Singing and Dancing My Way to Natural Birth With Pre-Eclampsia

My heartfelt thanks for reading my story. I'm so blessed and honored that you will post my birth story on your blog and social media.  I hope and pray that this would inspire more women to try birthing naturally and perhaps encourage them also to sing and dance their way through labor! 

I was diagnosed with Pre-Eclampsia with severe features due to the extremely high amount of protein in my urine. My blood pressure remained normal, below 120/80, all throughout my labor, delivery & recovery. This is my 5th pregnancy. My first pregnancy was with twins.  The 1st twin, Annalise, was born naturally (no anesthesia, IV, oxygen, pain meds) in our church's birthing clinic.  The 2nd twin, Therese, was born via CS in a hospital. I was transferred because Therese went transverse when Annalise came out and it was Therese's hand that first came out.  My midwife put her hand back twice before transferring us to the hospital.  

In most hospitals, 24 hour monitoring is only done in the High Risk unit, so when my fluid was low, I had to be monitored for a full 24 hours before I transferred to a regular room.  I went back to the High Risk unit again for the Magnesium sulfate, to counter possible seizure or convulsions, according to my OB.  They also don't allow the natural birthing suite for high-risk cases like mine, because I already underwent Caesarean in a previous pregnancy, even though I've already had 3 VBACs.

Valentine’s Day, Thursday, Feb. 14, 2019, I was looking forward to a lovely dinner that night with my husband of 13 years, Ritche, to celebrate our 15th year of being together, when we received news that my husband’s 98-year old maternal grandmother “Lola Auring,” whom he was very close to, had just passed away peacefully in her sleep.  He regretted not being able to visit her sooner when she was still alive but looked forward to flying out from our home in Metro Manila (Philippines) to their province to be with her for the last time.  

But, first things first… I had to go to St. Luke’s Medical Center in Bonifacio Global City, for my routine 36th week checkup & ultrasound.  My OB did a Biophysical Score of our baby and told me that my fluid was low.  In my mind, I thought, “Okay, I’ll just have to drink up at home then.” But, my OB had another plan... I needed to be admitted to the High Risk Pregnancy Unit and hydrate via IV. I called Ritche and he agreed for me to be confined, thinking we’ll just stay overnight until my fluid goes up in 24 hours.  

So, aside from the IV drip, I tripled my water intake to 3 liters in the morning, 3 liters in the afternoon and 2 liters at night, which equated peeing almost every hour! AND I had to be hooked to several machines so my heart rate, blood pressure, baby’s heart rate and my contractions will be monitored for 24 hours. It was super uncomfortable but I thought, “No problem! As long as baby’s fluid will go up right away.”  We then asked our churchmates and close family & friends to pray with us.  I also prayed that I would be discharged as soon as possible so that Ritche could still travel the next day to be with Lola Auring.

24 hours later, Friday afternoon, my fluid just increased a tiny bit so my OB double checked the protein-creatinine ratio in my urine. While waiting for the results, we got a regular room and waited another 24 hours.  My husband already cancelled his trip and let my mother-in-law, Mama Tess, go ahead to their home in the province.  My UPC ratio was still extremely high, which made me a candidate for severe pre-eclampsia. We couldn’t believe it.  Even my OB couldn’t believe it, either. I’ve always been careful with my diet, preferring veggies & fruits. I always made sure I had regular exercise.  My blood pressure has always been normal.  How could I have pre-eclampsia?   

We’ve been praying for Baby Abe to come out at least on his 38th week so, imagine our surprise when she advised us on Saturday afternoon that we’ll both be safer if he came out as soon as I reach my 37th week, which was the following day, Sunday!  Questions ran through my mind.  We knew 38 weeks is the ideal.  How do I induce labor?  We’ve always just waited for me to labor naturally.  With Agatha, our 5th child, we had to keep her in as long as possible.  With Abe, it seems, we now had to bring him out as soon as possible! We hadn’t even packed our hospital bag! We were just supposed to buy baby boy stuff this week!

I had my Birth Plan printed out for the doctors and nurses and went back to the High Risk unit so that I can be given magnesium sulfate to counter possible seizure/convulsions.  I was also given 4000 mg of Evening Primrose Oil every 4 hours to soften my cervix. It just seemed so foreign and unnatural to me that we had to naturally induce labor.  How do we do that?  

