What is Rhogam?


Raise your hand if you know a baby who died of erythroblastosis fetalis.

Not too long ago, there would have been a lot of raised hands. Before 1968, approximately 10,000 babies died each year of erythroblastosis fetalis, also known as hemolytic disease of the newborn (HDN). Then Rhogam was introduced.

It is fashionable in homebirth midwifery circles to determine what the scientific evidence shows and then reflexively recommend the opposite. Therefore, many homebirth midwives and advocates are now suggesting that women forgo Rhogam without having any understanding of what Rhogam is, what it does, and the nature, incidence and mortality rate of the disease that it prevents.

What is hemolytic disease of the newborn (HDN) It is a relatively common condition in which a mother produces antibodies that cross the placenta and destroy the baby’s red blood cells. The baby becomes profoundly anemic, develops severe jaundice and heart failure. The mortality rate used to be approximately 50%.

Why would a mother make antibodies to her baby’s blood cells? It happens when the mother and baby’s blood type differ in an important way. Usually the difference is that the baby is Rh+ (has the RhoD antigen on its red cells) and the mother is Rh-. The baby of an Rh- mother will be Rh+ only if its father is also Rh+, but not all babies of Rh+ fathers will be Rh+.

How does the mother make antibodies against the baby’s blood if the placenta prevents the mother’s blood from mixing with the baby’s blood? The answer is there are often small leaks of fetal blood into the maternal circulation, particularly at the time of birth. They are not large enough to have any impact on the baby, but only a small amount of Rh+ fetal red cells are needed to produce an immune response in the mother.

When such a response develops, the results are often devastating to the baby, not in the current pregnancy (especially if the sensitization occurs at delivery) but in subsequent pregnancies. What happens in future pregnancies?

… [M]aternal anti-D antibodies cross the placenta into fetal circulation and attach to Rh antigen on fetal RBCs … These antibody-coated RBCs are [destroyed] by lysosomal enzymes released by macrophages and natural killer lymphocytes …

… Tissue hypoxia develops as fetal anemia becomes severe… Hydrops fetalis … starts as fetal ascites and evolves into pleural effusions and generalized edema…

… Destruction of RBCs releases heme that is converted to unconjugated bilirubin. Hyperbilirubinemia becomes apparent only in the delivered newborn because the placenta effectively metabolizes bilirubin…

This is an unmitigated disaster for the baby:

Before any interventions were available, the perinatal mortality rate was 50%. Wallerstein introduced exchange transfusion in 1945 and reduced the perinatal mortality rate to 25%. Later, Chown suggested the early delivery of those severely affected nonhydropic fetuses by 34 weeks’ gestation followed by prompt exchange transfusion helped improve survival. The introduction of intraperitoneal transfusion by William Liley in 1963 and intravascular transfusion (IVT) by Rodeck in 1981 reduced the perinatal morbidity and the mortality rate was further reduced to the current rate of 16%.

Treatment for HDN has clearly improved dramatically, but a death rate of 16% is still extraordinarily high. Imagine if you could prevent your baby from ever getting HDN in the first place, and all it took was two small injections. Since 1968, when Rhogam was introduced, there has been no need to imagine.

Rhogam is human antibody to the Rh antigen. If any fetal blood cells escape into the maternal circulation, Rhogam binds to the Rh antigen and makes it “invisible” to the mother’s immune system. One dose at 28 weeks, and another at the time of delivery is enough to prevent the mother becoming sensitized. Additional injections are given whenever there is any other chance of fetal cells leaking into the maternal circulation, such as at the time of miscarriage, ectopic pregnancy, or episodes of significant vaginal bleeding.

Rhogam has dramatically reduced the incidence of HDN. The incidence is still not zero, however, because there are other less common antigens that can also cause sensitization.

What are the side effects of Rhogam? Sometimes there is a localized skin reaction and occasionally, in people who are sensitive to blood products, there can be an allergic reaction to Rhogam itself.

So why are homebirth midwives suggesting that women refuse Rhogam? Because, as usual, they have no idea what they are talking about.

They are motivated by their insistence that nature is perfect and technology is harmful. First, they insist, bizarrely, that the no fetal blood cells will ever find their way into the maternal circulation unless “interventions” occur during birth. Ignorant of history, they are apparently unaware that HDN was first reported by a French midwife in 1609.

Ignorant of the scientific facts, as always, they are unaware of the Kleihauer-Betke test, a that allows us to quantify exactly how many fetal cells are in the maternal circulation at any given time. That’s how we KNOW that small quantities of fetal cells often slip into the maternal circulation.

Then there is their pathological fear of technology. They are absolutely sure that Rhogam might cause some damage of some kind to babies who never needed it the first place since they had a perfect placenta. They offer no scientific facts to support this claim, since there is no evidence that it is true.

