated human plasma (i.e. a blood product), there is a tiny theoretical risk of infection being passed on. I’ve never heard of a case of this, and donated plasma is very carefully screened. Nevertheless, as I knew my baby would be Rh D negative, I decided there was no point in accepting even a tiny risk.
My other reason was purely convenience, which sounds terrible. I already had a midwife appointment and hospital appointment for my GD test that week, and I couldn’t justify another unnecessary afternoon off to go to another appointment. If it had been offered at my routine midwife appointment, maybe I would have been convinced to have it.
Another reason, although a minor one, was that because I knew I didn’t need it, I felt like it was a waste of NHS resources. Anti-D immunoglobulin is quite expensive to make, so there was no point in wasting it on me.
What happens if I refuse the anti-D injection?
When I decided not to have the anti-D injection, I started googling like mad to find information on women refusing anti-D injections for the same reasons as me. I’d read a fair bit about women being told things like ‘well, we don’t know the father of the baby is who you say it is, so you must have it’. I didn’t fancy being told off for being difficult or being accused of being unfaithful to my husband. I do understand why they are cautious, but I’d like to think women can be trusted to make the best decisions for their baby’s health and if they had any doubt about paternity, they’d just have the injection!
When I mentioned not having the anti-D injection to my community midwife, she understood my reasoning but got a bit twitchy. She said I needed to call the hospital and tell them I wouldn’t be attending and why. I did that, and the midwife on the phone told me she couldn’t just cancel my appointment. I’d have to speak to the head of midwifery first.
We arranged for the head of midwifery to call me back and I must admit I felt slightly apprehensive and like I was being ‘naughty’. It was all fine though. She talked through my reasons with me and was very understanding. She told me that they could check the baby’s blood type by testing the cord blood after birth and give me the anti-D injection then if I needed it. I agreed to that.
In the end, Jacob’s cord blood tested negative too, so I didn’t need any injections after birth.
So, should I have the anti-D injection?
If you don’t know the father of your baby’s blood type (or if you know he is positive), then yes! I would have had it in that situation. In my case I only refused because I knew with 100% certainty that my husband was negative. If there had been any doubt, I would have had the anti-D injection.
The NCT have a page on Rhesus negative blood and pregnancy.
NHS Choices have a handy summary of preventing Rhesus disease.