Q. i had a premature delivery 2 years ago, early this year i had a stil birth all along i did not know that i was rhesus negative after the stil irth i found out from the doctor that my condition could be the reason for this situations what can i do do have a baby in futrure? i have not had any treatment so far concerning my condition, please help me for iam so devastated and confused, dorah

A. I'm so very sorry to hear about the loss of your baby and understand how devastated you must be feeling. I hope that the following information about being Rhesus negative and its relevance to a pregnancy and the baby's well-being might be of some help; perhaps, even a starting point for moving forward and looking to the future. Given the specialist nature of your enquiry however, I would also urge you to speak with a health care professional about your concerns; this might be your local GP and midwife or, if possible, the doctor (Obstetrician) who looked after you following your stillbirth.

As you may be aware, there are four main blood groups: A, B, AB and O and alongside your blood group is the Rhesus factor (Rh), with the D antigen being the most important - this is a substance that stimulates your immune system to produce antibodies. If you have this factor you are described as being Rhesus D positive and if you do not have it, you are Rhesus D negative. Being Rhesus negative should not be seen as having an illness that needs treatment, it is something that is unique to you, but unfortunately it can cause problems for women when they want to have a baby.

The majority of people are Rhesus D positive but around 16 people out of every 100 are Rhesus D negative. Outside of pregnancy, being Rhesus D negative only becomes a concern should you need to have a blood transfusion. This is because you are very likely to be allergic to Rhesus positive blood and could become very ill, and in some cases people can even die.

At the very start of conception, your baby has its own blood group and will be Rhesus positive or Rhesus negative. Every baby inherits its blood type from one of its parents, so if the mother is Rhesus negative and the baby's father is Rhesus positive, the baby has a 50:50 chance of being positive or negative. If the baby is Rhesus negative, there are no concerns for its future health, but if the baby is Rhesus positive, this can cause problems if the mother's Rhesus negative blood and the baby's Rhesus positive blood come into contact with each other.

This should not happen as the mother and the baby have separate blood circulations, but we also know that this can happen in certain circumstances. Some of these we know about, for example, if you have some blood tests in pregnancy that involve putting a needle into the womb, and more commonly, during labour when tiny amounts of the baby's blood cross the placenta (the ‘afterbirth') and enters the mother's bloodstream.

When the baby's blood mixes with the mother's blood, this causes a form of allergic reaction in the mother, and she is said to be sensitised to this Rhesus positive blood. This is because the baby's blood is seen by the mother's body as a foreign substance, this is called an antigen, and the mother's body makes antibodies to fight the antigens, which in turn, affects the baby's red blood cells and they become very ill.
Once this sensitisation has happened, it will stay with the mother for the rest of her life and cannot be reversed. It also gets worse, so that with each pregnancy, where the baby is Rhesus positive, the effect on the baby gets more severe.

It has been possible to prevent these long term effects for quite some time. Women in the UK can be given an injection of an immunoglobulin (which is a major part of the body's immune response system) called anti-D. Anti-D has been offered to all Rhesus negative women in the UK for over 40 years and, to make the risks of the two bloods mixing even lower, this injection is now given as a preventative measure between the 28th and 34th week of pregnancy. However, if there is the risk that something might have caused sensitisation, anti-D is given to the mother straightaway or within the next three days. It must be given this quickly if it is to be effective in stopping the mother producing the antibodies against Rhesus positive blood. Therefore, if you gave birth to your first baby in the UK and this baby was Rh positive, you should have been offered anti-D within 72 hours of their birth. If the baby was not Rh positive, the immunoglobulin would not be needed.

The first time a Rhesus negative mother carries a Rhesus positive baby, it is rare for any sensitisation that has occurred during that pregnancy to affect that baby. However any sensitisation that occurred either before or at the time of your first baby's birth could seriously affect your next baby if that baby is Rhesus positive, and all other future babies who are also Rhesus positive. This is because your body will recognise the Rhesus positive blood in your baby and will fight against it. This means that your baby, even only a few months into the pregnancy, can become very ill, the condition is known as ‘haemolytic disease of the newborn' (HDN), also known as ‘rhesus disease' or ‘blue baby syndrome' and, if it is not recognised and treated, the baby is likely to die. In some cases, even if treatment is started early, the baby may still not survive. Your doctor has indicated that, very sadly, this might be a possible reason why your second baby was stillborn.

As you have this information now and you want to know about what will happen in the future, your GP or the doctor at the hospital who looked after your last baby will be happy to talk to you about what applies to you. They will be able to explain the risks about your next baby being affected and what could be given in the form of treatment.

If the Rh factor was the reason why your last baby died you should be referred to the doctors who can treat this problem very early in the pregnancy. This means that it is possible that things can be made better for your next baby, despite having this condition. It is very important that you talk to someone who was caring for you with your last baby, so that you have this information before you try for another baby, if you should wish to do so.

Losing a baby is heartbreaking and it is important that both you and your partner/family receive the support that you need to work through the grieving process. This might be from your midwife, local GP, or counselling/pastoral services at the hospital where you gave birth, as well as friends and family. Alternatively, you may wish to contact a specialist organisation who will be able to offer you information and guidance, for example, SANDS - ‘Stillbirth and neonatal death charity' at: http://www.uk-sands.org/

For additional information also see the Informed Choice leaflet: Information for women who are Rhesus negative at: www.choicesforbirth.org

My every best wish for the future

Best regards

Vicky