Cause for Celebration—and Concern

A martial arts mom gets a one-two punch when she learns that she has a heart condition—and that she’s pregnant.

An avid rock climber with a martial arts black belt, Cheryl Cordova was the picture of health. So, discovering that she had an arrhythmia (a heart rhythm abnormality) right before finding out that she was pregnant with her second child came as a shock. “Going from someone who was always an athlete to someone who had a health problem during pregnancy was really scary for me,” she says.

When Cheryl’s smartwatch picked up signs that her heart was beating irregularly, she went to see her doctor, who ran tests and discovered that she had a dangerous arrhythmia. And because she was pregnant, she required high-risk prenatal care. Cheryl feels fortunate that she knew about the quality of pregnancy care at Stanford Medicine Children’s Health, having had care there during her first pregnancy. In fact, Cheryl and her husband had talked about leaving California and moving to New York—but decided to stay for family-planning reasons. “The care I had with my first son was so good that I told my husband that we’re staying in California for our second baby,” says Cheryl. “Where else would you want to be if something goes wrong?”

Good news and bad news

Cheryl’s prenatal care was overseen at Stanford Children’s by maternal-fetal medicine/high-risk obstetrics specialists Deirdre Lyell, MD, and Erica Wu, MD, who have helped many women with complex health issues have a safe pregnancy. “We know arrhythmias are more common during pregnancy,” says Dr. Lyell. “Because the blood volume expands by about 50 percent, it puts a stress on the heart.” Sometimes, a pregnancy-related arrhythmia might unmask a cardiac condition that had been there before but wasn’t detectable. Other times, pregnancy can make diagnosed arrhythmias worse.

“There are a lot of physiologic changes in pregnancy, and for moms who have underlying disorders, including cardiac issues, close surveillance is recommended,” says Dr. Wu. This was the case for Cheryl, who was seen regularly by cardiac electrophysiologists at the adjacent adult hospital—Stanford Hospital—who performed frequent echocardiograms to track her heart rhythm. Cheryl also used a home cardiac monitor to get a long-term window into her heart health and to track it, beat by beat, for analysis.

“We try to balance being reassuring while also stressing the importance of close surveillance with our patients,” says Dr. Wu. Cheryl needed to go to regular office visits at the Stanford Children’s Obstetrics clinic, have fetal monitoring at least once a week, and have frequent check-ins with her cardiologists at Stanford Hospital. She had to stay vigilant about her overall well-being and any symptoms, like chest pain and shortness of breath.

Cheryl’s heart team put her on medication after weighing the potential benefits of pharmacological treatment against their potential risks. The maternal-fetal medicine specialists at Stanford Children’s are experts on this topic, which can be a gray area. “Some medications are incredibly important and may have very low risk to the baby, while some have a small risk of fetal growth restriction,” says Dr. Lyell. “We are cautious and careful, and laser-focused on the idea that whatever happens to mom also happens to baby. So, withholding appropriate medication is withholding appropriate care. Our approach is to balance any small medication risks with the risk of doing nothing, which could be a harmful move.”

Trusting the process

Cheryl needed to be admitted to the hospital a few times during her pregnancy because of heart palpitations and to rule out preterm labor. “It was definitely scary seeing the difference in the kind of care I required,” she says. “I felt kind of traumatized. In my first pregnancy, I didn’t go through any of this, and to get admitted to the hospital was really hard.” Still, she says, there was some relief in staying at Stanford Children’s, in that she was in the hands of Dr. Lyell and Dr. Wu. “They were lifelines for me—to know that things were going to be OK,” says Cheryl. “If I was scared, they displayed a level of ‘I got this’ confidence. It’s all routine for them, but they were mindful that it was a big experience for me, even though they see things like this many times a day.”

“It’s a good reminder that what we do every day and become comfortable with may be the worst event that happens in someone’s life, and everyone should approach all patients with empathy,” says Dr. Lyell. “In the end, we’re teachers and supporters. We’re teaching them about their condition, what we need to do to get them through pregnancy and be OK, and we’re supporting them through that.”

For Dr. Wu, being a mom herself helps her understand how challenging it can be to deal with uncertain situations, she says. “We love what we do here, and it’s an honor and a privilege to take care of moms during high-stress times,” she says. “It can be scary for them, but I think that knowing they can be cared for at a center like ours, even if something unexpected happens, helps.” Cheryl remembers how this approach soothed her. “They said, ‘Yes, this is a concern, but you’re also in the best place to get care. People fly here to get care at Stanford, and it just doesn’t get better than this.’ I needed to hear that.“

Coming out on top

A main concern with arrhythmias concerns the baby’s birth. “Anyone with an underlying heart condition will face major physiological challenges during delivery and will need special care,” says Dr. Lyell. Cheryl’s care included coordinating on a plan that avoided certain medications and using modifications for fluid management during labor. Cheryl had a planned C-section and a care plan co-created by her comprehensive team of specialists. Her Stanford Children’s high-risk obstetricians, obstetric team involved in her labor and delivery, and obstetric anesthesiologists, as well as the adult cardiology providers, came together for a multidisciplinary conference, where they discussed this birth plan in detail.

Even though she went into labor early, she didn’t have a cardiac event during the delivery. “The anesthesiologist, Joy Tsai, was very reassuring,” says Cheryl. “She kept touching my hair and was explaining everything during the surgery, and she was so comforting,” she says. Baby Teddy had some trouble breathing at first, but the team was prepared, and he was taken to the Intermediate Care Nursery (ICN), where he was cared for by a team of neonatologists.

“I couldn’t hold my baby right away, and my nurse really pushed for me to be able to see him before I got to the postpartum floor,” Cheryl remembers. “I didn’t realize how that small act of having him in my arms for a few minutes while he was hooked up to all these wires would give me this sense of wholeness. I really appreciated how the nurse advocated for me when I didn’t know any better and how she made sure we had some bonding time before I went to my room.”

After a day in the ICN, Teddy was cleared to be transferred onto the postpartum floor to be with his mother. Cheryl had a follow-up with her adult cardiologists a few days later, and they saw her several more times for echocardiograms and continued with on-and-off home monitoring. Now it’s been nearly a year, and her doctors plan to start tapering her off the heart medication soon. While she says her doctors “don’t want me to jump out of a plane, for now,” they have given her the green light to get back into some less extreme forms of exercise that don’t spike her heart rate—activities that Cheryl is very excited about.

As she looks forward to family activities like these, Cheryl is still grateful that she made the decision to stay in California. “My two sons are my entire world—the most important people in my life—so I know I made the best choice for our care by going with Stanford,” she says. “When I think back on how scared I was, there’s also this other side of it, in which I remember the doctors’ profound kindness, empathy, and professionalism. I really don’t know how I would’ve made it without them.”