Grand Multipara Birth

From www.nzdl.org

From www.nzdl.org

This is an online conversation that I had with a grand multip (woman who has given birth more than 5 times). There are special things about birth after the fifth baby. . . for instance, sometimes the process can be stop and start for days and, then, suddenly. . . here’s the baby. There is nothing wrong with that way of birthing but, because large families are relatively rare, many practitioners lose faith and patience and brand the woman as “failure to progress”.

Another unique thing about women carrying a fifth or more baby is that they are prone to what midwives call the “blue right leg syndrome”. It can be alarming to see how blue the right leg becomes in pregnancy but, then, the baby is out and the woman’s right leg looks just fine again. I like to read things by the midwives in the USA who serve religious groups with big families. Lots of little anecdotes like that.

CORRESPONDENCE BETWEEN GLORIA AND CAROLINE

Hi Gloria,
I am wondering if you could answer a couple things for me.
I was reading your post about the 30 Minute Third Stage, and saw your comment about the anti-bleed tea. I’m curious to know more about this.
I understood that shepherd’s purse was not to be used until after the placenta was delivered, and that it was dangerous to use it before.
I see that one of the ingredients for your anti-bleed tea is shepherd’s purse. Can you share with me how it differs in the tea, as opposed to using the tincture? Also, is this safe to use as a grand multip? This is my 10th baby, 14th pregnancy.
I tend to bleed a fair bit with my births, and I am trying to be prepared this time, (due in August) and read and research things that I could/should try to have on hand, especially in case my attendant doesn’t make it here on time. I tend to go quickly, and feel a strong need to be prepared this time.
Thank you for any input you are willing to share (smile emoticon). Caroline

TUES 22:35
Hi Caroline, One of the things with grand multips that really helps prevent bleeding is going for a 1/2 hour brisk walk. One of my clients found some research on it and it really seems to work. I don’t know why. As far as the shepherd’s purse, no one can really do studies on these herbs and their use after a birth. We worry more about after pains with grand multips. Therefore we give a cramp bark /cinnamon tea. A couple of things that I’ve seen lately that interest me for the after pains are 1. Increasing magnesium supplementation after the birth. 2. Emptying the bladder more often than you think you need to. Just get up and pee if it’s been a while and don’t wait till you feel like pee’ing. Apparently these 2 things are very helpful for cramps. Thank you for writing. I’d love you to have a smooth, relaxed birth. Gloria
06:07

Thank you so very much for your time!!
These are some very interesting points.

I’m curious for a little more information on the brisk walk. Is this something your recommend in labor? Or for the days leading up to birth?

I feel so much peace about our upcoming birth. Much more so than I’ve felt with any of the others. But I also am loving to learn as much as I can about birth as a whole, and things that could be useful for my own as well.
Thank you again. Caroline

10:30
You’re very welcome, Caroline. I mean a walking program starting NOW. I never ask women to walk when they are in the birth process. I’m afraid they will hit me! ha ha. You’ll know what you want to do when having the baby, it’s the preparation that’s important. By a walk I mean a brisk walk with no kids, no purse, flat shoes and really walking as fast as you can. Gloria

Gloria, Thank you! I will start doing that today. 😊

I am soaking up as much information as I can.

I also have to say that I love following your page and reading on your site. So much information that has been so useful.
Thank you for everything you do!!
Makes me wish I was in Canada and could meet you! Caroline

That’s very sweet of you. You are exactly the woman I am writing for, so many people just can’t “get” what I’m trying to communicate.
Gloria

I am loving the learning! I have been trying to dig as deep as I can, and find as many different ideas and perspectives as I can. I’m always thrilled when I find new perspective that makes sense!
Will you be offering your online class again in the future? I would be very interested in taking part, if you do.
Caroline

Added: Another tip I will give to grand multips. When you have lots of older children, they ALL want to hold the new baby. This gets to be a competition and a struggle and it could be a reason why the mother might bleed too much. Explain to the entire family like this: “It’s very important that Mommy has the baby on her skin for the first day of the baby’s life. That helps Mommy’s body to change over from being pregnant to being a nursing mother. If we want Mommy to stay at home and be healthy, we are ALL going to wait until the baby is 24 hours old before we take turns holding the baby.” In most families, the kids really understand this and they don’t mind so much not holding the baby as long as no one else is either.

