Labour, birth and after the baby is born

Labour and giving birth

Where can I give birth?

Most women with epilepsy will have a vaginal delivery, without complications. If you are considered to be at risk of having seizures during delivery or the following 24 hours, you will be advised to give birth in a consultant-led maternity unit. This is to make sure you receive one-to-one care from a midwife. It’s also to make sure that facilities are available if you or your baby needs emergency treatment.

To decide the safest place for you to have your baby, your midwife and doctors will work with you to do a risk assessment and care plan. They will ask about when you last had seizures, and whether you are still taking epilepsy medicines.

Most women with epilepsy will give birth in hospital. But it’s important that you have a choice of where you give birth, and that your wishes are central to any decision making.

You might find it difficult to reach an agreement on the safest option for you and your baby. You might want to give birth in a midwife-led unit or have a home birth. But your midwife or doctors may think a consultant-led maternity unit would be safer. If you still decide you want to have a midwife-led unit or home birth, your midwife will arrange for you to speak to a senior midwife, or the head of midwifery. This is to make sure your choice is as safe as possible for you and your baby.

If you are admitted to hospital at any stage of the pregnancy or labour, or postnatal, you should not be admitted to a single room unattended. This is to make you as safe as possible, should you have a seizure.

What pain relief can I have during labour?

There are different options for pain relief during labour. Here are some important things to consider:

• • Epidurals can be given to women with epilepsy
  • High doses of the pain relief drug pethidine can trigger seizures
  • Diamorphine can be used instead of pethidine
  • TENS machines are often used as pain relief during labour and are reported to be suitable for women with epilepsy
  • Gas and air can be given to women with epilepsy

Water birth

For most women with epilepsy, using a birthing pool or bath during labour is not considered safe. This is because of the risk of drowning if you had a seizure.

It might be an option if you have been seizure free and not taking medicine for a long time. Someone should always be with you and there should be a hoist available to get you out of the pool or bath, if need be. It’s also important that staff know how to manage a seizure in the water.

After the birth

Can I breastfeed?

If you want to breastfeed, having epilepsy and taking epilepsy medicines shouldn’t usually stop you. But talk to your midwife or infant feeding adviser first, for advice about how to breastfeed safely. The advice they give will depend on whether your baby was full-term or born early. It also depends on your baby’s health, the epilepsy medicine you are taking, and the type of seizure you have.

Epilepsy medicine can pass into your breast milk, which means your baby will get a small amount of your medicine when they feed. It’s rare for side-effects to be reported in breastfed infants of mothers taking epilepsy medicines. However, if your baby is very sleepy, hard to wake, struggling to feed, or has a rash, talk to your doctor urgently. They might advise you to stop breastfeeding and start formula feeds to see if your baby improves.

While you are breastfeeding, your night-time sleep will be broken regularly. If lack of sleep is a trigger for your seizures, this could be a problem. So, getting your baby into an early bedtime routine can help with this. You might have someone else that can feed your baby with expressed or formula milk to give you chance to catch up on your sleep. The NHS recommend that you don’t make up bottles in advance if possible, but if you need to, they have information on storing breast milk and formula milk safely.

Do I need my epilepsy medicines adjusting after the birth?

If your epilepsy medicine was increased while you were pregnant, it may need re-assessing once your baby is born. Otherwise, you might get side-effects from taking too much. It’s worth talking with your doctor or epilepsy nurse about this and having a plan in place before you go into labour. You can use page 4 of the epilepsy maternity toolkit to do this: womenwithepilepsy.co.uk/pregnancy-toolkit

Post-natal depression

It’s usual to feel a bit down, tearful, or anxious in the first week after having a baby. This is called the ‘baby blues’. Feeling like this doesn’t usually last more than two weeks, but if it does, it could be post-natal depression (PND).

Depression and other mental health conditions are common in women with epilepsy. Some studies suggest that mothers with epilepsy have a high risk of PND too. If you have symptoms of PND, talk to your health visitor or doctor. They will be able to help you. You can read about other women with PND on the Royal College of Psychiatrists’ website: rcpsych.ac.uk

Epilepsy Action has more information about epilepsy and depression.

Looking after yourself and your baby

Caring for a baby is hard work, and all parents need help from time to time. If you are still having seizures, it can be even more of a challenge. And you may need to put some additional safety measures in place.

It can also be hard to remember to take care of yourself when you have a baby. You might be more likely to forget to take your epilepsy medicine. And it’s common to have disturbed sleep. Both of these are common triggers for seizures, so it’s important to plan ahead and do what you can to reduce your risk of seizures.

For more information, see our tips for caring for babies and young children when you have epilepsy.