My husband comforted me and reminded me that we have a great and awesome God and that so many people are praying for us.  He had been diligently communicating with and updating our close friends.  My dearest friend Kartika from Singapore visited me twice. My best friend and sister, Lala and her husband, Solomon, came all the way from Carmona, Cavite, to encourage me with their love and presence.  Our dear godparents, Fr. Dino and Sis. Anj, braved the 3-hour traffic to show their support and pray with us. When they mentioned the words “total trust” and “perfect peace” in their prayers, I was inspired by the Holy Spirit to write down the alliterations the Lord revealed to me as they were born in my heart so I can meditate on them:

“Total Trust in Thee”  “Perfect Peace in the Prince of Peace”  “Sweet Surrender to My Savior”  “Calm and Courageous in Christ”  “Blissfully Blessed and Brave to Birth our Baby Boy”  “Relaxed, Rested and Ready”

Most importantly, my mother, Mama Lou, my father-in-law, Papa Adelo, and our 5 beautiful and wonderful children, gave me so much encouragement that I knew that we can bring Baby Abe out in God’s perfect timing.  The Holy Spirit will lead me and guide our baby out.

Monday, after the magnesium sulfate treatment, I had another ultrasound.  Baby’s fluid had significantly increased from 7.89 to 13!  Praise God!  We could really feel the prayers of everyone.  We were ready to induce natural labor.  My OB mentioned that Baby Abe could even be born on Thursday, which was her birthday!  But I thought to myself that I didn’t want to labor that long.  Our churchmates, Dcn. Jojo and Sis. Evelyn, brought homebaked muffins along with much laughter and prayed over us before leaving.

We finally finished my IV (Yay!) and I drank my red raspberry leaf tea, walked about our windowless room, slow danced, bounced on a birthing ball. Contractions were very mild at 3-5 minutes apart, but they weren’t “painful.”  Mama Chato, our midwife who helped me naturally birth our other children, taught us that we must reframe contractions as “good pain” because it helps bring the baby down.  The more you welcome each “good pain” and embrace the sensation, the more relaxed you will be and fear will leave you.  So, everytime I felt a contraction coming, I relaxed my facial muscles, my jaw, my shoulders and let the tightening sensation do its work on my belly. The uterus is a very powerful muscle and I looked forward to the pressure, imagining that every contraction brought Baby Abe closer to being in my arms.

The resident doctor did my first internal examination and said I’m only 2cm dilated.  Well, at least it’s not totally closed, right?  However, at 530pm, I had an unexplainable occurrence of “chills” where I suddenly felt like I was freezing.  I couldn’t stop my teeth from chattering and my body from shaking violently. My mom wrapped me in thick blankets, wore socks on me, rubbed my legs. I called my husband to hurry, as he was getting some documents for our hospital stay. I placed my cold hands in my armpits and prayed that the nurse won’t peek in and report that I’m having some kind of seizure.  The chills passed after 20 minutes.  My husband warmed me with his embrace.  However, I couldn’t sleep a wink that night.  My husband decided we transfer again to a normal room with windows so I could be more comfortable.  I searched online “how to dilate cervix fast” and visualized my cervix opening and prayed constantly to the Lord to give me thoughts of peace and not anxiety.  The baby knows when to be born.

Tuesday, I had a prenatal massage to relax and press those labor-inducing points, drank more red raspberry leaf tea, bounced on the ball and did more than walking, I did some dancing, too!  Contractions were still mild at 3-5 minutes apart. I had another bout of “chills” at 530pm so my mother wrapped me again and I rebuked every thought of convulsion or seizure.  I kept telling myself that this will pass and Baby Abe is safe in my womb. The chills stopped at 6pm. By 8pm, I was so tired from the lack of sleep that I was able to sleep very well, even with the regular rhythm of my belly tightening.  We continued to entrust everything into the Father’s hands. 

The next day, Wednesday, February 20, I was determined to up my natural induction techniques.  My OB was pleased with the progress of my labor but reminded me not to wait until my water broke.  She reminded me to let her residents know when I’m already 4cm dilated, because I gave birth so quickly to our last child, she almost didn’t make it.  

My Mama Lou and I danced belly, hip hop, Zumba to the jiggiest songs I could find (Think “Trolls” soundtrack, “Walking on Sunshine” “Moves Like Jagger” “Waka Waka” you get the picture) and I sang my heart out to our Hillsong & Bethel favorites (Oceans, What a Beautiful Name, O Praise the Name, Open Heaven/River Wild, It Is Well, No Longer Slaves, etc.) when I rested. The doctors and nurses were amazed I could still sing and dance through my contractions.  Haha!  It actually took my mind away from the pressure.  By 530pm, I thought my water was leaking so I called a resident to examine me.  No water, just the EvePrim Oil melting but I was 3-4cm dilated.  Yay! She then asked me to go down to continue laboring in the High Risk unit.   Labor progressed very quickly and I did feel more and more pressure every minute!  

