Introduction
When choosing a surrogate, many intended parents wonder whether a woman with a negative blood type (Rh factor negative) can safely carry their baby. Since the majority of people are Rh factor positive, and babies are more likely to inherit this trait, it is natural to question whether an Rh negative surrogate is a good match. The short answer is yes—with proper medical care and Rhogam injections, an Rh negative surrogate can have a safe and healthy pregnancy.
Understanding the Rh Factor in Pregnancy
The Rh factor is a protein that can be found on the surface of red blood cells.
- If you have the protein, you are Rh positive.
- If you lack the protein, you are Rh negative.
Most people are Rh positive, but about 15% of the U.S. population is Rh negative. Problems arise when an Rh negative woman carries an Rh positive baby—a condition known as Rh incompatibility.
How Is the Rh Factor Inherited?
The Rh factor is inherited through the RHD gene:
- The “D” allele (Rh positive) is dominant.
- The “d” allele (Rh negative) is recessive.
This means:
- If a surrogate inherits at least one “D” allele (DD or Dd), she is Rh positive.
- Only if she inherits two “d” alleles (dd) will she be Rh negative.
For example:
- A father who is Rh positive (Dd) and a mother who is Rh negative (dd) have a 50% chance of having an Rh positive baby.
- Two Rh negative parents (dd + dd) will always have an Rh negative baby.
Because the dominant “D” allele is so common, most babies are Rh positive, even if the surrogate is Rh negative.
Why Screening Matters for Rh Negative Surrogates
During surrogate medical screening, one important test is the antibody screen (also called an indirect Coombs test).
- If the surrogate’s blood already contains anti-D antibodies, it means she has been previously “sensitized”—for example, from a past pregnancy with an Rh positive baby or a blood transfusion.
- If she has developed these antibodies, her immune system would attack an Rh positive baby’s red blood cells, creating serious risks.
For this reason, surrogates who are Rh negative but already have anti-D antibodies are usually not eligible. If the antibody test is negative, the surrogate is safe to move forward—and Rhogam injections will prevent sensitization from happening.
The Role of Rhogam Shots
Rhogam (Rho(D) immune globulin) is a safe and proven injection given to Rh negative women. It works by:
- Binding to any Rh positive fetal blood cells that may enter the surrogate’s bloodstream.
- Preventing her immune system from recognizing these cells as “foreign.”
- Stopping her body from creating long-lasting antibodies that could harm this or future pregnancies.
When Are Rhogam Shots Given?
A surrogate may receive multiple Rhogam shots during pregnancy, including:
- At around 28 weeks of pregnancy.
- Within 72 hours after delivery, if the baby is Rh positive.
- After events such as miscarriage, vaginal bleeding, trauma, or procedures like amniocentesis or chorionic villus sampling.
These Rhogam injections are routine in obstetric care and are extremely effective at keeping the surrogate and baby safe.
How Effective Is Rhogam?
Before Rhogam was introduced, 10–15% of Rh negative women became sensitized after delivering an Rh positive baby. This often led to complications in future pregnancies.
Today, with proper use of Rhogam shots:
- The risk of sensitization is reduced to less than 1%.
- Clinical guidelines from the CDC and ACOG (American College of Obstetricians and Gynecologists) confirm that Rhogam is more than 99% effective when administered correctly.
This is why in the U.S., all Rh negative women—whether surrogates or not—receive Rhogam as a standard part of prenatal care.
Costs and Coverage
In most cases, Rhogam is covered by standard maternity insurance, though intended parents may be responsible for copays or deductibles.
Key Takeaways
PointSummaryAnti-D Sensitization RiskWithout Rhogam, ~12–16% of Rh negative women become sensitized after an Rh positive pregnancy. With proper prophylaxis, risk drops to <0.2%.Rhogam EffectivenessWhen given at 28 weeks and within 72 hours postpartum, plus as needed, Rhogam achieves >99% protection against sensitization.Who Requires ItAll Rh negative women—surrogates or not—should receive Rhogam when carrying or delivering an Rh positive baby.Insurance CoverageUsually covered under standard maternity benefits, but intended parents may still be responsible for copays or deductibles.
FAQs
1. Can an Rh negative surrogate carry an Rh positive baby?
Yes. With Rhogam shots, an Rh negative surrogate can safely carry an Rh positive baby without complications.
2. How many Rhogam shots are needed during pregnancy?
Typically, one injection at 28 weeks and another within 72 hours of delivery. Additional Rhogam shots may be given if there is bleeding, miscarriage, or medical procedures during pregnancy.
3. Are Rhogam injections safe?
Yes. Rhogam has been used for decades and is considered safe for both the surrogate and baby. Side effects are rare and usually mild, such as soreness at the injection site.
4. Does being Rh negative disqualify someone from becoming a surrogate?
No. Being Rh negative is not a disqualifier. The important factor is whether the surrogate has already developed Rh antibodies, which is checked during medical screening.
5. Who pays for Rhogam shots during surrogacy?
Insurance usually covers Rhogam as part of maternity care, but intended parents may still need to pay copays or deductibles.
Conclusion
An Rh factor negative surrogate can absolutely help intended parents achieve their dream of building a family. Thanks to the proven effectiveness of Rhogam shots, the risks of Rh incompatibility are almost entirely eliminated. With proper screening, medical oversight, and routine Rhogam injections, Rh negative surrogates can safely carry Rh positive babies—bringing peace of mind to both surrogates and intended parents.
Ready to Learn More?
If you are considering surrogacy and want to understand all aspects of medical screening and care, we are here to guide you. Contact Ivy Surrogacy today for a free consultation and personalized advice on your journey to parenthood.
