Pregnancy, birth & beyond

Pregnancy, Birth & Beyond A resource for women about hepatitis C

You are not alone

We’re here to help

Contents 2

Introduction

3

What is hepatitis C

4

Effects of hepatitis C

5

Women and hepatitis C

7

Hepatitis C and pregnancy

9

Self care during pregnancy

10

Pregnancy and birth care options

11

After the birth

12

Breast feeding

15

Disclosure

16

Hepatitis C at home

17

Other Issues

18

Useful contacts and resources

Updated SA version May 2016 Design: Design Edge Original text written by Hepatitis ACT Inc

The Hepatitis ACT gratefully acknowledges the models who posed for the photographs in this booklet.

Pregnancy, Birth & Beyond

Pregnancy, Birth & Beyond – the birth of a new resource It seems that often resources are

There are several people we would like

produced to meet a specific need in the

to thank for assisting in the content and

community. The Pregnancy, Birth &

editing of the resource; Rebecca Davey

Beyond booklet is no exception as it was

for her expertise and determination; the

produced after the ACT Hepatitis C

resource reference group consisting of

Council tried in vain to find a

Professor David Ellwood, Carolyn Pettit,

comprehensive resource for women

Jane Keany; representatives from the

with hepatitis C and contemplating

hepatitis C affected community and the

pregnancy. Despite extensive searches,

Australian Hepatitis Council.

the topic of pregnancy in women with hepatitis C, antenatal and post natal issues were not available in an informative booklet. Hence Pregnancy Birth & Beyond was born!

Our heartfelt thanks also to our sponsors, individuals and organisations which, without their support, the Pregnancy Birth & Beyond booklet would not have been published at all.

The ACT Hepatitis C Council has

So thank you to Calvary Hospital, Carlee

developed the resource for all women

Children’s Wear, Sexual Health & Family

with hepatitis C, their families, friends

Planning ACT, ACT Health, Canberra

and health care providers. Our hope is

Rape Crisis Centre, Schering Plough,

that it will be used extensively

Women’s Centre for Health Matters,

throughout the Canberra region as an

Suzanne Polis, Professor Frank Fenner

informative and unique resource, and fill

and the Interchange Medical Practice.

a very real gap in resources for women

We appreciate your support and

with hepatitis C.

commitment to women with hepatitis C. Carol Hart Executive Officer ACT Hepatitis C Council Inc

2

What is hepatitis C ?

When a person gets hepatitis C they may

liver. Hepatitis can be caused by

not notice the acute phase of the

chemicals, drugs, drinking excessive

infection, because in many cases the

amounts of alcohol or by different kinds

person does not feel sick. The body

of viruses. Viral hepatitis is the term

starts to build up antibodies to the virus,

used when hepatitis is caused by a virus.

but they often have no effect on the

There are three main types of hepatitis virus in Australia, hepatitis A, B & C. These all cause swelling of the liver but

virus. 75% of people with hepatitis C will develop chronic (or long term, even life long) hepatitis C.

may cause different symptoms and have

In Australia, approximately 230,000

different treatments, depending on the

people have hepatitis C. Each year

type of virus.

8,000 people are diagnosed and 500

Hepatitis C is transmitted by blood to blood contact between a person infected

Pregnancy, Birth & Beyond

Hepatitis means inflammation of the

die as a result of hepatitis C related liver disease.

with the virus to another person.

Hepatitis C may damage the liver, a vital organ that purifies blood, removes toxins from the body including drugs and alcohol, breaks down foods and makes the chemicals which help the blood to clot.

posed by models

3

Pregnancy, Birth & Beyond

Effects of Hepatitis C For most people, hepatitis C is a chronic illness. The impact of hepatitis C and its severity will vary over time for each individual.

Factors such as gender, immune system strength, health history, diet, life situation, age at infection, stress levels, and past and present consumption of posed by models

alcohol or other drugs will have an impact on how hepatitis C affects each person.

Every person is different and symptoms Common symptoms of hepatitis C can

may take years to develop. Because

include:

symptoms vary, and because the liver damage may fluctuate over time, it is important to have a qualified health

•

Flu like symptoms

•

Tiredness, lethargy

•

Nausea, generally feeling unwell

•

P ain over the liver region

•

P ain after drinking alcohol

•

Stomach upsets, diarrhoea

•

Depression, anxiety, moodiness

•

Intolerance to fatty foods

•

Night sweats

practitioner who is knowledgeable about hepatitis C.

posed by models

4

If new symptoms occur, consult your health practitioner.

Women and hepatitis C tampons in the women’s toilets. If these

walks of life. For some, being diagnosed

aren’t available, keep a pack of small

with hepatitis C can be frightening and

plastic resealable bags in your bag, wrap

shocking, while for others, it makes

the pad or tampon, and then place in the

sense of previously unexplained

general rubbish. Make sure you wash

symptoms. Women often have particular

then dry your hands thoroughly

concerns related to hepatitis C.

afterwards.