Shout out to the doctors and nurses of St. Luke’s BGC for honoring my Birth Plan as much as possible and I agreed that I will only be hooked to the monitor for 20-30 mins every 2 hours.. No pitocin, no IV, no oxygen and no pain meds.  By 8pm, I was 5cm dilated.  Hooray! That pushed me to do even more dancing, bouncing, marching, swaying & singing during contractions, with my husband playing every song I requested.  The pressure was already immense at this time, and I had a tugging feeling I was very close to transition, although it’s only been a couple of hours.  I was thankful that my husband was just right there to tell me I’m doing great, and my mother was also with us, cheering me on.  Whenever I felt the tremendous pressure, I would say, “Baby’s going down, down, down!  Yes, yes, yes! Go, go, go!” and I knew that they both agreed with me and believed with me.  

I was already speaking in tongues, asking the Holy Spirit to be my Comforter, my Teacher, my Guide.  I envisioned Mama Mary giving birth to our Lord and Savior Jesus Christ.  I remembered all our children who are happily awaiting their baby brother at home. They’re counting on me to give birth to Baby Abe soon.  I wanted to birth this beautiful being in my womb without fear, only love and joy and peace... Feelings of indescribable bliss welled up in my heart for this boy whom Ritche and I had so conceived in love.  I was determined to confidently bring him out in that same love that conceived him. 

At 1030pm, I asked the resident to check my cervix, which had already dilated to 7cm, with a “bursting” effacement.  I had to be strapped again so I lay down waiting for the nurse when, a minute after, the nurse relays the message from the doctor to tell them right away if my water bag ruptures. She hadn’t left the room yet when my water bag burst!  It felt like a water balloon popped out of me. 

I excitedly told everyone, “Baby’s coming out!”

 They wheeled me out our room into the delivery room right away.  I felt the head of Baby Abe crowning.. I thought I couldn’t hold him in anymore.. but I tried to relax, as the doctors were still preparing, I had to be moved from my bed to the delivery bed and my husband, Ritche, was also getting into scrubs. I requested that I be more upright and not lying down.  Our OB was nowhere to be found but already gave instructions to her three resident OBs present in the room.  I already felt like pushing but was holding Baby Abe in.. I was so excited.. I called my husband.. “Daddy!” and told the nurse, “The cellphone!” Haha!  I didn’t want the nurse to miss taking Daddy Ritche’s picture catching Baby Abe.

Finally, it was only a matter of minutes before I told them I had to push Baby’s head out.  The doctors assured me and said they won’t hinder me from pushing.  His head came out and the doctor was wise enough to remind me not to push anymore because he slid out so easily! It’s a birth phenomenon they call the “Fetal Ejection Reflex.” Pushing would have made the baby fly out.. Haha! It was amazing to see my husband “catching” our son!  As with all our other children (except Therese who underwent emergency CS), he did the ceremonial cord cutting after the cord stopped pulsating.  Baby Abe had already pooped meconium but miraculously, he didn’t ingest any and his Apgar score was 9 out of 10.  Thank God!

I delivered the placenta within 5 minutes. And our OB, Dra. Bambalan, arrived moments after to check on me.  Everything looked good.  My blood pressure stayed normal all throughout. I had a 1 mm tear that didn’t need any stitching. 

They were amazed at how easy the birth was and how fresh I still looked even after giving birth.  We all laughed at how my primary concern was to get the cellphone to the nurse and how Baby Abe didn’t want to have the same birthday as Doc.  Everyone in the room was lighthearted and Dr. De Guzman exclaimed that this was one delivery she will never ever forget!

All in all, we stayed in the delivery room for 18 minutes then I was brought out to the Recovery Room for 4 hours to check on Baby Abe and me.  By the end of the recovery period, my BP was still stable, Baby Abe and I had skin to skin contact and he latched on the breast perfectly, but there was just one problem.  The nurse said that they’d have to put a catheter on me if I didn’t urinate soon. No way!  I gently pressed on my bladder and, sure enough, I was able to pee on my own.

