Anti-D Explained

by Sara Wickham, Michel Odent (Foreword)

Fifty years ago, we learned that giving a medicine called Anti-D to childbearing women with rhesus negative blood could help protect their future babies from an age-old disease. But the same research which showed this also raised some tantalising questions, to which we still don't know all the answers. Today, rhesus negative women are offered Anti-D at several points during their pregnancy and birth journeys. Many would like to know more than they can read in the standard information leaflets on this topic. Many have questions about whether they really need this medicine. This book has been written to explain the issues, to answer key questions and to share information about what we do and do not know about Anti-D and related topics from research evidence and current thinking. Dr Sara Wickham is an author, speaker and researcher who has been writing and lecturing about Anti-D and pregnancy and birth related topics for more than twenty years. "Sara Wickham has found an original way to raise judicious yet unusual questions. Thanks to her exceptional capacity for lateral thinking she has developed the art of 'hitting the nail on the head'. The genuine pioneers are those who raise the right questions at the right time." Dr Michel Odent, Founder, Primal Health Research Centre. Foreword by Dr Michel Odent.

Genres: Health

178 pages, Paperback

Published June 5, 2021

Reviews

[Bethany · Rating 3 out of 5]

Anti-D Explained is a valuable resource for any Rhesus negative woman considering her options regarding Anti-D immunoglobulin. In fact, it appears to be one of the only books available on this topic, which makes it even more significant for those seeking information. Wickham provides a clear and accessible explanations, making this complex topic understandable even for readers without a medical background.

Wickham seems to have a fairly balanced perspective. She doesn’t simply follow standard medical recommendations; instead, she encourages informed decision-making and presents a range of viewpoints (although some of these viewpoints are simply theories and lack any evidence to support them).

The style of the book can feel somewhat rambling and repetitive at times, which may detract from the overall clarity. The lack of strong, high-quality evidence in the area of anti-D (particularly routine antenatal anti-D) makes the decision-making process difficult, even after reading this book.

[Melina · Rating 5 out of 5]

This book is good for rh- women and their families facing this issue. I would say that if you have questions about the Anti-d intervention then this book will give a broad perspective and understanding and hopefully help you come to an informed decision that is right for you.

Unfortunately, some of the women who really could benefit from this book might not even know it by the time they'd need to and that's a shame. While we as a society are aware about issues that arise in pregnancy that affect a percentage of women like ectopic pregnancy and gestational diabetes and interventions like C-sections, ultrasounds, and IVF... an informal and statistically insignificant survey I've done of some women that I know has revealed to me that few people have even heard about rh incompatibility and Anti-D.

So there's a section on NIPT, a test in which an rh- woman can find out if her fetus is rh- or +. It's a test that is not available in all jurisdictions and needs to be done between 11-16 weeks. The thing is, if a woman doesn't even know she's rh negative going into pregnancy and doesn't even have any awareness that this would in any way be an issue, she may miss this window. Particularly in places where it takes a long time to get in for your first appointment (let's say in the vicinity of 4+ weeks to see your GP or health care provider for that initial appointment), then they sit on the blood results for a few weeks and then a couple weeks after that mention in your next appointment that you're rh- and that you will need Rhogam/WinRho/Anti-D... that window may close. Not the way things should be, but this is how it plays out in a real world context sometimes. Then the woman doesn't even have the chance to have the time to research and inquire about the NIPT test. I believe that this issue would be alleviated if women knew about rh incompatibility before they became pregnant so they could be proactive in seeking to find out their rh status and if negative, could be on top of inquiring from their first appointment about whether NIPT is available to them.

Wickham does a good job at showing how the system and the regulatory boards that establish the standards of practice in this area are focused more on population-based metrics and lean toward pharmaceutical intervention (even if not individually needed) rather than pursuing and funding studies that would be more individually catered. She also highlights the studies that indicate that the intervention is indeed highly effective, but that different parameters of safety are not adequately studied (to satisfy such questions as what are the medium and long term effects on the fetus after they're born, if the shot was given while the woman was pregnant). She also highlights that because the individual approach is largely ignored, there are no studies researching why only some women become sensitized upon exposure, while many simply do not.

All in all, Wickham does a great review of the studies and research available and presents it in a format that the layman can understand. She does not tell anyone what to do. If there is a bias, it is likely the one that draws people to her book, and that is that it would be beneficial to many concerned women and families for research to be done to cater to individualized approaches. Not all women are keen to have a blood product injected into them (particularly while pregnant) as a matter of standard practice but possibly unnecessarily, while little research or funding goes toward studies that could potentially narrow the pool of women who actually need the intervention.

