Until becoming pregnant in China, I regarded my rare blood type as merely a fun fact. My mom had mentioned it to me in passing that I might need a special kind of medicine should my husband have a positive blood type. She didn’t really have a lot of specifics for me, but she said it was a pretty routine shot administered in the States and shouldn’t cause me any difficulty.

Famous last words.

For those of you who may be wondering what RhoGAM is all about, here’s the short version: It’s a sterilized solution made from human blood. It is given to many modern-day American moms who don’t have a substance in their blood that many others do (including potentially their babies who may carry their father’s blood type). So basically, if your partner has a positive blood type (A+ in my husband’s case) and you have a negative blood type (B- in my case), many doctors strongly recommend you have two RhoGAM shots: one at 28 weeks (in case of “silent bleeding” where the baby’s blood may have mixed with yours unknowingly) and one 48 hours after you give birth. If some kind of traumatic accident or fall happens, many doctors will want to give you RHoGAM then as well. If you do not get this shot and your blood mixes with the baby’s, your body will respond by making antibodies that will try to destroy all RH-positive blood cells. This shouldn’t be a problem for the baby you are currently carrying, but could cause severe medical problems for any RH-positive babies to come.

Well… I wasn’t in the States when I became pregnant with each of my kids. The hospital in Pingxiang city in Jiangxi province, where I went for my initial prenatal appointments informed me they had absolutely no RhoGAM on hand should I choose to deliver there. My husband and I wound up breaking our teaching contract a month early with our employer’s blessing to return to the US where I delivered our first child.

We returned to China, to a more developed city this time: Wenzhou city in Zhejiang province. The hospitals in Wenzhou also did not have RhoGAM, but they knew the American-Sino OB-GYN Hospital in Shanghai could get it. If we paid 50,000 yuan and traveled there to get it ourselves! So, that’s what we did. Two months before our son arrived, My husband took a train to Shanghai, showed the Shanghai doctors the paperwork from the Baijia Oriental Maternity Hospital in Wenzhou, paid a few months’ worth of salary, stashed the RhoGAM in a thermos full of ice, and took the train home. After ten hours of travel and a much lighter wallet, we had the medicine I needed! We decided to take a risk and skip the 28-week shot, just using RhoGAM for after the baby came. I had done research showing that European women rarely have RhoGAM administered and their next babies are usually ok, so I felt a tiny bit more comfortable doing this. But still—it definitely felt risky! Within the 48-hour time frame, the hospital in Wenzhou kindly administered the shot in my gluteus maximus.

Sometime in between when my son was born in 2016 and when my next child was born in 2018, China made RhoGAM an illegal drug. Without our knowledge. We didn’t find out until I was midway through my prenatal appointments with our daughter! The doctors I saw at the No. 2 public hospital in Wenzhou suggested Hong Kong as a good place to go to deliver our third child since they had different laws regarding RhoGAM there. Financially, hospitals and living costs in Hong Kong looked too steep for our growing family. A friend of ours found a forum talking about RhoGAM on a website that connects expat moms living in Shanghai. Another mama in my situation had gotten her shot from a source in New York flown into China. We followed the lead because it really felt like our only plausible option. Once again, we paid handsomely, and my husband flew to Beijing to acquire the medicine for our family to continue. When our baby girl was born, my husband spent the next two days running around the hospital getting paperwork signed and acquiring the permission necessary in order for the hospital to administer this shot.* The hospital explained that since their hospital pharmacy didn’t provide this drug, we would need to get permission from 3 different people before hospital staff could administer it to me. My husband tracked down the three people: 1) The director of the hospital. 2) The director of the pharmacy. 3) The head nurse who was working that particular day. Each person had to give their signature and we filled out paperwork taking full responsibility if anything adverse happened because of the shot. Thankfully, I got the RhoGAM within the 48 hours, and we had no further incident.

My husband and I are now expecting again! We are foregoing RhoGAM this time since we are planning for this baby to be our last naturally-born child.

I sincerely hope this article encourages families with similar RhoGAM issues to think wisely and plan early regarding their own family situation and being in China.

* The only way to bypass this process is if you have access to someone medically qualified to administer shots in the country in which you just gave birth.

Rachel Vanstrien

Rachel is an American expat currently living in Wenzhou, China, with her husband and three children. She and her husband moved to China 2012 and have lived in Jiangxi Province and Zhejiang Province. Rachel enjoys teaching, singing, playing piano, drinking tea, reading and camping with her family. She is passionate about education. You can check out her website at www.outoftheboxpreschool.com!