The next 48 hours were critical for me and Baby Abe. I recently saw the diagnosis of my OB upon discharge.  It was Pre-eclampsia with Severe Features.  But, thank God, we never manifested any complications.  No headache, nausea, vomiting, seizure, swelling, convulsion, shortness of breath whatsoever.  My blood pressure never elevated all throughout.  Baby’s oxygen levels were stable.  I didn’t go into shock, stroke, had brain damage or any organ failure. I didn’t need any kind of pain medication.  

Within 48 hours of delivery, we went home to our family, carrying our 6thbundle of joy, our second boy, whom we named "Abraham Nickola."  So thankful to all our family, relatives, friends, and churchmates for keeping us in your thoughts and lifting us up in prayer.  I believe that Ritche’s grandmother, Lola Auring, was also looking down from Heaven and interceding for us, along with all the saints and angels. To God be all the glory, honor and praise!  He is a miracle-working God who faithfully keeps all His promises and grants us the desires of our hearts!

By: Chat Jandayan @chatjandayan

Most of the photos were taken by my husband and my mom.

This is why excellent childbirth education is a must, why planning for your birth and the unexpected challenges that can arise, is so important today, and is a major reason why I created my Love Your Birth course. It is a comprehensive online course that teaches women what they need to know about planning and carrying out the birth that they want in all settings - the hospital, birthing center or at home. It’s a course on how to have a holistic, healthy pregnancy for the body, mind, and soul - and is how I have guided thousands of women and their families in my midwifery practice for over 21 years.

It contains a rolodex of my favorite resources with over 200 of the best books, movies and supplies I use personally and professionally with my clients, family & friends. Even diving into a fraction of this list will have you feeling empowered and prepared for conception, pregnancy, postpartum and parenting...It includes resources on improving and even ensuring ensuring healthier pregnancy and birth outcomes than the status quo, and preventing and healing from birth trauma so prevalent in the modern world!  

Be prepared to do some research on your own, but knowledge restores your power. I also help you prepare your mindset for such a task, to debunk myths, and to reframe any current ideas or conditioning about pregnancy and birth that can use a change in perspective or that are simply incorrect and do serve you. After finishing the course, the idea is that you are now able to create and have the healthy, beautiful and empowering pregnancy and birth that you want - so you can ROCK your birth, however it unfolds!

It’s wonderful alone, a great refresher or adjunct to any other course!

Should I Have an Ultrasound?

If you’re worried about ultrasound safety, good for you! You should be. The use of ultrasound in pregnancy has become almost a given. Most women in the US and Canada experience at least one ultrasound during pregnancy. Some experience several. There are certainly appropriate situations for the use of ultrasound, but a healthy pregnancy isn’t one of them.

If, after weighing the pros and cons of an ultrasound, you decide to have one, that’s entirely within your right. What’s important here is to make an informed decision rather than just exposing you and your baby to high-frequency sound waves as a matter of practice.

Is Ultrasound Necessary?

The answer to this question really differs from person-to-person and even situation-to-situation. When a health care provider recommends ultrasound to a pregnant woman, the FDA recommends that mom speaks with them to understand why the ultrasound is needed, what information will be obtained, how the information will be used, and any potential risks.

Medicine is big business. There is significant financial incentive for obstetricians to recommend ultrasounds to their patients, as they can bill many hundreds of dollars to insurance companies for each use. According to the Center for Disease Control (CDC), over-use of technology is one of the major reasons for the rise in healthcare costs.

More and more modern obstetricians have been trained to use ultrasound in place of hands-on skills to evaluate the health of the pregnancy. They use it to evaluate fetal growth and position in the third trimester, which can often be assessed by hands-on examination. They also use it to date pregnancies, which can typically be done with a little detective work.

Ultrasound is often used to determine whether a baby will be too large to be birthed naturally via the birth canal. However, ultrasound has been shown to be an inaccurate measure of birth weight. Further, our pelvic bones are joined together with ligaments that allow the pelvis to widen enough for birth to safely take place - especially when supported in upright and asymmetrical mobile positioning. This is true in almost every case, even when the mother is especially small or the baby especially large.

There are some situations in which an ultrasound is warranted. For example, bleeding in pregnancy or a serious abnormality that requires immediate or high risk hospital care. Or if mom has very irregular or absent cycles during breastfeeding, providing no real guideline for gestational age. Sometimes, if mom has a lot of anxiety about the health of her pregnancy and baby, a normal ultrasound mid pregnancy can provide some reassurance - while still not a guarantee.