Pregnancy Induced Hypertension, Woman Heal Thyself

I have had this article from the New Statesman (a British magazine) in my files for decades. I’ve given it to many women to underline the importance of daily quality protein in pregnancy. I can’t find any reference to it on the internet and I publish it here in order to have this history preserved. Remember when reading it that no one had home computers in 1984 and there were no search engines. We had to rely on TV, magazines, newspapers and medical libraries back then. There was no email so the British postal service was the way these women contacted each other. For this young woman to undertake this project in those days is truly amazing.

The terms toxemia (spelled toxaemia by the British), and pre eclampsia have both been retired and now all these words are under the umbrella term of “Pregnancy Induced Hypertension” (PIH). Enjoy the read and leave comments. Thanks Gloria

New Statesman 6 January 1984

Health

WOMAN HEAL THYSELF

John Hargreaves on a new approach to toxaemia

FEW PROFESSIONALS care to be lectured in their own field by their clients. But when Dawn James faithfully followed her doctor’s advice during pregnancy and succumbed nevertheless to a disease which kills an average twelve women and hundreds of fetuses every year in Britain, no one could tell her why. This 27 year old woman, living in a council flat in Hackney—‘shy, and not a speaker type at all. . . from a working class background and a secondary modern school’ –determined to find out for herself.

Two years later, she was invited back by the Senior Nursing Officer to the hospital where her baby was born, to explain to the midwifery staff what she believes are the causes of toxaemia of pregnancy and how it can be prevented.

Pre-eclamptic toxaemia (a misnomer because it is now recognized that no ‘toxin in the blood’ is involved) is a condition unique to pregnancy, generally diagnosed upon appearance of two of a triad of symptoms—high blood pressure, swelling, and protein in the urine. Abdominal pains, headaches and blinding flashes of light may alert a pregnant woman that something is seriously wrong. At its extreme, the condition becomes eclampsia, the epileptic-like convulsions that can be fatal to mother and baby.

Diagnosis of pre-eclampsia is confused by the fact that all three of its cardinal symptoms may arise from other causes, many of which are entirely benign. This is often not recognized by doctors, who may begin treatment of healthy pregnant women, sometimes causing problems where none in fact existed. Even in genuine cases, standard medical treatment with bedrest, sedatives, drugs to control blood pressure, and early induction of labour does little to ameliorate the condition. Many doctors believe that the only effective treatment is to end the pregnancy.

Pre-eclampsia is still hailed as ‘the ancient enigma’ in obstetric journals, and a consultant dealing with a reader’s problem for ‘Woman’ magazine wrote recently ‘the cause of pre-eclampsia is not known. . . Because of this it is not possible to give advice on how to avoid it.’ While midwives have taken Dawn James’s findings seriously, the obstetric profession remains obdurate and aloof.

It was in the women’s magazines that Dawn James began her own search, with a request that others who had suffered pre-eclampsia write to her. She had 200 replies. She sent them a questionnaire, and compared her findings with what she had learned from the textbooks. Pre-eclampsia was supposed to be more common in twin pregnancies, overweight women and diabetics, and to run in families. None of these categories fitted Dawn James, and none was common among her correspondents. These women, anxious about their future, had invariably been reassured by their doctors that pre-eclampsia was a disease of first pregnancies only. Yet out of the 32 respondents who had undertaken another pregnancy, 23 had suffered pre-eclampsia again! With the support of many of these women, Dawn established P.E.T.S., the Pre-Eclamptic Toxaemia Society.

DAWN BEGAN a massive educational effort involving correspondence with the experts’ across the three continents and delving through the medical journals reaching back over a hundred years. But alongside continuous reportage of this work in the quarterly P.E.T.S. newsletter, Dawn kept publishing the personal experiences of her members – tragic accounts of unsuspecting women meticulously following their doctors’ orders and yet succumbing quite suddenly to convulsions and coma and having either a premature, low weight baby (with a much higher risk of mental or physical disability) or a stillbirth.

An underlying theme did begin to emerge from Dawn’s reading, and that was the supreme relevance of the mother’s diet. John Lever at Guy’s in 1843 was probably the first obstetric physician to take a dietary history, noting a single daily meal of bread and tea from a woman with puerperal convulsions. The work of Hamlin in Australia, Strauss in North Carolina and, especially, Brewer in California made a strong impression. Here was an account of the aetiology of pre-eclampsia – from inadequate nutrition, through liver dysfunction, low blood albumin and reduced blood volume—which made sense and was supported by the evidence amongst the severely undernourished subjects involved. But how could this apply in Britain in the 1980s?

