GUIDELINES FOR WOMEN WITH
EPILEPSY
by Epilepsy Association of Scotland
Many women with epilepsy have children, enjoy a straightforward pregnancy
and labour, and have healthy babies. These guidelines are to help you and your
partner understand why some special precautions are advisable, even if your
epilepsy is very well controlled. It is recommended that you read them in
conjunction with the general information given to all pregnant women. To help
you have a relaxed, safe pregnancy and childbirth, it is advisable to keep in
close contact with medical staff and the midwife throughout your pregnancy.
Pre-pregnancy advice
Contraception
The effectiveness of some oral contraceptives is reduced by certain
anti-epileptic drugs. If you are seeking family planning advice, let the
doctor, nurse, or midwife, know about your epilepsy and medication. They can
advise you about appropriate contraception. Thinking about pregnancy You may be
aware that there is a small increase in risks associated with epilepsy for you
and your baby. The best time to ask questions of a doctor or midwife is when
you are thinking of becoming pregnant. Points to discuss regarding your own
individual medical history include:
- your epilepsy
- your seizure pattern
- your medication
- your family history
- your diet
Medication
Before pregnancy begins, it is important to discuss your medication with
your doctor, since it may need to be changed to promote the well-being of your
baby. The needs of your body will alter during your pregnancy, and it may be
necessary to increase the dosage of your drug. This is quite normal.
Family history
If other members of your family also have epilepsy, then you should ask your
doctor and/or a genetic counsellor about the implications.
Diet
Some anti-epileptic medication is known to increase slightly the risk of
neural tube defect (for example, spina bifida). Although a woman who may become
pregnant should eat a diet rich in folates and take folic acid supplement, if
you are on anti-epileptic medication it is particularly important.
Fertility
Anti-epileptic drugs do not cause infertility in women, but women with
epilepsy may find greater difficulty in conceiving than other women.
Anti-epileptic drugs may have some effect on fertility in men, possibly
altering sperm motility. If you are having problems getting pregnant discuss
this with your doctor.
During pregnancy
Because you will meet a wide range of health professionals during the period
of your pregnancy, it is important to keep everyone informed about any changes
that are made by your doctor, in either your treatment or medication.
Ante-natal booking
On your first visit to the midwife or GP ensure that you make it known:
- that you have epilepsy
- what your seizures are like (i.e. their nature, length, pattern, and
frequency)
- any contributing factors that can trigger them
- what medication you are taking
- whether your husband or partner has epilepsy
It could also be helpful if someone who has seen you having a seizure goes
with you to the clinic at an early stage in order to share information. Because
your seizures may become more frequent during pregnancy, you may find that you
are given special care and supervision, both during pregnancy and during your
period in hospital.
Medication
Taking your medication as prescribed is more important than ever when you
are pregnant, in order to prevent seizures and therefore minimise the risk of
injury to the baby. By keeping regular appointments with your doctor or at the
clinic, and by following the advice about taking medication, you can greatly
help to keep your unborn child safe. Throughout your labour and your time in
hospital, a careful watch will be kept on your medication, because the many
changes which will be happening to your body may affect how well it works.
Vomiting
If you have early morning sickness, or vomiting at any time during your
pregnancy, you may need to alter the time you take your tablets. If the
vomiting is persistent, be sure to discuss this with your doctor or midwife,
since it may mean that you are not absorbing your medication.
Home considerations
A midwife will visit you at home during your pregnancy. This gives an
opportunity to talk about issues relating to you and your baby, including
advice on preparing for a new baby in the house.
Bathing and showering
If possible, take your bath or shower when someone else is in the house.
Avoid hot, deep baths while pregnant, because they make you drowsy and may
perhaps trigger a seizure.
Screening tests
In most health authorities, women may be offered tests to screen for
abnormalities in their unborn babies. These usually take the form of an alpha
foeto-protein test (AFP), which is a blood test generally done at 16 -20 weeks.
You may also have an ultra-sound scan, usually at your initial hospital booking
visit.
Vitamin K
Depending upon the medication that you take, you may be advised to take a
daily dose of Vitamin K tablets for the four weeks before your baby is due.
This is thought to have a protective effect against certain types of bleeding
in the new born baby.
The birth
You will be able to discuss with your midwife a care plan for your labour.
You will talk about things like:
- different ways of relieving pain
- positions you might find comfortable
- factors which might trigger a seizure, such as bright lights and loud
noises
- who you would like to have with you to support you during labour.
Labour
Everyone will try to make your pregnancy and labour as relaxed and as
satisfying as possible. The delivery of your baby is not likely to be any
different from that of other mothers. The risk of an epileptic seizure is low.