What about the benefits? They don’t appear to understand that nearly 10,000 babies are saved from death by Rhogam each and every year. They have apparently forgotten, if they ever knew, about hemolytic disease of the newborn.

This is yet another example of how modern obstetrics is often stymied by its own success. A dread infant killer is easily prevented by a simple injection, so easily that homebirth midwives have no idea that the risk of death is very real and still exists.

108 Responses to “What is Rhogam?”

  1. CurlyQueue
    February 28, 2020 at 2:57 pm #

    I know this is an old post, but stumbled upon it. I absolutely can’t STAND this whole movement of pregnant, RH- women declining Rhogam!!!

    My first pregnancy ended in a stillbirth (no apparent reason). I received Rhogam within the prescribed time frame. Four months later, I was pregnant again. After the 8 week general blood work testing, I got a call from my OB telling my I was RH Sensitized. Had no idea what it meant but she referred me to a MFM. Ok, so because of my first pregnancy lost, I was already on a rollercoaster of emotions with my 2nd pregnancy. Then adding all this? The constant fear, testing, titre checks, MCAs, possibility of needing IUTs….etc. Luckily I never needed an IUT. But it was awful. Then to add on top of that, went into preterm labor at 34 weeks and needed a c-section (face presentation). My baby boy was fairly healthy but had to be in NICU for two weeks for Iso related jaundice and feeding issues. Fast forward for years to my 3rd pregnancy (took me that long to decide I was ready to go through what I knew would be a high risk, rollercoaster of a pregnancy). Early blood work revealed that not only did I have Anti-D, but also developed Anti-(big)C and -JKb. Cause apparently once you make one antibody, you’re more likely to make others. Another crazy pregnancy with additional complications. We made it to 35 weeks. But once my titres started to increase and knowing MCAs become less reliable after 35 weeks, my MFM called my OB and said, “Time to deliver now.” My son spend 1 week in Nicu. Oddly, he was RH- but coombs positive…he had the JKb antigen so still had iso related issues as well as needed some breathing assistance for the first 3 days.

    I’m on a FB group for Iso moms-to-be. Since it is so very uncommon these days, there’s a lot of OBs that don’t know much about it or follow the standard of care for treating an RH sensitized pregnancy. So we do our best to arm these mamas with knowledge and encouragement so they can advocate for their care and sometimes their babies lives if they have a particularly obtuse OB who won’t listen or read the literature out there on the standard of care. Can’t tell you how many mamas we’ve had whose baby didn’t make it. It drives us to insanity that there’s an actual movement out there where women are declining RHogam. They don’t won’t to walk in our shoes. But there ignorant decisions will ensure that many of them will.

  2. Kathrynne Willhoite
    May 7, 2019 at 1:40 pm #

    I’ve heard the statistic that 10,000 babies died of HDN prior to treatments such as the Rhogam injection and fetal blood transfusions a couple of times, but I’ve never seen a reference for it. I would be really interested to see the source of this statistic if you have it. Thank you!

  3. Kathrynne Willhoite
    May 7, 2019 at 1:40 pm #

    I’ve heard the statistic that 10,000 babies died of HDN prior to treatments such as the Rhogam injection and fetal blood transfusions a couple of times, but I’ve never seen a reference for it. I would be really interested to see the source of this statistic if you have it. Thank you!

  4. asnowrose
    May 29, 2018 at 12:13 am #

    I have a question. I see people stating that 2 negatives can’t have a positive, so shouldn’t that be the same so that 2 positives can’t have a negative? I am B+ and my husband is B+. My daughter was born in a military hospital and we were told she was B+ (it is on her newborn health record). Now 22 years later she is being told by her OBGYN that she is B-. My other two children were also B+. Rhogam is contraindicated for Rh+. Her husband is O+. I don’t want her to have the shot is she is Rh+ because of the side effects it causes in Rh+ people. Can anyone explain how she could have changed her Rh value? Thank you

    • swbarnes2
      May 29, 2018 at 3:05 am #

      so shouldn’t that be the same so that 2 positives can’t have a negative?


    • MaineJen
      May 29, 2018 at 9:01 am #

      Rh positive is a dominant trait; Rh negative is recessive. We have 2 copies of each gene, one from mom and one from dad. If you have only one copy of the Rh+ gene, you will be Rh+. You could still be a carrier of Rh-. If you and your husband are both carriers of Rh-, your daughter could very easily be Rh-, and if her husband is Rh+, she should indeed very much be getting the rhogam.

      Science: it works.

