Many people visit this website looking for Anti-D information.
Anti-D is the name of a medicine offered to rhesus negative women who may have been exposed to rhesus positive blood. It’s known as RhoGAM® in the USA.
Anti-D is given in the hope of preventing them from making antibodies which may cause problems for future babies.
I am the author of two books about Anti-D. The first was published in 2001, and things have moved on since then. Which is why in 2021 I published a brand new and updated book on this topic, Anti-D Explained. The book explains the issues fully and takes you on a journey through the evidence and the issues. It’s relevant no matter whether you’re just curious, pregnant, a parent, professional or someone just interested in the issues.
If you want to be led gently by the hand on a journey through the information, then my book is the answer! But I also offer links to a few supplementary Anti-D resources in this blog post. These include documents and resources that offer a variety of perspectives and levels of information.
I believe that women and families need to consider decisions from as many angles as possible. And I consider that professionals can offer the best help when they can explain issues from a variety of perspectives.
As I say in my book, Anti-D is one of the medical world’s success stories. But that doesn’t mean that it doesn’t have risks and downsides. It’s always good to ask questions. By looking at the evidence and understanding the bigger picture, we can make the decisions that are right for us.
Introducing the issues
So if you’re wondering what Anti-D is and why it’s an issue, the Wikipedia entry on this topic is here.
I’m not generally a fan of Wikipedia. I appreciate that it is ever-evolving, but birth-related entries tend to reflect North American terms, pharmaceutical products, policies and attitudes towards women. They are often obstetrically-focused and not very woman-centred. However, there are some useful links to other sources and it’s a good place to become familiar with the terms used to describe this in different countries.
As with many pharmaceutical and medical products, much of the information out there is written by marketers whose job it is geared towards letting you know how fabulous, necessary, effective and safe their product is.
Do bear that in mind as you surf.
Some of the information sources that I found while checking links for this page (including some written by midwives and birth workers, I am sorry to say) are rather shocking. The language is often insulting. Statements are more absolute than is warranted by the state of the evidence, and consent is assumed. So please use discretion! In fact, it was while writing Anti-D Explained that I was moved to write this post about language.
As far as statements such as ‘Anti-D is perfectly safe for you and your baby’ are concerned, I think it important to point out a key fact. Even the fab people at the companies who make Anti-D and who spend lots of time and effort ensuring it is as virus-free as possible would not claim that it is perfectly safe. It is as safe as their combined valiant efforts and modern technology can make it. And they work hard at this. But no medicine made from blood is ever going to be perfectly safe. And no scientist would make such a ridiculous claim. More in the book if you’re interested.
A few overviews
Let’s start with a couple of overviews of this area. These are quite variable in their level of assumed scientific knowledge. One of the better UK ones is that provided by NHS Choices, which has links to a few other relevant pages on their website. This one on Medscape may also be useful.
As I have noted, few resources really explain that women have a choice in this area. I feel quite strongly about that!
Your body. Your baby, Your decision.
During the writing of both of my books on this topic, I was contacted by many women who had concerns and questions about Anti-D. I also heard from women who had experienced problems after having it. So I find it interesting and also concerning that these concerns often aren’t reflected in online information.
For instance, in this summary from Mumsnet the quoted experiences are all positive. But it’s very possible that people with different experiences will share them in different places. I can tell you that I hear from many people with concerns.
Evidence and guidelines
Maybe you’d like to go a bit further and begin considering the evidence and guidelines. Yes, I do analyse these in depth in my book, if you’d rather have someone walk you through them. But for those who like to do their own analysis as well, here are a few of the key sources.
Let’s start with the current UK guideline. That details all the points at which rhesus negative women are offered Anti-D.
You might also want to look at the RCOG page on Anti-D which points to that and also other current documents.
In the UK, we also have the NICE antenatal Anti-D guidance and a NICE “information for the public” page on antenatal Anti-D.
If you’re in Australia, here’s the info and links from the Australian Blood Authority. And for those in Australia and NZ, the RANZCOG guideline on Anti-D.
If you’d like to know what I have to say about guidelines and the evidence that they sometimes include, have a listen to my podcast on The Midwives’ Cauldron!
Finally, some people like to look at the product information. A few starting points if you’re in the UK are the NICE product information page on Anti-D, the information page on D-GAM and the Rhophylac product information.
There is information on the gamut of variously named US preparations on Medscape.
Although it’s not as up-to-date as some of the others, the EMA guideline can be downloaded from here. And the NZ Medsafe drugs list is also useful, but it is frequently updated and you will need to search for the specific preparation you’re looking for.