Echoes of the Heart

At their 20-week anatomy scan, Bri and Brooke were excited. They had been trying and praying for this. They had made it through losses, an ectopic pregnancy and several appointments that ended in not-so-great news. Leading up to the halfway point, Bri’s pregnancy was high-risk but otherwise normal. 

“I felt good,” Bri said of her frequent prenatal visits to Ivinson Medical Group’s women’s clinic. ​“I was excited to be pregnant every time we had an ultrasound or checked vitals. Everything was really great so I thought we were moving along well. I was very blindsided by the diagnosis.”

Bri Montoya was one of seven patients that year whose ultrasound, performed by Ivinson ultrasound sonographer Randi Majewski, revealed a heart defect. As a result, Bri is one of seven reasons that prenatal care at Ivinson is now more advanced than ever.

Serving the Community

Taking the quality of care a step further, the women’s health clinic partnered with UCHealth to bring Maternal Fetal Medicine (MFM) to patients at Ivinson. Randi, now a full-time MFM sonographer in the women’s health clinic, has sharpened her skills in the OB field and received training to focus on high-risk pregnancies.
It was that very training that saved Bri Montoya’s baby.

More than a Gender Reveal 

“We were super excited for the 20-week scan,” Bri recalled, describing the thrill of meeting the halfway point in her pregnancy. ​“My step kids really wanted to throw a gender reveal for us. We had this really cute card and Randi was going to write in it and we were going to seal it and give it to them.”

At the 20 week anatomy scan, the baby’s position made some images harder to read.

“She was having a hard time getting pictures of parts of his heart,” Bri said, scheduling another appointment for more imaging in 4 weeks. ​“So we left and we thought things were fine. We knew IVF babies were at higher risk for heart issues, but we thought it was just a precaution.”

Bri and her family went on to have their gender reveal; she was having a baby boy.

A few weeks later, they returned for additional imaging.
​“In the anatomy scan we are looking at how a baby is developing,” 

Randi explains. ​“Some people have genetic testing done at 13 weeks, but not all anomalies are tested for when they do genetic screening. Cardiac anomalies aren’t going to show up on your genetic screening. That’s all something that needs to be imaged.”

Four weeks later, Bri returned and again, her baby’s position made imaging difficult. Working with the images she was able to capture, Randi kept going back to the heart, with a hankering feeling that something was not quite right.

Randi felt in her gut that something was off, but couldn’t get the baby in the position to see what. Despite being told by the reading provider that it was probably just a bad angle and everything was fine, Randi trusted her instincts.

She advocated for her patient to have additional imaging done with a specialist, and Bri was referred to Maternal Fetal Medicine in Colorado for a fetal echocardiogram.

A fetal echo is a specialized ultrasound test that provides detailed imaging of a baby’s heart while still in the womb.

Bri and Brooke drove to Fort Collins feeling uneasy. Away from home and without their usual support system, they received the bad news.

“This doctor walks in and my wife and I made a joke about how the picture of our son looks like an alien,” Bri said, making light despite her stress. ​“The doctor pulls out this piece of paper and starts drawing a heart. And then she said, ​‘there’s something wrong with your baby’s heart’. We were shocked.”

The doctor explained that Bri’s baby had transposition of the great arteries in his heart, meaning the aorta and the pulmonary artery were swapped.

​“She’s explaining it, but honestly, I just felt like it was someone we’d never met before, this doctor. We’re in this place we weren’t familiar with — I don’t think we were processing any of the information. We were far from home. We left the appointment really upset and then we had to drive all the way back to Laramie.”

From there, Bri was referred to Children’s Hospital of Colorado where she became very familiar with the facility between appointments and scans and follow ups every few weeks. At 37 weeks, the family relocated to Aurora, Colorado in preparation of the birth of their son who was going to require immediate interventions.

​“The travel was so stressful,” Bri said of traveling on highway 287 in the quickly cooling months of October and November. ​“A lot of times we would have to go down the day before to miss a storm. We knew these appointments were important. It was just this whole other stressor of having to be away. We left the comfort of our home and the people we were working with to go to new people, and that was pretty stressful.”

Baby Kai Benson Montoya was born on February 23, 2023 in a room filled with nearly 30 medical staff, all waiting and ready to care for him. Within hours of birth, Kai de-stated and quit breathing. In the NICU, Kai was intubated and, at a mere four days old, he was taken in for a 10-hour-long open-heart surgery.

Following his surgery, with tons of support and a lot of physical and occupational therapy, Kai bounced back. He returned home with his family and older siblings and is meeting many of the milestones most kids his age are reaching.

​“If it weren’t for Randi catching this, I don’t think his outcome wouldn’t have been as good,” Bri said. ​“We really credit Randi finding his defect and now we are able to help other families walk through the process.”

Delivering a Blessing

Gabby and Austin Decker were first time parents navigating a pregnancy that was anything but common.

Gabby’s baby was one of seven heart defects detected by Randi at Ivinson in the year following her own return from maternity leave.

Their son, Marshall, was discovered to have a heart defect at his 20-week anatomy scan. Marshall was diagnosed with a heart anomaly called cardiomyopathy. With cardiomyopathy, the walls of the heart are thickened because the heart is having to work harder.

“Gabby’s baby, at 20 weeks, we noticed that his heart didn’t quite look right,” Randi said. ​“We referred her down to [Children’s Hospital Colorado] for a fetal echo and they were able to do a lot more testing for her as well. And unfortunately, Marshall did not have as good of an outcome. There’s nothing that they could do.”

The Deckers would travel to Colorado every month for a fetal echo and monitoring. While baby Marshall grew steadily and safely in the womb, it was determined that his heart defect was incompatible with life.

