“Sometimes I forget I am adopted,” exclaims my amazing son as he grabs his backpack to head off to college. I had just let him know that his birthday this year falls on National Adoption Day. “So cool! We will need to do something special this year on my birthday, to celebrate both my birthday and my adoption! See ya, mom!” To Shaun, adoption is as easy as one, two, three, and just a part of everyday life. As anyone who’s been through adoption knows, this is simply not the case much of the time. While adoption helped us complete our family, the process can be exciting, thrilling and scary all at the same time! When another woman is carrying the baby that will become your child, you worry. Was she drinking alcohol? Taking a pain killer? What if she was using illegal drugs?! It can literally lead to countless anxious days and sleepless nights. I understand these concerns as I shared the same worries.

National Adoption Day, started in the United States in 1999, is celebrated each year on the Saturday before Thanksgiving. This year it happens to fall on Shaun’s birthday and reminds me of when we adopted him, many years ago. That time in my life was so powerful, but it was easier for me than it is for others as I was part of MotherToBaby and already knew where to find the answers to my pregnancy exposure questions.

My adoption journey has helped shape who I am today – a genetic counselor and a teratogen information expert who specializes in understanding exposures that can cause birth defects. The non-profit I work for provides this crucial service all across North America and I’m proud that my journey has brought me into a position to ease the minds of other prospective parents starting down the wonderful path of adoption. It reminds me of Austin and Drew, a prospective adoptive couple whom I helped in their adoption journey, “My partner and I did a lot of research as we started exploring adoption. After we started working with an agency, there were lots of questions about prenatal exposures, birth parent medical histories, etc. A lot of the information we found on these topics seemed to be contradictory and some of it was downright scary.”  My job allows me to be on the other end of the line talking to this couple, and others like them, helping fill out intake forms and providing evidence-based answers to some of their questions. “Luckily for us, our adoption agency suggested we reach out to Lori. After our conversation we felt much more at ease, and we felt like we had the information we needed to make informed decisions.”

My own journey has come full circle, utilizing my training to help those going through what I went through years ago. MotherToBaby specialists are here to help you too! As Rory Hall, Executive Director of Adoption Advocates, states, “couples approach the adoption process with so many myths about prenatal exposures and health concerns that might affect a baby. MotherToBaby experts help them approach adoption with relevant, scientific backed information so they can make informed decisions about the children they are hoping to adopt.”

Just before Shaun shuts the door to drive to school, he pauses. Sometimes wise beyond his years, he turns and says, “Mom, adoption is so wonderful because your birth parents gave you up so you could have a better life. Love you!” And just like that, the anxiety, and struggle during the adoption process go back to their place of being a very distant memory. #WorthIt.

More about National Adoption Day

National Adoption Day has been celebrated across the United States since 1999, helping to raise the awareness of the more than 100,000 children who are in foster care each year in the U.S. waiting for permanent families. For more information, see www.nationaladoptionday.org. And when you are going through your adoption journey, and have questions about exposures during pregnancy, contact an expert at MotherToBaby. You can reach us by phone at 866-626-6847 or by text at 855-999-3525.

Originally published 11/3/16, Updated 8/31/2025

Having worked as a Teratogen Information Specialist at MotherToBaby for close to 10 years, I have become well versed in the different exposures people commonly ask about. Allergy medications in the spring, sunscreen and bug spray in the summer, and cough and cold medications all winter long. So, when I logged onto our live chat service at mothertobaby.org on a Tuesday morning, I was surprised to see a question that doesn’t come up very often. Natalie, pregnant with her first child, asked: “I’m 24 weeks pregnant and my midwife says I need a RhoGAM shot at my next appointment. What could happen to the baby if I do not get this shot?”

Blood Type Basics

Blood type is hereditary, which means it is passed down from your parents. There are 8 common blood types: A+, A-, B+, B-, O+, O-, AB+, and AB-. If your blood type ends in a minus sign (like A- or O-), you are Rh negative. If it ends in a plus sign (like A+ or B+), you are Rh positive. Most people in the United States are Rh positive, but about 15 out of every 100 people (15%) are Rh negative. A blood test early in pregnancy will tell you your blood type.