      • asnowrose
        May 29, 2018 at 2:26 pm #

        Thank you, I understand the science, I just want to know how did her Rh factor change from + to -. It now looks like she is Weak D positive and the labs are no longer testing for it unless the blood is being donated. They are lumping all pregnant women with weak d as Rh negative because they don’t want to do further tests, even though if weak d are donating blood they are Rh positive. Sounds like another way to charge more money. Just take the shot even if you don’t need it, so what if it causes hemolytic problems for the mother. 🙁

        • MaineJen
          May 29, 2018 at 3:06 pm #

          As someone who actually performs said testing, I can tell you that it’s most certainly not “for no reason.” People with weak+ results on both forward and reverse abo/rh testing make me twitchy. The way I was trained, yes even a “weak+ or equivocal” result is considered positive. But the levels of antibody in circulation can and do fluctuate, which can complicate testing.

          Another complication are abo and rh subgroups, which are uncommon but can result in equivocal or weak positive response to standard lab reagents. Not every lab or blood bank is equipped to do subgroup testing.

          Recommendations are usually made to promote the most conservative option…if your daughter was donating blood, she would be considered Rh+ even with a weak/equivocal result, because it’s dangerous to give Rh+ blood products to someone who’s Rh-. But they may be considering her Rh- for the purposes of prenatal testing, because it would be dangerous for future pregnancies if she is indeed Rh- and has an Rh+ baby.

          I assure you, Scrooge McDuck is not sitting back here in a lab coat, rubbing his feathers together in glee as another woman is administered Rhogam.

          • May 29, 2018 at 3:31 pm #

            Ah. I’m wondering if that’s how I can be positive, though both parents are negative (and yes, they are my biological parents); Mom said a doctor explained to her how it was possible, but she didn’t remember his explanation. (Mom’s health literacy is terrible.) Perhaps Mom is a weak positive.

          • swbarnes2
            May 29, 2018 at 3:36 pm #

            First rule of biology…there are always exceptions to rules.

          • MaineJen
            May 29, 2018 at 3:36 pm #

            Second rule of biology: bodies are weird.

          • asnowrose
            May 29, 2018 at 3:50 pm #

            Thank you! You have given 10X more info than the OBGYN did today. Our plan forward is to wait until the baby is born, see what her Rh factor is and see if my daughter has an anti-bodies. With that knowledge, we will then make a decision on the shot

    • FallsAngel
      June 6, 2018 at 10:45 am #


      Everyone gets two genes for blood type, one from each parent. Two negatives will make a negative; two positives will make a positive; and a negative and positive will make a positive. So two people, (who test positive) who both have a pos and a neg, can have a kid who is negative. This actually happened with my parents, twice! My brother went to give blood for the first time and found out he is A negative. My mom called the Red Cross and told them they had made a mistake b/c she and my dad are both A pos. They told her it is possible (and that the Red Cross seldom makes mistakes). Then I got my blood tested and found out I am A neg as well!

      For your daughter, I would suggest she get tested a second time. She should talk to her doctor about this. If she needs rho-gam and doesn’t get it, it could be very bad for her next baby.

      There is no explanation for why her blood type could have changed. One of the tests is wrong.

      ETA phrase in (parens)

  5. Lisa
    March 30, 2018 at 4:00 pm #

    I was not given antigen d injections. I am rh negative blood group. My GP failed to take blood test. Six months to my pregnancy got up one morning and thought I was going to miscarry. I went to my GP straght the way and he just told me to go ante natal clinic. Ante natal clinic sent me to hospital where I was a bed patient for a month and had my baby at seven months. Not once was it mentioned that I am rh negative and that is the reason for my complications. I don’t know if any of the medical staff noticed. I have three sisters(older than me) and they were talking about the injections they had when pregnant. That was a year ago. I am still trying to get my mind sorted out and thinking what to do next. I went to my GP (not the same one) and asked if it would be possible to confirm my blood group but request was denied. My son has all the usual symptons of rh disease. At the moment I am very angry because all this could have been avoided. We only get one life and I feel so let down by the medical profession and I carry enormous quilt for my son’s suffering trough out his life. He has been so scared…

  6. Joanna Cook
    February 9, 2018 at 9:32 am #

    I’ve never heard of a midwife who didn’t recommend Rhogam

  7. Annie Schimpff VerSteeg Ibclc
    January 18, 2018 at 11:59 am #

    I’m a classically trained midwife. I am NOT an RN. We were schooled extensively on the use of Rhogam and ALL other blood disorders before during and after pregnancy. This was a huge part of our training.
    Your words about midwives not knowing what they are doing is so last century.
    I challenge you to have this discussion with InaMay Gaskin or any other true midwife.
    We follow very strict protocols including regular screenings by labs and our back up physicians.
    We regularly do titers. If the mother titers go up we transfer them out of our care. They are no longer qualified for a homebirth.
    We take Rh- blood in the mother VERY seriously. We have Rhogam administered within 72 hours of delivery.
    Your words are insensitive, rude, and derogatory. I can only imagine your assumptions about poverty, race and people who may chose a different life style from yours.
    Any midwife worth her salt would NEVER recommend not having Rhogam if she has given birth to an Rh+ baby. Never in a million years.
    We also recommend PKU screening.
    AND guess what, we think breastmilk is the best food for babies and if the supply is low or the baby is not gaining, we INVESTIGATE as to why. We pull in IBCLCs, we use formula when necessary.
    We treat every mother as an individual. Perhaps you could try that. Perhaps you could check your ego at the door and try listening. You’d be amazed at what you could learn.

