STM+ with Coombs positive babies please come in

sthomas1222

So, DD was Coombs positive. For those who don't know what that is some background. I'm O+, so I have A antibodies. DD has A blood type & some of my A antibodies were passed to her during birth resulting in a positive Coombs test. All this means that she had jaundice but that she was prone to bigger/higher jumps than normal newborn jaundice. That combined with 3 snowstorms & the hospital typically dealing with a less educated population (big, teaching hospital with outreach programs) resulted in a bullshit 5 day stay that left us very traumatized. We were left alone, questions not answered, procedures done & not done, nurse liason called in twice, talked down to & told I was risking brain death & hearing loss for my child... There is no way to prevent this or know if it will happen again. It was the driving force behind our home birth. That is no longer happening. We're back at this hospital b/c it really is the best & our stay is so far from the norm with them. We're with the midwives this time vs MFM & they stay involved PP instead of the OBs who just dealt with me & only me.

I'm just looking for stories that despite a Coombs+ baby or any other bilirubin issues things can be different, stories that will make me less anxious about it. I know plenty of friends who had mild-moderate bili issues & could follow up with their ped & were released. (With this hospital it's only their peds, no outside private docs have privileges). We're more prepared since we at least know about it this time & can better advocate. DD's bilirubin only got at the level where they wanted to do light therapy one time, she always was just under light level. DD has a ped appt this week & I'll be discussing this whole situation with our ped & what their view is should we have any issues. I'm just so overly anxious about this whole thing. I still can't talk about it without breaking down crying. So much is out of our control. Sorry for the rambling and whatnot.

CCR09

Sorry you had such a bad experience last time! Sounds awful! But, since you asked, I can give you a much better +Coombs story. My DD had a +Coombs and was pretty jaundiced. However, they let her go home with me (normal vaginal delivery) with a biliblanket. It's basically light therapy at home for a few days. They did warn us before we were discharged that if her follow-up bloodwork didn't improve, she would have to go back to the hospital to be admitted for light therapy-- I guess the biliblanket isn't quite up to the efficacy of the in-hospital treatment. So, yes, she was "our little glow worm" for a few days at home, but at least she was home! And our hospital experience was wonderful! I used midwives and absolutely loved them!!! I sincerely hope this L&D and postpartum experience is much, much better for you!

absentmindedwife

I don't really have a story to tell, but I work in a lab that does Coombs (direct antiglobulin) testing. I am sorry that they treated you poorly at the hospital and did not answer your questions. I might be able to shed some light on what is going on. First of all-- you do not need to worry!! A positive Coombs is just telling the Dr. they need to check the child's bilirubin. If the doctors said her bili level was only so much that she needed to be under the light one time, you really have nothing to worry about. Brain damage and blindness is caused when a child has a critically high bilirubin for a prolonged period of time (the baby cannot clear all the bilirubin from their blood and it accumulates in the brain). To keep that from happening, cord blood testing is done to see if the Coombs test is positive for all type O mothers. If the coombs test is positive, that then tells the Dr. to monitor the baby's bilirubin level appropriately. Assuming bilirubin levels were monitored appropriately (which I certainly think they would have been), and she was only ever put under the light for one day, I would not be worried. I would say if you are still concerned, or if she looks yellow, you could ask the pediatrician to have her bilirubin levels check again. 

On a side note, ABO incompatibility (type O mothers with type A or B babies) is the most common cause of positive Coombs in infants. They typically also cause much more mild cases of hemolytic disease of the newborn (HDN) than that of Rh (rhesus) or other blood group antibodies. Antibody screens are performed as routine prenatal testing for this reason, as patients with Rh or other antibodies are considered high risk pregnancies dependent on what antibody is present. All type O mothers have anti-A and anti-B antibodies. Whether or not they cause the coombs to be positive depends on the titer of antibody present. Unfortunately, anti-A typically reacts stronger than anti-B. There is no way to stop a type O person from having these antibodies, as your body naturally produces them.

sthomas1222

Yes yes I know all that (this happened with DD's birth sorry if that was unclear). That's one reason I was so pissed, there was no need to keep us 5 days when my ped could've checked her bili in the office. I would've been fine going to their office 2-3/day rather than stay in that hospital for no reason. I have my RN, I'm not uneducated or can be bullied like these doctors thought. I'm just worried that with this LO we will be facing the same thing again & I can't handle another PP stay like that.

sthomas1222

CCR09 said:

Sorry you had such a bad experience last time! Sounds awful! But, since you asked, I can give you a much better +Coombs story. My DD had a +Coombs and was pretty jaundiced. However, they let her go home with me (normal vaginal delivery) with a biliblanket. It's basically light therapy at home for a few days. They did warn us before we were discharged that if her follow-up bloodwork didn't improve, she would have to go back to the hospital to be admitted for light therapy-- I guess the biliblanket isn't quite up to the efficacy of the in-hospital treatment.

So, yes, she was "our little glow worm" for a few days at home, but at least she was home! And our hospital experience was wonderful! I used midwives and absolutely loved them!!!

I sincerely hope this L&D and postpartum experience is much, much better for you!

After the 1 round of light therapy I asked for the bili blanket b/c at that point she was cluster feeding & wouldn't stay under the lights without screaming the whole time. The docs & nurses acted like it was the biggest inconvenience to go to the NICU & get me one for our room so she could still nurse & get light therapy. That's when the one ped came in & started talking brain damage & hearing loss. I went off on her & she tucked tail & ran. Mama bear came out early. This time I'd really like a nice quiet PP & come home at 24 hours.

absentmindedwife

Just hope that this baby is type O just like you all problems avoided.

sthomas1222

absentmindedwife said:

Just hope that this baby is type O just like you all problems avoided.

If only... I can hope & pray.

kb2bkk

sthomas1222 said:

Yes yes I know all that (this happened with DD's birth sorry if that was unclear). That's one reason I was so pissed, there was no need to keep us 5 days when my ped could've checked her bili in the office. I would've been fine going to their office 2-3/day rather than stay in that hospital for no reason. I have my RN, I'm not uneducated or can be bullied like these doctors thought. I'm just worried that with this LO we will be facing the same thing again & I can't handle another PP stay like that.

Ouch.  I'm pretty sure she was just trying to help. 

hfooter

I had no idea this was something I should know about since I am O+. I'm going to be talking to my CNM tomorrow about it! Thank you for the education on this ladies!

sthomas1222

hfooter said:

I had no idea this was something I should know about since I am O+. I'm going to be talking to my CNM tomorrow about it! Thank you for the education on this ladies!

Yeh I had no clue there could be issues with blood type other than Rh incompatibility since that's all they talk about. The more I talk to people and hear stories the way we were treated makes less and less sense. Why we needed to stay for monitoring when she didn't even need light therapy is beyond me. We're fully prepared to say this time we WILL be leaving and it can be with a bili blanket or without. But I will not be staying there for monitoring when if I had been sent home we could've had her out on the porch (even though it was January by the time we got home is was like 60+ degrees out, VA is awesome like that) or by a window. The windows at the hospital are super tinted and it did no good And our ped could've been monitoring her as well. We did not need to be in the hospital that long. I talk with the midwives every visit about our PP stay last time but I really need to push for a consult with a ped ahead of time or at least a plan of action with the midwives. Something to ease my anxiety about it. It's all I think about right now. I'm trying to pack my bag and all I can think is "well we're supposed to be out in 24 hours but if what happens last time... I need more clothes for him, for me, etc..."