What is Rh Incompatibility?

During pregnancy, if a woman who is Rh negative is pregnant with a fetus that is Rh positive, a condition called Rh incompatibility can happen. Rh incompatibility becomes an issue if any of the Rh positive red blood cells from the fetus get into the mom’s Rh negative bloodstream. This is most likely to occur during a miscarriage, certain prenatal tests (like amniocentesis or CVS), a fall, labor and delivery, or if the placenta separates from the wall of the uterus. When this happens, the mom’s immune system might treat the fetus’ red blood cells as something that shouldn’t be in the body (like an infection) and start making antibodies against them. In most cases, these antibodies will not negatively affect the current pregnancy, but they might affect future pregnancies.

When Antibodies Attack

Once the mom’s body makes anti-Rh antibodies, they stay in her system for life. If she becomes pregnant again with another Rh positive fetus, the antibodies can cross the placenta and attack the fetus’ red blood cells. This can lead to a condition called hemolytic disease of the fetus and newborn (HDFN). Without enough red blood cells, the fetus cannot carry enough oxygen during development and complications such as jaundice (yellowing of skin and eyes), hemolytic anemic (low red blood cell count), hydrops fetalis (fluid buildup in the baby), high bilirubin levels, kernicterus (brain damage from the bilirubin), and even death can occur.

RhoGAM to the Rescue

Fortunately, there is a way to lower the chance of HDFN: The RhoGAM shot. Typically given around 28 weeks of pregnancy (and again within 72 hours of birth if the baby is confirmed to be Rh positive), RhoGAM is an antibody that helps stop the Rh negative mom from making antibodies that could attack a future fetus’ red blood cells and cause HDFN. Before RhoGAM was available, thousands of babies died from the condition every year. Nowadays, the chance of HDFN is less than 0.1% when the shot is given, making RhoGAM a remarkable intervention.

Protecting Your Future Babies

After sharing this information with Natalie, I summarized our conversation with a quick recap. Since she is Rh negative, her midwife was recommending a RhoGAM shot at 28 weeks to prevent the development of antibodies that could negatively affect a future pregnancy. An increased risk for miscarriage or birth defects is not expected since the shot is given later in pregnancy and Natalie is past the “critical period” for those outcomes to occur. Pregnancy complications, like preterm delivery and low birth weight, have not been reported in the available studies examining the use of RhoGAM in pregnancy. Natalie felt reassured after receiving this information and decided to proceed with the RhoGAM shot at her next midwife appointment.

If you have questions about the RhoGAM shot or any other exposures in pregnancy, please feel free to reach out to MotherToBaby by phone, chat, text, or email to receive evidence-based information that can help you make an informed decision.

References:

• American Red Cross. Facts About Blood and Blood Types. American Red Cross. https://www.redcrossblood.org/donate-blood/blood-types.html. Published 2025. Accessed April 29, 2025.

• Bowman J. Thirty-five years of Rh prophylaxis. Transfusion. 2003;43(12):1661-1666. doi:10.1111/j.0041-1132.2003.00632.x

• Hematology: Vaccinating the Rh-Negative. Time Magazine. June 21, 1968. https://time.com/archive/6636313/hematology-vaccinating-the-rh-negative/. Accessed April 30, 2025.

• The American College of Obstetricians and Gynecologists. The Rh Factor: How It Can Affect Your Pregnancy. https://www.acog.org/womens-health/faqs/the-rh-factor-how-it-can-affect-your-pregnancy. Published 2024. Accessed April 29, 2025.

• Yoham AL, Casadesus D. Rho(D) Immune Globulin. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2025 Jan. Updated May 22, 2023. https://www.ncbi.nlm.nih.gov/books/NBK557884/. Accessed April 28, 2025.