After the Baby is Born


That's unpredictable. Some women with epilepsy have changes in their seizures while they are pregnant. 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. A few other things to consider...

  • During pregnancy, concentrations of your seizure medication may change or decrease, putting you at greater risk for seizures. Your health care team 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 doctor to check medication blood levels more frequently in the first few months after delivery.
  • Keep in close contact with your doctor or nurse during this time until your body returns to its pre-pregnancy state.

Every parent has to think about this. Women who have just had a baby will have disturbed sleep (interrupted or not enough sleep), extra work and stress, and hormonal changes -- and for a woman with epilepsy these factors can increase the risk of seizures. Here are a few safety tips to consider...

  • Include other family members and friends in the care of your baby to give you a chance to rest.
  • Take good care of yourself after delivery - it's just as important as during pregnancy! Remember the basics - get enough sleep, eat well, exercise regularly and take your prescribed seizure medication.
  • Talk over any problems with your health care team and get their advice about possible adjustments in your lifestyle.

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, primidone (Mysoline), or benzodiazepines (valium, lorazepam, and clonazepam, clobazam). 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, talk to your you child's pediatrician. He or she may recommend switching to formula. A combination of breast and bottle may be an option depending on your baby's symptoms.
  • Talk to a breast-feeding specialist for help - she can work with you, the pediatrician, your doctor and nurse, and help you find the best approach.
  • You may be asked to keep track of how often your baby feeds, how long at each time, as well as voidings and stools so the doctor can evaluate how much nourishment your baby is getting.
  • Continue to take your prenatal vitamins 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.

Seizures are unpredictable. There is no way to ensure that you won't have a seizure while you are caring for your new baby. Yet you can have a plan to protect the baby if a seizure occurs. 

  • Start with a home safety assessment. Where are the risky areas? Consider what would happen if you were to have a seizure and not be aware for a short period of time. 
  • Set up a safe place in each room of your house where you can place the baby if you have a warning before a seizure or feel unsafe. 
  • Some women don't have a warning, but may feel a bit strange or uneasy for several hours earlier. Ask a friend or family member to stay with you when this happens. 
  • Consider using a seizure alert system that could notify someone if you have a seizure and need help.

Some other tips to consider...

  • If you use a changing table, make sure your baby is always strapped in. Or use a portable changing pad on the floor. 
  • Don't bathe the baby by yourself if you're alone. Make sure someone else is with you in the room.
  • Always fasten the safety straps in an infant seat, even if you are right there.
  • If you do not fall during seizures, you may want to use a cloth-front baby carrier whenever you are walking or standing and holding your baby.
  • If you are alone and bottle-feeding, don't carry the baby to the kitchen -- leave your baby in the crib while you prepare the bottle and bring it back with you.
  • Consider putting your baby in an infant seat while feeding her. Or sit on the floor while holding and feeding your baby. 
  • Never hold your baby while cooking, ironing, or carrying hot liquids.
  • For safety, don't have the baby sleep in your bed. 
  • Make sure your house is “child proofed” with all safety measures for doors, stairs, and any potentially hazardous areas. 
  • Taking your medication as prescribed and consistently is the most important factor in reducing the chances of having a seizure at any time. 
  • Medicine levels may be changing. You will need blood tests of your seizure medicine done more frequently. 
  • If medicine doses were increased during pregnancy, they may rise too high after delivery. Make sure you know the symptoms of high drug levels and what to do if you don't feel well. 
  •  Keep regular appointments with your epilepsy team. 
  • Try to sleep when the baby sleeps, although this can be difficult if you have other small children. When you first bring the baby home, ask family and friends to help so you can get enough rest.
  • Use babysitters, even if you're home. Having someone else take care of the baby for a period of time may give you time to rest or get other things done. 

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.

  • Whenever possible, encourage your spouse or partner to do the night feedings so you can get uninterrupted sleep. 
  • If you breastfeed, try pumping breastmilk into bottles so your spouse can use these at night. Or supplementing breastfeeding with formula can be tried. 
  • Keep the baby's crib 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. 

Women with epilepsy experience the same emotional adjustments as other women after having a baby.

  • Talk about your risks for postpartum depression with your health care team, especially if you have had mood changes or depression before. 
  • 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.
  • If you are feeling down or depressed, don't keep it to yourself! Talk with family, friends and your health care team so you can get help. 
  • If you see a counselor or psychiatrist, make sure to keep regular appointments with them. 
  • If you take medications for mood, don't change these unless instructed by the doctor prescribing the medicine. 
  • Assess your stress level and how you're coping.. If you don't have a counselor, consider seeing one. Having epilepsy and having a baby are both very stressful. Having emotional support is very important for everyone!

It's a good idea to think about this. Breast-feeding and hormonal changes in the early months after delivery 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 methods instead of, or in addition to your hormonal contraception. Or talk to your providers bout long-acting forms of contraception. 

Reviewed By:

Kimford J. Meador MD
Patty Obsorne Shafer RN, MN

on Friday, March 07, 2014


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