As a 27-year-old runner, biker, hiker, snowshoe and equestrian enthusiast, Hannah Webb’s muscles are strong and finely tuned.
But her heart muscle is not.
Born with congenital heart disease, Webb underwent valvuloplasty surgery at 10 months old at Spectrum Health Helen DeVos Children’s Hospital in Grand Rapids, Michigan. Doctors used a balloon catheter to widen her pulmonary valve, which had narrowed as a result of congenital stenosis.
She hasn’t had any interventions since infancy.
Now, she has a baby of her own on the way. She and her husband, Travis, are expecting their first, a baby girl, on March 11.
Back in the day, having congenital heart disease and becoming pregnant could be a dangerous combination.
But with a Spectrum Health multidisciplinary team watching every move of her heart and pregnancy, the Cedar Springs, Michigan, woman said she feels confident and comfortable.
All eyes on the hearts
Helen DeVos Children’s Hospital adult congenital cardiologist Stephen Cook, MD, FACC, is monitoring Webb’s heart while the high-risk maternal fetal medicine group keeps constant tabs on her baby.
Because of the added stress carrying a baby puts on the heart, Webb has to wait to resume running, biking and horseback riding. Dr. Cook said she’s still encouraged to participate in regular aerobic exercise during pregnancy.
“I was running 6 miles and biking 20 to 30 miles,” said Webb, sitting in an exam room at the Helen DeVos Children’s Hospital Congenital Heart Center.
She feels at home here. She’s been monitored by Helen DeVos Children’s Hospital doctors since she was in diapers. It’s a continuum of care, from pediatric through adult, heart through maternal fetal medicine.
“One-stop shopping,” Dr. Cook said. “Patients like Hannah can undergo evaluation by High Risk Maternal Fetal Medicine and Adult Congenital Cardiology, all in the same offices on the same day.”
Because of Webb’s heart issues, she’s a high-risk pregnancy, but specialists are doing everything they can to keep that risk low.
“When we got pregnant, I met with my doctor and told him what I was doing for exercise,” she said. “He said, ‘Let’s not do that anymore.’ It was just overworking my heart with all the extra blood flow. I like to be very active so sitting around is difficult.”
These days, she’s focusing on yoga. And knitting a blanket for baby.
She’s thankful it will be the first gift she gives to her daughter. She was worried the first gift may be a genetically bad heart.
Dr. Cook said if a mom has congenital heart disease, the baby has a three times greater risk of developing heart issues.
“They did a fetal echocardiogram on my baby in November and she looks healthy so far,” Webb said. “That was my biggest concern. It was always in the back of my mind, what if this complicates things or what if I pass it on to the baby? But I have a pretty optimistic outlook on things.”
As Webb spoke, Dr. Cook entered the room.
“How many weeks are you?” he asked.
“Twenty-six and two days,” Webb told him.
Dr. Cook asked if she had any concerns from a heart standpoint.
“Occasionally I feel my heart is all over the place,” she said. “Usually earlier in the morning or later at night. It speeds up and slows down. I’ll check it on my Fitbit and it’s usually elevated.”
Dr. Cook listened to Webb’s heart, her abdomen and checked her ankles. He detected the leakiness in her heart valve that went from moderate to severe with her pregnancy.
“The heart murmur from the leakiness associated with the valve sounds louder as a result of both the baby’s and mother’s blood volume,” Dr. Cook said. “I expect to hear these changes as we head into the third trimester. When looking at your echocardiogram, your heart chambers are tolerating that leakiness very well.”
Judging by his findings, Dr. Cook told Webb she would likely navigate through this pregnancy very well.
“I’ll see you next March 2017,” he said. “Otherwise, I think everything should go along (he rolls his stool back to knock on the counter top) seamlessly. But if you walk up a flight of steps and your heart stays racing, racing, racing, that’s a phone call to us.”
Because she’s high-risk, her heart will be monitored before delivery, during and after.
Dr. Cook wished her well and left the room. As Webb waited for the next doctor, Vivian Romero, MD, a Spectrum Health Medical Group maternal fetal medicine specialist, she spoke of her college days in Tennessee and her adventures on the equestrian team.
Reining in the risk
She still has a horse. Phil was a gift from her uncle when she was a kid. She can’t wait to ride him again. She hopes her little one develops a fondness for horses, too.
She’s debating how to decorate the nursery. Horses? Unicorns? Floral? Or perhaps a mixture of all three.
Dr. Romero entered the room and asked how Hannah has been feeling. Her team sees Webb every three to four weeks.
“We monitor both the mom and the baby to make sure they are handling pregnancy well,” Dr. Romero said. “We’re assessing risk factors, that’s why we see her so frequently.”
Dr. Romero and Dr. Cook said it’s more efficient for team members to work with a patient for months ahead of time, and less stressful for the patient because she doesn’t have a bunch of strangers coming in on delivery day. She knows the team and the team knows her. No surprises.
“I think the stress level decreases for everyone,” she said. “We want this to be a happy moment for the mother. We want her to enjoy the pregnancy and delivering the baby. We worry about everything else.”
Webb said the team approach, in a place she’s so familiar with, is comforting.
“I just feel like I’m coming home when I come here,” Webb said. “It’s so comfortable. …They know where I’m at and know where it’s going and how I’m doing. They help to keep things no-stress here, which is really nice.”