Women who survive a heart attack caused by a condition called SCAD are usually told not to have children due to the risk of it happening again. Now the first babies are being born at the world's first clinic that helps heart attack survivors to have a baby.
Hayley Martin, 47, vividly remembers the morning her life changed forever.
"I woke up and I felt very, very poorly. I put my hands to my head and I was drenched in sweat. I knew straight away it was a heart attack," she told the BBC's Victoria Derbyshire programme.
She was a healthy 38-year-old when she had a Spontaneous Coronary Artery Dissection (SCAD), a rare and often undiagnosed condition.
It is the leading cause of heart attacks in women of childbearing age, affecting around 1,000 women a year.
It occurs when there is a sudden tear in one of the coronary arteries, blocking the flow of blood to the heart.
In hospital, Hayley, from Congleton in Cheshire, feared the worst.
"I can remember saying to them, 'am I dying?' And they just kept saying, 'we've tried everything we can, but nothing is working,'" she said.
'I felt less of a woman'
She survived, but like many women with SCAD, was told pregnancy would mean the risk of another heart attack.
"I think it was another thing that was stolen from me, so I almost don't allow myself to think about it, because it could take you down a dark path of sadness," Hayley reflected.
"I felt less of a person, less of a woman, more of a failure, like I was faulty."
What is SCAD?
- Spontaneous Coronary Artery Dissection (SCAD) is an under-diagnosed heart condition
- It affects mainly women, occasionally during – or soon after – pregnancy
- Menopause, extreme stress and exercise have also been associated with it
- During an attack, a sudden tear or bruise develops in one of the coronary arteries blocking the blood follow
- It can cause death, heart failure, cardiac arrest, and require heart bypass surgery
Source: Leicester Cardiovascular Biomedical Research Unit
Patient's decision
Hayley is the kind of woman who consultant cardiologist Dr Abi Al-Hussaini is trying to help, with her clinic at the Chelsea and Westminster Hospital.
Dr Al-Hussaini assesses the damage done to the heart by the SCAD and reviews the patient's medication, generally lowering the amount they are on.
She uses that information to advise the patient how risky a pregnancy could be.
This does mean sometimes she has to advise that the risk to health might be very high, but the key is the patient makes the decision, rather than the usual blanket advice not to get pregnant.
If one of her patients decides to proceed, they are referred to the pre-existing "high risk pregnancy team" at the hospital, who monitor them throughout the pregnancy.
"I have seen a lot of patients over the last few years who have come to me unhappy that they have been told they cannot have a child ever again," she explained.
"That's one of the reasons I established the clinic, to give these patients the correct advice and allow them to make an informed decision themselves."
She believes a lack of research into the condition is why most cardiologists prefer the blanket advice.
Sharp pain
One of the first women helped by the clinic was Julie Murphy, 40, from Ruislip.
Shortly before her honeymoon in 2013, she started to feel unwell, like she had flu. While on holiday in Kenya, the symptoms got worse.
Then, while swimming, she had a sharp pain in her chest. When she got home, she had tests on her heart and, "the next day I found out I'd had a heart attack".
The days and weeks that followed were very tough.
"All the medication I was on really slowed me down so I couldn't even walk up the stairs when I came home from hospital. That was really difficult to get my head around," she says.
Like Hayley, Julie was initially told she would not be able to have children. But she became part of a research project led by Dr Al-Hussaini and had her first daughter, Holly, in 2015.
'Awesome team'
She then became one of the clinic's first patients when she became pregnant for a second time.
"I was worried that they would say there's no possibility or it would be too dangerous for us to try to have a baby, that it might mean that I'm putting my life at risk," she said.
Bella was born in April.
"They're such an awesome team that you felt so looked after," Julie said.
Despite the hope she is giving patients, Dr Al-Hussaini says she has encountered resistance from doctors around the world, in terms of what advice they give their patients.
"In America, they are against becoming pregnant any time after a heart attack, or having had a spontaneous coronary artery dissection," she said.
"But again, I think that's because there hasn't been a huge amount of research – but there is a growing amount of research at the moment that's been developed."
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