Red Scare

Friday night Julia came home early. This wasn’t a big deal since it was a slow day for her and we thought we’d go shopping. After Julia got home, she went upstairs to change her shoes before we went walking around shopping. A few minutes later, she comes down and tells me to call the doctor.

After a brief conversation, the nurse tells us to head to the ER where they will be expecting us. During pregnancy (especially your first) any bleeding can be a bad sign. We’ve know too many people who have miscarried, which is why we wanted to wait to announce our pregnancy. but then we realized that if anything goes wrong, we’ll need our friends and family to support us.

We had called the doctor just after 4:30 and were at the ER by 5pm. What came next were 5 hours of nerves and fear and worry. Worried about a miscarriage can be very draining. Especially when it takes so long to find out. The only way to know is to take another sonogram. The sonogram we had two days earlier only took about 15 minutes. This one took almost an hour. And that was after waiting 2 hours doing routine blood work and examinations. So it wasn’t until about 8pm before we saw the tiny heartbeat again. It was nerve racking, sitting there, watching the screen, hoping to see something positive. The nurse isn’t allowed to say anything. She just measures and scans and records data for the doctor’s use. She doesn’t even look for the baby at first. But once we saw the tiny flicker of light that is the baby’s heartbeat, the worry was lifted.

It turns out, they don’t know why Julia had some bleeding (spotting is normal) but we did learn of another risk. Julia is Rh-negative. It turns out that an Rh-negative mother can make antibodies (part of her immune system’s response to invaders) against Rh-positive blood cells, even against those of her own baby. This is called Rh sensitization. These antibodies have the potential to cross the placenta and attack the fetus’ red blood cells, which in turn can cause low blood count (anemia), congestive heart failure, and even fetal death. This is called hemolytic disease.

Now if the mother and father are both Rh-negative, there is no risk since the baby will be Rh-negative, too. But when the father is Rh-positive, then the baby could go either way. Hence the risk. Now, blood type is based on particular molecules (called antigens) that sit on the surface of red blood cells. People either have A antigens (type A blood), B antigens (type B), both (type AB) or neither (type O) on their red blood cells. When it comes to Rh factor, some people have the antigen (Rh-positive) and some people don’t (Rh-negative.) In other words, your blood type identifies which antigens you have from each group.

An Rh-negative mother will develop antibodies against Rh-positive blood cells (become sensitized) only if fetal blood crosses the placenta and enters her bloodstream. Her immune system then “sees” these cells, identifies them as foreign, and mounts an immune response. The injection of Rh immunoglobulin blocks the mother’s immune system from seeing the fetal cells, if they do happen to get into her bloodstream, so she will not become sensitized and make antibodies. Rhogram is a type of Rh immunoglobulin.

Since Julia’s blood type is O-negative, she is also Rh-negative. But I believe I’m O-positive which means I’m Rh-positive. Which means our baby is Rh-positive, too. Thus our baby is at risk. But we didn’t know this Friday night. So the doctors did what doctors do. They ran more tests. Actually, they developed a Rhogam shot for Julia. To do this, they use a sample of Julia’s blood to make a specific treatment to match Julia’s blood. [note: this part was updated thanks to commenter Danielle who pointed out my error.]