Platelet count and home birth

[HankHill]

Just after anybody's experience or knowledge about going ahead with a home birth with a low platelet count.

I've looked at a fair bit of the research and it seems that issues with clotting aren't considered a real risk unless levels are between 30-50. "Normal" ranges are between 150-400. My first count was 148 so really borderline and my next follow up was 120 so seems they are dropping

Does anyone have any medical knowledge or personal experience about the likelihood I'll still be able to go ahead with a home birth? I've apparently been referred to a consultant but this was 5 weeks ago and haven't heard anything yet.

TIA

Hiya. Sounds like you have gestational ITP, May I ask how far you are along in your pregnancy?

I have ITP which was worsened by pregnancy. Each NHS trust will have their own guidance however in my case having ITP meant I was high risk. This alone meant I couldn't go to a midwife led unit, I'm sure they wouldn't have sanctioned a homebirth. However the choice (&potential risk) is ultimately yours, I believe.

If your platelets stay around where they are now that's not too much to worry about. Precautions would be taken in labour re your baby in case they have ITP (no forceps, ventouse etc) but if they get lower than about 80 you wouldn't be able to have an epidural/spinal block due to the risk of bleeding. For info, my platelet count was lower than this & I managed an induced labour with a little gas & air albeit in a hospital.

I understand they only consider platelet transfusion if they drop below 50 for natural delivery or 20 for c section, I didn't need this so I'm uncertain.

In short, they are going to class you as high risk & say you need to give birth in a hospital due to the risks associated with low platelets & blood clotting. But take some advice & learn more about the implications of gestational ITP. In my experience the consultants were pretty inexperienced with it, also definitely check up when your appointment is...good luck.

I had low platelet count with my first and other than repeating a blood test very little was said about it, it was mentioned prior to induction but I don't think they treated me any different, not aware of any precautions. I will have to ask more questions if it happens again this time.

Very unlikely you would later be advised a home birth is safe...ITP often results in platelets dropping as pregnancy goes on, increasing the risk of bleeding a significant amount at or after delivery, and of bleeds before labour.
Platelet infusions possible, but only done at low levels; effects often short-lived.
Healthy mother and baby much more important than a home birth in this instance - sorry, appreciate probably not what you want to hear. I’m a former consultant obstetrician.

Thank you for the replies. Indeed @quince2figs it isn't what I want to hear. But I'm aware I need to think of all the risks and not put me and baby at any risk. I had a home birth with my first and I am extremely nervous about going to hospital so this has really thrown me.

I haven't heard anyone mention ITP yet but I'm guessing they will when I eventually see the consultant? God the more this sinks in, the more absolutely gutted I am. I just can't see myself in hospital giving birth, I'm absolutely petrified. I just want to be at home where it's nice and calm and peaceful 

@alwaysthinkingofsleep I'm 33 weeks now. 148 count was at 28 week midwife check then I ended up in hospital with something non-pregnancy related. Happen to overhear my platelets were 120 at that point.

I suffer with ITP . During both my pregnancies I had platelet transfusions and my 2nd labour I lost a lot of blood very quickly , they warned me not to have any more children .

I think I would rather be in hospital and have a safe delivery rather than at home with no help if anything goes wrong .

Sorry to hear that, OP.
It may be a good idea to discuss what your concerns/fears are about hospital with your midwife, and with the consultant that you see. However, it doesn’t sound like you have had a repeat blood test (full blood count) or a diagnosis of ITP yet....so first things first. Your initial count of 148 was almost normal. A plan needs sortin* pretty quickly if you are 33/40 now!
Best of luck, and I hope all is well.

You are on the home stretch so hopefully your platelets won't drop much further! But you absolutely need a plan in place now. For my first pregnancy they didn't get a plan figured out until I was admitted to hospital & I gave birth 4 days later...very poor. Call them today & insist on an appointment with your consultant. If your figures stay around this number you shouldn't need a platelet transfusion, obviously no one can predict how your body will behave during/after labour & how much blood you could lose so this will be why they recommend a hospital delivery. Good luck! X

Thank you both @alwaysthinkingofsleep @quince2figs

That was my thinking - these low counts don't necessarily mean ITP so I'm holding on to that for now. A couple of days after my 28 week app the midwife called and said she'd referred me to the consultant and I should get a letter before I next see her (the midwife). She is repeating my bloods next Tuesday at my 34 week appointment (even though she did say she should do them after 4 weeks so not sure why she didn't) and no word from consultant.

I think you're right - the fact it's getting on a bit with regards to time and nobody has even talked to me about what they're thinking, is probably why I'm getting a bit anxious.

Thanks for the advice.