The American Institute of Ultrasound in Medicine advocates for use of ultrasound solely for medical purposes, and never for things like keepsake images. And the American College of Nurse-Midwives’ position is that “Ultrasound should only be used when medically indicated.”

What Do We Know About Ultrasound Safety?

Ultrasound waves have the potential to produce biological effects on the body. They can heat bodily tissue, as well as produce small pockets of gas in bodily fluids or tissues (known as cavitation). The long-term consequences of these effects are still unknown.

Dr Sarah Buckley provides an extensive article in which she weighs ultrasound safety. In it she says,

“If there is bleeding in early pregnancy, for example, ultrasound may predict whether miscarriage is inevitable. Later in pregnancy, ultrasound can be used when a baby is not growing, or when a breech baby or twins are suspected. In these cases, the information gained from ultrasound may be very useful in decision-making for the woman and her carers. However the use of routine prenatal ultrasound (RPU) is more controversial, as this involves scanning all pregnant women in the hope of improving the outcome for some mothers and babies.”

Dr Buckley goes on to say,

“Studies on humans exposed to ultrasound have shown that possible adverse effects include premature ovulation, preterm labour or miscarriage, low birth weight, poorer condition at birth, perinatal death, dyslexia, delayed speech development, and less right-handedness.”

Despite its rampant use, there has not been sufficient testing for ultrasound safety - especially concerning routine use in healthy pregnancy. In fact, there has been very little testing at all since the 1980s even though the FDA allowed exposure limits to increase by 8 fold in 1992.

It’s important to acknowledge here that technology is often assumed safe until proven otherwise. Just a couple generations back, it was general practice to x-ray pregnant mothers. Sounds crazy now that we know more about the dangers of x-rays to the developing fetus, but back then it made perfect sense.

As Dr Kelly Brogan states, “Multiple Cochrane reviews have demonstrated a lack of perinatal mortality benefit for routine ultrasound in a normal pregnancy, and an increased risk of cesarean section with third trimester screening. A review of outcomes literature condemns ultrasound when used for dating, second trimester organ scan, biophysical profile, amniotic fluid assessment, and Doppler velocity in high and low risk pregnancies.”

While our reasons for using ultrasound are typically focused on healthy pregnancies and healthy babies, there has been virtually no proof that more ultrasounds in a population equate with better health. What’s worse is that there are concerns about their possible link to the alarming increase in autism. In addition, false positives of congenital malformations are not unusual. Sadly, this has lead to more invasive testing and abortions misunderstood to be medically necessary when there is nothing actually wrong. At the very least, this puts undue stress on momma, partner and baby.

In my opinion, technology has put distance between mommas and care providers. In situations where a midwife historically would take a literal hands-on approach to mom and baby’s health, technology now allows for a disconnect where mom is sometimes never touched by her birthing support team. My belief is that this impersonal approach can do just as much harm as the technology can.

The over-use of ultrasound also undermines a woman’s trust in her healthy body’s ability to grow and birth her healthy baby, as modern day families are putting more and more trust in technology over themselves.

Alternatives to Ultrasound

We do not fully understand the effect of directing loud sound waves at baby so frequently, but it does alter DNA in the test tube and there is strong evidence to show that any damage done is cumulative. So, if you must have an ultrasound, keep it as brief as possible and limited to as few as possible. If all is well and you know your cycles or date of conception, but you really want one, do it mid pregnancy…and of course, make sure to request a keepsake picture of your baby.

A doppler is an ultrasound device that can detect fetal heartbeat as early as 10-12 weeks, depending on the device, the location of baby, and position of mom’s uterus. It is used for each prenatal visit in many obstetrical care offices and clinics. If you want to minimize ultrasound exposure, ask for the fetoscope.

A fetoscope, which is similar to a stethoscope and works to amplify baby’s heartbeat, can be used in place of ultrasound or doppler after around 20 weeks gestational age to listen to the fetal heartbeat. It can also help assess baby’s position in later pregnancy.

When baby starts to move regularly, especially in the third trimester, I teach fetal movement awareness and kick counts. Basically, babies sleep a lot, especially when you are busy running around; but they tend to get up and become active after you eat and when your’e resting. Become aware of when and how often your baby is most active and take notice of your baby’s typical daily patterns of movement. An active baby, moving as much as usual, is a sign of fetal health and well-being. If you did not feel your baby move as much usual on a given day, eat food that has previously stimulated lots of fetal activity - usually carbohydrates like a peanut butter and jelly whole grain sandwich or cereal and nut milk - plus have two glasses of orange juice and a cup of coffee; recline in 30 - 40 minutes and count at least 10 separate kicks, body shifts, punches in the hour. Most babies will produce more than that in a few minutes, but if you are not feeling 10 separate moves in that hour, call your provider.

