Q: My wife had a successful open heart surgery to close a hole in her heart. She was also suffering from blood clotting in the lungs. Before the operation, the pressure was very high so the doctor suggested us to avoid pregnancy but post operation everything was normal and after one year she was pregnant. The doctors suggested us for a caesarean and we got a healthy baby. Because of her complications, we cannot use any contraceptives except condom, which failed in our case and she is pregnant again after one year of the first delivery. During pregnancy she took heparin injections from the fifth month till delivery. The doctors said that she cannot bear the pain and the pressure of delivery and a c-section is the only option, is it right? Also I want to know in our case, what is the best contraceptive since I want one more child after 3-4 years.

A:Cardiac surgery per se is not reason enough to always have a caesarean section but your treating physician is the best person to decide whether in your case it is required or not. Also, since you already have had a caesarean earlier, now the possibility of a normal delivery is further reduced. You will have to trust your treating physician and in case you have doubts, it is within your basic right as a consumer to have a second opinion from another doctor. The decision to have a normal/caesarean delivery would be taken in the last month and it would be best if your cardiologist/cardiac surgeon and obstetrician discuss and decide, informing you all the pros and cons of the situation. As far as contraception is concerned, no contraceptive has absolute contraindications but all of them have a problem in your wife's case. Hormonal contraception has problems in blood clotting mechanisms and IUCDs (Copper T) etc will cause pelvic infections (also doubly unsafe for your wife because of the heart surgery). Your physician should decide what is the best contraceptive for you. Sterilisation, once you have two healthy children, (either in you or your wife) may be the best thing you can do. I wonder, however, why with your wife's condition you want to subject her to a third pregnancy, if this pregnancy is also healthy and you have two healthy children in the end. Of course, the decision is personal between you and your wife but any clinician would probably advise you to be happy with two children and not get greedy and keep trying till one such pregnancy proves too much for your wife or her heart.