Epilepsy and epidural

[Hafa9141]

Hi all,
I have epilepsy which is controlled for 8 years now with Lamotrogine.
I am fairly confident that I will be fine in labour, however my epilepsy is triggered by extreme stress and I am worried labour will do that.
I am also a complete wuss with pain so I feel as though an epidural is best to keep pain low and stress low.
Does anybody think there would be any reason that I couldn't have one? From what I have been told so far (I am getting really clued up before TTC) by my doctor, it most likely won't be a case of being sent home as I'm not dilated enough etc. I will have to be closely monitored, so hopefully this boosts my chances.

We would heavily recommend having an epidural with epilepsy for the reasons you describe.
Midwife should have referred you to an obstetrician for you to discuss this and make plans :)

(Am a consultant Obstretrician)

As nanosecond said - have you been referred? I had pre-conception consultation with the neurologist and was closely monitored throughout by an obstetrician. My actual delivery went a bit wrong (stress and exhaustion induced seizure but there were other things causing both of these other than the simple fact of labour) so I had an emergency section. If I’d ever been lucky enough to have another child I’d have requested a planned section.
I found my hospital extremely supportive and helpful throughout and extremely keen to make the whole process as doable and painless for everyone involved. Best of luck with it all!

@Nan0second we aren't TTC yet I have a mirena coil which I am planning ti have removed towards end of May.
When we start trying do I have to see a neurologist?
I have been in talks with my gp about this for ages and they've been really helpful, but as I haven't needed any treatment (obviously my tablets though) I was discharged from neurology by my consultant.
I rang them a while ago and was told I need to get my go to refer me when I get pregnant. Is that right or is it before we try?

I saw neuro beforehand because I was taking sodium valproate and needed to minimise my risk. That isn’t an issue for you, but he did also put me on a high dose of folic acid and said I should stay on it as long as there was any risk of becoming pregnant. You need that from the moment of conception (or I did 12 years ago!). There may be less of an issue re formation with Lamictal though - but really worth having a chat with the epilepsy nurse, or contacting the epilepsy society for further information. They will also advise about pregnancy and managing post-natally.

You sound very much like me OP so I’ll tell you about my experience.

When I was pregnant with DS I had been on Lamotrigine for epilepsy for the previous 3 years. No seizures since starting medication and that’s still true. I’m a fairly mild case though I think, I only take 100mg Lamotrigine a day.

Anyway - yes defo be taking high dose folic acid (5mg) before you start to ttc as Lamotrigine can affect growth and cause neural tube defects. (My DS wasn’t affected though). You need to get that on prescription.

As soon as I was pregnant the GP/midwives referred me for consultant care so I had loads of extra appointments and extra growth scans too.

I wasn’t able to give birth on the midwife led unit because of being high risk so I was in the consultant unit. I did end up having an epidural and there were no issues at all. Despite being in hospital for 4 days and barely sleeping through a long arduous labour, I had no seizures at all and also nothing in the post natal period (I had thought that I might suffer due to stress and sleep deprivation). They never recommended an epidural in particular though, that’s just what I ended up choosing after a couple of exhausting days!

I’m now on my second pregnancy and because I’ve no seizures or issues for nearly 10 years now they’re much more laid back - only one extra scan and consultant appointment so far and apparently I’m allowed to be on the midwife led unit this time as long as it all continues to be straightforward.

Anyway that was just my own personal experience, hope it helps!

@Origamoo wow your insight was so helpful!

I have been taking folic acid 5mg from the GP since Feb and just ordered another prescription today.
I am hoping to start TTC in the next few months so will keep taking it as you said.
As soon as I find out I am PG (hopefully) I will contact my GP.
My GP is really good (I see numerous doctors there but they are all fantastic) I'm not usually waiting longer than 2 days for an appointment. The extra scans and having them keep a close eye on me puts my mind at ease because as rude as it may sound nobody knows better than them.
I am quite excited now, have to book in to get my coil removed first though haha!

I think an epidural would mainly be to keep me relaxed rather than blur out the pain so I think I will try and insist on that unless there is any other complications or circumstances.

Yes OP, get referred! As Origamoo says, there are lots of extra things to take into account and it is reassuring to have someone overseeing it all.

For me, as well as being on the 5mg dose of folic acid, I had to have regular blood tests to check lamotrigine levels - they can drop during pregnancy as there is so much more of you... I had these done at the GP but a consultant can adjust the dosage if necessary. I had a clump of seizures towards the beginning of the second trimester and was put on Zonegran aswell. I hadn’t originally wanted to, but my consultant said, ‘the first trimester is about taking care of the baby, and the second two are about taking care of the mother.’ ie - the first trimester is when teratogenicity is most likely. You will probably have extra scans for the baby too - eg a foetal heart scan - to check for abnormalities. If you have a specialist epilepsy nurse in your area they will be invaluable for support and advice.

As far as labour goes, I ended up having an epidural not because I’d planned to, but because it was a long labour and I hadn’t slept for two nights. They were worried about tiredness so they gave me an epidural so that I could get some sleep. I LOVED it.