Advice for pregnant women with epilepsy

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1 Ayrshire Maternity Unit Advice for pregnant women with epilepsy Information for you Follow us on Find us on Facebook at Visit our website: All our publications are available in other formats

2 Now you are pregnant Professionals caring for you Because you will meet a wide range of health professionals while you are pregnant, it will be important to keep everyone informed about any changes that are made by your doctor in your treatment or medication. Antenatal booking At your visit to the midwife or family doctor (GP) make sure that you tell them: that you have epilepsy; what your seizures are like, their nature, length, pattern and frequency; any contributing factors that trigger your seizures; what medication you are taking; and whether your husband/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 2

3 special care and supervision 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 your baby. Occasionally the medicine you are taking will need to be changed. By keeping regular appointments with your doctor or at the clinic and following the advice about taking medication you can greatly help to keep your unborn child safe. Folic acid is known to reduce the risk of having a baby with spina bifida. You should take 5mg of folic acid each day before becoming pregnant, and for the first 12 weeks of pregnancy. You should take your epilepsy medication into hospital with you to ensure you get your medicine at the right time for you. Vomiting If you have early morning sickness, or vomiting at any time during your 3

4 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 as this may mean you are not absorbing your medication. Home considerations A midwife will visit you at home during your pregnancy. This will give you 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 we recommend that you take a shower but if you do use a bath make sure the door is unlocked. Take your bath or shower when someone else is in the house. Avoid hot, deep baths while pregnant as they can 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. Routine screening for Spina Bifida and 4

5 Down s Syndrome (AFP/HGG) is offered at weeks. You will also be offered an ultrasound scan, usually at your initial hospital booking visit, and again at around 20 weeks for development problems. We cannot detect all possible abnormalities in your developing baby by scan. Vitamin K Depending on 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 a care plan for your labour with your midwife. 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; and 5

6 who you would like to have with you to support you during labour. Medication Throughout your labour and your time in hospital we will keep a careful watch on your medication. The many changes which will be happening to your body may affect how well it works. Labour Everyone will be working to try and make your pregnancy and labour as relaxed and 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. Most babies are given Vitamin K after delivery and it will be particularly important for the baby to protect it from a deficiency which may have been 6

7 caused by your medication. Our paediatricians recommend Vitamin K injection rather than the oral alternative because of this higher risk. Your baby s first few days Feeding Babies benefit from breastfeeding and the fact that you are taking anti-epileptic drugs should not be a problem. In fact, breastfeeding 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 you can sit on the floor with your back to the wall with cushions positioned on either side, so your baby will not have far to fall if you lose consciousness. Some babies do not suck well at first but gradually things will improve. 7

8 Make sure that you ask the midwife to help you with breastfeeding. Sleep Because sleep deprivation makes seizures more likely, you should take the opportunity to rest whenever you can. Lots of visitors can be tiring. Talk about this with your family and friends before you go into hospital. If you are getting over-tired talk to your 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 you 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 8

9 a seizure. Extra care can be taken by letting the midwife know when you are going to have a bath or a shower and by keeping the door unlocked. At home The midwife, family doctor 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. It is not unusual for seizures to become more frequent or different in character after your baby is born. 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 distance from you when feeding or cuddling. 9

10 Bathing and changing your baby 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 outside 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. It may be safer to use a baby chair to carry your baby. If your epilepsy is like this you might consider attaching wheels to a carrycot which will allow 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. There are prams and buggies available which 10

11 have a safety brake which will come on if you stop moving. Reins should be used for toddlers. Parenthood Like all new parents, you and your partner will find parenthood exciting and challenging. The pleasure that you get from your newborn baby should not be affected in any way by the fact that you have epilepsy. As with all new parents you should make your house baby safe by using safety gates, fire guards and other safety devices. Educate your child as soon as possible about what to do if mum has a seizure and they will cope extremely well and take it in their stride. 11

12 Advice on epilepsy is available from the following organisations: Brainwave: The Irish Epilepsy Association 249 Crumlin Road, Dublin 12 Telephone: Epilepsy Action New Anstey House, Gateway Drive, Yeadon, Leeds IS19 7XY Telephone: Epilepsy Scotland 48 Govan Road, Glasgow G51 1JL Telephone: Mersey Region Epilepsy Association Glaxo Neurological Centre, Norton Street, Liverpool L3 8LR Telephone: National Society for Epilepsy Chalfont St Peter, Gerrards Cross, Buckinghamshire S19 ORJ Telephone:

13 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 OBE Telephone: The National Childbirth Trust Alexandra House, Oldham Terrace, London W3 6NH Telephone: La Leche League Helpline Telephone: Crysis (telephone helpline for parents with crying babies) Telephone: Acknowledgement RCM/Joint Epilepsy Association 13

14 Your notes 14

15 Your notes 15

16 All of our publications are available in different languages, larger print, braille (English only), audio tape or another format of your choice. Tha gach sgrìobhainn againn rim faotainn ann an diofar chànanan, clò nas motha, Braille (Beurla a-mhàin), teip claistinn no riochd eile a tha sibh airson a thaghadh Tell us what you think... If you would like to comment on any issues raised by this document, please complete this form and return it to: Communications Department, 28 Lister Street, University Hospital Crosshouse, Crosshouse KA2 0BB. You can also us at: comms@aaaht.scot.nhs.uk. If you provide your contact details, we will acknowledge your comments and pass them to the appropriate departments for a response. Name Address Comment Last reviewed: December 2015 Leaflet reference: ACH GD