The preconception care experiences of women with epilepsy on sodium valproate

Lorna Lawther, Helen Dolk, Marlene Sinclair, jim morrow

Research output: Contribution to journalArticle

Abstract

Purpose: To understand the preconception experiences of women with epilepsy who have been taking the
teratogenic drug valproate.
Methods: 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).
Results: 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.
Conclusion: 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.
LanguageEnglish
Pages82–89
Number of pages8
JournalSeizure - European Journal of Epilepsy
Volume59
DOIs
Publication statusAccepted/In press - 4 May 2018

Fingerprint

Preconception Care
Valproic Acid
Epilepsy
Pregnancy
Decision Making
Seizures
Interviews
Delivery of Health Care
Health

Keywords

  • Epilepsy
  • Sodium valproate
  • Preconception care
  • Decision-making
  • Pregnancy
  • Interpretative phenomenological analysis

Cite this

@article{cef2cab118354e01abcf4e865de267d8,
title = "The preconception care experiences of women with epilepsy on sodium valproate",
abstract = "Purpose: To understand the preconception experiences of women with epilepsy who have been taking theteratogenic drug valproate.Methods: Seven women were recruited, three from a preconception clinic and four from an antenatalclinic in a region of the UK. All had taken valproate preconceptionally. Three preconception clinicencounters were observed and audio-recorded. Interviews with all women were analysed usingInterpretative Phenomenological Analysis (IPA).Results: Women experienced a “trajectory of balance”. Women moved from “maintaining balance” byusing valproate to control seizures, to a “shattering of harmony” at the prospect of changing medicationand as a result of the physical and mental effects of changing medication, to “restoring balance” whichcould involve “a new self” due to dramatic changes. Women balanced their health needs with those oftheir baby, and took responsibility for medication decision-making. They found it difficult to see “who islooking after me” in the healthcare system, either to access preconception care, or to support themthrough the stress of changing medication. Their journey ended with coming to terms with a variety ofexperiences: choosing not to have a baby due to unsuccessful change from valproate, recognising that achild from a previous pregnancy had been harmed by valproate or that the current pregnancy might be atrisk, or successful medication change in preparation for pregnancy.Conclusion: A clear and adequately funded preconception care pathway is needed from epilepsydiagnosis, including support for stress. Understanding what influences maternalisation may helpunderstand uptake of preconception care.",
keywords = "Epilepsy , Sodium valproate, Preconception care, Decision-making, Pregnancy, Interpretative phenomenological analysis",
author = "Lorna Lawther and Helen Dolk and Marlene Sinclair and jim morrow",
year = "2018",
month = "5",
day = "4",
doi = "10.1016/j.seizure.2018.05.003",
language = "English",
volume = "59",
pages = "82–89",
journal = "Seizure - European Journal of Epilepsy",
issn = "1059-1311",
publisher = "Elsevier",

}

The preconception care experiences of women with epilepsy on sodium valproate. / Lawther, Lorna; Dolk, Helen; Sinclair, Marlene; morrow, jim.

In: Seizure - European Journal of Epilepsy, Vol. 59, 04.05.2018, p. 82–89.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The preconception care experiences of women with epilepsy on sodium valproate

AU - Lawther, Lorna

AU - Dolk, Helen

AU - Sinclair, Marlene

AU - morrow, jim

PY - 2018/5/4

Y1 - 2018/5/4

N2 - Purpose: To understand the preconception experiences of women with epilepsy who have been taking theteratogenic drug valproate.Methods: Seven women were recruited, three from a preconception clinic and four from an antenatalclinic in a region of the UK. All had taken valproate preconceptionally. Three preconception clinicencounters were observed and audio-recorded. Interviews with all women were analysed usingInterpretative Phenomenological Analysis (IPA).Results: Women experienced a “trajectory of balance”. Women moved from “maintaining balance” byusing valproate to control seizures, to a “shattering of harmony” at the prospect of changing medicationand as a result of the physical and mental effects of changing medication, to “restoring balance” whichcould involve “a new self” due to dramatic changes. Women balanced their health needs with those oftheir baby, and took responsibility for medication decision-making. They found it difficult to see “who islooking after me” in the healthcare system, either to access preconception care, or to support themthrough the stress of changing medication. Their journey ended with coming to terms with a variety ofexperiences: choosing not to have a baby due to unsuccessful change from valproate, recognising that achild from a previous pregnancy had been harmed by valproate or that the current pregnancy might be atrisk, or successful medication change in preparation for pregnancy.Conclusion: A clear and adequately funded preconception care pathway is needed from epilepsydiagnosis, including support for stress. Understanding what influences maternalisation may helpunderstand uptake of preconception care.

AB - Purpose: To understand the preconception experiences of women with epilepsy who have been taking theteratogenic drug valproate.Methods: Seven women were recruited, three from a preconception clinic and four from an antenatalclinic in a region of the UK. All had taken valproate preconceptionally. Three preconception clinicencounters were observed and audio-recorded. Interviews with all women were analysed usingInterpretative Phenomenological Analysis (IPA).Results: Women experienced a “trajectory of balance”. Women moved from “maintaining balance” byusing valproate to control seizures, to a “shattering of harmony” at the prospect of changing medicationand as a result of the physical and mental effects of changing medication, to “restoring balance” whichcould involve “a new self” due to dramatic changes. Women balanced their health needs with those oftheir baby, and took responsibility for medication decision-making. They found it difficult to see “who islooking after me” in the healthcare system, either to access preconception care, or to support themthrough the stress of changing medication. Their journey ended with coming to terms with a variety ofexperiences: choosing not to have a baby due to unsuccessful change from valproate, recognising that achild from a previous pregnancy had been harmed by valproate or that the current pregnancy might be atrisk, or successful medication change in preparation for pregnancy.Conclusion: A clear and adequately funded preconception care pathway is needed from epilepsydiagnosis, including support for stress. Understanding what influences maternalisation may helpunderstand uptake of preconception care.

KW - Epilepsy

KW - Sodium valproate

KW - Preconception care

KW - Decision-making

KW - Pregnancy

KW - Interpretative phenomenological analysis

U2 - 10.1016/j.seizure.2018.05.003

DO - 10.1016/j.seizure.2018.05.003

M3 - Article

VL - 59

SP - 82

EP - 89

JO - Seizure - European Journal of Epilepsy

T2 - Seizure - European Journal of Epilepsy

JF - Seizure - European Journal of Epilepsy

SN - 1059-1311

ER -