Of Midwives and Monkeys

Monkeys and midwives, not something you usually associate together, (at least I hope you don’t associate them together) but one particular monkey has been of incredible service to maternity care providers, mothers and babies for the last 70+ years.

Rhesus Monkeys are small furry primates, native to much of Asia, who have been beneficial in the discovery of many medical breakthroughs over the years. In the late 1930’s early 1940’s Doctors were able to use the Rhesus monkey in understanding a particular marker on the human red blood cell, and so from the Rhesus monkey, the Rh factor got its name.

The Rh factor is an antigen, a specific microscopic ‘marker’ that is part of the red blood cell. Most people have this particular marker on their red blood cells, they are termed Rh positive (+) but a few people don’t have this factor, they are termed Rh negative (-).Who cares? Well in the normal day to day life, nobody. Rh positive blood will look just like Rh negative blood if you happen to cut yourself. But we do know that it becomes very important in the event of a blood transfusion, or in the event that a pregnant mom happens to be Rh negative.

This tiny marker on the face of the red blood cell causes the body to see that cell as belonging to the person who carries it. It is seen by the body’s immune system as part of the body and therefore to be defended. However, for those without this tiny marker naturally on their cells, their body sees any blood cells with this marker as foreign. If the body is exposed to this foreign antigen, the first time it sees it, it will recognize it as foreign and develop specialized antibodies, like soldiers, specifically designed to attack any time they see this particular marker.

This becomes incredibly important when it comes to expectant mothers who do not carry this marker on their blood cells, but are carrying a baby who does carry this marker. While the blood supply of mom and baby shouldn’t normally mix, it does occasionally happen at the time of birth or in the event of an accident or anything that might damage the placenta. If the blood cells of the baby carrying the marker gets into moms blood stream, this signals her immune system to produce these ‘soldiers’ should she ever see this marker again. Mom’s first baby isn’t affected because she just developed these soldiers after the mixing. But should Mom become pregnant with a baby who has these markers on their blood cells again, these tiny antibody ‘soldiers’ are already in her blood stream and will quickly cross over into the baby’s blood stream and attack the baby’s red blood cells. Mothers who have developed this antibody are called isoimmunized. Isoimmunization leads to major problems with future babies. Her second baby, with the help of much modern technology, may go on to live a healthy life after being delivered early, but a third and any subsequent baby is likely to have problems so severe, that it cannot live.

This heart wrenching problem of a mother that simply miscarries and miscarries is unbearable. Such heartbreak for her and her family left us searching for an answer to treat this problem.Since shortly after the discovery of what was causing this problem, modern medicine has been blessed to find a ‘treatment’. The treatment though, is not so much a treatment as prevention.We have discovered that if blood mixes between mom and baby and the mother develops these antibodies (soldiers) its too late. Word got out to the body that foreign cells have invaded and now we have a full blown war on our hands. But we also know that if we can destroy any blood cells before her body recognizes them, we can keep her immune system from developing these antibody ‘soldiers’. The way these cells are destroyed is to give the mother artificial antibody ‘soldiers’ to go and destroy the red blood cells that entered the system and destroy all the evidence before the body’s immune system can make its own.This amazing breakthrough, (we call the artificial antibody ‘Rho-Gam’ or Rh-D antiglobulin) has saved countless lives. But it only works as a prevention, not a cure. You can’t give it to moms who have already developed their own antibodies or you’ve simply complicated the problem.So, we started to give mothers these artificial soldiers after delivery of a baby who has these markers on their red blood cells, just in case some should have crossed over.And it turns out we reduced the rate of mom’s who were effected drastically. We then started giving these soldiers at the end of pregnancy as well as after delivery and we found that we reduced the incidence of moms developing this to less than a tenth of a percent.This amazing breakthrough in understanding has saved he lives of countless babies.

So, today I am grateful for a monkey, who helped in the quest to improve the lives of innumerable people across the world!