Emotional Effects

Sex

The emotional effects can vary greatly

There is no evidence to suggest that

and be difficult to cope with. Some

women experience a reduction of their

women feel tired and depressed, short

sex drive because they have hepatitis C.

tempered and snappy. Often women

However, because some women feel very

complain they feel forgetful or vague.

tired or depressed they may not have the

Lifestyle choices such as nutrition and

energy to have sex. Honest and open

exercise, medication or complimentary

communication may help your partner

therapy, may be beneficial. For more

understand your needs.

information, consult your health practitioner or the ACT Hepatitis C Council.

Generally risk of transmission during sex is low, however, there is a greater risk of transmission if the woman is

Periods

menstruating or spotting, or if either

Most women’s periods do not change

partner has sores, a sexually transmitted

when they have hepatitis C, although

infection (including HIV), cuts, abrasions

some find their periods are shorter or

or blisters. Some sex including anal sex,

they may miss the occasional one.

abrasive sex, the use of sex toys and

It is important that you dispose of tampons and pads carefully, whether at work or at home. Most work places have hygienic disposal bins for pads and

Pregnancy, Birth & Beyond

Women with hepatitis C come from all

rough sex can cause blood to blood contact. In these cases it is wise to use a condom with a water-based lubricant, and apply the lubricant often.

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Pregnancy, Birth & Beyond

Hepatitis C and conception

Other suggested steps you can take to

Hepatitis C does not affect either the ova

improve your health before pregnancy

(the woman’s egg) or the sperm.

include:

Therefore, it doesn’t matter whether it is

•

eat a well balanced diet

•

drink plenty of water

•

q uit or cut down on smoking

the male or female partner (or both) with hepatitis C, there will be no adverse effect on the baby.

cigarettes

Pre-conception care The aim of pre-conception care is to prepare your body for pregnancy. This

•

avoid caffeine

•

avoid alcohol

•

let you health care practitioner know

should ideally occur at least 4 months prior to conceiving. Preconception care

that you are trying to become

improves your chance of becoming

pregnant

pregnant more easily, having a healthy baby and being healthier and able to cope well with your pregnancy.

The one universally recommended supplement is folic acid. Folic acid is a B group vitamin needed for healthy growth and development of the baby in

•

if you own a cat, get someone else to empty the kitty litter due to the risk of infection with toxoplasmosis, a parasitic infection transmitted by uncooked meat and food contaminated by cat faeces.

the first weeks of life. Research has found that taking a folic acid supplement reduces birth defects such as spina bifida. The recommendation is to take at least 500 micrograms of folic acid per day for at least 1 month prior

of pregnancy.

6

posed by models

to pregnancy and for the first 3 months

Hepatitis C and Pregnancy (unless clinically appropriate) as they

hepatitis C to your baby while pregnant

can break the baby’s skin, possibly

or during birth is less than 5% if you

allowing blood to blood contact to occur

have detectable levels of the virus in

between mother and baby. There will be

your blood (that is, if you had a PCR test

times when these procedures are

that indicated the presence of the virus

unavoidable, and your pregnancy care

in your blood). Women with very low

provider will discuss this with you in

levels of the virus (where a PCR test

this instance.

showed negative for the presence of hepatitis C in the blood) are very unlikely to transmit hepatitis C to their

Pregnancy, Birth & Beyond

The overall risk of transmitting

There is an increased risk of transmission from mother to baby when the mother:

babies. However, women infected with both HIV and hepatitis C have a higher

•

of hepatitis C infection;

risk of transmitting hepatitis C to their baby (transmission rates of 16% have been recorded for mothers co-infected with HIV and hepatitis) than women

is in the acute (newly acquired) stage

•

is co-infected with HIV;

•

has ongoing injecting drug use risk behaviours.

who are not co-infected.

Current research suggests there are no Current research about the timing of transmission from mother to baby is inconclusive. There is some evidence that transmission occurs during pregnancy, while other studies indicate that transmission occurs at the time of birth. In the absence of conclusive research about the timing of transmission the use of forceps, vacuum and scalp electrodes during labour and birth should be avoided if possible

particular issues in women with hepatitis C being pregnant. However, some side effects of pregnancy are more apparent in women with hepatitis C, such as the ‘pregnancy itch’, a side effect of the extra stress the liver is under during pregnancy. There is some evidence that some women with pregnancy itch may develop cholestasis of pregnancy, this will require close monitoring and may need specialist management.

