If you've already given birth (post ppcm pg)

[naturalmama1012]

My cardiologist's new latest concern seems to be the first hours and days following delivery, as there is increased fluid load on the heart at this time. I am just curious if your cardiologists brought this up with you, if they did anything preemptive like diuretics after you gave birth, and if you had any complications due to this. I can't get anything other than vague answers out of her... she just wants to watch me closely and thinks that if ever there was a time for me to go into heart failure, that would be it. (Such a pessimist, eh?)

[tabs]

My doctor had me on strict ins & outs. My known ef at the time was 43%. Others with lower ef's have had SWANs (a line in the neck that travels into the heart and can be used to monitor pressures in the heart).

Twilah

[mikeyandBellesmommy]

I guess that depneds on what your EF is at the time of delivery, mine was 40-45% and I was forced to stay in the CCU for two and 1/2 days post delivery because maternity does not have the proper monitors etc.. I went down to maternity on my third day...

If your ef is normal the procedure may just be monitoring swelling etc.. in the normal maternity floor. I am not sure because mine was NOT normal, LOL!

[jbrunetti]

My fluids were restricted only during my C-section and after that I was able to drink whatever I wanted. I did retain quite a bit of fluid after the baby was born and it took about 2 weeks before it was all gone. My Doctors didn't want to put me on a diuretic because it would decrease the amount of breast milk I produced. If my echo 2 days post pardum would have shown any drop in ef I am sure they would have started the diuretic.

[tabs]

My ef wasn't normal during delivery either! I think it all depends on your team of doctors. After they experienced my delivery and subsequent decline, I think that they will not treat any other women the way they treated me!

[Tammy]

I was treated as a normal L&D No monitoring, etc other than normal post delivery.
I had a natural VBAC (no drugs or needles) and my EF was around 55%
For me I was fine.

[SerenaWelsh]

Becki,

The fluids were a huge concern for the docs with me. At 20 weeks my EF was 5-15%, depending on who read the echo - so there wasn't a whole lot of room for me to take a "slight" dip.
My baby was born by C-section and 28 weeks, in the main OR with more people than could really fit in that room. The situation was very controlled - they planned for the absolute worst. I did my recovery in CCU, and had a Swann-ganz cath in for I think 4 days after the delivery - until they were convinced the fluid shifts weren't going to kill me.
One of the cardiologists flat out told me that I would not survive the fluid shifts, regardless of when they delivered. Shows what she knows...

[jmonte]

Becki,

I have heard the same from my doctor. I was wondering what your doctor's opinion is on c-section vs. vaginal or vbac? Did you have a "C" with your first? I am very confused at to what might be the safest. thanks, Julie

[naturalmama1012]

Julie,

I had a vaginal birth with the first, so I couldn't tell you as far as vbac, we've never discussed it. My guess would be that part of the decision with that would be your heart function at the time of the second pg.

In my case both cardio and OB feels strongly that avoiding a c/s would be preferable, due to additional fluid loss during a c/s which could potentially destabilize everything, and pressure changes, etc. They would like me to have a vaginal birth. The only argument right now is whether or not I should be allowed to labor naturally (decreasing risk of c/s) or should just have an early epidural to keep things more controlled.

Currently my OB wishes to monitor me in the post-partum OB unit and give me a dose of lasix pre-emptively to counter fluid shifts, as well as monitoring my lungs for edema every few hours... cardio wants to be more conservative, but I am balking at the idea of going to the cardiac unit "just in case" to be watched if that means baby and I am seperated even though I'm doing fine. I told her I don't want to be moved unless I appear to be in some distress... I went through this with #1 and never had a complication, and I was retaining A TON of fluid, this time I (so far) have ZERO swelling anywhere. My EF by MUGA is 59% but by echo it always reads more like 45%.

[Tammy]

Naturalmama,

It's so hard to know what the best course of action will be. For me, I didn't have the same cardiologist that I was dx with. I ended up moving durning my 2nd pregnancy and the ob that I was seeing didn't take me seriously and didn't think it was PPCM at all and just an isolated case. So the cardio wasn't even an issue for me, although it did make me upset.
The ob took it a bit more seriously but didn't make it a topic. I think it may have alot to do with that I wasn't in the same city/hospital again with my 2nd.
I think what you should do is figure it out for yourself. You know your body and PPCM probably better than your dr's. Think about it (pray if that's what you do) and figure out what you would like. Work on a birth plan with what you want including how you would like things to go if you have problems.
Discuss it with your dr. Figure where you both feel comfortable with compromising.
If you are happy with your chosen drs (which I am assuming you are) then finding out where your dr is comfortable is important as well. (i.e. you dont want a dr to give an episomety(sorry can't spell this morning) if they are not comfortable doing so!)
If you don't like the idea of having labor on the cardio floor, and you haven't done so yet, tour the cardio floor feel it out. Talk to the cardio floor nurses. Ask the dr if a L&D room can be adjusted to include anything that maybe needed immediately if something was to happen and you could be transeferred to a different room at that time. Seek out other options, bring them up to your dr and work out a plan. HTH

[JennNIN]

after a week stay in the hospital in november, I started going to a cardiologist. In January I switched to a cardiologist who was a heart failure specialist. He recommended me have a c-section the following week. I gave birth at 37 weeks. I too had a SWAN cathether during the c-section and for the day I spent in CCU. My echo before the birth showed an EF of 32%. They were preparing for the worst as well but the fluid shift really did nothing to me. They did give me diuretics during my stay in the hospital and monitored my fluids in and out.

I'm only 4 months post partum and not out of the woods yet. My last echo in February was an EF 38% and no change in the enlargement of the LV. I've been swelling a bit more lately than I would like to be. I've also not been eating as well as I should be. (I've gained weight that's NOT water. =( ) I do have an echo scheduled for this Thursday so we'll see what the heck is going on.