Hesperian Health Guides
Labor and birth
Many people with epilepsy plan to give birth at a medical center or hospital. That reassures them they can get help if a seizure or other unexpected situation develops during labor.
A person with epilepsy can have a vaginal birth just like someone who does not have epilepsy. Because giving birth is a physically tiring, stressful, and painful process, the person with epilepsy, her family members, and health workers should all try to reduce the impact of these or any other conditions that might trigger a seizure during labor. Seizures that do not cause a person to lose consciousness or fall, such as absence or some focal seizures, do not harm the pregnant person or baby in any way that affects birth.
Epilepsy and C-sections. Not all pregnant people with epilepsy need to deliver by Cesarean section. C-sections may be planned if the person had a tonic-clonic seizure or was injured during a seizure while pregnant. C-sections may be necessary for anyone, with or without epilepsy, whose baby is in a difficult position, who has a problem with the placenta or umbilical cord, whose baby has taken too long to be born, or who is in trouble in another way. If a person feels too sleepy, weak, or in any other way unable to participate in labor because of a seizure or antiseizure medicine, they will need a C-section.
A common problem during labor is that the person with epilepsy misses or takes an incorrect dose of their antiseizure medicine. This is no surprise since so much is happening! But even during labor, it is important to continue taking antiseizure medicine. If medicine cannot be taken by mouth, an intravenous (IV, or injected into the vein) option may be called for, but should only be given by someone who knows how to do so. The effect of missing a dose during labor can be the same as at any other time—it may cause a “breakthrough seizure.”
Birth emergency: Seizures that happen during labor
Seizures during labor are rare, but they can happen if a person is tired, dehydrated, stressed, or misses a dose of antiseizure medicine. Seizures may be dangerous if they slow the baby’s heartbeat or cause a decrease in oxygen to the baby.
In the unlikely event that a seizure happens during labor or delivery, protect the person from injury, turn them on their side, and make sure their airway is clear. If they are still in early labor, after the seizure ends, consider taking them to a medical center where they can be supported by a health worker with emergency training. If they are about to deliver or in the middle of delivery, wait for the seizure to end, deliver the baby, and then consider taking them both to a medical center.
If a seizure during labor lasts more than a few minutes or repeats, an emergency medicine like lorazepam may be needed.
Give 4 mg lorazepam through an intravenous (IV) drip for a generalized tonic-clonic seizure. If lorazepam is not available, diazepam or midazolam can be used. For information about rescue medicines, see Chapter 4.
How to adjust antiseizure medicine after delivery
