The time period of the pregnancy that puts most strain on the heart is from 20 to 34 weeks (depending on the severity of the heart disease). This is when the woman's blood volume increase is reaching its peak, increasing the workload on her heart. The woman may need to have bed rest at this time. If the heart disease is severe, the heart may not be able to cope and fluid may accumulate in the woman's lungs (called 'pulmonary oedema'). This requires admission to the hospital for treatment.
If the woman's heart condition becomes serious during the pregnancy, the baby may be put under stress because of a reduced oxygen supply. The caregiver may recommend delivering the baby
prematurely(before 37 weeks of the pregnancy) by emergency Caesarean. Anaesthetics for pregnant women with heart disease are normally given with much consideration and care, depending on the type of heart condition. Ideally, you should have an anaesthetist who is experienced in dealing with giving anaesthetic to pregnant women with heart conditions. For some women, an epidural or spinal anaesthetic is not recommended because they can potentially lower the woman's blood pressure rapidly, causing further problems. For other women, a
general anaesthetic is only given in an emergency situation, because the anaesthetic itself can cause further complications for the woman.
When a woman with heart disease goes into labour, the action of her uterus contracting can increase the workload on her heart by about 20% after each contraction. However, this is only usually an issue in the more severe cases of heart disease. During the 2nd stage of labour, the strain of pushing can put further stress on the woman's heart. This is why many caregivers will recommend the use of
forceps to deliver the baby, to prevent the woman having to push. Using an anaesthetic (such as a
Pudendal block) for
forceps, or a local anaesthetic to repair an
episiotomy