Marking the milestones in a child's life is a typical part of parenting for most moms and dads. But for 29-year-old Ashley Zimmerman, those celebrations are particularly sweet, considering her journey to motherhood — a journey that was almost halted by a stroke and emergency heart valve surgery.
When she was younger, Ashley couldn't wait to get married and start a family. But then in 2014, when she was 24, the New Hampshire native was taken to a local emergency department with a high fever and chest pain. While waiting for a diagnosis, Ashley suffered a stroke — the result of a blood clot in her heart. Ultimately, that led to a diagnosis of endocarditis, an infection of the heart lining, and emergency open-heart surgery to replace a damaged mitral valve.
"It all happened so fast that I didn't realize how very life-changing it would be," Ashley says.
During the surgery, Ashley received a new mechanical mitral valve. Though the new valve effectively replaced Ashley's old one, the carbonate in the mechanical valve activated her body's clotting system. As a result, Ashley had to take a daily oral dose of the blood-thinning medication Coumadin to prevent the formation of blood clots and reduce the risk of another stroke.
"The doctors told me I would still be able to do certain things, but that I had to monitor everything I eat and drink, and have my blood levels checked weekly," Ashley says. They also advised her against getting pregnant.
Two months after her surgery, Ashley married. She and her husband relocated to Jacksonville, Florida, to be closer to his family. At that point, Ashley's wish to start a family led her to seek a second opinion on her medical condition.
"I was going to a local community cardiologist and mentioned my pregnancy desire. I was told it wasn't a good idea. But I knew there had to be a way," says Ashley, who began researching options.
"Dr. Phillips said that although it wasn't going to be the easiest journey, it could be done. She gave me such hope."Ashley Zimmerman
Enter Sabrina Phillips, M.D., a Mayo Clinic cardiologist who specializes in maternal cardiology. Dr. Phillips works with women with congenital heart disease or other cardiac anomalies that affect their ability to conceive and have a healthy pregnancy and delivery. Maternal cardiac disease complicating a pregnancy occurs in approximately 1% to 3% of pregnancies.
It was late 2017 when Ashley met with Dr. Phillips at Mayo Clinic's Florida campus. "I felt a little lost and sad at first. But Dr. Phillips said that although it wasn't going to be the easiest journey, it could be done," Ashley says. "She gave me such hope."
Because of Ashley's condition, everything, including conception, had to be planned. "Pregnancy with a mechanical valve is one of the highest-risk cardiac situations of maternal cardiology," says Dr. Phillips, noting the blood-thinning medication causes significant risk to the mother and baby.
Ashley admits that, at times, she and her husband were conflicted about pregnancy. "We went back and forth with having a child or not to have a child," she says. "But we decided to try at least once. And if it didn't happen, then it wasn't meant to be."
Ashley remembers well the day in February 2018 when she began to feel unwell at work. "We were actively trying to get pregnant then, so I went home and took a test. I was a little shocked and in disbelief when it came back positive," she says. "A lot of emotions were running through my head. I was excited and nervous."
Ashley recalls her greatest fear was the possibility of significant health issues. "It was just really scary to think that either the baby or I could have a clot or, later, have bleeding," she says.
"The difficulty with pregnancy with a mechanical valve is the fact that Coumadin crosses the placental barrier and can affect the fetus," Dr. Phillips says. "During embryo genesis, when the fetal organs are being made, Coumadin can result in birth defects."
"The team at Mayo Clinic was amazing. They really listened to me and helped me understand my options."Ashley Zimmerman
After the first trimester, the risk is bleeding in the fetal brain, she adds. "It is imperative to come up with alternative strategies for blood clot protection during each stage of pregnancy and delivery to provide optimum protection to the mom with minimal risk to the baby."
Injectable medications are typically used during the first trimester, as they do not affect the fetus. But these therapies require close monitoring with specialized blood testing. During her first trimester, Ashley received the injections. Then, during her second trimester, she switched back to oral medication. She also received monthly ultrasounds to check the baby's development.
The only hiccup in Ashley's pregnancy came in the third trimester when she thought she had gone into labor early. Fortunately, that wasn't the case. Dr. Phillips worked with Ashley's obstetrician to make adjustments.
"It was a very dynamic time," Ashley says. "And it was scary — not just for me, but also for my family and my husband."
Despite that scare, on Sept. 26, 2018, Ashley welcomed her son, William, into the world. Weighing a healthy 8 pounds, 2 ounces, William was everything his mom had hoped for.
"It definitely wasn't easy, but having the right doctor at your side makes everything possible," she says. "The team at Mayo Clinic was amazing. They really listened to me and helped me understand my options. They educated me on all of the possible things that could happen, but they were willing to work with me to move forward."
Today, Ashley looks forward to celebrating her first Mother's Day with her son, as well as all of the other milestones and memories to come, particularly enjoying vacations as a family. "We love to travel. The last trip we went on was in 2017 to Jamaica, right before I got pregnant," Ashley says. "I am looking forward to taking a family trip together."