THE MARRIAGE OF BETTE AND BOO: The Rh Factor

Probably the most shocking moments of The Marriage of Bette and Boo occur each time after Bette gives birth. A doctor drops the baby on the floor and pronounces it dead. (He’s wrong the first time but not after that.)

The doctor explains that the babies are stillborn because the father’s blood is Rh postive, the mother’s blood is Rh negative, “and so the mother’s Rh negative blood fights the baby’s Rh positive blood and so: the mother kills the baby.”

The doctor warns Bette that continuing to have babies will just mean more stillbirths, and will endanger her health as well. She continues anyway. Matt later mentions that a serum to prevent Rh factor deaths was developed, but too late for Bette.

In real life, such a preventive vaccine has existed since the mid 1960s, and so few people are even aware of what was once a very real, very disturbing problem. But what came to be called Rh Factor Disease was definitely a killer, from as far back as humanity goes. In the 1940s, for instance, it was estimated that from 5,000 to 10,000 babies died each year in the U.S. Sometimes the mother died as well. Sometimes the baby was stillborn, but often the child lived several days. Some survived, but with various physical and mental conditions, brain damage and deafness being among the most typical.

In this play, the doctor’s description of the cause is brutal but basically correct in many but not all cases. Bette’s first child--her son Matt-- doesn’t die, and that was also typical—it was usually (but not always) the children after the first who were affected.

But for most of history the cause of this disease wasn’t known. That it was in fact one disease was only discovered in the 1930s, when it was proven that four causes of infant death were actually expressions of the same problem.

Researchers theorized that blood was involved, but blood science was primitive. Basic ABO blood typing wasn’t exact until the 1940s. The Rh Factor in blood wasn’t discovered until 1940, and typing for it wasn’t widespread until 1950 or so.

Despite the first stillbirth and her doctors warning in the play, Bette continues to try to bear children. This was a real concern, and led to serious consideration of forms of eugenics. A 1946 article in a medical journal stated: “The question has been raised concerning the desirability of discouraging marriage between Rh – women and Rh+ men. In one state legislature there has already been a bill proposed to make such marriages illegal, and at least one judge has found the inability of a couple to have children because of Rh factor incompatibility sufficient grounds for divorce.”

But there was no single rule for what mothers might be affected, or whether the disease would affect any particular pregnancy.

Bette has her first child in 1951. By then, there were two methods of blood transfusions that saved the lives of many affected babies. Virtually all of the baby’s blood was drained and replaced. But though this treatment could work in the first days or even hours after birth, there was little that could yet be done to prevent stillbirths.

The disease is still in some senses mysterious, but researchers in England and the U.S. developed an effective vaccine in the mid 1960s. Although it was not widely available for at least another decade, it has resulted in making Rh Disease largely of historical interest.

On the positive side, there was almost no fetal research or fetal medicine before research into Rh Factor Disease. Such now common practices as amniocentesis were developed in order to study this disease.