Pregnancy, Postpartum Complications, and the Importance of Advocacy

By: Aaliyah Ellison-McPeters

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Pregnancy Complications

While expecting mothers who have epilepsy have several concerns during pregnancy, most of these mothers will have healthy babies, and pregnancy will not drastically affect their epilepsy. Common pregnancy complications that women with epilepsy face include slowed fetal heart rate, decreased oxygen to the fetus, preterm labor and birth, and low birth weight. The type of seizures epileptic mothers have can determine how high of a risk these complications occurring are. It is best to discuss with a healthcare provider to assess a personal level of risk. Epileptic women also have an increased risk of developing preeclampsia and bleeding during pregnancy. Preeclampsia is a severe condition that can develop after the twentieth week of gestation or postpartum and is persistent high blood pressure often related to high protein levels. Preeclampsia can affect the blood flow to the placenta, which can cause premature babies or babies of lower birth rates. It can cause damage to the mother’s kidney, liver, brain, and other organ and blood systems and increase a mother’s risk of heart disease and stroke. Studies show that women with epilepsy are at increased risk for this condition; however, though it is unclear if the increased risk is due to epilepsy alone, the use of antiepileptic drugs, or a combination of both, recent studies suggest that there is a connection between AED usage and complications in pregnancy and labor. 

Postpartum Complications 

Common postpartum complications include excessive bleeding, infection, breast pain, incontinence or constipation, and mood disorders such as postpartum depression or anxiety. While bleeding after labor is normal for the first two to six weeks, some women experience postpartum hemorrhage. Normal postpartum bleeding typically slows in the first few days; however, if blood flow does not slow or large blood clots are continuously passed, a doctor should be contacted. Infections that can occur postpartum are uterine, urinary, wound, upper respiratory, and mastitis. When infections are caught early, they are typically resolved with antibiotics.; however, if left untreated, infections can lead to sepsis, pulmonary embolism, and more. Expecting mothers with epilepsy are at a higher risk of developing postpartum mood disorders such as postpartum depression (PPD). Studies show that PPD rates are higher in women with epilepsy than other women, especially those taking AEDs or AED polytherapy. No evidence indicates that AED selection could modify the risk. Understanding the risk factors and symptoms of depression can help treat new mothers. Many mothers confuse baby blues with PPD, as the symptoms are similar. Baby blues after childbirth commonly includes mood swings, crying spells, and anxiety, to name a few. Baby blues last only a few weeks, whereas postpartum depression lasts until treated, and the symptoms are often more severe than baby blues. A healthcare provider diagnoses PPD, usually treated with antidepressants, psychotherapy, or other medication.

Advocacy During Complications

Advocacy during pregnancy and labor should begin when you hire a healthcare provider and assemble your birth team. Inquiring about their medical training, degree, previous births attended, and overall treatment of the mother is a great start. Self-advocating for oneself includes understanding your right to accept or refuse any unnecessary medical tests, procedures, or interventions; acknowledging that you are a part of your birth team, and while babies and birth can be very unpredictable, your wants and needs still matter. Having your spouse or partner during the process can help alleviate the stress of advocating for yourself alone and having a doula. Birth doulas are trained to help the mother advocate for herself and can provide information to families to help them reach a decision. Speaking up about your pain, fears, or anxieties is important if complications arise. It helps every member of your birth team when they always understand your state during any complications. Advocacy and trust in your providers go hand in hand; choosing the best provider for your needs and expectations is essential to a positive experience.


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