Birth Small Talk

Talking about birth

Missing pieces in the Anti D puzzle – book review

Photo by Roksolana Zasiadko on Unsplash

Sara Wickham has recently published her new book exploring the use of Anti D in maternity care. There are three things I really appreciate about Sara’s writing. First, she always starts by making her own position in relation to knowledge in maternity care clear. Then she undertakes a comprehensive and detailed review of the existing literature. I am confident that when I read her work, I’m getting an accurate portrayal of what is known about the topic. Finally, she writes in a way that makes even challenging concepts easy to understand. I always come away with new ideas about communicating topics with women when I finish one of Sara’s books. 

Reflecting Sara’s approach to laying her cards on the table at the start of her books – I will do the same. Sara is my friend. I have had the pleasure of sitting in her garden, drinking gin, and putting the world to rights with her on the occasions I have visited the UK. Sara asked me to review certain parts of the book prior to publication and provide feedback. She sent me my copy as a thank you for my input into the draft of the book. 

I read Sara’s first Anti D book years ago. It was a very different book, written for a different audience. I recall being shocked to discover how many gaps there are in our knowledge around rhesus disease causation and prevention. The amount of knowledge we maternity clinicians need to absorb is vast. As a junior doctor I decided that rhesus disease was simple – check the woman’s rhesus status, give Anti D – job done. This apparent simplicity is, I suspect, a large part of the reason behind the gaps in our knowledge. It is easier to continue to believe that the answer is this simple, despite the reality that everything in healthcare is inevitably complex. 

Sara’s “Anti D Explained” includes all the latest research and continues to highlight the absence of evidence to underpin some of the ways in which Anti D is typically used. There is now a handy section on the use of non-invasive prenatal testing to determine the blood group of the fetus during pregnancy. The book is so up to date that there is even a section exploring the question of whether COVID19 can be transmitted via Anti D!

If you are a clinician counselling women about Anti D use during pregnancy and after birth, or are a rhesus negative woman navigating your own decisions about Anti D use, Sara’s book is a great addition to your collection. You can find a list of options for purchasing the book on Sara’s website

Categories: Book reviews

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1 reply

  1. Looking forward to reading Sara’s book as I’m currently updating a prophylactic use of Rh D immunoglobulin guideline.
    The move to selective prophylaxis based on NIPT rather than universal for all Rh negative women appears to be a move in the right direction. However a deeper dive into the National guideline gives the impression the decision is economically driven resulting in a cost shift to the woman. This creates significant barriers in access for women who can’t afford to self fund the NIPT

    Liked by 1 person

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