It is reassuring that most women with epilepsy have a normal birth and healthy baby. Only in extreme cases is epilepsy an indication for induction of labour or caesarean section. If you have active epilepsy/ prescribed epilepsy medication you are advised to attend a consultant led maternity unit for labour. The risk of seizures in labour is low however; additional monitoring may be required for you and baby.
Please discuss your birth choices with your midwife and have the knowledge that your birth plan is a working document you can change and adjust to meet your individual needs. Consider what you do/don't want and feel you can use a check list to help you write your birth plan to maximize your safety whilst in hospital care. Example:
Your midwife will encourage you and baby to be skin-to-skin following birth and support you with your chosen method of feeding. It is advised to consent to baby having a vitamin K injection to reduce the risk of epilepsy medication related haemorrhagic disease of the newborn. Baby will be examined by a paediatrician to reassure normality following birth.
On the postnatal ward; ensure you continue to take your epilepsy mediation. Unless the ward can accommodate partners overnight; you are not advised to stay in a single room because of dangers related to unwitnessed seizures whilst in hospital care. Let a staff member know if you require additional support to optimize your safety or if you feel at risk of a seizure. Conduct your own risk assessment for the hospital environment: Epilepsy Society Risk Assessment
Women taking epilepsy medication are usually supported with their choice of infant feeding but it is important to consider safety and the impact infant feeding has on sleep. If you decide to breastfeed, this is generally encouraged by our national guidelines and considered safe or moderately safe for most epilepsy medications1, 2. However, all babies should be monitored individually for signs of adverse effects including excessive sedation. If baby is preterm or jaundiced, seek further advice from the paediatrician about the safety of breast feeding. If you take more than one epilepsy medication, take epilepsy medication in high doses, primidone, phenobarbital, clobazam, clonazepam, diazepam or lorazepam extreme caution should be taken because of the risk of drowsiness in the infant3. Ethosuximide, lamotrigine, primidone, levetiracetam and zonisamide transfer to breast milk easily3 therefore, please obtain urgent professional support if baby develops breathing problems, rash, excessive drowsiness, diminished ability to suckle or static weight gain. If baby does develop rash, it is usually recommended that breast feeding is discontinued. In some cases it is advised that baby's serum levels of your epilepsy medication, platelets and liver function are monitored; in the event of this careful consideration should be given about continuing breast feeding because of baby having invasive blood tests. Contact your doctor if you are concerned about baby reaching its developmental milestones. To view research evidence about the epilepsy medication you are taking and effect on breastfeeding, click TOXNET. To ensure baby is suckling well, do ask a member of staff to observe your feeding technique. Additional support and information about breast feeding can be obtained from the organisations listed at the bottom of this page.
Epilepsy medication blood levels rise rapidly to pre-pregnancy levels in the early days following delivery. If the dosage of epilepsy medication was increased during pregnancy, this may result in adverse effects: excessive sleepiness, double vision, unsteadiness, low mood or irritability. Having a flexible medication reduction plan in place in preparation is ideal; if not, obtain urgent advice from your prescriber if you or baby develops adverse effects. Please inform your GP of any changes that have been made to your medication.
It is so important to continue taking your epilepsy medication as prescribed, stay well hydrated, eat a healthy diet and have adequate sleep. Infections can trigger seizures; if you develop flu like symptoms, temperature, offensive vaginal discharge, mastitis, uterine or wound infection, please seek urgent treatment from your GP/midwife. Please report any change in your usual seizure control to your doctor/specialist team urgently, as women can remain vulnerable to seizure change in the months following the birth of their baby.
Sleep deprivation related to parenting is extremely common; this can be particularly provocative for seizure control with a parent who has epilepsy. Getting into an early night sleeping routine can be helpful as well as gaining feeding support from your partner overnight. Further information can be gained from: Emmas diary baby sleep NHS getting baby to sleep
Having a baby Epilepsy Action
Pregnancy & parenting Epilepsy Society
BabyCentre.co.uk evidence-based website for expectant parents
Author: Kim Morley (2018) Information to optimise your birth experience and well-being. Available from: www.womenwithepilepsy.co.uk