[Sarah Schaefer · Rating 1 out of 5]

The majority of research used was 30+ years old, there was a good amount of fear mongering but also some decent explanations. Im not a fan of blaming the lack of studies in patriarchal views when in reality many of the studies would not be indicated, which shows a large misunderstanding of the testing available in this field as well as a misunderstanding of immunology. She does bring up some good points that there are risks to receiving RhIG, but she also fails to mention that the production of this drug is significantly safer than what it was 35 years ago. She quotes other women's experiences without considering that many of these problems they face after receiving RhIG are considered to be associated with pregnancy naturally. Is it the drug or the condition of the patient? It is irresponsible to assume one or the other. One massive thing that she fails to mention is having anti-D (true antibody, not passive) does put a woman at risk if she is over the age of 50 and gets uncrossmatched blood since she will likely get Opos blood. RhIG is ALSO given to people receiving Rh positive blood products when they are Rh Neg. She uses inaccurate terminology throughout the entire book. I love that she is trying to educate patients but she needs more education herself it seems.

[Mikaela · Rating 5 out of 5]

this book took me quite a while to muscle through, but that's because I'm not a medical professional. I had made my decision regarding the RhoGam shot and wanted to have this extra chunk of research and information in my back pocket for my next birth experience. Dr.Sara Wickham does a really great job explaining things and presenting information In an understandable way for someone who does not typically read medical journals etc. I would encourage any RH- mother to be, to give this book a read l, especially if you are unsure what decision to make regarding the RhoGam shot. it's encouraging and informative In a way I needed postpartum with my first.

[Dorothy Vandezande · Rating 4 out of 5]

Good information. Not a lot of really new stuff. Suitable for parents or providers; almost too basic at times, IMO.
The word robust is massively overused. 😅

[Kari Matadobra]

Worth reading

I am RH - with an RH+ husband. Apparently my risk is about 1 in 7 in becoming sensitized. In my last pregnancy I was given Anti-D twice in pregnancy due to miscommunication between offices, and 1x after birth. I felt conflicted and unhappy about it, but was told little about it, just that it was necessary. Although this book helped clarify Anti-D, it went little into actual Rhesus disease, and barely discussed alternatives. The book calls for the need for more research on nearly every page. I would have also appreciated far more anecdotal evidence. Overall, it is one of the only, if not the only book out there even attempting to discuss this, so I certainly appreciate that it is available.

[Private Account · Rating 5 out of 5]

This was so insanely informative. No one could answer my questions about my super rare negative but kind of positive blood. Every doctor I talked to wanted me to take the shot just in case! As if there are no risks! They put no effort into thinking about it!
This book was able to answer my question. This book was thorough and spectacular, how books should be. Sara doesn’t tell you what to do. She just gives you all the info.

[Jurene · Rating 5 out of 5]

This book is so informative and unbiased. She tells you the information that is out there, the pros and cons, and the unanswered questions. It leaves you to make an informed decision about what is right for you and your baby. She doesn't decide for you. This is truly an informative book.

[Jessica · Rating 5 out of 5]

A must read for any Rh- woman considering having children or currently pregnant. Informed consent doesn’t seem to be common with the administration of Rhogam from medical providers so this book covers most all of the necessary information to make an informed choice.

[Ash Anderson · Rating 5 out of 5]

Very good overview of the anti-d situation as it stands. She does a good job explaining what we don’t know and why we don’t know it, and unfortunately why many of the reasonable questions women and their providers have likely won’t be answered any time soon.

[Tiffanie · Rating 5 out of 5]

Absolutely love this book and the vital information inside!

[Elizabeth Snyder · Rating 4 out of 5]

Extremely helpful. The most information I could find on this topic anywhere.

[Lexi Zuo · Rating 4 out of 5]

Very helpful look to learn about Rhesus negative blood types and pregnancy.

[Kylah Streeby · Rating 5 out of 5]

A very unbiased book that helped me better understand the Rhogam shot and when it is necessary.

[Sara Hill · Rating 5 out of 5]

A totally unbiased view of Anti-D from a lady who has done her true research.

[Charity (Booktrovert Reader) · Rating 5 out of 5]

Very informative and helped me make an informed decision