MADISON, Wis. – For months, Samantha Hughes and Brandon Brewer, from Freeport, Ill., knew their son Houston was potentially facing serious challenges in his first moments after birth.
In December, during a routine visit to her OB-GYN in Freeport, Hughes learned that Houston’s heart rate was very low. To learn more, a fetal echocardiogram, which is similar to a standard ultrasound procedure but focused on the child’s heart while they are still in the womb, was performed by Dr. Syed Masood, pediatric cardiologist at UW Health in northern Illinois.
In Houston’s case, his heart rate was around 70 beats per minute and was also irregular. A heart rate between 120 and 160 is considered healthy for a child before birth.
Typically, a child’s heart beats a lot faster than an adult's, according to Dr. Shardha Srinivasan, fetal cardiologist, UW Health, who monitored Houston’s condition during Hughes’ pregnancy.
“Baby can go into heart failure if the rate is too low,” she said.
The fetal echocardiogram also suggested the low heart rate was the result of a disruption in the electrical signal that controls the timing of the upper and lower chambers of Houston’s heart.
When operating properly, the upper chambers of the heart pump blood into the lower chambers then send an electrical signal to the lower chambers to pump. Houston’s lower chambers were not receiving the signal to pump. This scenario is called a heart block.
To strengthen a baby’s heart and prevent heart failure until delivery, mothers can be given steroids and other medications, and when the child is born, a pacemaker may need to be implanted immediately after birth, Srinivasan said.
Once the diagnosis was made, teams of specialists in cardiology, maternal fetal medicine and neonatology began to assemble a plan for Houston’s delivery at American Family Children’s Hospital in Madison in March, according to Allie Kiley, a registered nurse and a fetal cardiology coordinator, UW Health Kids.
From December to the time of delivery, Kiley stepped into action coordinating care for both mother and baby, providing constant support, education and communication with all the different care teams.
“This wouldn’t be a standard delivery where a nurse or two and a doctor would oversee the process and the mother would get to hold her child right away,” Kiley said.
On that day, there was a team of about seven in the delivery room, in addition to the surgeons who performed the cesarean procedure. In the operating room next door, a team of at least a dozen different medical professionals awaited Houston to evaluate him, and if, necessary, perform CPR or even place pacing wires on the outside of the heart to help it beat at a faster rate and more effectively until a permanent pacemaker could be implanted.
“I was definitely scared and excited to see him, but then I was also happy there were so many people there in case worst came to worst,” Hughes said.
In addition to the medical professionals, there was one other person present at the delivery. As he has done throughout the pregnancy, Houston’s father Brandon Brewer provided comfort and calm for Hughes.
“I felt like I was in an episode of Grey’s Anatomy,” he said. “It was very overwhelming, so I just tried to keep her calm."
Everyone in the operating room waited with anticipation because it was unknown how Houston would respond to the demands on his heart at birth. But when the moment arrived, there was an incredible sound: Crying.
“When he was born, he was reaching out to us, and I knew he was going to be OK,” Brewer said.
A lot can be learned in the first second after birth, and one of the most encouraging sounds to the medical providers is a vigorous crying baby, according to Srinivasan.
“Houston was a little special, whether it was intrinsic or he responded well to the treatment, he had a pretty decent heart rate for someone who had a complete heart block,” she said.
Though he gave tell-tale signs of good health, Houston was whisked next door to be evaluated to ensure his heart was ready to take over without his mom’s assistance.
“There is a huge change when the baby is born,” Srinivasan said. “Birth is a big transition point for babies because the lungs and heart have to work on their own.”
And that they did. After evaluation, Houston was reunited with his mom, and his family was given the gift of a healthy baby boy.
“The scariest part was not knowing what was going to happen to him,” Hughes said. “I was happy to hear him cry and do all the things a baby should do.”
Houston will still be monitored for the rest of his life, and if his heart shows signs of weakness, a pacemaker may need to be implanted, but for now, he is healthy and thriving, Srinivasan said.
Now, about a month out from uncertainty, Mother’s Day provides a new perspective for Hughes as they are all home healthy.
“I’m happy, growing up with my mom, and now I have a child, I understand how she felt and how I feel; it’s just instant love for a baby,” Hughes said.
