The preconception care experiences of women with epilepsy on sodium valproate

• Published in: Seizure (London, England) Vol. 59; pp. 82 - 89
• Main Authors: Lawther, Lorna, Dolk, Helen, Sinclair, Marlene, Morrow, Jim
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.07.2018
• Subjects: Decision-making; Epilepsy; Interpretative phenomenological analysis; Preconception care; Pregnancy; Sodium valproate; Decision-making; Pregnancy; Sodium valproate; Interpretative phenomenological analysis; Epilepsy; Preconception care
• ISSN: 1059-1311; 1532-2688
• DOI: 10.1016/j.seizure.2018.05.003

•Extreme physical and emotional imbalance can occur when changing from valproate.•Suboptimal care and advice worsens the difficulties of changing from valproate.•Individual valproate risk information facilitates patient-centred decision making.•Inability to change from valproate impacts self-identity and mental health.•Pregnancy valproate exposure warrants early problem detection and intervention. To understand the preconception experiences of women with epilepsy who have been taking the teratogenic drug valproate. Seven women were recruited, three from a preconception clinic and four from an antenatal clinic in a region of the UK. All had taken valproate preconceptionally. Three preconception clinic encounters were observed and audio-recorded. Interviews with all women were analysed using Interpretative Phenomenological Analysis (IPA). Women experienced a “trajectory of balance”. Women moved from “maintaining balance” by using valproate to control seizures, to a “shattering of harmony” at the prospect of changing medication and as a result of the physical and mental effects of changing medication, to “restoring balance” which could involve “a new self” due to dramatic changes. Women balanced their health needs with those of their baby, and took responsibility for medication decision-making. They found it difficult to see “who is looking after me” in the healthcare system, either to access preconception care, or to support them through the stress of changing medication. Their journey ended with coming to terms with a variety of experiences: choosing not to have a baby due to unsuccessful change from valproate, recognising that a child from a previous pregnancy had been harmed by valproate or that the current pregnancy might be at risk, or successful medication change in preparation for pregnancy. A clear and adequately funded preconception care pathway is needed from epilepsy diagnosis, including support for stress. Understanding what influences maternalisation may help understand uptake of preconception care.