    • MaineJen
      January 18, 2018 at 12:40 pm #

      “Any midwife worth her salt would NEVER recommend not having Rhogam if she has given birth to an Rh+ baby. Never in a million years.”

      I remain unconvinced. Until there is a firm set of practice standards for EVERY midwife to follow (CNMs and CPMs alike), we cannot assume that every midwife is following the testing and risking-out protocols you describe. Perhaps YOU could check YOUR ego at the door, and check out what some of your fellow midwives have been up to, and why a blog like this is necessary in the first place.

    • Amy Tuteur, MD
      January 18, 2018 at 2:20 pm #

      “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.

      In my own practice, my partners and I – like many other midwives – do not advise women to accept Rhogam prenatally unless there has been a traumatizing event.”

      Ina May Gaskin. Ina May’s Guide to Childbirth. Pages 199-201.

  8. Laura pisani
    October 20, 2017 at 12:54 am #

    I am a RH negative but refused to take RhoGAM until the blood type of my fetus was determined from amniotic fluid samples that had been taken. My child was RH negative as well, so I did not need RhoGAM. If genetic analysis is done for the pregnancy, this is a better alternative to prophylactically giving all pregnant RH negative women RhoGAM.

    • Box of Salt
      October 20, 2017 at 1:53 am #

      So . . . are you advocating all Rh-negative women get an amniocentesis to determine their fetus’s Rh factor instead of offering them a simple injection, or do you have some other way to obtain those fetal samples?

      • Thomas Marallo
        December 12, 2017 at 9:20 am #

        Risks of complications from amniocentesis, although low, are far greater than the extremely rare reaction to RhoGAM. Why would any thinking person undertake this risk to avoid a simple injection?

  9. Meaghan Bond
    August 31, 2015 at 8:52 pm #

    You might enjoy my blog, which tells the story of how Rh disease and RhoGAM work using cartoons: http://www.pathologystorybook.com/rh-disease-sweet-sweet-blood-cells-part-1/

  10. rick
    August 17, 2015 at 7:22 pm #

    people if your still around how is this one, My wife was Typed Rh-blood at Duke, she was given the RhoGam shot Years later my wife had her blood typed as being A at three different sources. what do you think is the child and mothers outcome year later. Mother has autoimmune and child has fibromyalgia. No other family member has these diseases.

    • Young CC Prof
      August 17, 2015 at 8:34 pm #

      ABO and Rh +/- are separate issues. A person can be A-positive or A-negative.

    • Maria Foster
      July 18, 2017 at 7:00 pm #

      hmm… 2 weeks after getting the Rhogam I start getting regular fevers and my labs are indiciating an autoimmune disorder. This is why I’m looking into side effects of rhogam

  11. Happy Student Midwife
    March 23, 2015 at 10:45 am #

    You are absolutely right Melissa!!!! It is not right to call CPMs lay midwives. Dr. Tuteur do not have enough sense to get out of the rain.! Student midwives know much more that Dr. Tuteur would ever know in her little brain!

    • Amy Tuteur, MD
      March 23, 2015 at 11:14 am #

      Sure you’re happy. You are so ignorant you actually think you’re smart.

  12. Luqman Khan
    February 4, 2015 at 1:06 am #

    After how much time mother will be safe?

  13. Luqman Khan
    February 4, 2015 at 1:05 am #

    Plz inform me about the life circle of Rh antibodies once sintasised. I mean what is life of Rh antibodies, after hours much time pregnancy will be safe if We didn’t give RhoGAM to Rh negative mother having positive baby in previous baby??
    Plz must reply

    • Young CC Prof
      February 4, 2015 at 1:12 am #

      OK, sensitization is permanent. It doesn’t go away. However, sometimes you get lucky and it doesn’t happen the first time. She should go to a doctor and get tested to see if she has antibodies.

  14. Ellen Mary
    December 24, 2014 at 3:44 am #

    YES! I really had to advocate for myself to get Rhogam post m/c & abo . . . I definitely insisted upon it.

  15. Kathleen Elisabeth
    July 13, 2014 at 6:47 am #

    To tar ALL ‘midwives’ with the same brush is rather ludicrous and ‘ignorant’ in itself. Whilst I agree 100% with Dr Tuteur’s informative explanation regarding RhoGAM, and its remarkable advantages in preventing hemolytic disease of the newborn, we must make it very clear that all ‘midwives’ are not created ‘equal’. Properly trained midwives and ultimately state licensed, as such, are first trained as and then registered nurses, who further train and prepare to sit state board examinations which license them as certified midwives. Such a person would totally understand the scientific concept of why it would be necessary for a Rh- mother to receive RhoGAM. There have, of course, since time began, always been women who have assisted at home births, both in third world and also westernized countries, who are medically untrained, who have little to no scientific knowledge, and who have historically called themselves and been known as ‘midwives’.

