Epi-Life.com

IS IT SAFE FOR ME TO BREAST FEED MY BABY?

Generally, breast feeding is to be encouraged and in women with epilepsy, this is no exception. Even if a woman with epilepsy is taking anti-epileptic medication, breast-feeding is not affected as the baby has been exposed to the drugs whilst in the womb. When feeding the baby it is advisable for the mother to sit on floor cushions and lean against the wall to reduce the risk of dropping the baby in a seizure. Bottle- feeding, in which the partner can share, may also be helpful if the mother’s seizures increase because of tiredness or a lack of sleep.

Some drugs e.g. phenobarbitone, may result in the baby being oversleepy. In this case, it may be necessary to alternate bottle and breast feeds.

WHAT ABOUT IMMUNISATION?

The whooping cough vaccine is generally the one which causes concern. The guidelines from the Department of Health about immunisation are written in their publication “Immunisation against Infectious Disease” the most recent edition being that written in 1996. With reference to the whooping cough vaccination, it states 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 epilepsy, immunisation is generally recommended.

The guidelines also state that: “No child should be denied immunisation without serious thought as to the consequences, both for the individual child and for the community". Where there is doubt, advice should be sought from a Consultant Pediatrician.

Medication

WILL ANY CHANGES HAVE TO BE MADE TO MY MEDICATION BEFORE I BECOME PREGNANT?

It is very important for women with epilepsy to talk to the doctor responsible for their epilepsy treatment, ideally before conception or if not, as early on in pregnancy as possible. If they have been free of seizures for more than two or three years, the doctor may consider withdrawal of anti-epileptic medication.

It should be taken into consideration what the effect would be on that person’s lifestyle if they had another seizure e.g. the loss of a driving licence or possible employment implications.

If someone is still having seizures, the medical practitioner will want to make sure that the individual is on the lowest dose of the most effective treatment which gives the best control of seizures. Any changes of medication should always be under the supervision of the doctor.

During pregnancy, the body uses up more of the anti-epileptic medication and the levels of the drug within the blood may fall so blood levels should be monitored regularly and the dose may have to be increased.

HOW GREAT ARE THE RISKS OF TAKING ANTI- EPILEPTIC MEDICATION DURING PREGNANCY?

It is commonly recognised that during pregnancy it is best to avoid any drug including both alcohol and tobacco. However, women with active epilepsy will still need to continue taking their anti-epileptic medication during pregnancy. The dangers of not taking medication and running the risk of having a seizure are generally greater than the risks associated with taking anti-epileptic drugs. With any woman having a child there is a 3% risk that the baby may be born with some form of abnormality. It is recognised that if a mother is taking one sort of anti-epileptic drug the risk rises to 7% and if two or more anti-epileptic drugs are being taken the risk increases to 15%. It is also true to say that the risk increases further if large doses of the drugs are being taken.

WHAT ARE THE RISKS?

The problems which may affect children born to mothers taking anti-epileptic medication may include abnormalities such as hare-lip or cleft palate. Sometimes malformation of the limbs may occur and more rarely of the internal organs.

Problems associated with anti-epileptic drugs also include that of neural tube defects (an example of which is spina bifida). The risk of neural tube defects in the general population is 0.2 - 0.5%. If someone is taking sodium valporate (Epilim) during pregnancy, there is a 1-2% risk of neural tube defects, and a 1% risk with carbamazepine (Tegretol). These risks are reduced if the dose of the medication is lower rather than higher. It is recommended that the mother takes a supplement of 4 mg or 5 mg a day of folic acid before conception and during pregnancy as this markedly reduces the risk.

Vitamin K 20 mg by mouth per day for the last month of pregnancy is also recommended to avoid the risk of the baby having problems with bleeding.

Seizures

AM I LIKELY TO HAVE AN INCREASE IN SEIZURES DURING PREGNANCY?

Most women with epilepsy do not have an increased number of seizures during pregnancy but for those who do (between 17 and 37%) this increase is often associated with anti-epileptic medication not being taken properly (or not working properly because of vomiting), sleep deprivation or because being pregnant has caused the drug levels in the blood to fall.

In about 50% of women their epilepsy is better controlled during pregnancy, often because they are more careful about getting enough sleep and about taking the medication regularly.

WHAT IS THE LIKELYHOOD OF HAVING A SEIZURE WHILST IN LABOUR?

Only 1-2% of women with active epilepsy will have a tonic-clonic seizure in labour and a further 1-2% will have one in the next 24 hours. Anti-epileptic medication should be taken as normal during labour. Deliveries should be in hospital and the delivery team made aware of a diagnosis of epilepsy and the treatment.

It should always be remembered that the vast majority of women with epilepsy have uncomplicated pregnancies with normal deliveries and healthy children

Childcare

WILL I BE ABLE TO LOOK AFTER THE CHILD?

If seizures are well controlled, having epilepsy will not interfere greatly with looking after a child. If seizures are not well controlled then risks do exist and these risks will depend on the nature of the seizures the mother has.

If seizures are sudden and unpredictable, dressing, changing, feeding and bathing the child should be carried out on the floor. The baby should not be bathed in deep water if the mother is by herself and sponging the baby down on a changing mat of the floor is safer.