Rhesus Negativity 🩸💉
There is something that comes up again and again when it comes to the request for optimal cord clamping and waiting for white after birth......Rhesus negativity!
When the birthing person is rhesus negative, they are offered blood tests right after birth.
One sample of blood comes from the baby’s cord to check the baby’s blood group.
If the baby is also negative, no further action is offered.
If the baby is positive, the other sample, from the mother, checks if any of the baby’s blood has mixed with the mother’s during birth.....depending on how much has mixed, a dose of anti D is offered (to stop sensitisation to the rhesus positive blood of the baby within the mother, which has the potential to affect future rhesus postive baby pregnancies).
Midwives often still feel that cords need to be cut and clamped quickly for rhesus negative people, to avoid harm to baby (I’m not entirely sure from what as the blood that is transferring to the baby has been circulating through the baby all through pregnancy anyway) and to be able to take the cord blood sample to check the baby’s blood group.
This is NOT necessary.
Rhesus negative babies born to rhesus positive mother benefit from optimal cord clamping and ‘waiting for white’ just as much as other babies.
But what about the cord blood sample?
Well, in MOST cases it is perfectly possible to take a sample from the placental surface vessels when the placenta has been born (there has only been one time I didn’t manage this)....or the sample can be taken from the cord while the placenta is still in utero, in the same way it would be taken if it was clamped......the oozing from the puncture site is usually very mild and stops very quickly, or with a little gentle pressure from a gauze swab it will stop.
And even if there WAS more significant oozing, this blood will be coming from the umbilical vein, and there is no risk for the baby to lose blood directly from it....the only issue is that the cord may not transfer as much blood as it normally would have done or it ceases pulsing a little earlier than normal.
Clamping and then taking the sample would be far more drastic than that though, as it stops any blood transfer immediately and prematurely anyway.
IF for some reason a sample can NOT be obtained from the cord, the blood can also be taken from the baby directly.
Some parents are not willing to have this done, and the option in that case is to check the maternal blood for any blood mixing and have the anti d anyway.
This may require a chat to a haematologist, as it is an ‘off menu/guideline’ choice, BUT it is possible.
The argument is usually that anti d is a blood product, and it should not be given without clear indication.
This is of course true, and it might not be necessary if the baby is rhesus negative like the parent, but just for perspective, in most trusts, anti d is offered to all rhesus negative people in pregnancy, even when not knowing if it is necessary, purely as a ‘just in case’, so it’s also possible to do this after pregnancy.
Of course some trusts offer to check the baby’s blood group in pregnancy which can eliminate some of this, but it’s not universal in the UK. Yet.
P.S: another option is to decline testing and anti d of course, after considering very carefully if this is the right option for you.