    • Trixie
      July 13, 2014 at 8:24 am #

      Are you a new reader? She uses “homebirth midwives” as shorthand for lay, DEM, and CPM midwives, to distinguish them from hospital-based CNMs and CMs who, as you say, have the proper training.

      • Kathleen Elisabeth
        July 13, 2014 at 9:46 am #

        Yes, I am. OK. Thanks

    • Happy Student Midwife
      March 23, 2015 at 10:41 am #

      Mrs. Trixi, You are absolutely wrong. I am a student CPM and we are STRONGLY encouraged to use RHoGAM. CPMs do have proper training in this area. Dr. Tuteur, being a doctor does not understand that midwives are first of all Biblical and second CPMs, are properly trained. I certainly do not agree with traditional midwives. But CPMs ARE properly trained to use RHoGAM. What Dr. Tuteur said is true but she should not look down on midwives just because she is a “doctor”

      • moto_librarian
        March 23, 2015 at 11:34 am #

        She doesn’t look down on midwives. Dr. Tuteur happily worked with CNMs and viewed them as excellent colleagues. Like the good doctor, I believe that CPMs are a pale imitation of real midwives.

      • An Actual Attorney
        March 23, 2015 at 8:27 pm #

        First, biblical? WTF does that mean?

        Second, how do plan to get this rhogam you are trained to use?

      • Daleth
        December 12, 2017 at 9:46 am #

        Dr. Tuteur doesn’t look down on midwives. She speaks very highly of CNMs. She looks down on Certified Pretend Midwives who couldn’t be bothered to go to nursing school for proper training.

      • December 12, 2017 at 11:29 am #

        Why the fuck should I trust someone who is a “Biblical” health provider first? They didn’t even advocate washing of hands. Their idea of ‘treatment’ for leprosy was to kill a chicken and swing its corpse around to sprinkle blood on people. If that’s your model of health care, you shouldn’t anywhere near real actual patients who need real actual health care.

        Lets put it this way. I have precisely zero actual medical training aside from a first aid and CPR course when I was a Girl Scout. I looked over the online courses and tests for CPMs. I could pass them with less than a week of study. Any “medical” certification that I can pass in less than a week isn’t worth the paper it’s printed on. If you want to be a midwife, go to nursing school.

  16. June 15, 2014 at 12:22 pm #

    Midwives are to obstetricians what LPN’s are to RN’s. They know just enough to get everyone in trouble if they stray outside their scope of practice.

  17. drhoob
    May 11, 2014 at 5:28 pm #

    It is the amount of IgG your body can produce, continuously and increasingly, after detecting the antigen. RhoGAM is one amount of IgG given once or twice, to neutralize any of the baby’s blood that may be circulating in your system. It does not increase in amount or duration as immune anti-d IgG will. It is out of you system in about a month. Ant-d IgG from your immune system increases in amount until the antigen is gone- and if you’re pregnant- it could be the duration of your pregnancy. If your anti-d levels are increasing, then inducing is an option that could be safer than waiting until they reach a devastating level.

  18. saramaimon
    May 11, 2014 at 5:25 pm #

    yes blood type and rh are routine in the US. Haley perhaps you can explain? also just wondering why you were seeing both a midwife and a dr? not that i have any problem with that, just wondering.

  19. saramaimon
    May 11, 2014 at 5:20 pm #

    great comment. i have a friend who is an activist on both these issues- autism and vaccine, and im sure she’d appreciate your comment. would you mind if i cut and paste it to her on facebook?

  20. rstikyfiner
    May 11, 2014 at 5:08 pm #


  21. stewart p flemming
    May 11, 2014 at 5:04 pm #

    Absolutely correct- when RhoGAM seems to have failed, it is because it was not given properly- lots of easily found research have backed this up as well (PubMEd/NCBI etc.)

  22. SilbKL
    May 11, 2014 at 5:01 pm #

    Just like MMR and dTAP and other vaccines these days- people think the problem doesn’t exist because they haven’t seen it. HUGE mistake to make.

  23. Penelope Shiraz, MD
    May 11, 2014 at 4:58 pm #

    RhoGAM is not prepared that way at all. RhoGAM (Rho (D) IgG antibodies) is made by the immune systems of women who are RH – but have been sensitized to the Rho (D) antigen and thus produce antibodies against it-it is filtered out and purified and sterilized and tested before ever getting to your Dr. It is impossible for your blood to make RhoGAM (Rho (D) IgG antibodies) if you have never been exposed to Rho (D) / Rh factor (i.e. Rh + blood). There is no way an immune system can produce antibodies that quickly either, unless it has already been exposed to the antigen before. It literally takes two or more weeks from the first exposure of the antigen to produce antibodies. So what you described is impossible.

