View this presentation by Dr. Michael Sperling, Director of the Jefferson Comprehensive Epilepsy Center as he discusses the relationship between epilepsy and genetics.
Will my seizure pattern change after I have my baby?
That’s unpredictable. Some women with epilepsy have changes in their seizures while they are pregnant. During pregnancy, concentrations of your antiepileptic drug (AED) may change or decrease, putting you at greater risk for seizures. Your physician may increase your seizure medication for better seizure protection.
After your baby is born, your hormones change and medication levels in your bloodstream tend to rise, increasing the possibility of side effects. These factors may make it necessary for your physician to check medication blood levels more frequently in the first few months after delivery. Keep in close contact with your physician during this time until your body returns to its pre-pregnancy state.
Stress and lack of sleep make my seizures worse. I’m worried about taking care of my baby.
Every parent has to think about this. Women who have just had a baby will have disturbed sleep, extra work and stress, and hormonal changes — and for a woman with epilepsy these factors can increase the risk of seizures. Include other family members and friends in the care of your baby, to give you a chance to rest. As a parent, during pregnancy and after delivery, the best thing you can do for your baby is to take good care of yourself. Get enough sleep, eat well, exercise regularly and take your prescribed seizure medication. Talk over any problems with your neurologist and your primary health care provider, and get their advice about any necessary adjustments in your lifestyle.
I want to breast-feed my baby. Will that be safe?
For most women with epilepsy, breast-feeding is a safe option. All seizure medications will be found in breast milk, but this usually does not affect the baby who has been exposed already to the mother’s medication during pregnancy.
Talk with your doctor about your medications and breast-feeding, particularly if you are taking phenobarbital (Luminal), primidone (Mysoline), or benzodiazepines (valium, lorazepam, and clonazepam). Women who breast-feed while taking these medications will need to watch their baby carefully for any signs of excessive sleepiness or irritability. If your baby fails to gain weight because it is too sleepy to eat, you will need to follow up with your child’s pediatrician, the nurse, or a lactation (breast-feeding) consultant recommended by the doctor about switching to formula. A combination of breast and bottle may be an option depending on your baby’s symptoms. If you consult a breast-feeding specialist, this individual will work with your child’s pediatrician, the nurse, and you to determine the best approach. You may be asked to keep careful records of the time of each feeding and the number of minutes your baby breast-feeds, as well as voidings and stoolings so the doctor can evaluate how much nourishment your baby is getting.
Continuing to take your prenatal vitamins is important if you breast-feed and if you plan on having another baby.
While you are pregnant, it’s a good idea to learn as much as you can about breast-feeding and about resources in your community so you’ll know what to expect and what supports are available to you.
What if I have a seizure while I’m holding the baby?
There is no way to ensure that you won’t have a seizure while you are caring for your new baby. But you can always have a plan to protect the baby if a seizure occurs. If you have a warning before you have a seizure, you can maintain a secure area in each room of your house where you can safely lay the baby down if you feel a seizure coming on.
Some women don’t experience an immediate warning before a seizure, but they may feel a bit strange for several hours earlier. If this describes you, you may want to have a friend or family member stay with you during a day when such a feeling occurs.
Whether or not you have one of these warnings, you can minimize the risk of potential harm to your baby by taking the following precautions whenever the two of you are alone:
- If you use a changing table, make sure your baby is always strapped in. Or you may want to change your baby’s diapers and clothing on the floor.
- Never give your baby a bath by yourself. Make sure someone else is with you in the room.
- Always fasten the safety straps whenever you put your baby in an infant seat, even if you intend to be right there.
- If you do not have generalized tonic-clonic (grand mal) or other falling-type of seizures, you may want to use a cloth-front baby carrier whenever you are walking or standing and holding your baby.
- When feeding your baby, you may want to use an infant seat, or use pillows to make a comfortable seat on the floor.
- Never hold your baby while cooking, ironing, or carrying hot liquids.
Taking your medication as prescribed by your physician is the most important factor in reducing the chances of having a seizure while holding the baby. It is also very important to get enough sleep. Try to sleep when the baby sleeps, although this can be difficult if you have other small children and no one to help you. During the period when you first bring the baby home, you may need to enlist the help of family and friends to ensure that you get enough rest.
Family members may also be able to help you during the night, by taking turns with feedings. Some mothers who breast-feed extend their sleeping time by pumping breast milk into bottles and then refrigerating it, so another family member can feed the baby at night.
At least one study has shown that seizures are more likely to occur in the period following birth, known as the postpartum period. The processes of labor and delivery have stressed your body. It’s hard to find time to rest. You may be excited and anxious. Your hormones are changing. All of this contributes to stress, and sometimes to sleep difficulties as well.
What about night-time feedings and getting enough sleep?
Breast-feeding is good for your baby and good for you, but it may create more demands on you, especially at night with loss of sleep. Keep the baby next to your bed at night, and feed her in bed with you. Whenever you are feeding your child, sit or lie down — this is a perfect time to put your feet up and relax. If there is concern that loss of sleep may trigger seizures, breast milk can be pumped in advance and used for night-time feedings by your partner or another family member. Having a family member feed the baby at night is ideal but not always possible.
I have heard a lot recently about postpartum depression. Is that something I need to think about?
Women with epilepsy experience the same emotional adjustments as other women after having a baby. Be sure to discuss any changes in mood with your doctor, particularly if they continue or recur over time and if they prevent you from carrying out your normal routine.
I’m concerned about getting pregnant too soon after I have my baby. What can I do to prevent an unexpected pregnancy?
It’s a good idea to think about this. Breast-feeding and the expected hormonal changes in the months right after having a baby can make birth control complicated for any woman. Work with your neurologist and your gynecologist/obstetrician to choose the birth control method that is most appropriate for you.
If you are using hormonal contraception (birth control pills, hormone implants or hormone injections), you may need to consider using barrier birth control methods instead of, or in addition to your hormonal contraception. Barriers are diaphragms, spermicidal vaginal creams, intrauterine devices (IUDs) and condoms. Together, you and your health care providers can make the decision that will work best for you.