A few days after my first prenatal appointment, in my first pregnancy, I got a call from my OB’s office.
“Have you ever had a blood transfusion?” No.
“Have you ever had a miscarriage?” Not that I know of.
“Have you had a Rhogam shot recently?” I didn’t even know what that was.
“Have you ever used intravenous drugs?” Definitely not.
The nurse explained that anti-D antibodies had turned up in my bloodwork. These antibodies develop in reaction to contact with Rh positive blood. Since I was so early in my pregnancy, the doctors were baffled as to how I had already become sensitized. Our best guess is that there must have been an early, silent bleed where a small amount of blood mixed, but we’ll never know for sure.
Though my titers were low (1:4) and my OBs understood the basics of the condition, they had me see a perinatologist (maternal fetal medicine doctor) for a consultation. She went over a treatment plan: titer checks every 4 weeks, unless the titer reached 1:16 or higher. In that case, they would start MCA scans every 2 weeks to check for anemia. If anemia was detected, an IUT (intrauterine transfusion) could be performed to give the baby blood. She ordered a non-invasive blood test to check the baby’s blood type and antigen testing for my husband.
Before leaving her office, I asked what the technical term for this condition was. Isoimmunization. I went home to search the internet. There wasn’t much out there. Most articles referenced the advent of Rhogam, the miracle drug that prevents anti-D sensitization in most Rh negative women. Now that I was sensitized, Rhogam couldn’t help me. I did find a small group of very supportive women on a Babycenter forum. This group later went on to form the ISO Moms Facebook group.
My pregnancy was mostly uneventful. My OBs handled my care since my titers never went above 1:8. I learned from the Babycenter group that titers should be checked every 2 weeks in the third trimester, and my OBs agreed. The office phlebotomist, Lillian, knew me by name.
One thing I did not know to advocate for at that time was early delivery. The doctors thought that since my titers were low I should be able to go to term. I was induced at 41 weeks, but ended up having a c-section for unrelated reasons.
Holden was a big baby--9 pounds, 7.5 oz. and 22.5 inches. It was odd to see him in the NICU, a monster baby amidst the tiny preemies. He had some breathing issues due to the c-section, and then his bilirubin began to rise. He was put on phototherapy, first in the NICU and then, as he started to respond to the treatment, on a bili bed in my room. For 4 days he could only come out for 15 minute feedings every 3 hours.
Once his bili was going down on its own without lights and got below 10, we were discharged. We followed his bloodwork for the next few weeks, but he never required any further treatment.
My second pregnancy was managed pretty much the same, with added bi-weekly NSTs in the third trimester and a plan to deliver by repeat c-section no later than 38 weeks. My titers never went above 1:4. When our baby girl, River, was born, our pediatrician came to deliver the good news personally--River was Rh negative like me and could not be affected by my antibodies.
Today, Holden is a healthy ten year old. He is sweet, sensitive, and academically gifted. Both of our kids understand how blood types and blood antigens work, and know the importance of Rhogam for Rh negative mothers. I consider us incredibly lucky to have had such a positive outcome, but in reality our story is typical of most iso pregnancies. The extra monitoring and worry are so insignificant in comparison to the years of happiness our iso baby has brought us.