Bell’s palsy during pregnancy
The most common cause of facial palsy during pregnancy is Bell’s palsy. Research shows that the majority of women who develop Bell’s palsy during pregnancy do so within the third trimester (the last three months pregnancy), or within seven days of delivery. Clinicians involved in your care should not assume the cause is Bell’s palsy. If your facial palsy has been developing slowly over several weeks or months this is not Bell’s palsy and it is important to rule out other potential causes/diagnoses.
Causes
Long-standing high blood pressure and obesity are key risk factors in the development of Bell’s palsy in the general population. Pregnancy can make these symptoms more pronounced and so increase the risk of developing Bell’s palsy.
There are other theories as to why pregnant women are more at risk. These relate to physical changes which occur in the body and which may cause or trigger the onset of Bell’s palsy. For example:
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- Eclampsia (seizures/fits in women with pre-eclampsia)
- Fluid retention which can result in a build-up of fluid around the nerves called peri-neural oedema
- Altered levels of the hormones oestrogen and progesterone
- A form of diabetes that occurs during pregnancy but goes away after the baby is born (gestational diabetes)
- Increased cortisol levels which start during the second trimester of pregnancy (3 – 6 months), and peaks in the last few weeks before delivery.
- During the third trimester of pregnancy and during the first 7 days following childbirth, women are thought to be particularly at risk of infection from the Herpes Simplex Virus (HSV). This may be due to a weakening of the immune system caused by raised levels of cortisol.
Symptoms
The symptoms of Bell’s palsy during pregnancy are exactly the same as for the non-pregnant population. These include:
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- Inability to close the eye or blink
- Muscle weakness or paralysis
- Loss of expressiveness including raising the brows, frowning, smiling, pouting and whistling
- Difficulty eating and drinking due to muscle weakness/paralysis of the cheek and lips
- Loss or altered taste
- Hearing sensitivity
- Pain in and/or around the ear
- Dry mouth
- Difficulty speaking due to muscle weakness/paralysis of the cheek and lips.
Treatment
The treatment for Bell’s palsy during pregnancy is exactly the same as the non-pregnant population. For example:
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- Commencement of oral Prednisolone steroids within 72 hours following the onset of symptoms.
- Preservative-free eye drops
- Taping the eye closed for sleep
Considerations
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- Once there is a confirmed diagnosis of Bell’s palsy, your doctor should consider treatment with steroids, as research shows this improves the chance of making a full recovery. However, your suitability will depend on your personal medical history and medication that you may currently be taking.
- Steroids have been used safely in pregnancy for many other conditions, for example, asthma. If your doctor is in any doubt refer him/her to this article.
Outlook
In the past, for women who develop a complete Bell’s palsy during pregnancy, the recovery rate has been poorer compared to the general population. The recovery rate is thought to be 52% compared to 77-88% in a similar age group of non-pregnant females. There is now greater awareness and understanding of the treatment and management of Bell’s palsy in pregnancy. Historically, clinicians were reluctant to prescribe steroids, such as prednisolone, which may be the reason for a poorer recovery rate in pregnancy.
The psychological effects of Bell’s palsy in pregnancy
Developing a facial palsy can be an isolating and lonely experience especially when it happens during pregnancy.
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- Childbirth can be a challenging experience without the added complication of Bell’s palsy. It is generally an intensely emotional experience and one that is shared with family and friends. The added complication of Bell’s palsy may mean that happiness is compromised by feelings of anxiety, fear for the future, and a sense of isolation. The professional concern is focused towards the baby to ensure all is well and the health of the child is paramount. This may mean you are left unsupported at a time when you feel most vulnerable.
- You may feel self-conscious when eating or talking and everything may feel strange and unfamiliar. It may be a struggle to cope with your own needs and the needs of the baby.
What to do about photographs
Documenting experiences with photographs and videos is popular especially during pregnancy and upon the arrival of a new baby. There is an expectation that photographs will be taken and shared with family and friends. Your Bell’s palsy may make you feel self-conscious. Wishing not to be photographed is normal. Many mothers with Bell’s palsy feel like avoiding the camera because their joy cannot be expressed in the conventional way. It is important to have these moments documented, as they cannot be retrieved at a later date, and regret may follow.
Some suggestions:
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- Pose for your photograph with the unaffected side facing the camera, and the photo taken at an angle.
- Control the circulation of photographs so that you choose which ones are circulated and those you prefer to keep to yourself.
Get support
Facial Palsy UK have a support network for pregnancy/mothers
https://www.facialpalsy.org.uk/support/further-help/
Join the Facebook group
https://www.facebook.com/groups/FPUKFacialPalsyPregnancy/
Read more