By the time the next newsletter was compiled, Dawn had made the most significant step of all, by simply asking herself, as so few obstetricians have asked of their patients since John Lever, ‘what exactly had I been eating?’ ‘During the first twelve weeks of my pregnancy, I was constantly vomiting day and night and survived a few weeks mostly on bottles of lucozade. . . then, at about 5 months, I was told I had gained ‘too much’ and that I should cut down on my food. I felt really hungry all the time and would sneak a potato or some bread until my husband would remind me of the expert advice and I would go back to mostly salads. . . . When I was in hospital. . . I hardly ate at all during those two weeks prior to my induction.’

Underweight and premature

Underweight and premature


Again and again, the personal experiences indicated maternal under-nutrition, sometimes instigated by doctors setting artificial weight limits. And more scientific studies, conducted by dieticians and public health physicians rather than obstetricians were given a new prominence in P.E.T.S. They showed that pre-eclampsia could be effectively prevented by thorough nutrition counselling or diet supplementation.

The obstetric profession doesn’t like this idea. ‘I would counsel that you drop any reference to Brewer’s work,’ wrote Professor Ian MacGillivray about the California champion of the nutritional thesis, ‘if you wish to have any support from research workers into this problem in the United Kingdom or for that matter, any part of the world.’

Nancy Stewart, another P.E.T.S. member and recent editor for the Association for Improvements in the Maternity Services, believes that this is inevitable given the training and role of obstetricians. ‘Prevention through good nutrition is a woman-centred approach, which means being in touch with women’s daily lives. And it has to do with health, rather than disease. This is the approach of midwives, as the guardians of normality. Obstetrics is not about health, but about diagnosing and treating disease. It is a male science, and within the political structure of maternity care it is these men, trained to approach pregnancy as a medical event, who have the power to define health care.’

Pre-eclampsia is more prevalent among unskilled working class people and teenaged, Asian and single mothers—those statistically least likely to meet the extra nutritional demands of pregnancy. How can a few informed women hope to change the system of maternity care to benefit these in greatest need? Midwives may learn eagerly from P. E. T. S., and may even recall the days when their duties included baking and delivering egg custards to get concentrated protein into poor pregnant women, but their role as independent practitioners is being rapidly diminished into one of obstetric nurses.

Perhaps P.E.T.S. can work its approach into the health care system through the back door, women taking the lead. But in the meantime as many as 15 per cent of women in pregnancy are diagnosed as pre-eclamptic, and very few of them discover in time the protective effects of sufficient high quality foods. Instead, they are categorized immediately as high risk and referred to the obstetric clinic, where sophisticated, expensive diagnostic procedures chart with scientific precision the worsening and irreversible damage to their babies.

(Transcribed by Gloria Lemay, Vancouver BC Canada from the original magazine article)

Hemorrhoid Treatment

Dear Gloria, I had a great birth with my second baby and didn’t even tear. Next problem, what do I do for a hemorrhoid though? Decent sized one, too. I’ve been putting ice and witch hazel on it. Do you have any tips??

Dear Catherine,
Yes, actually, we’ve just had a big discussion on that subject on the Ancient Art Midwifery list. After you’ve gone pee, got yourself a drink, and have 1/2 hour of “lying on your side nursing the baby” time, get a warm soapy facecloth and towel and get into bed with baby. Then, with just your finger, gently push the bumpy veins inside your bum and clench your bum cheeks tight to keep them in for the 1/2 hour. Clean your hands with the facecloth and dry them and then lie on your side, like that, with babe feeding/cuddling and you clenching tight for 1/2 hour. This allows the veins to be placed where they are supposed to be, reduces the swelling and allows the blood flow to resume properly. You may have to do this more than once but it brings instant relief.

Dear Gloria, Oh that’s great!! Will try this today as it’s the only part of me that’s sore!

I just put the witch hazel on it to reduce the size and did exactly what you said – I already feel better! Now I can enjoy my baby properly! I couldn’t sit at all. . . You have no idea how much you’ve helped me. . . I could burst into tears! Thank you!

