When I was five weeks old, I had surgery to repair a narrowed aortic valve. Life was fairly normal with annual check ups, until December 2004, when I developed an unexpected arterial thrombosis in my left leg. As a result, I was started on lifelong warfarin.
In September 2012, I underwent open-heart surgery to have my aortic valve replaced with a mechanical heart valve. From then on, anticoagulation became an even more important part of my life, protecting both my valve and reducing my risk of another thrombosis.
I always knew pregnancy would need careful planning.
Before trying for a baby, my cardiology team made sure my heart was strong enough to cope with pregnancy, and I knew I would need to contact them as soon as I had a positive pregnancy test. Warfarin isn’t suitable during pregnancy because it crosses the placenta, so I needed to change to Clexane injections as early as possible.
When I found out I was pregnant with my first baby in 2016, I was 38 years old. Within hours I had spoken to my GP, my anticoagulation clinic and my cardiology team. I stopped warfarin and started injecting Clexane twice a day, alongside aspirin.
I’d been self-testing my INR for years, so swapping tablets for injections took a bit of getting used to. I don’t particularly like needles, but there wasn’t really time to think about that. I just got on with it.
Very quickly, hospital appointments became part of everyday life. Between the Royal Brompton, Chelsea and Westminster Hospital and my local anticoagulation clinic, I was regularly seeing cardiologists, obstetricians, haematologists and midwives. Looking back, I realise how much communication there was between all of the teams to make sure everyone was happy with my treatment.
The main message was always the same – keeping my anticoagulation at the right level was the priority.
The injections became harder as my pregnancy progressed. My stomach became bruised and sore, and eventually there wasn’t much space left that hadn’t already been used. My partner started giving some of the injections into my back to give my stomach a bit of a rest, and later I also used my thighs.
Alongside all of that were the usual emotions that come with pregnancy, but with a few extra worries. Because of my own heart condition, I was anxious about the specialist scans checking the baby’s heart. I was so pleased when they told me everything looked normal.
Towards the end of my pregnancy, my cardiologist noticed that the sound of my mechanical valve had changed. Because of my history, they wanted to make absolutely sure there wasn’t a clot on the valve, so I was admitted to hospital for further tests. Thankfully everything was fine, but it reminded me how seriously the team took anything that could increase the risk of thrombosis.
Although the original plan had been to induce labour, my waters broke unexpectedly at 36 weeks. As I’d taken my Clexane the previous evening, I couldn’t have the epidural we’d planned. The team carefully managed my labour because they needed to balance the risk of bleeding with the need to restart my anticoagulation as soon as possible afterwards.
After just over 12 hours of labour, our son Noah was born with the help of forceps.
After the birth I restarted warfarin while continuing Clexane until my INR was back in range. Noah developed jaundice, so we stayed in hospital a little longer than expected, but we both recovered well and were soon home.
Three years later, in 2019, we decided to have another baby.
Because of everything that had been learnt during my first pregnancy, my anticoagulation was managed slightly differently. This time I needed three Clexane injections every day to make sure my anticoagulant levels stayed stable between doses. It meant even more injections, but I understood why it was important.
I also had a planned induction at 37 weeks, allowing the team to carefully manage when I stopped and restarted my anticoagulation.
Our daughter, Hope, was born safely and, like Noah, she has a healthy heart.
Looking back, I don’t think about the number of injections or hospital appointments quite as much as I think about the people who looked after me. Every decision was made with my safety and my babies’ safety in mind, and I always felt that my different specialist teams were working together.
Living with lifelong anticoagulation doesn’t necessarily mean you can’t have a family, but it does mean pregnancy needs careful planning and specialist care.
If there’s one thing I’ve learnt, it’s to trust your medical team, ask questions when you’re unsure and remember that every blood test, scan and injection has a purpose.
Today, I have two wonderful children, and I’m very grateful to the teams whose care made that possible.