Between visits to Colorado, Gabby and Austin came to Ivinson to see Randi. Together, they celebrated milestones, watching him grow and hearing his heartbeat together.

“Scanning these patients you kind of build this relationship with them, you are a familiar face that they don’t have to explain their story to,” Randi said. ​“With Gabby, I scanned Marshall every week until he delivered. I got to watch their baby grow with them. I felt like I was able to make an impact. We got to share a lot of special moments where we got to hear his heartbeat, and we got to see his face, and we got to see him grow and thrive.”

For Gabby and Austin, they found comfort in the familiarity of their care team, knowing every appointment at Ivinson would be with staff they knew and staff that cared for their family personally.

​“It’s like having an appointment with your friend,” Gabby said. ​“Walking through our pregnancy, Randi was there with us. When we were looking for something bad to happen, every ultrasound, Randi was happy and positive. That was always super encouraging for me, because, during that time, it was really hard, and every appointment I felt like crying. But she was always a super bright person.”

With no interventions available, the Deckers would deliver at Ivinson Memorial Hospital’s Women and Children Center and make the most of the time they had. Marshall was born on March 29, 2023 surrounded by love.

According to the Children’s Heart Foundation, congenital heart defects (CHD) are the most common birth defect in the United States. Each year, approximately 40,000 babies are born in the United States with a congenital heart defect. Nearly one of every 110 babies is born with a CHD. This equates to 1 child every 15 minutes.

For the Decker family, their faith has carried them through their journey and remains a pillar of their relationship.

“God created Marshall perfectly,” Gabby says. ​“He created him exactly the way that he needed to be.”

Over a year out from Marshall’s birth, the Deckers have grown their family and continue to hold space for Marshall and his story.

​“We love talking about Marshall,” parents Gabby and Austin said. ​“We love sharing this story because it really did change our lives. But also, we just love to share the joy of it.

Because even though it is not the way that everyone expects their first pregnancy or any pregnancy to go, every part of it was really hard. But it was the greatest joy of our life.”

Better Services at Home

About 1 in 4 babies with a heart defect have a critical heart defect. Infants with critical heart defects generally need surgery or other procedures in their first year of life.

In the case of Bri and baby Kai, it was the early detection at Ivinson that allowed his family and his care team to prepare for the heart surgery he needed.

​“If it weren’t for Randi catching this, I don’t think Kai would be doing as well as he [is] or even here today,” Bri said.

Since the year Randi detected heart defects in Kai and Marshall, she and the women’s health clinic at Ivinson have taken steps to further advance and improve the care for expectant parents at Ivinson.

Maternal Fetal Medicine providers, in their partnership with Ivinson, now provide telehealth visits for high-risk and other higher-level care needs from exam rooms at Ivinson. Additionally, they now read all of the prenatal ultrasounds at Ivinson regardless of patient history.

Driven by patient interactions like that of Bri Montoya and Gabby Decker, Randi wanted to do more. Advocating for her patients, Randi campaigned to bring fetal echoes to Ivinson. Rather than referring these patients to Colorado, they can now see a familiar face in a familiar office. These families can now see Randi for fetal echoes at Ivinson Medical Group.

Families receiving fetal echoes at Ivinson may have had a detected anomaly and require multiple echoes. If either parent or a sibling has had a heart defect, or in the case of some twins, a fetal echo is necessary to ensure the heart health of a baby still in the womb.

​“Finding Kai’s heart defect and Marshall’s heart defect after that really impacted me,” Randi said. ​“Fetal Echo wasn’t necessarily on my radar until I started finding heart defect after heart defect after heart defect.
Then it was like, we could offer this. Being able to offer fetal echo services in Laramie is huge because it’s my community, this is where I grew up. This is a service that I can offer to my friends and my family and so many other people in my community.”

Peace of Mind

When Gabby and Austin Decker were expecting again, Randi was ready for them. Their family being one of seven reasons Randi worked to bring fetal echoes to Ivinson, she was now able to offer the Deckers that service, right here at home.

​“I’m really happy that we have Randi as our ultrasound tech,” Gabby said, returning to Ivinson. ​“To see that we had the need for fetal echo last time, and this time that there’s the option to not have to drive all the way down to Denver. It saves us time, it saves us money, it’s less stressful when you know the people that you’re going to see. You have this trusting relationship already and you know that they’re going to give you the best care that you’re expecting and go above and beyond.”

Gabby and Austin were able to stay with Randi and the team at Ivinson for the duration of their care. Their baby was scanned at 20 weeks and received a fetal echo to receive a clean bill of health.

On June 28, 2024, Austin and Gabby welcomed a healthy baby boy Kit Bear Decker.

“Since I started coming to Ivinson, it’s been the best healthcare I’ve received in my life,” Gabby said. ​“Knowing we had the need for these services and Ivinson made those advancements to prenatal care made us feel like our needs were taken seriously.”

As parents of babies with heart defects, both Gabby and Bri shared the importance of the 20-week anatomy scan as more than a gender reveal but also a time to ensure the health of your baby. Knowing there is risk in every pregnancy, the 20-week anatomy scan marks the halfway milestone and also gives care teams and parents the assurance that things are progressing as expected. In the instance that anomalies are found, it gives families and medical teams the opportunity to plan for next steps.

Both Bri and Gabby take pride in knowing that improved care is now available at Ivinson for families like theirs because of families like theirs.

​“Being congenital heart disease parents, it is important for us to share how common this is,” Bri shared. ​“Now, Ivinson has made it possible to catch, diagnose and follow up with babies that do have congenital heart defects — that is huge. It’s going to save lives. It’s going to have better outcomes for these kids and these families. This is really important care, here at home.