  24. another ge
    May 11, 2014 at 4:40 pm #

    If she didn’t go through the trauma = no illness. The trauma, including the pychological aspect of it, is what caused her illness. If she had an epidural, then she would not have felt the pain that caused the trauma in the first place.

  25. Sheesh
    May 11, 2014 at 4:37 pm #

    Because those are logical options for everyone..

  26. Haley
    May 1, 2014 at 8:43 pm #

    Well I was enjoying this article until I got to the part about Midwives knowing “nothing as usual” which is where I stopped reading. My Midwife agreed that I take the Rhogam after my doctor suggested it, so not ALL MW’s are uninformed. She has also given me natural alternatives to small ailments that completely cleared up the issue where a GP would have prescribed unnecessary and potentially harmful drugs. This article went from interesting and factual to ridiculous generalization and overblown. As with all professionals, try to find someone who knows what they’re talking about and is educated in ALL methods (sounds like this skeptical OB is one of the close-minded and the kind I avoid like the plague).

    • Young CC Prof
      May 1, 2014 at 8:55 pm #

      Your midwife waited for the doctor to suggest it? She should be urging all women to be checked for Rh incompatibility.

      And the article doesn’t say that midwives know nothing, it says homebirth midwives know nothing. There are thousands of smart, well qualified midwives working in medical offices and hospitals, it’s only the ones who take on home births who lack knowledge and/or good judgement.

      • saramaimon
        May 11, 2014 at 5:10 pm #

        actually there are plenty of midwives who practice in hospitals alongside their homebirth practices. (although this is likely to dwindle after the most recent study).

        • Trixie
          May 11, 2014 at 11:00 pm #

          There are a few CNM practices that offer home birth and gave hospital privileges. I can’t imagine there’s more than a dozen or two practices in the whole country. I’d hardly call it “plenty.”

      • Erika
        July 10, 2014 at 8:53 pm #

        Guess what? Doctors should be more aware of Rh incompatibility as well. I had a miscarriage one year ago. Even though the ER doctor did a blood test and was aware that I was Rh negative, he ‘forgot’ to give me a Rhogam shot. Fortunately, I caught it and squeaked back into the ER before the recommended 72 hours lapsed. The nurse (RN) there had the nerve to tell me that some studies suggested I didn’t even need it (so not really a big deal). Seriously.

        My husband and I tried again after the miscarriage. Both our new midwife AND new OBGYN missed my Rh negative status… I had to fill them in once I realized they didn’t pick it up from bloodwork. I also had a light episode of bleeding around 21 weeks. The ER docs missed it too (in a different hospital)! When I knew they were going to release me, I requested a rhogam shot.

        Each time I’ve informed a doc of my Rh status they seem skeptical and demand proof…of which I respond, “could you please check my blood type in your lab work? Thanks.”

        • Elizabeth A
          July 10, 2014 at 9:15 pm #

          ER docs are often terrible at OB issues. Their training requires that they be more generalized, and they often just aren’t comfortable with pregnant patients. My observation was that they would kick me up to L&D as soon as they suspected I was pregnant, but different hospitals have different polices for handling OB cases in the ER. Some seem to try to keep patients out of L&D until the middle of the 2nd trimester. The results of this are very mixed.

          Last time I was pregnant, I had a lot of bleeding issues, and the hospitals I was at all began to insist on rechecking blood types at every admission. Because, I guess, they might have mistyped the lab results all those other times they ran a blood type on me, at previous admissions in the same pregnancy, when I miscarried, when I delivered my son, and when I was born myself. I guess they had some problem with misapplication of something and got twitchy.

          I periodically get pushback from asking for what seems like an innocuous drug from doctors I don’t know. (Is there some kind of black market for diflucan? Is someone, somewhere, getting dangerously high off of Rhogam? What do they think I’m going to do with a refill of heparin or neulasta, besides use as prescribed?) I think some of them are reflexively negative, either by nature or as a result of dealing with a lot of drug-seeking patients (especially in the ER). In all of these cases, once they confirm that I have the need I say I have, I wind up with the prescription.

          • Kathleen Elisabeth
            July 13, 2014 at 7:05 am #

            An ER doctor, attending a new patient, regardless of previous hospital admissions and records, as protocol will run new blood tests to check a myriad of potential concerns which are not necessarily obvious. Furthermore, they are trained for all medical emergencies and after the crucial phase and/ or during, will bring in a subspecialty referral to continue the specialized care of the patient.

      • Lisa Chantel Hill Wade
        November 16, 2017 at 10:31 am #

        That is not true, either.

