so naturally, when i first became pregnant i began doing my research. not only was i searching for birth stories and experiences, but i wanted to know more about the scientific aspects of pregnancy...specifically labor and birth. who knew you could learn so much amazing science just from being pregnant? thanks to pregnancy i've learned of the intricate, and well-timed scientific process your body goes through when you're in labor and why the "pain" during childbirth is actually normal. a lesson in human anatomy and physiology, you might say, right?
or how about a nice little lesson on microbiology when i tested positive for group B strep? and then there were the natural preventative measures i looked up in order to prevent the same thing happening while pregnant with cash. you could consider that a quick study on naturopathic medicine. right? okay, maybe i'm stretching it a bit, but there is so much amazing natural science just within the scope of pregnancy and childbirth.
why bother with learning all this stuff? like i said, i'm a girl that likes to make a well-informed decision. it helps me find peace that the decision i'm going to make is the best one for me and/or my family. and helps me get an idea of how my decision will impact the future. that doesn't mean that i don't trust my healthcare provider, but i also don't see her as the ultimate decision maker in regards to the health and well-being of my body (this would apply to my children's pediatrician too). i am ultimately responsible for my own health, including the decisions i make about the health and well-being of my body. i suppose you could compare it to smoking. smokers know the risk they're taking by smoking (it kills your lungs, there's an increased chance of lung cancer, etc., etc.), but does that stop them from smoking? no. does that mean that smoking is good for your health? no. most smokers are well-informed of the risks, but ultimately the choice to continue or stop is up to them.
so now, baby number 4 is growing in my belly nearing the half-way point in my pregnancy. what's new this time around?
nothing much except that now i have developed the E antibody (or anti-E) in my blood. what the heck is anti-E? good question. of course it's not one of those fairly common things that pregnant women get, so there's not much lay people information on it except what's found in forums (they have been quite helpful, though sometimes it's hard to tell what's fact and what's not). what's left is a handful of medical journals i get to sift through to get a better understanding of what this means for me and the baby during the rest of my pregnancy.
i did get a general explanation from my midwife and some very helpful friends (who's information i trust). but did you think i would be satisfied with that? ha! of course not. let me tell you i have been learning a lot about hematology, biochemistry and genetics. not anything crazy in-depth like some kind of med student, but enough for me to take notes and draw pictures.
so back to the big E.
what is it?
you have to first get back to the basics of blood. from my understanding, blood is made up of white blood cells, red blood cells and platelets. within the red blood cells you have proteins and plasma. then there are these molecules that hang out on the surface of your red blood cells. they're called agglutinogens and there are 2 types: type A and type B. that's what makes up your blood type. if your blood doesn't have A or B then you have type O (or "zero" or the absence of A and B). so that's where people have either these 4 blood types: A, B, AB or O.
then there's the Rh protein (or the Rh factor) that hangs out on the surface of your red blood cells too. you either have it or you don't. that's where the + or - comes in with your blood type. so for example, if you're blood type is AB+ then you have type A and B agglutinogens and have the Rh protein. and all this blood stuff is genetic...and can affect whether or not you have a high-risk pregnancy.
not to make things more complicated but the Rh protein is made up of these antigens: D, Cc, Ee (there are also the kell, duffy and kidd genes possible, but they're very rare). and you can have a number of different combinations within the D, C and Es when you factor in the dominant and recessive genes. if there are 8 possible combinations (CDE, CDe, CdE, Cde, cDE, cDe, cdE and cde) for each parent then you've got a nice little mix of possibilities for each child. and when that child is grown and has his/her own babies there is another fun set mixing, and so on and so on (this site has a neat little table if you're a visual person)
if you've ever been pregnant you've probably heard about the Rh factor in pregnancy, and what happens if you're a mom who is Rh-. apparently, this Rh factor that's most commonly talked about during pregnancy only addresses the D antigen (RhD). so if you've ever gotten a rhogam treatment it was for the D antigen. why only the D antigen? because the others are uncommon and occur only in a small percentage of RhD cases. of course it is (please add sarcastic tone to that statement). the more i read, the more i understand that genetics is very, very complicated...even if it's only looking into the blood factor.
here's the interesting thing about blood types: your blood is picky. if you receive a transfusion you can't just get any old blood type. it has to be compatible with yours. if you get an incompatible blood it's going to attack that "foreigner" by killing off the red blood cells and produce antibodies (similar idea to when you get sick). the same thing applies to having babies. blood type is a factor in your pregnancy experience. if your blood type is incompatible with your baby's blood type (hemolytic disease of the fetus or newborn) then you could have issues.
now, i have never received a blood transfusion so the only other possibility of me developing the E antibody is through the exchange of blood types between me and one of my babies during childbirth. it also means that my dear husband carries the (capital/dominant) E protein...which means that one (or some) of our 3 kids is carrying that same gene. i, however, do not carry the capital E protein so when i was exposed to it, i developed the (capital) E antibody. clear as mud? of course.
what's the next course of action?
not much but pray :).
i can't do a rhogam injection because that's only used to treat RhD. i'll probably get titers done to make sure my big E levels don't get too high. when it gets high, that's when it can cause fetal anemia (if the blood types cross paths) or super, worse (and very, very, very rare) case scenario of miscarriage, stillborn or hydrops fetalis. however, it is possible to do an intrauterine blood transfusion if the fetus develops anemia. after birth, the newborn baby will most likely develop jaundice because mama's blood has been trying to attack and break down all the baby's "foreign" red blood cells (most likely explanation as to why gibson and cash had jaundice, but emma did not). a lot of the information on how to handle anti-E requires medical intervention, which i am not a huge fan of. obviously, when it's a medical necessity then i understand intervention is necessary. but i suppose it's important to first define what qualifies as medical necessity. for example, there is a method via ultrasound that allows the baby to be monitored and checked for fetal anemia, which i think is a far better choice than the intrusive (and more high risk) amniocentesis. but as we approach the birth of this baby, there will probably be other factors to consider, and we may have to consent to certain medical interventions that were not the norm during my other births for the health and safety of mother and baby.
there's a 50/50 chance that the baby will carry the big E protein so it's hard to tell if there will be any "issues" at all. most cases i've read, the worse and most common complication the babe experiences is jaundice.
my only question, even after all this research, is why i can be Rh positive but still develop the E antibody. is it because i don't carry the big E and just the little e, but maybe i carry a big D or C? like i said before, genetics is very, very complicated. any geneticists out there? anyone?
so...there you go.
i know there hasn't been much updates with this pregnancy, but here's one "for the books." ha! quite frankly, i'm not worried, because i know the good Lord has it handled. i feel like the information i've gathered has provided me with enough knowledge about the issue so that i'm not confused about it (especially when discussing this with my midwife). i do want to put this information out there for any other mamas experiencing something similar since it's not something common experienced in pregnancy.
ultimately, the outcome of all this is in the Lord's hands and i trust that he will work all things for good and for his glory.
- management of pregnancies complicated by anti-E alloimmunization
- hemolytic disease of the newborn due to isoimmunization with anti-E antibodies: a case report
- isoimmunization and fetal anemia
- anti-E in pregnancy
- the rhesus antibody anti-E in pregnancy and blood transfusions (you can download full text on the site)
- defining the Rh blood group antigens
- genes and blood type
- blood types, blood compatibility and Rh inheritance