Women with epilepsy have cesarean deliveries (“C sections”) much more often than women without epilepsy. The reasons for this difference are poorly understood. Women with epilepsy who are taking high dosages of antiepileptic drugs may have slightly weaker contractions of the womb (uterus) during delivery. Or perhaps the high rate of cesarean sections may have more to do with the perceived risks rather than actual risks of a vaginal delivery.
The use of drugs to induce labor is approximately three times more common among women with epilepsy than among women in the general population, although the reasons for this are not fully understood. Epilepsy itself is not a reason to induce labor, as most women with epilepsy are able to have normal, spontaneous labor and deliveries. In selected situations, however, it may be prudent to induce labor in women with epilepsy. The potential benefits of an induced labor must be weighed against the risks, which include prolonged labor as well as uterine and physical exhaustion. If an induced labor does not progress, a C-section may be necessary
For nearly all women with epilepsy, there is no reason not to have a natural vaginal delivery. However, for women who have uncontrolled tonic-clonic seizures during pregnancy or those with tonic-clonic seizures during labor and delivery (approximately 1-2% of women with epilepsy), cesarean section may be indicated.
The frequency of seizures increases slightly during labor and delivery and the first 2 days after delivery. An additional 1- 2% of women may have tonic-clonic seizures during this period. This increase may result from the failure or inability of the women to take antiepileptic medication, sleep deprivation, hyperventilation, stress, physical pain, and other medications such as meperidine (Demerol). Women should prepare for labor with a reminder to take medications as scheduled, and they should tell the doctor if they are unable to take them because of nausea or pain.
Spinal anesthesia is safe for women with epilepsy. If general anesthesia is required, it also can be given safely. The anesthesiologist should be informed about the woman’s history of epilepsy and the antiepileptic drugs she is taking (as well as about other medical disorders and medications).