Murray » Alisa Bernard tired easily and struggled to breathe, but figured it was because she was pregnant with her fourth child and close to her due date.

But due to a rare condition that affects women in their last weeks of pregnancy or in the months following delivery, her heart was barely moving. It was functioning at 5 percent capacity, which is why she would also wake up in the middle of the night gasping for breath.

Once the problem was diagnosed, the Layton mother was shocked to learn she had a 50 percent chance of dying. And because the oxygen level in her blood was low, her baby was at risk, too.

In what Intermountain Medical Center doctors described as one of their most challenging cases, they decided Bernard would have to give birth in unusual circumstances: In a heart catheter lab, in case her heart failed, surrounded by heart and high-risk pregnancy specialists.

She couldn't push, because it would stress her heart, so doctors used forceps. And immediately after the Nov. 10 birth, instead of holding Lily Marie, Bernard was transferred from the delivery bed to another bed in the room so a doctor could implant a tiny pump in her heart.

Awake while the device was guided up her leg into her heart, Bernard knew her daughter was OK when she heard her cry and the doctors and nurses cheered and clapped.

"I thought, 'We did it,' " Bernard said Tuesday, holding 2-week-old Lily at a news conference at Intermountain Medical Center, with her husband, Paul, and three boys ages 13 to 2 nearby. "I was just hoping I would make it through. I just thought, 'I want to be able to raise all my kids and her.' "

Doctors can't say why Bernard developed peripartum cardiomyopathy, which affects one out of every 1,300 to 4,000 pregnant women. Many times, the condition is reversible, according to the National Institutes of Health, though some women need heart transplants.

Bernard's doctors said her heart is still recovering. If its function doesn't improve, she risks the same problem in subsequent pregnancies and would have a 60 percent chance of dying.

Bernard also developed pulmonary hypertension, a type of high blood pressure that affects the arteries in the lungs and weakens the heart.

It wasn't until Bernard had an echocardiogram at McKay Dee Hospital in Ogden in early November that doctors knew her difficulty breathing was so serious. She was rushed to IMC by a Life Flight helicopter, where doctors had to decide if she should get the heart pump before or after delivery.

If she had it before, the necessary blood thinners would increase the risks of serious bleeding during delivery. Implanting the device after was risky too, since childbirth, and the subsequent shift of fluids, could have further weakened her heart.

"This was like a medical Rubik's Cube," said cardiologist James Revenaugh, who implanted the heart pump, an Impella 2.5. It is the smallest pump available in the United States and works by pumping blood from the left ventricle into the aorta.

He said that after Bernard's labor started, her blood pressure dropped dangerously, proving that " it was unlikely she was going to be able to get through the days after pregnancy without some level of support."

The pump was removed before Bernard left the hospital Sunday, two weeks after giving birth. She now has a defibrillator to monitor her heart rate and deliver an electric shock if her heart beats too fast.

"When you look at patients with weak hearts, the most common way they die is sudden cardiac death," said one of Bernard's cardiologists, A.G. Kfoury, describing the need for the defibrillator. He said Bernard's heart now functions at 20 percent, while a normal heart functions at 50 percent to 70 percent.

Before delivery, Bernard knew she might not make it. "That [mental] place is too depressing so you have find that place where there's faith and hope that everything's going to be OK."

hmay@sltrib.com