You made it! On this page, you will find things to keep in mind when delivering an ISO baby. If you haven't already, it is helpful to keep a notebook and write down all your questions (and the doctor's answers) about birth and the hospital's processes. Also, make sure they will have antigen negative blood ready for baby. If you've got anti-Kell, baby needs Kell negative blood. If he needs a transfusion, you don't want to wait several hours and risk brain damage while they find blood. You will want to read about the testing that needs to be done after birth. Don't forget to pop over to the Printables page  to help you keep track of all the test results. You'll also find the pages on complications and interventions helpful.

Delivery

Induction

Delayed Cord Clamping

Vaginal Birth

Cesarean Birth

Special Care/NICU



Delivery

You made it! Baby is here (almost). Here are some things to keep in mind when delivering an ISO baby. If you haven't already, it is helpful to keep a notebook and write down all your questions (and the doctor's answers) about birth and the hospital's processes. Also, make sure they will have antigen negative blood ready for baby. If you've got anti-Kell, baby needs kell negative blood. If he needs a transfusion, you don't want to wait several hours and risk brain damage while they find blood.


Induction

Depending on the severity of your ISO, and other factors in your pregnancy, you may be scheduled for an induction. These can occur at any number of weeks, but are typically 32-37 weeks. There are a variety of methods used for induction. Ask your doctor for additional resources, what the procedures are, and any other questions you may have.


Delayed Cord Clamping

Delayed cord clamping is a practice where the umbilical cord is not immediately clamped or cut after birth. The delay time can range from a few minutes up to half an hour. Generally the cord will be limp, pale, and no longer pulsing when clamped. Up to 1/3 of the baby's blood is in the placenta at the time of birth. Delayed clamping allows the baby to get his extra blood back from the placenta. Keep in mind though that with the blood comes the antibodies too.


Our MFM recommended it. Our ISO case was not severe, and there was greater benefit to our baby getting the extra blood than the risk from the extra antibodies. He did have a significant drop in his hemoglobin levels (3 whole points), but because he had his extra blood, it was not low enough to need a transfusion. Some MFM recommend against it. In severe cases of ISO, your antibodies will do more harm than the good the extra blood will do. In this case, it is preferable to give the baby a transfusion with clean donor blood than to give him blood with more antibodies. Talk with your doctor and decide what is best for you and your baby.


Vaginal Birth

Even if you have ISO, you can still have a vaginal birth. For us, it meant there was an entire team of people in the delivery room (9+), including a midwife, obstetrician, neonatologist, some people from the special care nursery, lab tech, and several nurses. Talk with your doctor and see what they recommend, and who they recommend be present. Blood needs to be drawn at birth, so have someone, such as your support person, make certain that it is done. Since it is not commonly done everywhere, it can be easy for delivery personnel to forget to do the immediate draw.

Cesarean Birth

Cesarean sections, C-sections for short, can happen at any time for ISO babies. Talk with your doctor about a contingency plan for if you need a C-section, who will be present, what will happen with the baby, will you get to hold him/her, etc. Delayed cord clamping is also possible with a C-section. Keep in mind that a C-section is still major surgery and you will probably feel out of sorts for a few days. It's a good idea to have some extra help with moving, caring for the baby (and other children), housework, etc.

Special Care/NICU

Regardless of how you deliver your baby, An infant born to an isoimmunized mother shows clinical signs based on the severity of the disease. The typical diagnostic findings are jaundice, pallor, enlarged liver and/or spleen (hepatosplenomegaly), and fetal hydrops in severe cases. The jaundice typically manifests at birth or in the first 24 hours after birth with rapidly rising unconjugated bilirubin level. Occasionally, conjugated hyperbilirubinemia is present because of placental or hepatic dysfunction in those infants with severe hemolytic disease. (5)

For this reason, you should talk to your doctor about delivering in, or near, a hospital with a NICU or special care team equipped to take care of the baby. One of the worst things is to be stuck at one hospital while your baby is sent to another hospital (possibly hours away), without you. We have 2 hospitals in my town, one with a NICU, and one without. I chose to deliver at the one without the NICU, but I was informed beforehand that if my baby needed a transfusion or special care, the baby would be transferred, but I may not be (depending on how busy the hospital was).


These are pictures and descriptions of what care for an isoimmunized pregnancy and a baby with hemolytic disease of the newborn looks like. The photos might seem scary at first, but remember, knowledge is power. It's much better to have an idea of what things might look like, than to be shocked when your medical team first does something. It should also be reassuring the number of babies who have gone through this before and are now perfectly healthy, normal children. All of the babies below were in the NICU. Not all babies born with iso are sent to the NICU. For the babies who did not have HDN as severely, see photos on the Birth page.
  • Born at 31 weeks after a failed IUT.
    Born at 31 weeks after a failed IUT.
  • Born at 31 weeks after a failed IUT. This baby is swollen from hydrops.
    Born at 31 weeks after a failed IUT. This baby is swollen from hydrops.
  • This baby is swollen from hydrops.
    This baby is swollen from hydrops.
  • This baby was born at 28 weeks 6 days.
    This baby was born at 28 weeks 6 days.