low platelet count - no homebirth?

[panda]

I posted this in the general I'm Pregnant forum. I hope it's okay that I post it here as well.

Does anyone here have experience with low platelet counts? Did you have a homebirth? Were you able to raise the levels, and if so, how? Did your providers consider it serious, or a high risk situation?

I'm planning a homebirth in about 8 weeks. My midwife repeated a blood test (first at about 20 weeks, second at about 31) because my initial platelet count was on the low side of normal (first count was 150 on a range of 140-400). She seemed quite confused and concerned that it had gone down to 113.

She recommended I take alfalfa tablets, nettle and red clover tea, and VitB complex, which I'm now doing. She wants to retest at week 33. She expects my levels to rise. If they fall below 100, she said we should plan for a hospital birth.

I've done some homework since my appointment. My understanding now is that platelet levels fall for most women throughout pregnancy as blood volume increases. 5-10% of women start on the low end of normal, and drop from there. I'm reassured since it doesn't seem particularly dangerous as long as there are no other symtoms, but I haven't read much to make me think I can raise the levels.

I'm also wondering, in this case, how much "say" I have with sticking to homebirth. I don't want to take unecessary risks, or disregard her expertise. But I'm not yet convinced this is a valid reason to birth at the hospital. Of course, she could refuse to attend me, and I'm not prepared to go unassisted. I don't want to make our relationship contentious, but I don't want to give up on homebirth unless it's really necessary.

Any info or advice would be greatly appreciated.

Thanks!
Deb

[mom3b1?]

It sounds to me like your MW is on the right track. If I were apt to have bleeding problems I'd not want to birth at home either, and that's saying a LOT.

In your place I'd probably check to see what the numbers should be, and if 100 really is an appropriate cut off. I'd look to see how accurate testing is (if the test says 100, could that mean you are really in the 90-110 range?). Your list sounds good to me, but I'd search to see if there is anything else to be done to get the platelets up. Your MW might be able to provide you with the reseach supporting her plan. I'd look for studies to show at what point the risk of bleeding out really gets bad, and if my MW wouldn't attend me, and I felt I had research on my side I might UC. I'd not UC if I knew my blood platelets were too low for reasonable safety, or even homebirth.

I don't plan on having mine tested this time around, but I have a history of great levels in that area. Mine were fabulous at my last physical, and I'll eat so as to prevent those kinds of problems. (Better send DH out for Alfalfa tabs soon).

It sounds like you've got a good chance of bringing up the platelet levels and may not have a problem at all. It's amazing how many "problems" can be resolved through good nutrition!

I hope this helps. It's hard to write to someone else about what they should do, as really that's your own choice. It's so much easier, and feels so much more appropriate, to say what I'd do in the same situation, but it never really is the same.

But, if you want pure opinion, I do think a real verified risk of bleeding out, is something worth transferring to the hospital for, and there is precious little I feel that way about.

Kiley

[pamamidwife]

first, know that platelets can vary GREATLY day to day, hour to hour. as long as the count is above 100, I'd be fine. Heck, I'd be fine even if it was lower than that, though not much. You're right about the drop being due to the blood volume expansion. I'm surprised your mw is freaked about it. I consider some variation to be normal...and from what I know and have experienced there is little you can do to really raise platelet count much. It's not like iron levels.

Have you had any unusual pain? Anything like a kidney infection or kidney stones or something that could affect your platelets at all?

[panda]

A hearty and belated thanks for your responses.

I have no pain, bruising, or bleeding. No symptoms of anything, the only thing that seems slightly amiss is this platelet thing.

I had an appointment with the midwives last week. We repeated the blood test at their insistence and the results should come tomorrow or the next day. There are 2 midwives that I'm seeing. The first gave me a cutoff of 100, as I mentioned. The one I saw last week thought that was way too low, and thought 140 would be a minimum. She implied that they will be the deciders. Neither of them gave me the impression of having a well researched or supported understanding of the issue. That may sound snotty of me, but I'm on pins and needles here, and I will hate to be forced to change our plans when I'm not convinced the risk is significant. In my opinion, the risks of birthing at the hospital are quite significant and well documented.

The second midwife seemed surprised that I'd done some reading and research on the topic. I'm surprised that she did not seem familiar with what I'd found. Right now I'm so frustrated that the options for homebirth are so limited.

I'm trying to get my head in a more positive space. I hope that will be easier once I have more information. I'm grateful for my health and the health of this baby, and I feel confident that we can have a good birth experience wherever we end up.

Thanks again.

[ladyleigh]

Good luck, Panda! My levels were 140 at week 36. My mw put me on similar suppliments. She just said she liked to see her mama's at 150. But she never talked about taking them again or going to a hospital. I can understand your concern! It must be hard to be so far along and not know what is going to happen. I hope you levels were high when last tested. Keep us posted.

[allbrightmama]

I am right there with you Panda! I feel great and everything is normal except for a low platelet count. It is very frustrating to feel like I could have to give up my homebirth plans because of it. The reading I have done indicates that there isn't anything we can do to increase it. If there is I will gladly do it! My dh has a high platelet count. He actually donates platelets and gives twice the normal amount. Wish he could loan us some.

My platelet count was lower than 130 at around 28 wks. Can't remember the exact number. My midwife just took blood yesterday (34 1/2 wks) to make sure it hasn't gone much lower. She didn't give me a cut off. I didn't press her for one. She certainly hasn't freaked about it but she is concerned enough to want to keep an eye on it.

Please update when you get your results!

[panda]

Another update: my lastest blood test platelet level was 110. The midwives feel confident going ahead with homebirth plans. DH and I started to feel nervous though. We talked to our midwife again, and just had an appointment with my family doctor, who is supportive of our homebirth plans, to get a second opinion.

The doctor said she's not concerned, and that 110 is a pretty safe number. She consulted with a hematologist and gave us a lab order for a number of blood tests (antibody tests, and others). She said these would rule out some unlikely risk factors, and if the tests come back fine with a platelet level over 100, she encourages us to go ahead with the homebirth. Which is fine, since the midwives have agreed on the same cutoff.

So, one more blood draw tomorrow and I'll let you know how it goes! Good luck everyone.

[pamamidwife]

just remember your platelet counts vary minute to minute, hour to hour. 110 to 100 isn't very far....

I would be fine with a plt count at 100, since there is so much variance.

[rere]

I had a low platelet count and birthed my babe at home.I'm sorry I don't remember the numbers but I just wanted to let you know it doesn't have to be the end.