Hesperian Health Guides
Breastfeeding for people with epilepsy
HealthWiki > Epilepsy and Seizures > Chapter 7: Pregnancy and birth with epilepsy > Breastfeeding for people with epilepsy
Breast milk gives babies all the nutrients and fluids they need for healthy growth and development. It is the best food for a baby, especially during the first 6 months of life. It is fresh, ready-to-use, at the right temperature, and it protects children against many infections and diseases. Breastfeeding is considered safe and is encouraged for mothers with epilepsy, just as it is for all mothers.
It is impossible to pass epilepsy to a baby through breast milk. Concerns about passing antiseizure medicine through breast milk should not stop the mother of a newborn from breastfeeding. The benefits of breastfeeding far outweigh any possible harms from your antiseizure medicine. So breastfeed as often as you are able.
For the health worker. Talk to families and encourage them to give nothing but breast milk, not even water, for the first 6 months and to continue breastfeeding for at least 1 year.
It is not enough to just talk about breastfeeding. Some people may need support to learn how to breastfeed successfully. Help them find a neighbor, relative, or health promoter who can assist in learning how to hold the baby correctly, how to get the baby to latch on properly, and to provide emotional support. They may also need creams or medicine if skin problems develop on their nipples or breasts.
Some skin infections can be passed from mother to baby and make breastfeeding a challenge. For more information about breastfeeding, see Chapter 7 of Hesperian’s Where Women Have No Doctor. There are many problems that can make breastfeeding difficult, and occasionally not possible. Alternatives like formula are sometimes necessary. Help all families do the best they can to find their own ways to care for and be close with a new baby.
Breastfeeding and antiseizure medicines
A small amount of antiseizure medicine passes to a baby during breastfeeding. While there is not yet 100% certainty that the breastmilk of people who take antiseizure medicine is totally safe, no studies show negative health effects on children breastfed as infants by mothers taking antiseizure medicine. All studies highlight the benefits of breastfeeding for mother and baby.
Medicines that pass at higher levels in breastmilk are phenobarbital, levetiracetam, zonisamide, and ethosuximide. That there is more of it in your breastmilk does not necessarily mean it will cause problems for your baby. If you have concerns about how breastfeeding is affecting your baby, talk with a midwife or other health worker. If you want to change your medicine, talk with them about how to do so safely.
While these medicines are considered safe for breastfeeding, pay attention to if and how they are affecting your baby.
Carbamazepine. Note your baby’s signs of sleepiness, vomiting or upset stomach, or poor weight gain. These are side effects of carbamazepine on the baby. Keep track of them like you would track your own side effects. If the baby shows signs of jaundice (yellowing of eyes and skin), talk to a health worker immediately.
Ethosuximide causes side effects in some babies, such as sleepiness, lack of interest in breastfeeding, poor weight gain, irritability, and vomiting. Keep careful track of these side effects. Because ethosuximide is often used with other antiseizure medicines, side effects could be caused by the combination of medicines, not just ethosuximide. Talk with a health worker about any side effects you see in your baby.
Lamotrigine rarely causes side effects except for skin rash. Talk to a health worker if the baby develops a rash.
Levetiracetam only occasionally causes sleepiness in babies.
Phenobarbital can cause sleepiness and poor weight gain in infants, especially if used with other antiseizure medicines that have similar side effects. Breastfeeding may need to be stopped if the baby’s drowsiness or poor growth does not improve, especially if the baby was born early and small, making them more sensitive to phenobarbital.
Zonisamide * A health worker may suggest supplementing breastfeeding with bottle feeding and breastmilk with formula if side effects like lack of interest in breastfeeding, dehydration, irritability, and poor weight gain continue. If there are other options, they may suggest changing your antiseizure medicine. If other options are not available, a lower dose of zonisamide may be considered.
*(This medicine is not included in Chapter 4: Medicines for epilepsy and seizures, because it is not available in many communities Where it is available, this information is useful to know.)
Tips for breastfeeding when taking antiseizure medicine
If you take antiseizure medicine once a day, take it just before the baby sleeps the longest, usually after the bedtime feeding.
If you take antiseizure medicine more than once a day, breastfeed your baby just before you take a dose. This is when the amount of antiseizure medicine in your body will be lowest.
Disrupted sleep and tiredness can trigger seizures. Removing breastmilk with your hand or a pump and then keeping it cool allows another caregiver to feed your baby so you can rest or get a good night’s sleep. For information about removing milk by hand, see Chapter 7 of Hesperian’s Where Women Have No Doctor.
Take precautions while feeding your baby to prevent injury from seizures that occur without warning. For example, sit on a low bed or mattress with your back to the wall and surround yourself with cushions.
Helping mothers feel confident about breastfeeding
There will be less stigma against people with epilepsy breastfeeding when families and communities have correct information about epilepsy. Help people learn that breastfeeding cannot cause epilesy and seizures. Let others know that epilepsy cannot be passed through breastmilk to the baby. Encourage mothers with epilepsy to have confidence in their ability to breastfeed.
One way to build confidence is to bring together a group of mothers with epilepsy and their babies and encourage them to enjoy each other’s company. As they share experiences and tips about breastfeeding and parenting, they can also share ideas about how to challenge epilepsy myths and stigma. For more information about other ways to challenge stigma, see Chapter 5.