Laura Erickson Refuses Rhogam; Mother is Isoimmunized

In 2008 midwife Laura Erickson of Alma Midwifery refused to administer Rhogam to a young mother who requested it after experiencing bleeding in her first trimester.  When the mother asked again in her third trimester, Ms Erickson refused saying that “Rhogam is not necessary for first trimester bleeding, and told the mother to “think it over and be sure” stating that there are unknown effects of the drug.  All medical evidence suggests that Rhogam is very safe for mothers and babies. Prescribing info for Rhogam says it is indicated for bleeding at any stage of gestation including the first trimester.   Shortly after this mother questioned Ms Erickson’s motives in refusing the Rhogam Ms Erickson dropped her as a client via a phone call, and did not appropriately transfer care.  This mother became isoimmunized and suffered pre-eclampsia.   The refusal of Ms Erickson to give the Rhogam resulted in this mother’s 3rd child being born prematurely after having had to be transfused twice in utero. Her baby spent over a month in NICU.

 

Questions to consider:

  1. The prescribing information for Rhogam states that it is indicated for bleeding during any stage of pregnancy, including the first trimester. As someone who is licensed to carry and prescribe legend drugs like Rhogam, how did Erickson not know this? If she was uncertain, should she not have looked it up? Or did she know that it is indicated, and chose to lie and mislead her client? Why would she do that? http://www.rhogam.com/Patient/PaPrescribing/Pages/default.aspx
  2. Did Erickson fully inform the mother as to the statistical risk of isoimmunization if Rhogam is not given?  http://www.ncbi.nlm.nih.gov/pubmed/14974293 Was she able to show any data supporting her insinuation that Rhogam causes autistic spectrum disorders or learning disabilities or other “unknown effects”? (Hint: no such data exists. 30+ years of research and clinical use shows Rhogam is safe except in the vanishingly rare event a woman has an allergic reaction to one of the ingredients.)
  3. For other professionals who drop a patient from care without appropriate notice or transfer of care, there are severe consequences. Erickson was reported to OHLA for this incident but there was no rule against midwives dropping a pregnant woman from care and leaving her with no provider, so she was not disciplined. But why would a midwife not want to be certain her former patient was accounted for somehow, simply on an ethical level?