Friday, February 3, 2017

An Rh Sensitized Pregnancy (Part 2)

It has long been a mantra of the natural birth birth community that "women's bodies aren't broken." And long have I subscribed to that idea, since I was pregnant with my son and even through both of my miscarriages.

Even now, I still believe it, at least in the sense it was originally intended. Our bodies do indeed know how to give birth, for the most part. When left to their own devices, most women with low-risk pregnancies will go into labor on their own, and given enough time and the right support, birth will eventually happen with no or minimal intervention.

The key word there, of course, is low-risk. More than halfway through a high-risk pregnancy, my perspective on the general not-brokenness of my body has changed.

Almost 26 weeks!

When your baby is in danger from your own body... When your own immune system views your baby as a threat that it may eventually do its best to eliminate... Well, excuse me if it feels sometimes like my body is indeed quite broken.


About three weeks ago, I missed a phone call from my doctor, and was rewarded with an ominous-sounding message: "I need to talk to you about your most recent titer test."

We all know that if the news had been benign, she would have just said so in the message. Heck, for most of my blood tests, I never received any kind of call at all, as my doctors apparently subscribed to the idea that no news is good news. So when I received a call regarding my latest blood test, and that call came not from a nurse or the most recent OB I had seen but from my perinatologist (high-risk doctor), you'll forgive me for immediately assuming the worst.

Well, it wasn't the worst, but it wasn't good, either. My titer--my blood antibodies against Rh(+) blood--had just jumped up. For the first few months of my pregnancy, those antibodies were barely detectable, and now they were suddenly in the range that meant I--and more importantly, my baby--required more intensive monitoring. My doctor immediately referred me to a new doctor at a new hospital, an hour away but where they had more experience dealing with Rhesus isoimmunization.

So a few days later, the whole family set off on a long morning drive to see someone new. I had another ultrasound, just as extensive as the typical "anatomy scan" already done at my normal hospital just a few weeks prior, and more bloodwork done, since apparently every new hospital wants to type my blood and establish their own baseline when it comes to my antibody count rather than just relying solely on the medical records they have received for me.

Then, we sat down to talk with the newest high-risk doctor on my team and to get an idea of what we could expect from here on out.

The current prognosis: baby is not in danger. Yet. But we will be monitoring her/him much more closely for the remainder of my pregnancy.

The current prescription: more ultrasounds. Lots more ultrasounds. Weekly ultrasounds.

Monitoring the MCA

It looks like, for the foreseeable future, I will be alternating between my "normal" hospital and the higher-risk hospital for those ultrasounds. Most of them will be rather quick and to-the-point, checking just a handful of things that may or may not indicate anemia:
  • The velocity of the blood flow through the medial cerebral artery (MCA), which is one of the arteries in the brain. If the blood is flowing too fast, it's an indication of the blood being too thin, which is a potential marker for anemia. It doesn't mean baby is suffering from anemia in and of itself, but as the doctor explained, there is a range considered normal; a faster blood while flow doesn't necessarily mean anemia, every baby he has encountered who had rhesus-disease-based anemia also had a blood flow that was above that average range.
  • Hydrops fetalis, or a buildup of excess fluid (edema) in at least two parts of the baby's body. The places the ultrasound technicians are looking are in the lungs, in the stomach, and around the baby's heart.
  • Swelling of baby's liver or spleen. The liver handles the decomposition of red blood cells; if my immune system is attacking the baby's blood and damaging baby's red blood cells, the liver will be working overtime to deal with the aftermath. An enlarged liver is a sign that baby's body is having a hard time keeping up with the damage my immune system is dishing out. Likewise, the spleen plays a role in disposing of old red blood cells, and an enlarged spleen can indicate that the spleen is working too hard to keep up with what's being demanded of it.
  • The amount of overall amniotic fluid. An excess of amniotic fluid (polyhydramnios) is another indicator that Rh disease is starting to become a problem.
Every ultrasound I get will be checking those things, and if the doctors see any combination of things to concern them, then I will potentially face more invasive procedures to verify if baby is actually suffering from anemia (via testing a sample of baby's blood taken from the umbilical cord), and then to treat baby (via intrauterine blood transfusions) if that is the case.

The good news is that, barring some sort of complication (there is approximately a 1% chance that, during an intrauterine blood transfusion, a problem will necessitate baby's immediate delivery), I will most likely be able to keep baby inside until she/he reaches term. If blood transfusions become necessary, they will have to happen every three weeks or so, but the doctor specified that they aim to time them so that the final one happens around 35/36 weeks; baby may still require induction if labor doesn't start on its own before 38/39 weeks (note that my son came at 37 and a half weeks entirely of his own volition, but every pregnancy and every baby is different, so who knows how long of a gestation this baby would choose if left to her/his own devices), but an induction at 38/39 weeks is infinitely preferable to an induction at 34 or 36 weeks, as I was initially told was a possibility.

My second high risk doctor doesn't seem interested in doing any further blood work; as he says, my titers are already up and so we will step up the monitoring in response, and it doesn't really change anything to know exactly what the titers are at in the future. On the other hand, my primary high risk doctor (who I will now be seeing for all future regular prenatal checkups, instead of OBs and nurses from the standard OB/GYN group) sees value in continuing to monitor my titers; while they're in a concern-causing range now, and have only gone up in the past few weeks, it would be a good sign if they either stabilized or started to decrease again. So it looks like I get to continue being a pincushion, but only part-time.


So we'll see how things go from here on out. Optimistically, ultrasounds will be the extent of baby's additional monitoring, everything will continue to look normal, and I'll be able to go into labor naturally and have the nice, normal birth I want. But that is far from a guarantee at this point. There's still a pretty high likelihood that induction will be necessary, and a slight chance still of a premature baby if complications occur at some point.

All in all, a high risk pregnancy is the pits. It's unpredictable and completely out of my control, which makes it that much more stressful for me; about the only thing I feel I have any control over at this point is keeping baby's sex a secret until birth, and even that is in danger should any individual ultrasound technician forget my wishes and reveal the sex during one of my many upcoming scans.. For the time being, I am trying to remain focused on my joy at having this baby in my uterus, my excitement at eventually getting to meet her/him, and the knowledge that I have a solid team of doctors overseeing my care and doing everything possible to ensure a healthy outcome.

That's about all I can do. Stay strong, little baby! We're more than halfway there!


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  1. It's remarkable that with this many ultrasounds you've kept them from revealing gender ... I love that. . Do you have time remind them every time?

    1. Up in Maryland, where I've been seeing the specialist, they have a note in my chart, and it's somehow digital in the sense that it pops up on screen every time they go to do an ultrasound for me. Plus, I was there so often that I was on a first-name basis with the sonographers, so they usually remembered. I still remind them every time anyway, though, just to be safe.

      At my normal hospital, I think they have it written into my chart somewhere that it's a surprise gender/sex baby, but I don't trust that at all. I tell them every time, too. I don't want to know!