7

Pregnancy, Birth & Beyond

correlation between viral clearance and

Can a partner transmit hepatitis C to an unborn baby?

pregnancy, however this is not likely. We

There is no evidence to show a father

do know the combination of pregnancy

with hepatitis C can transmit hepatitis C

hormones can change the way in which

to the baby either at conception or in

the liver reacts to the hepatitis C virus

the womb.

It had been thought there may be a

during pregnancy. Once the baby is

If I have hepatitis C are there any special tests I should have?

born, you will need to have your liver function tests repeated. Liver function

Your liver function tests may well

tests results may show an increase in

become altered during your pregnancy.

values, though this may readjust as your

However, in the absence of any

body returns to a non-pregnant state.

abnormal symptoms, there is no need for any further or specialised tests during your pregnancy. This will be dependent on the amount of liver damage you had prior to pregnancy, and if you have any concerns, you should discuss these fully with your pregnancy care provider, GP or liver specialist.

posed by models

8

Self-Care During Pregnancy Alcohol

The liver plays an important role in the

When women are pregnant, it is wise to

digestion of food. During pregnancy

avoid alcohol. No amount of alcohol is

women sometimes experience nausea,

considered safe in pregnancy as it can

acid reflux and constipation. These

adversely affect the unborn baby.

problems are directly related to the

Anyone with hepatitis C should limit

hormones of pregnancy. Changes in diet

their alcohol to no more than seven

may help to limit these symptoms, and

standard drinks spread over the week,

include:

with at least two or three alcohol free

•

Limiting saturated (eg animal) fats

•

Eating more fresh vegetables

•

Eating more fresh fruit and

Pregnancy, Birth & Beyond

Diet

days each week.

Smoking Smoking is not recommended during

drinking pulpy juices •

pregnancy as it can lead to small birth weight babies, premature (early) labour,

Eating more whole grains

and may place the mother at risk of

and legumes

pregnancy and birth complications.

Pregnant women are also advised to avoid foods such as soft cheeses, processed deli meats, pre-prepared creamy salads and undercooked meats.

These foods can contain a bacteria called listeria which can be harmful to the

Smokers also have a greater risk of miscarriage. There has also been a correlation made between smoking during pregnancy and after the baby is born, and SIDS (Sudden Infant Death Syndrome).

baby. Consult your pregnancy care

If you are planning a pregnancy or are

provider for more information.

in early pregnancy, discuss your smoking habits with your pregnancy care provider.

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Pregnancy, Birth & Beyond

Pregnancy and Birth Care Options There are a number of options for your

more likely to need further interventions.

pregnancy and birth care. Depending on

Such interventions may put your baby at

your preference, you may need to make

a higher risk of contracting hepatitis C

a decision early on in your pregnancy to

during birth. Therefore, unless there is a

ensure you are able to book into your

medical reason for an induction of

preferred facility or pregnancy care

labour, it is not recommended that

provider.

women with hepatitis C have labour induced.

Labour

Women with hepatitis C should consider

There is nothing to suggest that women

the options for pain relief and other

with hepatitis C have a different course

assisted birth interventions carefully.

of labour to other women. It is standard

Studies have found that one intervention

for labour to last between 4 hours to

often leads to a cascade of other

about 24 hours, however this does vary

interventions. Each level of intervention

greatly from woman to woman, and

may carry an increased chance of the

from baby to baby.

hepatitis C virus being transmitted to

Pain relief

your baby.

There are a number of pain relief options

Monitoring your baby

available to women in labour. These

Once you are in labour and either in

options will be discussed with you in

hospital or being cared for by a midwife

birthing classes, with your pregnancy

at home, your labour will be monitored

care provider, or in most pregnancy books.

to ensure both you and your baby are

Medical intervention

safe and well. This involves checking

Some women, regardless of whether they have hepatitis C or not, may require medical interventions to assist their labour and birth. A common intervention is to have labour induced (artificially started early). Research has 10

proven that if labour is induced, you are

your pulse, blood pressure and temperature, and listening to the baby’s heartbeat. These observations will vary from person to person and situation to situation. Your pregnancy care provider can discuss this in more detail with you.

After the birth Pregnancy, Birth & Beyond

Bleeding It is normal for women to have vaginal bleeding for up to 6 weeks after the birth of the baby. The hepatitis C virus is found in this blood. However, if you follow the precautions you would normally take during your period, you will ensure there is little or no risk of transmission during this time.

Post Natal Depression It is common for many women to feel ‘down’ after they have had their baby.

For the majority of women this feeling

they will experience significant depression.

posed by models

will quickly pass, but for some women

If you have a history of depression it is wise to talk to your pregnancy care provider about strategies you can put into place before you have your baby, to help you cope if you do become depressed.

If you do suffer from depression for the first time after you have your baby, there are many support groups that can help you. For information about support groups, refer to the contacts section.

Some women will find this support is sufficient, whilst other women will require more help and might need medication. Your GP, pregnancy care provider or hepatitis C specialist will be able to provide more information.

