Epilepsy affects around 1 in 100 people and every year around 2500 women with epilepsy become pregnant. Although most will have an uneventful pregnancy, pregnancy for women with epilepsy carries additional risks to their wellbeing and that of their developing fetus and their infant. For some women, these risks include worsening symptoms of epilepsy, increased mortality risks and less effective treatment of other conditions and comorbidities like depression. For the developing fetus and infant, exposure to antiepileptic drugs can affect organogenesis and later development. This article highlights essential knowledge about this condition in pregnancy and considers how midwives can contribute to working collaboratively in ways that optimise pregnancy outcomes for these women.