Westerners’ pregnancy issue
I am American-Spanish and am pregnant with my third child. I want to share my story of a severe medical mistake that has put my baby's life at risk and is forcing us to leave Taipei for treatments that are not available in Taiwan.
I have Rh- blood. It is incompatible with Rh+ blood and will attack and potentially kill the fetus if the mother is “sensitized.” This occurs when the Rh- mother’s blood mixes with the baby’s Rh+ blood type (from having a partner with Rh+ blood).
To prevent sensitization, according to the American College of Obstetricians and Gynecologists, an Rh- mother should receive the RhoGAM injection at 28 weeks, 72 hours after birth and after any situation in which her blood and the baby’s blood might mix, such as in bleeding during pregnancy, a miscarriage or trauma.
I asked repeatedly for the RhoGAM injection from my doctor and nurse at a well-known clinic in Taipei that promotes itself to foreigners. The clinic even offers a translator to follow each case. The translator’s reply was always that I do not need the RhoGAM injection. The doctor insisted that the only time RhoGAM is necessary is after birth.
I requested that they take my blood and test me for Rh sensitization to be sure the baby was safe. They agreed. I reminded the nurse multiple times after the appointment with the doctor. She assured me that she knew which tests I needed and to stop worrying so much.
When I got my blood test results back, the sensitization tests were not included. I messaged the nurse who wrote: “I do not know what happened, but you can go to the ... clinic and get your blood taken again free of charge.”
Then, hours later, she messaged me again saying: “I checked with my colleague and we do not offer those tests... You will have to go to a hospital.”
This is a test that is done routinely at the first prenatal visit on every Rh- mother in the US to determine early on in each pregnancy whether sensitization has occurred. For them to not have it is shocking and dangerous.
I went to a hospital, where I found a doctor who has studied and worked in the US. I got the test, and my results (indirect Coombs test) came back positive, meaning I am sensitized: I am now in a high-risk pregnancy with many possible negative outcomes for the baby from jaundice to death.
The new doctor said I absolutely should have gotten the RhoGAM at the first signs of bleeding, but she told me that only 0.3 percent of the population in Taiwan is Rh-, so most ob-gyns go their whole career without seeing it or knowing how to assess or treat it.
While I understand that it is extremely rare, if you are going to be accepting a high number of Western patients, you best be informed and up to date on best-practice procedures.
This is my call to action, to not become complacent with doctors insisting they know best. They are also human and need to know when they should show humility and say: “Let me look into it more.”
When I told my nurse translator that my test came back positive and that I was switching hospitals, she wrote: “OK, I will cancel your appointment.”
I was made to feel like I was overreacting and hormonal during my appointments requesting the injection and blood tests. There were laughs at my questions and eye rolls.
I have e-mailed the doctor to tell him my indirect Coombs test was positive and that I am sensitized.
I recently received a reply: “Rh negative is not resulted in vaginal bleeding. It is totally different story. RhoGAM is only needed right after birth. All you worry about is not necessary.”
Not only does this not make sense (of course Rh- status is not from vaginal bleeding, I was born with it), it demonstrates again how I am made to feel like I am worrying without need and being dismissed. I have become sensitized under the care of this doctor.
The possible treatments for Rh sensitization include intrauterine blood transfusions and blood tests that are not even available in Taiwan, according to my new doctor, so to have these as options we must go abroad, spending thousands, without any assistance, because of one doctor’s pride in his fancy clinic.
Please be advocates for yourselves. Research, share the research and seek a second, or third, opinion if needed.
This letter has been updated since it was first published to include the author's introductory paragraph, which was omitted from the published version.
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