For most of history we did not know we were having a boy or a girl until the birth of our baby. There is something special about the surprise. But for those wanting to know the sex of their baby, blood tests are now available and are actually more accurate than ultrasound for this purpose.

Your Choice

Medical interventions like ultrasound often play into our fears and turn us away from our intuition. We have come to have less trust in the process and believe that we need to rely on technology to assure us that our babies are safe. As mommas, we have thousands of years of the birthing wisdom of our elders that we carry in our DNA. Is that less reliable than a relatively new, under-tested technology when all is well?

Midwives typically use touch and hand skills in place of technology like ultrasound. As a wholistic and integrative midwife that specializes in healthy pregnancy, I always give the option for ultrasound, and discuss the pros and cons with each family in my care. Some opt out of all unless there is an issue or complication when the benefits outweigh the potential risks of sonogram. Some do want one to confirm they have a baby in the uterus with a heart beat before it is too early to tell in the office, and a basic scan between 18 -22 weeks. For those birthing at home, some want just this mid-pregnancy ultrasound to check baby’s anatomy and that the placenta is in the right place, so they are reassured there is nothing detected that warrants birth in higher risk hospital setting.

As midwives, we do not fix what is not broken. We instill trust in the pregnancy and birth process, and have confidence in a mom’s ability to do it.

Learn more about how you can date your pregnancy,  as well as have a holistically healthy journey and birth with confidence.

RhoGam Shot in Pregnancy

Risks and Benefits of RhoGAM

Many expecting parents have questions about whether or not to get the Rh immune globulin (RhoGAM) shot if the momma to-be is Rh-negative. This applies to a small number of women, but it is extremely important for them to be armed with all the information prior to making a decision.

If you are among the roughly 10 - 15% of people who are Rh negative, your pregnancy could be affected if your baby is Rh positive.  In this situation, obstetric providers often recommend RhoGAM.

However, it’s not always that simple. If you’re not sure you have all the information for an informed decision, you’re in the right place. Below are some frequently asked questions and points to consider.

What is the Rh factor?

The Rh factor is a protein that can be found on the surface of red blood cells. If your blood cells have this protein, you are Rh positive. If they do not have this protein, you are Rh negative. This is the negative or positive after your blood type: A, B, O or AB. It is simply about different normal variations in red blood cells. For example, you can be A positive or O negative. The negative or positive is your Rh factor. A pregnant woman will get a blood type, Rh and antibody screen as part of the routine prenatal blood tests; if she is Rh-negative, her antibody response will get tested several times as indicated throughout the pregnancy to check for Rh sensitization.

What is Rh incompatibility and sensitization?

Rh incompatibility is when the blood of a fetus is Rh-positive but the momma’s is Rh-negative. In this situation, if baby’s blood gets into mom’s bloodstream, the mother creates a defense system against the different type of blood; it is perceived as foreign by her body, even though it belongs to her baby. She will react against it by making anti-Rh antibodies. When a pregnant mother makes antibodies against the Rh factor on her baby’s red blood cells, it is called sensitization. Once a mom is sensitized, it stays with her forever.

This rarely causes complications in a first pregnancy, as the primary immune response takes time to develop and initially produces IgM antibodies that are too large to cross the placenta. However, it could be dangerous in future pregnancies for the fetus or newborn baby, when the secondary immune response is more rapid and the body has made smaller IgG antibodies that easily cross the placenta. Once these antibodies can cross the placenta, they try to destroy the fetus’s red blood cells.

How can Rh problems affect the fetus during subsequent pregnancies?  

Rh sensitization can lead to a wide variety of mild to serious health issues in a fetus or newborn of the next pregnancy. The main concern is a severe type of anemia in the fetus, in which red blood cells are destroyed faster than baby can replace them. Red blood cells carry oxygen to all parts of the body. Without sufficient red blood cells, the fetus will not get enough oxygen, and this can result in hemolytic disease of the fetus and newborn causing jaundice, brain damage, heart failure and death.

How can my fetus’s blood get into my bloodstream?

During healthy pregnancy, a mom and her fetus usually do not share blood, thanks to the placenta that keeps the fetal and maternal blood circulation separate. But sometimes a small amount of blood from the fetus can mix with the mother’s blood. Typically, there is no mixing sufficient enough to risk sensitization unless there is are complications like miscarriage, placental abruption or previa, abdominal trauma, or an invasive medical/surgical procedure like chorionic villus sampling or amniocentesis, abdominal surgery and even ultrasound. 