Dear Catherine, Glad that helped, you’re welcome. I know you’ll pass the info on to others and help other women recover from birth smoothly. Love Gloria
_________________________________________________________________________________________________________________________________________

2016 Update: Just looking through some old emails and found this comment from a reader about using a tip in the comments of this article:

“An update about my behind… because I’m sure you’re dying to know 😉 The potato poultice that one of your commenters mentioned has been sent down from heaven on the wings of angels. I’m left with some extra ‘skin’ but most of the inflammation and pain is gone. All the blood has drained as well.”

end of quote.
So nice to know that this exchange of info really helps someone who is suffering. Keep the comments coming, please. Gloria

Helping your client avoid a Gestational Diabetes diagnosis

There is controversy in obstetrics about the diagnosis of gestational diabetes and the testing that is done to ascertain which women are at greatest risk. Dr. Michel Odent has written an article GESTATIONAL DIABETES: A DIAGNOSIS STILL LOOKING FOR A DISEASE? which can be viewed online at http://www.gentlebirth.org/archives/gdmodent.html

Pregnant woman testing blood sugar levels

Pregnant woman testing blood sugar levels

.

Until all the controversy is resolved and a more scientific test can be offered, we are stuck with the glucose tolerance test at 28 weeks gestational age. The mother can look at the list of who is at greatest risk and decide to decline the test if her risk is low.

Women at risk:
– maternal age over 25
– – obese woman prior to pregnancy
– – previous birth of baby weighing over 10# at birth
– – previous unexplained stillbirth at term
– – family history of diabetes (esp. close relatives who became diabetic at a young age
i.e. juvenile onset diabetes)
–previous history of recurrent miscarriages
–extremes of heaviness or thinness
–history of alcohol abuse
–history of anorexia or bulimia

This risk factor screening will only pick up 50% of women who are GD. Therefore, we would be wise to treat everybody “as if” they are GD because the diet and lifestyle changes are good for everyone (preventive health care).

If your client has any of the above factors, urge her to follow a GD diet and exercise program as early as possible and then, if she does take the 28 week test, she will usually sail through it with flying colors.

This doesn’t mean that she can start eating junk food though. I tell my clients that ice cream and chocolate are toxic to unborn babies–there is way too much fat, salt, sugar and caffeine in these products for a baby in utero to cope with.

Whole, organic foods, fresh water, and love are the ingredients to grow a healthy baby.

How can we best serve the health interests of mother and baby?

If you meet your client prior to the 28 week test, you can let her know that she can improve her chances of passing the test by eating healthy, unrefined food for the week preceding the test and exercising every day (a 20 minute brisk walk that elevates her heart rate). You can explain to her that some healthy women who just ate badly (lots of sweet desserts and junk food) prior to the 28 week test have tested positive for risk of GD and then had to undergo the more unpleasant fasting 3 hour blood tests.

If you meet your client after she has been diagnosed as GDM (gestational diabetic mother), I would encourage you to attend with your client at the diabetic clinic where a nurse will give her counseling and nutrition advice. Usually, the woman will be asked to maintain a food diary and daily ‘exercise after meals’ regimen. She will be shown how to test her own blood and may be asked to count the number of times her baby kicks in a 12 hour period.

The philosophy behind the diet is that the GDM needs to control her blood sugar levels at an even rate (also known as staying in the Zone–not getting stuffed or starved) and can do so by “grazing” on small amounts of wholesome food, eaten often.

What foods should your clients avoid?
*sugar (white or brown)
*honey, molasses, syrup, jams, jellies, marmalade
*chocolate, candy
*puddings, Jell-O, fruit yogurts
*desserts—cakes, pies, pastries, iced cookies, etc.
*soft drinks, tonic water
*sweetened condensed milk
*sweet sauces—oyster sauce, teriyaki, plum, sweet & sour, ketchup

Caffeine has been shown to make the body more resistant to the effects of insulin so tea, coffee and all soda pop should be avoided.

Fruit sugar should only be consumed in small portions. ½ a banana, 10 grapes, a small apple are the serving sizes. Milk products are also high in sugar and should be used in moderation according to the advice of a diabetic nutritionist.

    Update: June 16, 2015

Nice compilation of articles about Gestational Diabetes by an Australian doula http://www.themoderndoula.com.au/g-is-for-gestational-diabetes/

Midwife’s Guide to an Intact Perineum

by Gloria Lemay

 

An intact perineum is the goal of every birthing woman. We love to have whole, healthy female genitalia. Many people consider the health of the vagina/perineum to be a matter of chance, luck or being at the mercy of the circumstances of the forces that prevail at the time of the birth.

