Women, Pregnancy, and Epilepsy
Prepare in Advance for Pregnancy With Epilepsy continued...
If you are making any changes in your antiseizure medications at all, you should do that at least a year before getting pregnant. Switching medications has risks, too. You may not respond well to the new drug and have breakthrough seizures, which could be harmful to a pregnancy. When changing medications, doctors will usually add the new drug before stopping the old one. If you become pregnant during this time, the baby could be exposed to both drugs instead of just one.
Whether you change seizure drugs or not, be sure to add folic acid to your daily schedule. Starting before you get pregnant, take prenatal vitamins with 0.4 milligrams of folic acid every day, and keep taking them throughout the pregnancy. Folic acid has been shown to reduce the risk of some birth defects by 60% to 70%. Because there are some extra risks associated with pregnancy when you have epilepsy, it's important to do everything you can to minimize those risks.
Epilepsy and Labor
Many women with epilepsy worry that they will have a seizure during labor. This is an understandable fear. As your pregnancy progresses, your metabolism changes. By the time you are nine months pregnant, the blood volume in your body is 50% greater than it was before you got pregnant. This means that the antiseizure medications in your body will be more diluted. That's why your doctor will be monitoring the levels of medication in your blood throughout your pregnancy, and might increase the dosage if it's getting too low.
So when labor starts, you may already be a little more vulnerable to a seizure. Then, you may miss a dose, because things don't always go exactly according to plan when a woman goes into labor. You will also be in pain and breathing hard, which can increase the chance of a seizure. This doesn't mean that seizures are common during labor and delivery, but they are a possibility.
What happens if you do have a seizure during labor? Your doctor may give you IV medication to stop the seizure. If that doesn't work, you may have to have a caesarean section. Although most women with epilepsy have normal vaginal deliveries, they do have a higher rate of C-sections than other women. Sometimes, anticonvulsant drugs can also reduce the ability of the muscles of your uterus to contract. If this happens, your labor might not progress as well and a C-section may be your best option.
All of these concerns can seem overwhelming, but there's no need to become overly anxious. It's important to be aware of the risks. But it's also important to keep in mind that the vast majority of women with epilepsy get through pregnancy just fine. Your chances of having a healthy child are excellent, especially if you talk with your doctor early and often, follow the advice you are given, and take good care of yourself.