By taking your medication regularly, and getting as much rest as possible, you
can help keep any risk at a minimum. During birth and after the baby is born,
you will, like all other mothers, have a midwife with you.
Most babies are given Vitamin K after delivery. It will be particularly
important for your baby, to protect it from a deficiency which may have been
caused by your medication.
Early days
Feeding
Babies benefit from breast feeding, and the fact that you are taking
anti-epileptic drugs should not be a problem. In fact, breast feeding can be an
effective way of weaning your baby off the small amount of medication it will
have absorbed during your pregnancy. Raising the issue with your doctor or
midwife before your baby is born can reassure you about the safety of your
particular medication.
The sooner you put your baby to the breast, the easier it is. You need to
feel comfortable and secure before you start to feed your baby. If you are
concerned about dropping your baby in a seizure, sit on the floor with your
back to the wall, with cushions positioned on either side, so that your baby
will not have far to fall if you lose consciousness.
Some babies do not suck well at first, and you can ask the midwife to help
you to fix the baby at the breast.
Sleep
Because sleep deprivation makes seizures more likely, you should take the
opportunity to rest whenever you can. Having lots of visitors can be tiring.
Talk about this with your family and friends before you go into hospital. If
you are getting overtired, talk to the midwife about it.
Drug withdrawal
Because some of your medication will have been absorbed by your baby during
pregnancy, you may be anxious about possible withdrawal symptoms after birth.
If your baby is irritable for this reason, the effect will soon clear, but talk
to your paediatrician or midwife if you are concerned.
Bathing and showering
It is better to run the cold water first, as the water in hospitals is often
very hot. Deep hot baths are best avoided as they make you sleepy, which can
trigger a seizure. Extra care can be taken by letting the midwife know when you
are going to have a bath or shower, and by keeping the door unlocked.
At home
The midwife, GP, and health visitor, will provide support when you return
home, and can advise you if you are concerned in any way about yourself or your
baby. If your seizures become more frequent or different in character after
your baby is born, this is not unusual. However, it is important that you seek
medical advice promptly and continue to take your medication in the normal way.
Sleep
Plenty of rest is beneficial for both you and your baby, so take up any
offers of help from your family or friends.
Hot drinks
Avoid any danger of scalding yourself or your baby by keeping hot drinks a
safe distance from you when feeding or cuddling.
Bathing and changing
Bathing your baby can be fun, and you can make it safer by sharing it with
someone else. Using a bath stand is hazardous, so put your baby bath into the
big bath or on to the floor. If you are on your own, it is safest to sponge
your baby on a waterproof sheet on the floor.
Changing your baby in the cot or on a changing mat on the floor is also a
good idea. You can kneel to the side, so that you fall away from your baby if a
seizure occurs.
Carrying your baby
You may prefer to avoid carrying your baby while alone if you are subject to
very frequent seizures which start with a sudden loss of consciousness. In this
case, consider attaching wheels to a carrycot, which allows you to wheel your
baby alongside you. When going outside, a length of cord from your wrist will
stop the pram from running away from you should you fall. The cord should be
long enough to ensure that you do not pull the pram over.
Immunisation
The whooping cough vaccine is generally the one that causes most concern.
Current Department of Health guidelines state that where there is a personal or
family history of febrile convulsions, immunisation is recommended, with advice
being given on preventing fever if this were to occur after being immunised.
Similarly, if there is a family history of eplilepsy, then immunisation is
generally recommended.
Parenthood
Like all new parents, you and your partner will find parenthood exciting and
challenging. The pleasure that you get from your new born baby should not be
affected in any way by the fact that you have epilepsy.
Useful contacts
At some time in the future, you will want your child to learn about your
seizures. Advice and help on this and many other aspects of epilepsy is
available from the following organisations:
Brainwave (The Irish Epilepsy Association)
249 Crumlin Road
Dublin 12
 353 1 455 7500
British Epilepsy Association
Anstey House
40 Hanover Square
Leeds
LS3 1BE
0113-243 9393
Epilepsy Association of Scotland
48 Govan Road
Glasgow
G51 1JL
0141-427 4911
Mersey Region Epilepsy Association
Glaxo Neurological Centre
Norton Street
Liverpool
L3 8LR
0151-298 2666
National Society for Epilepsy
Chalfont St. Peter
Gerrards Cross
Buckinghamshire
S19 0RJ
01494 873991
Comprehensive advice and information on all aspects of pregnancy and
childbirth can be obtained from:
The Royal College of Midwives
15, Mansfield Street
London
WM1 0BE
020-7872 5100
Other sources of help are:
The National Childbirth Trust
Alexandra House
Oldham Terrace
London
W3 6NH
020-8992 8637
La Leche League Helpline
020-7242 1278
Cry-sis (telephone helpline for parents with crying babies)
020-7404 5011
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