Sensitization is usually associated with a rapid and large volume of fetal-maternal blood mixing. The most common time for Rh-positive fetal red blood cells to enter mother’s bloodstream, is during childbirth, though it can occur at other points during pregnancy - mainly in the third trimester.

Traumatic and difficult births with a high level of invasive procedures increase the likelihood for baby’s blood to mix with mom’s. So can certain routine interventions including use of the synthetic drug Pitocin to induce or augment labor, local or regional anesthesia, forced directed pushing, clamping the umbilical cord too early, pulling on the cord and putting pressure on the fundus to hasten delivery of the placenta.

A gentle birth process with minimal intervention and time allowance for the placenta to separate provides a reduced risk of significant mixing of blood between mother and baby.

While not a guarantee, planning for a natural undisturbed physiologic pregnancy and birth may certainly help prevent the mixing of fetal and maternal blood that leads to sensitization and hemolytic disease.

Can you tell if the baby is Rh-positive?

There is a new noninvasive blood test, which can detect fetal blood type using a blood sample of the pregnant mom. It is said to be highly accurate, almost as reliable as the conventional test, that uses a blood sample of the newborn after birth. It is almost, but not 100% accurate; and it is not available everywhere or covered by all insurances.

I recommend dad getting his blood type and Rh factor tested. If the father is Rh-positive and the mother is Rh-negative, there is about a 75% chance baby is Rh-positive, and providers will probably recommend RhoGAM. But if both parents are Rh-negative, baby will also be Rh-negative; in that case, there is no risk of Rh sensitization, and no need for RhoGAM.

What is RhoGAM?

RhoGAM is a drug made from human blood plasma, that prevents the mother from making antibodies against the positive Rh factor in baby’s blood. It is given via intramuscular injection, to prevent the immune response of sensitization against baby’s Rh positive blood, and subsequent hemolytic disease of the fetus or newborn in future pregnancies.

 
What are the benefits of RhoGAM?

RhoGAM’s effectiveness has been demonstrated in multiple studies around the globe. According to Dr. Murray Enkin et.al of A Guide To Effective Care in Pregnancy and Childbirth , one of the widely respected and authoritative founders of evidence based care, RhoGAM given after birth reduces the rate of hemolytic disease from 15% down to 1.6%.  RhoGAM administration prenatally in the third trimester has been shown in studies to further decrease the incidence to 0.06%.

The administration of RhoGAM medication to Rh-negative mothers is thought to be a major achievement of modern obstetrics by many in the medical profession. Before RhoGam’s introduction into routine practice in the 1970s, hemolytic disease of the newborn was a major cause of serious illness, death and long term disability in babies.

RhoGAM does not typically benefit firstborn babies unless the mom who is Rh negative has previously experienced a reaction to a mismatched blood transfusion, an abortion, miscarriage or ectopic pregnancy untreated with RhoGam.  

When is RhoGAM recommended, and why?

For women who are Rh-negative, health care providers routinely recommend a shot of RhoGAM around 28 weeks of pregnancy and then again within 72 hours after birth, in order to protect the baby of a subsequent pregnancy.

Providers must decide about the RhoGAM shot and its dose based on how likely it is for the baby to have Rh-positive blood, as well as how likely it is for the baby and mother’s blood to significantly mix during pregnancy and birth.

Is there controversy around RhoGAM?

This standard approach is not without its critics, especially regarding its routine use during pregnancy, in which only about 1.5% of Rh negative moms with Rh positive fetuses develop antibodies and become sensitized against the baby’s positive Rh factor. Risk of sensitization is significantly higher after birth. Administration of RhoGAM postpartum is much less controversial, where benefits of the medication more clearly outweigh potential risks.

“The problem with routine prescription of prenatal RhoGAM is that many babies who are Rh negative like their mothers will be exposed to the drug, and there has been no systematic study of the long term effects of this product in babies.” - Ina May Gaskin

 “RhIG is not given for the direct benefit of the recipient or even her current fetus. The only beneficiary will be an RhD-positive fetus during a subsequent pregnancy (although the woman would also benefit in the event of a wrongly typed transfusion during the time of birth). Furthermore, prenatal prophylaxis unnecessarily exposes the 35% of fetuses who are RhD-negative to RhIG. These babies are at no risk of RhD sensitization. RhIG is completely unnecessary when a baby is the last child in the family. In the absence of clear answers to these pressing questions, the routine use of RhIG assumes that the birth process for RhD-negative women is inherently flawed.” - Anne Frye

Reliable research and meta analysis of the studies on benefit and harm of routine use of RhoGam in pregnancy are still limited, especially as it relates to who, when and which dose is needed, as well as its cost effectiveness.

