Most pregnant women with epilepsy have a normal pregnancy and childbirth. The frequency of seizures may increase in pregnancy in around 3 in 10 women with epilepsy. For women with epilepsy, the risk of complications during pregnancy and labour is slightly higher than for women without epilepsy. The small increase in risk is due to the small risk of harm coming to a baby if you have a serious seizure whilst pregnant, and also the possible the additional risk of harm to an unborn baby from some Anti Seizure Medications (ASMs).
The risk of complications to both mother and baby is greater with uncontrolled seizures compared to the risks of taking medication. It is not proven that uncontrolled seizures cause congenital abnormalities but there appears to be a risk of increased miscarriage and maternal death. In Ireland the guidelines caring for pregnant women with epilepsy suggest that you should be seen by an epilepsy specialist at least once a trimester (i.e every 3 months).
If you are on Lamotrigine and Leviteracetam, your ASM level should be recorded at each visit or sooner if warranted. Pregnant women and girls who are taking ASMs should be offered a high-resolution ultrasound scan to screen for structural anomalies. This scan should be performed at 20-22 weeks’ of the pregnancy by an appropriately trained ultra-sonographer.
Giving birth/Labour
Most women with epilepsy will have a normal vaginal delivery. The risk of having a seizure when you are in labour is between 1% and 2%. If you have a seizure during labour, it does not mean that you cannot continue on to have a normal delivery. Once the situation is assessed you may still be able to have a normal delivery. If the obstetrician has any health concerns about you or the baby they may suggest a caesarean section.
The below are some suggestions for lowering the risk of having a seizure during labour:
- Take your own epilepsy medicine clearly labelled to the hospital with you, and take it at your usual time. You may want to “blister pack” your medication. Your pharmacist can help guide you with this. You could ask your midwife or your birth partner to help you remember to take it.
- Consider an early epidural.
- Discuss seizure management with both your epilepsy specialist and obstetrician before your planned hospital admission; have this documented in your maternity hospital notes.
- Typical triggers to including vomiting, sleep deprivation, emotional stress and pain may increase your risk of having a seizure. Ensure that the team caring for you are aware of your usual triggers and how best to avoid/treat them.
- If you feel nauseous or sick, make sure to ask your midwife for something to help with this as it is very important to continue your seizure medicine as normal during this time. If you cannot take your medication as normal your midwife will have to consider giving it to you via another route (i.e intravenously).
With regard to pain relief during labour, there are number of options that are open to women with epilepsy. The below are some things to consider when discussing with your medical team:
- High doses of pethidine (a drug used for pain relief in the early stages of labour) can trigger seizures; therefore it is best avoided. An alternative medication can be used instead - please discuss with your Obstetrician.
- An early epidural should be considered in order to promote rest and pain relief.
- Doing breathing exercises and using gas and air may help you manage pain during labour. But you should be careful not to over-breathe. Overbreathing can trigger seizures for some people.
- Unsupervised water births, and having an unsupervised bath during labour are not usually recommended for women with epilepsy due to the risk of drowning as a result of a seizure.
- TENS machines are often used for pain relief during labour. These are perfectly suitable for you if you have epilepsy.
Vitamin K
All children born to mothers taking enzyme inducing ASMs should be given 1mg of vitamin K by injection at delivery. However, in the Republic of Ireland all babies are routinely given 1mg of Vitamin K intramuscular to prevent haemorrhagic disease of the new-born.