Experience with Valium during labor?

[fireballgirl]

I am a pregnant (23 weeks) mother of one with VERY mild epilepsy. I chose to have a natural birth (ie intervention-free/medication-free) with my first child and had a very difficult month before the birth as well as a long labor. I was severely sleep-deprived during the week before the birth, had contractions every 5-15 minutes for 2 days, and then was in hard labor for about 18 hours before I laid down to take a nap and had a tonic-clonic seizure. Everything turned out well (was able to go on to deliver vaginally), and had all sorts of MRIs and EEGs that turned out to be normal. Nevertheless, the neurologists want to put me on medication permanently that I do not feel is safe for a developing fetus or breastfeeding child.

I was able to see a epilepsy specialist who also is an expert in pregnancy. He agreed that the benefits of AEDs outweigh the risks in my situation, but (along with my OB) wants to prevent another possible seizure during labor with my next child. He said that the best option would be to take a dose of Valium or Ativan (which are known to prevent seizures) when I go to the birth center. He said that the side effect might be that I am too sleepy to push and also that the baby may have side effects. Does anyone have any experience with Valium or Ativan during childbirth? Would an epidural (I am considering one this time) contribute to any problems, or help? Are there any other issues I should be considering?

Thanks!

[happyartmama]

UNfortunately I don't have experience/any answers for you (and by the reader count, it looks like we're not able to point you to any answers so far!); just wanted to say I really hope you're able to discover the benefits/effects to put your mind at ease, and have a healthy, happy pregnancy and birth. Good luck!

[pamamidwife]

I wonder if there is an anti-seizure med that would be easier on you and your baby for the last months of pregnancy?

[fireballgirl]

Thanks for the empathy and best wishes!

The specialist I saw is actually a professor at a major medical school. I first saw the fellow he was training and that's what he (the fellow) recommended (an AED for the last trimester). But my concern all along has been that there is no data showing that the medications are safe after birth--I mean--we know what the risks are up until birth (slight risk of birth defects) but we don't know what happens to those children ten to twenty years down the road. Do they end up with learning disabilities, etc.? But I was open to that idea.

I heard the professor and the fellow discussing it out in the hall and the professor said, "Yeah, but twenty years ago, we thought [whatever drugs] were safe too." Then he came in to me and explained that while all the major organs are formed in the first trimester, the brain is actually growing fastest in the last two months and first two years and they've found that certain AEDs do lower the IQ of kids who are in gestation or breastfeeding while their mothers are taking them. So hence the "acute" suggestion of valium or ativan.

I have an appointment with my midwife in a couple of weeks, so I'll see what she says at that point. I'm just trying to get as much information as I can before then.

Thanks again!

[MindfulBirth]

Are you currently on AEDs? I know that Lamictal and Keppra have had *some* safety studies done (Keppra's is still ongoing) on pregnant and nursing moms. If you are currently on meds at a theraputic level, then maybe you could just assume that those drugs will do their job to prevent you from having a seizure and then keep the diastat or ativan on hand to be administered as soon - if- a seizure were to take place during labor. Also do all in your power to go into your labor as rested and calm as possible (I know - easier said than done). If you are working, maybe take your leave a week earlier, have DH to all the cooking (!), ask friends and family to help with the other kids while you nap, etc.

You might also want to ask about biofeedback for seizure control. Have you tried a low-carb diet? Just cutting out sweets and bread has helped my own myoclonics. Obviously it would not be advisable to do the Ketogenic or Atkins diets while you are pregnant, but you could cut your carbs down quite a bit (and not raise the fat level).

All the best.

[fireballgirl]

It's really nice to hear about your experience with sugar and bread. Years ago, I noticed that the simple partials seemed to be related to diet, but the doctors said that that didn't really play a part--that sleep deprivation, alcohol and drugs were the most well-known triggers. But I wonder if my case is similar to yours, and those are things I should be cutting out anyway. The doctors also said that nutrasweet doesn't have a strong correllation, but ever since I stopped using aspertame, I have not had one episode at all.

No, I'm not currently on AEDs. The doctors decided that in my case, because it is so mild, the risks of AEDs outweigh the benefits. Although there have been some studies done, with Lamictal, there is no data at all (that I have been able to find--let me know if I'm wrong!) about the impact on a child's emotional or intellectual health 10 - 20 years from now. As the specialist said, 20 years ago, they thought other AEDs were fine, but now they know that they lower the IQ of children who got them in-utero. Additionally, infants don't have the metabolic pathways to break down Lamictal, which can then reach therapeutic, or toxic levels in some infants. So women shouldn't breastfeed, or if they decide to, they should have their babies tested for the levels of the drug in their bodies. For these reasons, I've decided not to take the AEDs, and like I said, the specialists agree that my case is mild enough (I've never had an unprovoked seizure). With that said, we never know how the labor is going to go, and that's why they want to protect me on a short-term basis.

I am going to take time off before work. My midwife already wrote my FMLA letter so that I'll be able to leave work two weeks early, and my husband is off work beginning a week before the baby is due, so he can take over. (Did I mention that in the month before my first baby, I bought a house in the US, held a surprise 30th birthday party for my husband, managed three huge events at work the week before my due date, picked up the moving truck on my due date, loaded it, moved from Canada to the US [we live on the border and my husband is Canadian] two days later, unpacked, looked for a new car [ours broke down on the way to the US], went into prodromal labor, so I missed one night of sleep at the hospital thinking it was the real thing, had contractions every 5-15 minutes for three days, sold our house in Canada on the way to the hospital [actually faxed the acceptance papers from the birth center because we didn't think we had time to go find another fax], then was in hard labor with no pain meds from 7:00 pm to 10:00 am when I decided to lie down to have a nap, and then had the seizure.) No wonder I had a seizure, LOL! Thank goodness for a midwife (CNM, so we were at a hospital) who didn't freak out and allow them to do a c-section. After the post-ictal period, they let me push and I was able to deliver vaginally. So I almost feel comfortable trying nothing at all, but like they said, we never know what is going to happen.

[DoomaYula]

Well, I've been doing a little research lately on Attivan (Lorazepam) and it's *relatively* safe during bfing -- I believe Dr. Hale considers it the safest of the benzodiazepams. However what I keep reading about benzos in general are that they shouldn't be taken too near labor because they are muscle-relaxers, which can make labor and pushing more difficult. hth!