RhoGAM®: It does not need to be this difficult

When someone with an Rh-negative blood type gives birth to a baby with an Rh-positive blood type, their blood can mix, resulting in antibodies forming that can attack the red blood cells of future babies. This is a life-threatening complication for the mother's future babies, and it can be easily prevented when the mother has an injection of RhIG, more commonly referred to by the trade name "RhoGAM®." It is recommended that RhoGAM® be given at around 28 weeks of pregnancy, and then again within 72 hours of the birth since the last trimester and the birthing process are the times when maternal and fetal blood are most likely to mix. RhoGAM® is also recommended after miscarriage since that is another time when maternal and fetal blood can mix and create antibodies that can affect all of that person's future pregnancies. About 15% of people have Rh-negative blood type, so the need to access this important medication is very common.

This story is from a mother who faced difficulty accessing RhoGAM® after her baby was born. If her midwife had been legally allowed to possess and administer RhoGAM®, the mother could have easily received this medication at home. It is unnecessary for people to have to jump through so many hoops merely because of an outdated law that prevented her Licensed Midwife from being able to administer a medication she is trained to use.

I recently gave birth at a highly reputable birth center facility under the excellent care of fully certified CPM and Doulas and was prescribed all precautionary medications through a nurse midwife who has an independent practice and partners with my CPM. One of the prescriptions was rhoGAM (not needed unless baby’s blood type requires after it is tested after birth and only available in a OB office or hospital unless it’s ordered by a specialty pharmacy). My daughter was born 10 days ago at the beginning of a weekend and her blood type came back late on a Friday revealing that I did in fact need the shot. This must be given within 72 hours after birth so it couldn’t wait until Monday when any specialty pharmacy would get it in as a special order. Because it was a weekend we were faced with either spending all day in an ER waiting for the shot (backing up actual emergencies and wasting precious hours with my newborn and recovery and risking infection in a hospital) or hoping and praying we found the medication in stock somewhere by some fluke. We spent my daughters first day home calling every pharmacy we and my midwives could think of hoping they might have one dose in stock. Within 200 miles, only ONE place happened to have one available and it was located two and a half hours away. My husband then left me home alone with my 2day old and toddler to pickup and pay CASH price for my shot. We are extremely lucky to have found that but had my birth center been authorized to prescribe and handle this medication (and honestly all other meds we ended up paying cash for just as a precaution) in house as the skilled well trained professionals they are, the whole situation could have been avoided and saved us much strain and expense as a family and for myself in recovery.