    • Trixie
      May 1, 2014 at 9:04 pm #

      Haley, out of curiosity, is your midwife a CPM or a CNM?

    • Mishimoo
      May 1, 2014 at 9:12 pm #

      Natural does not mean safe. I hope you double-checked her alternatives with a reputable source.

    • saramaimon
      May 11, 2014 at 5:14 pm #

      “This article went from interesting and factual to ridiculous generalization and overblown.” yes haley that is pretty much par for the course for this blog. me too, i am rh neg and the homebirth midwives i consulted with during my own pregnancy- as well as have worked with in the past- all gave rhogam without fail.

    • thesouthway
      May 11, 2014 at 7:18 pm #

      I read through this article several times trying to find where Dr. Amy accused ALL midwives of being ignorant/uninformed about Rhogam. In fact, she specifically accuses homebirth midwives which, more often than not on this blog, is specifically referring to un(der)educated lay midwives (CPMs, DEMs, etc). Further, she is only accusing those HB MWs who are recommending against Rhogam of ignorance and endangering their patients.

      What I find disconcerting, however, is that you would rather chastise Dr. Amy for her tone and supposed sweeping generalizations than focus on the actual problem at hand. There are HB MWs who are advising their patients against a course of treatment that saves lives. Whatever the reason why, their advice is actually putting their patients and their babies in danger. Unlike Dr. Amy, whose words are only a danger to fragile egos, these HB MWs could KILL. Why aren’t you more outraged about that? Why are you more concerned with asserting that not all MWs are “like that” then you are with the willful spreading of false information that could result in deaths?

      IMO, any competent MW would do absolutely everything in her power to distance and discredit herself from the kind of rogue birth junkies that Dr. Amy condemns. These faux-HCPs do far more damage to midwifery then Dr. Amy could ever imagine. And by choosing to focus on tone or characterizations instead of condemning these women and their practices, you are helping them hurt people.

      • Kathleen Elisabeth
        July 13, 2014 at 6:51 am #

        Doctor Amy could have avoided criticism by perhaps clarifying the differences between the title of an untrained and a clinically trained. ‘Midwife’

        • Sue
          December 30, 2014 at 10:38 pm #

          Kaathleen – she has done this many many many times before.

        • Daleth
          December 12, 2017 at 9:52 am #

          A homebirth midwife, which is what Dr. Tuteur was talking about, is almost by definition not a CNM. Essentially all homebirth midwives in the US are CPMs or even less rigorously trained DEMs/lay midwives.

          About half of US states are willing to license CPMs as midwives, but FYI, they wouldn’t be allowed to practice in any other developed nation in the world, because their training is so inadequate. American CNMs are the equivalent of midwives in Canada, the UK, the EU, Australia, etc. American CPMs are… um, NOT.

          Women who do homebirth don’t know that, of course, because the CPMs/DEMs/etc. who seek out their business conveniently never bother to explain the differences between themselves and real midwives.

          Those differences include not just woefully inadequate training, but also the fact that the vast majority of CPMs who sell home-birth services do not carry liability insurance. So if the midwife screws up and your child ends up permanently disabled from a traumatic birth, guess who has to pay for that child’s lifelong care? Not the midwife. The parents. Here’s the story of just one family that happened to:


  27. Lindy
    April 29, 2014 at 11:15 pm #

    But obviously, if both parents are negative, you don’t need the shot. I wasn’t informed of this…I was basically told to get this shot or my baby would die. Both of my children were negative bloodtype (because two negative parents CAN’T make a positive). I wish I had been informed of this…but then I guess the hospital wouldn’t have gotten the $750 for each child I had for the shot.

    • Trixie
      May 1, 2014 at 9:02 pm #

      Because there’s never 100% certainty that the father is who the mother says it is, it’s not worth gambling with a baby’s life. Rhogam for everyone.

      • jennie R
        May 11, 2014 at 5:17 pm #

        i am not a lawyer but i believe you are mistaken according to US law and that your statement violates the doctrine of informed consent.

        • May 11, 2014 at 6:25 pm #

          No, it’s smart doctors who know that patients lie. Often. Repeatedly. And with very bad results.

          Doctors who assume a patient could be lying, and treat accordingly, are just practicing smart medicine. Any lawyer will tell you so. Now, they do need to inform you of what they are doing and what the possible side effects are, but they do not have to tell you that they’re doing it because patients lie a lot.

          • Young CC Prof
            May 11, 2014 at 11:20 pm #

            And even patients who are trying to tell the truth may mix things up, or might not accurately know their medical history. When I advise professionally, I always like to see in writing what the situation is, sometimes because students lie, sometimes because they remember wrong, sometimes because they misunderstand the question.

            If I worked in the medical profession, I’d never bet a patient’s life on the accuracy of information conveyed verbally by the patient or patient’s relative if there was reasonably easy precaution to avoid the whole problem.

