Book Review
Anti-D in Midwifery: Panacea or Paradox?
Sara Wickham
ISBN: 0-750652-32-2; 2000; 165 pages; Books for Midwives, Oxford;
Annette Summers
Associate Professor (Midwifery), Division of Health Sciences, University of South Australia, SA
This interesting book by Sara Wickham questions the global routine administration of anti-D immunoglobulin (ant D) to rhesus negative (Rh. Neg) mothers following the birth of a rhesus positive (Rh. Pos) child. Wickham argues that there is no evidence to show that transplacental haemorrhage always occurs and that the subsequent immunisation of the mother is inevitable. She cites cost, lack of new and relevant research and other incumbent risks of administering anti-D, such as allergies to gamma globulin, as grounds for her argument.
Wickham initially puts forward a well-researched and thought-provoking theory, which must make every midwife ensure that their practice is based on evidence and not just tradition, whether or not this might be old or new tradition. Wickham does not argue the case for no anti-D to be administered. Rather, her chief concern is that routine prescribing of anti-D to all Rh. Neg. women with a Rh. Pos baby has its own inherent risks and that it should only be given to women who need it and indeed those who choose to have it. Through her arguments, it is disappointing to see that Wickham manages to convey the notion that people who are Rh. Neg are an aberration of the 'normal', which is a little disconcerting if you are a Rh. Neg reader.
Wickham then goes on to describe her own research, which she terms as the search for midwifery evidence (as opposed to medical science evidence). While the comments from midwives' experience is interesting and often supports Wickham's use of personal research, it does fail to strengthen her previously well-argued theory. Indeed, the discourse tends to divert to other radical midwifery arguments that detract from the original thrust of the book.
In summary, this book presents some thought provoking discussion on the routine administration of anti-D immunoglobulin (ant D) to rhesus negative (Rh. Neg) mothers following the birth of a rhesus positive (Rh. Pos) child. The theoretical arguments presented in this book will be of interest to midwives, nurses and allied health practitioners who do seek to base their practice on evidence rather than tradition.
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