Some argue that there may be other factors that contributed to the marked decline in severity and prevalence of perinatal morbidity and mortality associated with Rh incompatibility and sensitization, and medicating healthy pregnant women undermines those who trust the inherent wisdom in the natural process of childbearing. That being said, the issue remains an issue which, still today, impacts babies of pregnant women who are Rh negative.

What are the risks of RhoGAM?

Despite excellent results, the medication retains an FDA Pregnancy Category C: “Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.”

The known possible side-effects to RhoGAM include local swelling inflammation at the site, skin rash, body aches and sometimes hives. Infection from the blood product of modern preparation is rare, but still a possibility.

Expecting mommas should also keep in mind that standard RhoGAM preparation in many countries contains the mercury compound known as thimerosal, which has a litany of health risks.  However, pregnant mommas can request the use the mercury-free RhoGAM, if it is available where they live. In the United States, RhoGam is said to be mercury-free, although it may still contain traces.

So, is the RhoGAM shot absolutely necessary during pregnancy? 

This is a hard question to answer for each individual person, on a blog.  Although much of the research is compelling, it is dated, was largely funded by the pharmaceutical companies and it is not without bias, flaws and some conflicting conclusions. For an eye opening text analysis of the data though 2001 and guidance from a traditional midwifery perspective, check out “Anti-D in Midwifery: Panacea or Paradox? 2nd Edition”, by Sara Wickham.

As always, pregnant mommas should empower themselves with knowledge and talk with their provider to fully understand the benefits and risks of all medications unique to their situation. 

I encourage my clients to take great care of themselves, be well-educated on their health-related issues, and to be in tune with their bodies.  While I aspire to provide evidence based information about medications and recommended treatments, I also know that there is much we do not know, and I am wary of routine medical and surgical interventions in a healthy natural process Too often they are widely used before sufficiently evaluated or harm has been identified. I feel informed and empowered moms are best able to make decisions for themselves.

Understanding that the vast majority of woman who are Rh-negative will not become sensitized during pregnancy, as it is rare that mixing happens until birth, is an important consideration when balancing the risks and benefits of using a pharmaceutical therapy while pregnant.

If you are Rh-negative and baby’s dad is Rh-negative, no, you do not need the shot. If baby’s dad is Rh-positive, and you choose to refuse the shot in pregnancy, you may still need it later if you suspect bleeding or another reason for sensitization, or if you change your mind. If you have done your research, you believe you are low-risk, and you do not feel comfortable with the shot while pregnant, do not let a provider pressure you. 

According to those who advocate a gentle birth process with minimal intervention and time allowance for the placenta to separate, there is usually less risk of significant mixing of blood between mother and baby. But mixing and sensitization can certainly still occur during healthy natural birthing. Traumatic, highly interventive and difficult births increase the likelihood for fetomaternal hemorrhage and sensitization. So can certain routine interventions including ultrasound, use of the synthetic drug Pitocin to induce or augment labor, local or regional anesthesia, forced directed pushing, clamping the umbilical cord too early, pulling on the cord and putting pressure on the fundus to hasten delivery of the placenta - anything that possibly disrupts the delicate physiology of placental separation or cause tiny fetal blood vessels to rupture and bleed. Planning for a natural undisturbed physiologic birth may certainly help prevent the mixing of fetal and maternal blood that leads to sensitization and hemolytic disease.

If you are feeling overwhelmed, or do not even know what questions to ask, I can help you! Check out my number one international best selling book Natural Birth Secrets and my online course - an online version of how I have helped thousands in my local practice. Both resources are unique, but each provide an in depth, one-of-a-kind holistic approach created by me, a seasoned nurse midwife of over two decades, who has seen everything!

If you need more personalized guidance and help navigating these and other tough decisions, you can arrange a consultation with me, bundled with my online course. Or I invite you to choose from a variety of services I offer to the global community. Rock Your Journey To Motherhood is my most comprehensive, supportive offering for pregnant mommas anywhere in the world.  You will have personal access and guidance from me as we co-create your joyful journey from pregnancy to postpartum healthy bliss.