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Continuing With The Pregnancy
If you choose to continue with the pregnancy, there are many aspects of the delivery and treatment of the baby to consider. The following section explores this area of care but it is very important to talk to your obstetric and cardiac team to clarify what care is planned for you and the baby.
Where will I have the baby?
Your baby needs to be delivered in a hospital which has a Neonatal unit where a specialist team can carry out the immediate care that your baby will require after birth. This team will also organise the safe transfer of your baby to the children's heart unit.
If the hospital where you initially booked to have the baby is a small district hospital they may not have these facilities. It may therefore be necessary to transfer your obstetric care to a unit which has these specialist services.
When an abnormality is found in a baby, the focus of attention for you and the health-care professionals shifts towards the baby. It is very important that the needs of the mother are not forgotten. All the normal antenatal check-ups should proceed as planned either with your midwife, GP or at the hospital.
There may be extra scans arranged at the specialist unit to monitor the baby's condition and often parents find these consultations stressful, as they wonder if further problems may be detected. You may find that the Specialist Midwife attached to the fetal Cardiology service/Fetal Medicine department is a valuable source of support and can help you with the ongoing concerns you have about the pregnancy and birth. They will also be able to liaise between the Cardiac Liaison Team from the heart unit, your own hospital and your GP/community midwife to ensure that all cares are kept up-to-date with information about the baby's condition.
Preparing for the Birth
Many parents feel increasingly anxious as they approach the time of delivery. Mothers often express how they feel protective of their unborn baby, knowing he or she is safe inside them. Facing the reality of what their baby will go through after birth is a daunting prospect over which they have little control.
Once again, being able to talk through these feelings with your midwife/GP/obstetrician can be helpful.
Will I need a Caesarean section?
Many parents, understandably, think that because the baby has a heart problem, a Caesarean section would be the safest way to deliver the baby.
In face, for most mothers, the opposite is true for the following reasons:
- Whilst the baby is in the womb, it is receiving all the oxygen it needs from the mother via the placenta (afterbirth) and this continues throughout labour until the baby is born and the cord is cut.
- Being born naturally allows the baby's chest to be squeezed as it comes through the birth canal. As the baby is born the release of pressure on the chest encourages the baby to take a deep breath and this helps the lungs expand.
- You will want to spend as much time as possible with your baby in the time leading up to the first operation and your recovery following a normal vaginal delivery will be much quicker than following a Caesarean section.
During labour your baby's heartbeat will be monitored. If there are any signs of distress, or if there are problems for the mother, a Caesarean section may become necessary.
Some mothers do require Caesareans because of problems that they have had with previous delivery or because of a problem with the size of their pelvis or birth canal.
If this becomes necessary the maternity hospital will link with the cardiac team to ensure that the mother has as much contact with the baby as possible.
The most important thing to remember is that the mother and baby are kept as well as possible.
Will I need to be induced?
It is preferable for your baby to be born at the end of pregnancy, when it is well grown and the lungs are mature, and you go into labour naturally.
Prior to 34 weeks of pregnancy, the baby's size in conjunction with immature lungs, may mean that surgery is not possible.
It may be necessary to induce labour for the following reasons:
- If you have gone past your expected date of delivery.
- If your blood pressure rises and it is felt that it is safer for the baby to be delivered.
- If the baby stops growing.
- If you are delivering your baby at a unit which is some distance from where you live, it may be easier to plan a date for induction of labour, after the 39th week of pregnancy. This can be planned in liaison with the neonatal unit and the specialist cardiac unit, to ensure cots are available.
Can my partner be with me when I have the baby?
Your partner/other family or friend will be able to be with you throughout the labour and the delivery.
If you need to have a Caesarean section, your partner will be able to be with you if you choose to be awake and there is time to insert a spinal anaesthetic. Spinal anaesthetics are commonly used for Caesarean sections and this allows the procedure to be pain-free, but enables parents to share the moment of birth together.
Some women prefer to be asleep (have a general anaesthetic) for a Caesarean section. If the baby becomes distresses, the Caesarean may have to be done as an emergency procedure under a general anaesthetic, because there is no time to insert a spinal anaesthetic. In these instances, your partner will wait in the recovery room. Once the baby is safely delivered, as long as he/she is stable, your partner will be able to hold your baby whilst the operation is completed.
Will I see the baby after he/she is born?
The baby should be in a good condition at birth as the connection (Ductus Arteriosus) between the Pulmonary Artery and the Aorta does not close immediately. A paediatrician (baby doctor) will be on hand at birth to assess the baby's condition.
If the baby is stable, there should be no reason why you should not be able to hold and cuddle your baby and put the baby to the breast if that is what you wish.
After a short while, the baby doctors will want to take the baby to the neonatal unit, to insert a drip (infusion). In the case of babies dependant on the fetal circulation, this enables the baby doctors to give the hormone Prostaglandin, which keeps the Ductus Arteriosus open and allows the baby to remain stable until they receive their first surgical treatment.
Who will be looking after the baby?
The paedatrician and nurses in the neonatal unit will be caring for your baby and making sure that the baby's condition remains stable.
A scan of the baby's heart will be carried out in the first few hours following delivery by one of the specialist cardiologists from the children's heart unit. On the basis of this assessment, surgery can be arranged and at every stage the doctors will discuss the plan of care for the baby with you.
Your partner and immediate family - other children and grandparents - can visit the baby on the neonatal unit and depending on how you feel after the birth, you will be able to spend as much time as possible with the baby.
If the baby has to be transferred to a specialist heart unit, can we go with him/her?
You will be encouraged to go to the children's heart unit with your baby, although the baby will travel by ambulance with medical staff if the heart unit is in a different hospital.
If you are well enough to be discharged you may follow the baby in your own car or the hospital will arrange transport if you are still a patient.
Feeding
Will I be able to breastfeed the baby?
Once the newborn baby's condition has been assessed and if they are found to be stable it may be possible to put the baby to the breast soon after delivery. Once the drip has been inserted and the baby is receiving Prostaglandin to keep the duct open, as long as the baby is stable, it may be possible to breastfeed up to the time of surgery. From then on you can use a breast pump to express milk. The milk can be stored safely and then can be given to the baby either through a naso-gastric feeding tube of eventually a bottle.
Although breastfeeding will be encouraged, it is important to realise that feeding will be very tiring for the baby. To help support their heart function, they will need to have more calories than other babies, but they do not always have enough energy to take all the milk that they need. Often a mixture of feeding styles may be needed. For example, bottle or breastfeeding, calorie additives and naso-gastric feeding (a tube from the nose into the stomach) will ensure that the baby receives enough calories to grow.
If you are keen to breastfeed, ask for support from the hospital team and your visiting midwife. It may also help to talk to other parents who have successfully breastfed a baby with complex heart disease. This can be done through the hospital or through Little Hearts Matter.
Who looks after the mother after the birth?
It is important that the delivery of the mother's medical needs are not forgotten in the midst of all the care being organised for the baby. Before the mother can be discharged from the maternity unit she will be examined by one of the obstetric team at the maternity unit. She will then be transferred to the care of either her home based community midwife or the community midwife who covers the children's cardiac unit. A new mother needs regular check-ups from the midwife. If there are any concerns about her condition whilst at the children's unit, a midwife will be called and any hospital care will be organised at the closest maternity unit.
Although the mother is worrying about the baby, she must organise plenty of rest for herself and eat regularly. She needs to recover well from the delivery so that she has the energy to look after the baby once they are discharged home.