Ireland has one of the lowest numbers of female cardiologists in Europe, in the final part of our series celebrating the women looking after Ireland’s hearts, meet Dr Orla Franklin, Ireland’s only female paediatric cardiologist who looks after the tiniest of babies from the time they are first diagnosed with a heart condition in the womb

Originally from Cork, Dr Franklin grew up in the shadow of UCC and graduated in medicine from there in 1992. She knew from an early age that she wanted to become a doctor and it was when she started studying paediatrics in 4th year medicine that she said she was drawn to looking after sick children.

“I liked the fact that with children it was terribly clear cut that they were either sick or they were well and there was no over lay of any symptoms. Children have a vested interest in being well and being active and therefore they are an unchallenging group to work with. They are desperate to be well, all they want is to get out there and play, so they are a lovely group to look after.”

After successfully completing the paediatric training scheme in Dublin, Dr Franklin moved to the UK to work in the world-famous John Radcliffe Hospital in Oxford where she was inspired to specialise in paediatric cardiology, as it provided an interesting mix of intensive care medicine and imaging. She completed her training in Great Ormond Street Hospital and was appointed a consultant there in 2005.

Today Dr Franklin works at Children’s Health Ireland at Crumlin (Crumlin Children’s Hospital) as well as the Coombe Women and Infants Maternity Hospital and, the Rotunda Hospital.

Dr Franklin’s main area of interest is imaging or scanning children with congenital structural heart disease and she carries out a lot of non-invasive foetal imaging in the womb before the baby is born.

“When an obstetrician feels that a foetal cardiac scan is not normal, they will refer the baby to me so, increasingly the diagnosis of complex heart disease is made before children are born. We begin 20 weeks before the child is born with a plan that involves the parents understanding the nature of the condition and what will need to be done to make things right, and what course of action is likely to be followed after birth,” she explained.

According to Dr Franklin, most complex congenital heart diseases that may require surgical or cardiac catheterisation once the baby is born, can now be diagnosed in the womb at a pregnant mother’s 20-week scan.

“Not all Irish women are offered a 20-week scan, but all Irish women should be offered one. The standard of prenatal imaging in Ireland is superb and the pickup rates are excellent. The problem sometimes is that not everyone gets a scan but if you get a scan you will get a very good scan and if there is an abnormality, the foetal medicine obstetrician will refer that child to me,” she said.

Devastating news

When a woman or a couple hear the devastating news that there is something wrong with their baby’s heart, they receive regular counselling so that once their baby is born, they will have a good understanding of the diagnosis and what the care pathway will be. They are also invited to visit Crumlin Children’s Hospital and see the cardiac unit where their baby will be cared for and meet the staff, so they know just what to expect once their baby is born. This ensure a seamless and less worrying transition from the maternity hospital to Crumlin for the new parents and the baby.

The majority of Dr Franklin’s patients are under the age of two and many are hours or weeks old.

As the heart disease she sees is congenital, which means the babies are born with it and a lot of it is inherited, unfortunately, Dr Franklin sees a number of families who have more than one child who is born with heart disease.

The good news is that the vast majority of children born with congenital heart disease in Ireland today will, following one or more surgical interventions, go on to have a normal life. And it is thanks to advances in paediatric cardiology, that some of the parents of babies born today are themselves survivors of congenital heart disease. This also means however that they have an increased risk of having a baby with the condition.

People with no history of congenital heart disease have a risk of 0.1 per cent of having a baby with heart disease however, if the mother or father was born with the condition, their risk increases 20-fold.

“We operate on about 500 children a year and most of those are under the age of one. We perform 400 to 500 cardiac catheters on children each year, ….many will have one curative intervention and for a smaller number of children they will have a series of interventions that will span from womb to two. They will begin their process on day one and at 10,20, 30, 40 and 50 will still be seeing a cardiologist,” Dr Franklin explained.

‘The majority of children here have one curative operation; a smaller number of children will have a problem that is not amenable to one surgery and will have multiple surgeries. They are a small but very challenging cohort to look after because they are sick and need a lot of care,” she added.

Many women are now survivors of congenital heart disease

In relation to the Irish Heart Foundation’s Go Red for Women campaign, which aims to raise awareness of cardiovascular disease in women, Dr Franklin said it was important to note that not all women with heart disease have coronary vascular heart disease as many are now adult survivors of congenital heart disease.

“Many women are now survivors of congenital heart disease and we are reaching a tipping point in the world where there are now more adults who are survivors of neonatal and paediatric congenital heart disease and who themselves are having their own families than there are children with heart disease, so the metric is totally changing. Adult congenital heart disease in other words supporting 20,30, 40-year olds whose problem started in the womb, is a huge sub specialty now in cardiology,” she added.

While Dr Franklin acknowledged that cardiology training was difficult and the hours meant that family life could be challenging particularly as a woman, she said she would encourage other women to work in the specialty as it was a rewarding and fascinating career.

Rewards and Challenges

Commenting on the most challenging and rewarding parts of her job she said the most rewarding was being able to treat and cure very sick babies however sadly they are unable to save everyone.

“We meet parents when they are at their lowest ebb…if you think having heart disease yourself is bad, I can assure you that it is much worse looking at your baby with heart disease. So, we meet parents when they are at rock bottom and what we can offer most of them is clarity in terms of a diagnosis, hope in relation to the fact that treatment is available and confidence that they are getting that treatment in an environment where the results are excellent and their baby is ultimately likely to survive.”

“The difficulty of course is that it doesn’t work for everybody and therefore there is a proportion of children where it is clear that there is no intervention that is going to make a difference and that their life is going to be really curtailed and their lifespan limited by heart disease despite the best efforts of their parents and our best efforts.

Coupled with delivering devastating news to new parents, Dr Franklin said that trying to deliver the very best for sick children in a resource limited health service was another huge challenge.

Finally, as a woman and a cardiologist Dr Franklin said the best piece of advice, she could give to women in relation to their heart health was to try to make time for self-care.

“It’s about maintaining a balance between diet and exercise and particularly for women engaging in self-care. At that time in your life when you appear to be snowed under by a combination of small kids and a challenging work environment, try to take time out for yourself to engage in physical exercise which is good for your body and excellent for you mental health.”

She added that she welcomed the Irish Heart Foundation’s Go Red for Women campaign as it was a great way of promoting the importance of women’s cardiovascular health.