Heart disease is the single major cause of maternal mortality in developed countries. 0.8% of babies are born with a congenital heart defect and because most now survive to adulthood, providing care for mothers with a congenital heart defect makes up the majority of an obstetrician's workload in relation to heart disease. However, acquired heart disease is the major cause of cardiac related maternal death, due to the trend of mothers to have babies at an older age and the fact that many cases are undiagnosed until there is an acute event. Because good care requires a detailed knowledge of both pregnancy and cardiac pathophysiology, multidisciplinary care is essential. Continuity of care is also vital to ensure correct management; litigation increasingly follows on if there is any substandard practice. Modern practice emphasises partnership with the pregnant woman and her family, with fully informed consent being essential in the modern era of ‘patient centred care’. Technology in the form of apps is being developed to help make sure that key risk factors are not overlooked, and agreed guidelines are correctly followed.