When we’re pregnant, we can’t wait to hear baby’s heartbeat. It’s one of the first signs of life in the womb. Heartbeats are picked up as a flicker at just 5 weeks gestation, but we can begin to hear them more closely around 8 weeks or later. It’s a special moment to listen in on baby’s heartbeat for the first time — one that we’ll never forget. While baby’s heart develops fully by week 12, his heartbeat continues to regulate as the weeks go by, decreasing from a high of about 175 beats per minute in the ninth week.
Heart health is important to all of us. Right now, we’re focused on baby, but what about us? For decades, women with congenital heart disease have been told not to give birth because pregnancy and labor would be too hard on their body. However, new recommendations are making pregnancy more possible for these women.
In this post, we’ll review the definition of congenital heart disease, how it affects pregnancy, and ways in which these women can have a safe and healthy pregnancy — and get closer to that precious day when they get to hear their own baby’s heartbeat.
What is congenital heart disease?
Congenital heart disease isn’t so much a “disease” as it is a defect. These are problems with the heart found at birth, with defects possible on the interior walls of the heart, valves inside the heart, or arteries and veins carrying blood to the heart.
Congenital heart defects can be severe or have no symptoms. They are the most common type of birth defect, affecting 8 out of 1,000 live births.
Many heart defects are simple conditions that don’t require much treatment. Because of health advances, even children with complex heart defects will end up living happy, normal lives. And maybe one day become pregnant.
How does congenital heart disease affect pregnancy?
When a child is born with congenital heart disease and needs regular checkups during their youth, she may also need to keep seeing specialists into adulthood. Surgery for a congenital heart defect as a child is not a cure-all, so regular doctor appointments are important to monitor the defect.
When a woman becomes pregnant, her blood volume and heart rate increase. For women with heart defects, pregnancy increases the risk that she may experience complications and puts her in the “high-risk” category.
It’s important to know that your risks also may be greater to have a child with a heart defect when you also have a heart defect. A fetal echocardiography (echo) uses waves to create images of the baby’s heart, giving doctors information about its size, shape, and how well its chambers and valves are working. Women who have a heart defect should speak with their doctor about having an echo when they become pregnant.
In planning for pregnancy, women with heart defects should educate themselves on the best types of birth control to use, as not all are safe. Birth control pills raise women’s blood pressure, for instance, while IUDs may pose a risk of endocarditis, an infection of the heart’s lining.
How can I have a healthy pregnancy?
Seeing a specialist who has experience treating pregnant women with congenital heart defects is one good step toward having a healthy pregnancy.
New recommendations for women with complex heart defects, published in the American Heart Association journal Circulation, analyzed data that hadn’t been readily available before. Information on successful pregnancies for these high-risk pregnancies was culled from hundreds of doctors.
According to the data, women with heart defects who are interested in having children should do the following:
Women should properly assess their physical condition ahead of conception, with the help of tests including electrocardiograms, echocardiograms, and exercise stress tests. They should work closely with a cardiologist and OB-GYN who specializes in high-risk pregnancies. Genetic counseling also may be recommended.
Women should continue being monitored by their cardiologist and high-risk OB-GYN in addition to a specialist in maternal-fetal medicine. Because the heart works overtime during pregnancy, supplying blood to the uterus and placenta, doctors have to make sure it’s strong enough for both mother and baby.
A team of specialists will need to be in place during your labor. You’ll want to be at a large medical center with plenty of staff on standby in case of complications, including a heart surgeon — though this isn’t possible in some rural areas of the U.S. Your birthing plan should be delivered to your medical team between your 28th and 32nd week of pregnancy. While a vaginal delivery is preferred, a C-section may be needed because of how hard childbirth is on the heart.
Your cardiologist may need to monitor you for 6 weeks to 6 months postpartum. The heart can be damaged during birth, leading to long-term issues.
Despite the risks of childbirth with a heart condition, it is possible to have a healthy pregnancy with proper planning and medical experts. You’re probably in great hands. However, mistakes do happen. If you have a heart defect and your medical team did not act quickly enough to perform a C-section, or a communication error led to birth trauma, you have legal options.
Contact Safe Birth Project to see how we can help.
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