Advice for low(ish) platelet levels and midwife-led care?

[TheSubtleKnifeAndFork]

I've been diagnosed with gestational thrombocytopenia, which I also had in my last pregnancy. It's pretty mild as my platelets are still in the 130 region (129 at last test) and my level in previous pregnancy was very similar (lowest was 119).

Last pregnancy I was sent to a consultant who said I must give birth at the hospital, rather than the community midwife-led unit that I had planned to use. I didn't argue as I wasn't well informed, and the consultant wasn't very forthcoming with information on risks etc. it was more or less a flat "no".

This time I'm - once again - being sent to a consultant. I've also had extra bloods taken for a blood film, which is to look at platelet function, so see if the platelets I do have behave normally.

If possible I still really want a midwife-led birth, ideally at my local unit. The circumstances with obstetric units in my area has changed and my closest hospital has closed their department, the result being a "choice" of one hospital, which is now hugely overwhelmed. Ultimately I'll do what is best and I won't go against sound medical advice, but I want to be fully informed and actually have a two-way discussion with the consultant about my care.

Does anyone have any experience gestational thrombocytopenia and being considered low risk in terms of place of birth?

I have been doing some research into the nice guidelines and it would appear:

1. Levels above 100 are still considered low risk and suitable for a planned birth OUTSIDE of an obstetric unit.

1. Women with gestational thrombocytopenia are generally considered low risk for bleeding complications at birth, particularly with platelet levels greater than 80.

1. Babies of women with gestational thrombocytopenia (as opposed to the ongoing immune condition) will not be affected and so any risk of bleeding applies to the mother and not the baby.

So assuming my platelet function is normal, I don't feel it would be unreasonable to push for ongoing monitoring of levels, and only modify my birth plan if the levels drop below 100. My last birth was straightforward and I didn't have any bleeding complications.

I just wondered if anyone had had success when having such conversations with a consultant?

Hopeful bump!

I thought I would update this for anyone in a similar position. It may be helpful

I did give birth at the midwife-led unit. I met with the consult at 34 weeks who gave this the OK (my full bloods didn't flag any additional issues and actually platelets were 154 when I had them taken!). I went to the appointment armed with a folder full of highlighted excerpt from the NICE guidance and research papers, etc... but I didn't need to get this out (probably a good thing as I would have looked a bit crazy I'm sure). The consultant did say I would need platelets checked when I went into labour, but she didn't write this (legibly at least) in the notes, so it didn't happen (and in order for it to happen I would have had to go to hospital which would have defeated the object). As it was I had the level checked a couple of days before I went into labour and they were still ~140 so I had no concerns when labour kicked off.

The one concession I made was to agree to a managed third stage, which was really fine by me.

I had an amazing birth experience and I'm glad I decided to push for what I wanted. I'd advise any woman in a similar position, who felt strongly enough about her birth plan, to read the relevant NICE guidance and make an informed choice too!

I should add, consultant had no concerns providing platelet level stayed ≥100. Mine were NEVER below 100 and were well above this a couple of days before labour, hence I had no concerns. Obviously would be different if platelets were lower and dipping below 100.