 

Folklore abounds about doing perineal massage prenatally. No other species of mammal does this. Advising a woman to do perineal massage in pregnancy implies a lack of confidence that her tissues have been designed perfectly to give birth to her infant.

 

The intact perineum begins long before the day of the birth. Sharing what the feeling of a baby’s head stretching the tissues will be like and warning the mother about the pitfalls in pushing will go a long way to having a smooth passage for both baby and mother.

 

The woman will be open and receptive to conversations in prenatal visits about the realities of the birth process. Here, in point form, is the information I convey for the second stage (pushing):

 

1. When you begin to feel like pushing it will be a bowel-movement-like feeling in your bum. We will not rush this part. You will tune in to your body and do the least bearing down possible. This will allow your body to suffuse hormones to your perineum and make it very stretchy by the time the baby’s head is stretching it.

 

2. The feeling in your bum will increase until it feels like you are splitting in two and it’s more than you can stand. This is normal and no one has ever split in two, so you won’t be the first. Because you have been educated that this is normal, you will relax and find this an interesting and weird experience. You may have the thought, “Gloria told me it would be like this and she was so right. I guess this has been going on since the beginning of humankind.”

"Red (or purple) Line that extends upwards between the bum cheeks"

“Red (or purple) Line that extends upwards between the bum cheeks”

 

3. The next distinct feeling is a burning, pins-and-needles feeling at the opening of the vagina. Many women describe this as a “ring of fire” all around the vaginal opening. It is instinctive to slap your hand down on the now-bulging vulva and try to control where the baby’s head is starting to emerge. This instinct should be followed. It seems to really help to have your own hands there. Sometimes women like to have very hot face cloths applied to their perineum at this point. If you like the feeling of this, say so, and if you don’t, say so. We will do whatever you feel like.

 

4. Most women like pushing more than dilating. When you’re pushing, you feel like you’re getting somewhere and that there really is a goal for your efforts.

 

5. This is a time of great concentration and focus for you. Extraneous conversation will not be allowed in the room. Everyone will be silent and respectful in between sensations while you regather your focus. Once you begin feeling the ring of fire, there is no need for hurry. You will be guided to push as you feel like until the baby is crowning (the biggest part of the back top of the head is visible). All that will be touching your tissues is the hot face cloth and your own hands. It is important for the practitioner to keep their hands off because the blood-filled tissues can be easily bruised and weakened by poking, external fingers. This can lead to tearing. We will use a plastic mirror and a flashlight to see what’s happening so we can guide you. We won’t touch you or the baby.

 

6. This point of full crowning is very intense and requires extreme focus on the burning—it is a safe, healthy feeling but unlike anything you have felt before. You may hear a devil woman inside your head who will say to you, “All you have to do is give one almighty push here and it will all be over—who cares if you tear . . . just give it hell and get that forehead off your butt!” This devil woman is not your friend. Thank her for sharing and then have your higher self say, “Just hang in there. It’s OK. Panting and rising above the pushing urge will help me stay together, and I will have less discomfort in the long run.” Your practitioner will be giving only positive commands at this point, and she will be keeping them as simple as possible to maintain your focus. Typically the birth attendant’s instructions are “Okay, Linda, easy . . . easy . . . easy . . . pant . . . pant with me . . . Hah . . . Hah . . . Hah . . . Hah . . . Hah . . . Hah. Good, that one’s over. You’re stretching beautifully; there’s lots of space for your baby. This baby’s the perfect size to come through.”

 

7. You will be offered plain water with a bendable straw throughout this phase because hydration seems to be important when pushing, and you can take the water or leave it, as you wish.

 

8. Once the head is fully born, you will feel a great sense of relief. You will keep focused for the next sensation, which will bring the baby’s shoulders out, and the baby’s whole body will quickly emerge after that with very little effort on your part. The baby will go up onto your bare skin immediately, and it is the most ecstatic feeling in the world to have that slippery, crawling, amazing little baby with you on the outside of your body. Your perineum may feel somewhat hot and tender in the first hour after birth, and believe it or not, the remedy that helps the most is to apply very hot, wet face cloths. This is in keeping with the Chinese medicine theory that cold should never be applied to new mothers or babies. Women report that they feel instantly more comfortable when heat is applied, and any swelling diminishes rapidly.