          • Elizabeth A
            May 11, 2014 at 11:51 pm #

            And even patients who are trying to tell the truth may mix things up, or might not accurately know their medical history.

            Yup. I was talking to my husband this morning, and despite the fact that he *ordered* me a RoadID tag that has my correct blood type on it, he misremembered my blood type. He cannot for the life of him remember our children’s Rh status. (I am reasonably confident of his blood type only because it’s the only option that gets us to our children’s phenotypes. Blood type is clearly not the sort of thing he remembers.) I am sure that plenty of people “know” their blood type by parental report, and I am sure that plenty of those are accidentally misreported.

            The hospital’s cut of the cost of a Rhogam shot is much, much smaller than the hospital’s cut of the cost of NICU treatment for HDN, or of the treatments to prevent HDN where Rh sensitization has occurred. They could make far more money by not bothering with Rhogam.

          • Kathleen Elisabeth
            July 13, 2014 at 7:22 am #

            Exactly. In the ER patients often lie. Physicians are well aware of this and it is a great hazard, both to the physical well being and outcome of the patient’s treatment and also the outcome of the physician’s career, should they trust and act upon the misinformation provided by a patient whose purpose for lying is self serving.

      • Kathleen Elisabeth
        July 13, 2014 at 7:06 am #


    • Kathleen Elisabeth
      July 13, 2014 at 7:17 am #

      A doctor cannot ascertain, second guess, or prove the genetic paternity of the fetus purely because the mother states it to be so. If doctors relied and acted upon all information provided by patients, alone, there would be chaos. Your doctor gave you prophylactic RhoGAM, which is the standard treatment.

  28. Becky
    March 19, 2014 at 6:26 pm #

    With my first two pregnancies I had CPMs. Both times the CPM was absolutely insistent that I must get a rhogam shot.

  29. L
    April 7, 2013 at 1:32 pm #

    In this article you noted that mothers only need to get the RhoGAM shot if the father is positive. In my understanding (I work at a Maternity clinic) that there have been a few cases where the father was tested and was positive so the mother did not get the shot. Because there was a positive blood type somewhere in the family and the babies were positive and they passed away. This is probably very rare but in the clinic I work in EVERY mother who tests negative is given the shot.

    • Dr Kitty
      April 7, 2013 at 2:25 pm #

      There are plenty of cases where the “father” was not the father.
      The only reason a RH negative women shouldn’t get Rhogam is because her BABY is RH negative too.

    • Lindy
      April 29, 2014 at 11:18 pm #

      Two negative parents CAN’T make a positive…it’s not possible. Therefore, either the father isn’t who she says the father is, or they were wrong about his bloodtype. They give every RH- mother the shot because they want the $800 it brings in.

    • saramaimon
      May 11, 2014 at 5:33 pm #

      my son’s results came back negative just like mine… and yet i begged the hospital for a dose of rhogam because i didn’t trust them not to mix up the results, like other things they mixed up… they refused to give it to me. well i hope for the best.

      • Young CC Prof
        May 11, 2014 at 11:15 pm #

        If you are worried about it, (I assume this was something that happened some time ago, not within the past few days) you can have your son’s blood type tested privately. You can also have yourself tested to see if you are sensitized.

  30. Allie, CNM, WHNP
    April 4, 2013 at 12:46 am #

    I find this rant against Midwives highly offensive. The comment of: “Midwives don’t know what they’re talking about” is especially condescending. As a Midwife with 2 Masters Degrees would like to say that I DOknow what I’m talking about and I am highly prepared to assist women in their planned home deliveries.

    • Dr Kitty
      April 7, 2013 at 2:19 pm #

      Good. You know what you’re talking about.
      Does the average CPM or DEM?

      Carry on.

    • Haley
      May 1, 2014 at 8:47 pm #

      Yes! My midwife is amazing and educated in both natural and conventional methods and tells me when the conventional is necessary and when it is not! This article is just some angry windbag who thinks they know everything. It’s crap.

      • Young CC Prof
        May 1, 2014 at 8:57 pm #

        Wait, your midwife tells you when to listen to your doctor and when to ignore your doctor.

        Why don’t you just find an actual doctor you trust and cut out the middleman?

      • Amazed
        May 1, 2014 at 9:27 pm #

        Why do you even bother with a doctor? Go off with your amazing midwife! Have your baby at home! Surely this Wonder Woman can set up an OR in your kitchen?

  31. Desi_redux
    February 22, 2013 at 4:15 pm #

    Oh, I couldn’t help sharing this link on here even though this is an older post. Since my MIL almost lost my husband to HDN, it makes me mad to see idiots come up with woo like this: http://www.unhinderedliving.com/rhogam.html

  32. amir
    February 18, 2013 at 6:27 am #

    hello, I want to get this medicine. Please guide me how to do it and mention its price


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