 

9. When you push your placenta out, the feeling will be like that of a large, soft tampon just plopping out. It is a good feeling to complete the entire process of birth with the emergence of the placenta.

 

When a new mother has an intact perineum, she recuperates faster and easier from birth. I like to twist a diagonally folded bath towel into a very tight roll and coil that into a ring for the woman to sit on when breastfeeding. Lovemaking can resume whenever the couple is ready; it feels good to use a little olive or almond oil as a lubricant the first few times.

 

Originally published in Midwifery Today Magazine.

Blood typing the infant of a Rh negative mother

When the mother of a newborn baby is Rh negative and the father is Rh positive, there is a good chance that the baby will be a positive blood type. Blood in the umbilical cord and the placenta will be only the baby’s blood. Here are instructions on how to obtain a sample:

  1. At the time of birth do not rush the clamping and cutting of the cord. I like to see the placenta birthed (this will usually take longer than 30 minutes if Nature’s way is followed) before clamping and cutting of the cord.
  2. Take the bowl with the placenta to the kitchen and get everything together before taking your blood sample. You will need
    • 2 pairs of nonsterile gloves to protect yourself from body fluids
    • 1 container with a lid in which to put the placenta
    • 1 blue waterproof 17- by 21-inch underpad
    • 1 3-cc syringe and needle
    • 1 purple test tube with stopper (Check with your local hospital to determine what color stopper they prefer. The purple stopper tube has an anticlotting chemical in it to prevent the blood from clumping.)
  3. Before putting on your gloves, write the necessary information on the label of the test tube in very tiny printing. Remember: it is very important that blood samples not get mixed up at the hospital. You will get along well with the blood bank if you mark your samples carefully. In my area, we print the mother’s full name and date of birth, the title “Cord Blood,” baby’s date of birth, and mother’s personal health number. When you get to the blood bank, they will also want you to fill out a requisition. On that form, put attendant’s name, pager number, the physician’s name, and the mother’s date of birth and personal health number. Write for the instructions “Type infant cord blood for screening; infant of Rh negative mother.”
  4. Now that you have all your supplies together and the tube is labeled, take the cord blood before inspecting the placenta. Pull the placenta out of the bowl and put it on the blue pad so that it is sitting on the counter with the cord draped over the edge of the counter; the clamp is on the end of the cord. You want to keep the label of the tube clean and legible, so you may want to change your gloves or wipe blood off them on the blue pad’s edge. Take the lid off the tube and hold it at the clamped end of the cord. Cut off the clamp by making a fresh cut in the cord and allow the blood to run into the test tube. When a half-inch of blood has accumulated in the bottom of the tube, close the tube and rock the blood back and forth. If you can’t get enough blood you may have to squeeze the blood down from higher up in the cord or cut the cord again near one of the black blood pools that you can see along the cord. Occasionally you may have to run the 3-cc needle into one of the vessels on the fetal side of the placenta, draw back on the plunger to extract the blood, and then squirt it into the test tube.
  5. Now you can do a complete inspection of the placenta and then put it away with a lid and label on it in the refrigerator.
  6. When you take the test tube to the lab, ask the technician to page you with the results as soon as possible. If the baby’s blood is Rh negative, ask the lab to fax a copy of the result for your records. If the baby’s blood is Rh positive, the lab will require a blood draw from a vein in the mother’s arm. Again, be sure you have the requisite stopper color test tube. The maternal sample is taken to the lab and checked for baby’s blood cells. If there are none in the mother’s blood, a low dose (120 micrograms) of WinRho (Rhogam in the United States) is given. If baby cells are present in mother’s blood, I have had as many as 900 micrograms prescribed. The package includes instructions on how to give the injection intramuscularly. It is given into the large muscle on the upper outer quadrant of the thigh. If you have to give more than 300 micrograms, you must give it in multiple sites. Injecting anything under the skin can cause harm, so be very careful you are sure of what you are doing and that you’ve had good instruction.  There will be an instruction leaflet in the box of Winrho (Rhogam), read it carefully before giving each injection because the information can change.

First published by Midwifery Today , 2004, updated Nov 18, 2008
UPDATE: September 2014 Article by Sara Wickham in the United Kingdom on a test to help limit the number of women who receive Rhogam (WinRho) unnecessarily in pregnancy. http://www.sarawickham.com/research-updates/yet-more-evidence-to-help-women-avoid-unnecessary-anti-d/