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Pregnancy, Birth & Beyond

Breast Feeding The choice to breast feed is very

Correct attachment

personal and for most mothers is an

To ensure your nipples don’t become

important and enjoyable part of being a

damaged, ensure proper attachment with

mother. Breast feeding should not be

each and every feed. The baby needs to

avoided simply because a woman may

attach to the darkened area around the

have hepatitis C. Breast feeding is

nipple call the areola, and not just the

encouraged in all mothers where

nipple. Your midwife or lactation

possible, as breast milk supplies a

consultant can assist you with your

balanced food supply for the baby, as

technique. Correct attachment of the

well as protecting the baby from many

baby to the breast will reduce the

illnesses especially in the first

likelihood of damaging the nipple.

weeks of life.

Damaged nipples

Hepatitis C has been found in breast

Many women find their nipples become

milk, however, it is not thought to be a

grazed or cracked in the first few weeks

major factor in passing on the virus.

of breastfeeding. This damage often

Anything that may allow blood to be

occurs at night or when the mother is

mixed with the milk may pose a risk to

particularly tired and the baby becomes

the baby. It is recommended that PCR

poorly attached. This is very common,

positive mothers who decide to breast

and does not mean that you are not

feed take particularly good care of

good at breast feeding.

their nipples, examining them before feeding to ensure they are not cracked or bleeding.

If your nipples do become grazed or cracked, it is recommended that you do not feed your baby from the damaged nipple. If only one nipple is damaged, continue to feed your baby from the undamaged nipple each feed and express milk from the other breast until it is healed. You can use a hand held breast

1012 posed by models

Pregnancy, Birth & Beyond

pump, an electric breast pump, or hand express the milk off at this time. Throw away this expressed milk.

Expressing will ensure you continue to produce milk from damaged breast so that as soon as it is healed, you can continue to feed your baby without the need of having to rebuild your supply.

will need to either feed your baby with formula until they are healed, or feed

posed by models

Should both nipples be damaged, you

your baby with any expressed breast

woman has been expressing milk in

milk you have stored which you know is

large amounts). The breast may be

not blood affected.

reddened and feel hot and painful. The

Damaged or infected breasts

woman will usually find she has a raised

If your breast has become bruised through some type of injury, the milk

temperature, and she feels unwell, similar to ‘flu symptoms.

ducts may contain small amounts of

Treatment for mastitis is usually a

blood which can pass into the milk.

course of antibiotics for the infection

Mastitis, or an infection of the breast,

and paracetamol for pain and fever. If

may also make it possible for small

you have hepatitis C it is recommended

amounts of blood to be present in

that you don’t breast feed from the

the milk.

affected breast until the infection has

Mastitis will often occur if there has

healed.

been damage to the nipple, or if a

For advice on breast feeding issues, refer

woman’s breasts have become badly

to your pregnancy care provider,

engorged (this often occurs in the first

lactation specialist, or the contacts at the

week after the baby is born, or if the

back of this publication.

13

Pregnancy, Birth & Beyond

Teething Baby Once a baby begins teething the risk of

If the test is positive your child would be

damage to your nipples increases. The

eligible for a PCR test which would be

baby’s gums may also be bleeding at

useful to establish whether she/he has

this time and if your nipples become

heptatis C infection. If your child’s PCR

damaged there is a small risk of passing

test turns out positive, it is important that

hepatitis C to your baby.

she/he is monitored by a GP or specialist.

Does my baby have hep C?

Consult your GP or specialist on how often the visits should be

All babies born to women with hepatitis C will test antibody positive at birth because they inherit their mother’s antibodies. Antibodies are like

IT IS IMPORTANT TO NOTE THAT IN MOST CHILDREN DISEASE PROGRESSION IS VERY SLOW.

memory cells, reminding the body that it has been infected with a virus or bacteria in the past. These antibodies pass through the placenta to the baby during the pregnancy, however they do not infect the baby with the virus.

REMEMBER FOR MOST BABIES TRANSMISSION OF HEPATITIS C WILL NOT OCCUR By around the age of 18 months, around 92-95% of babies will have cleared their mother’s antibodies and test negative for hepatitis C. If parents are still concerned following discussion with their health care provider or liver specialist, then antibody testing should only be carried out

14

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after the child reaches 18 months of age.

Disclosure

Your decision to tell your children about

Disclosure to childcare/school/playgroups

your hepatitis C status or their own

You are under no legal obligation to

hepatitis C status may weigh heavily on

disclose to childcare centres or schools

your mind. This is a very personal issue

that your child has hepatitis C.

and every family decides what is right

All Australian childcare centres or schools

for them. No matter how well you know

have protocols relating to blood and body

your children, it might be useful to

fluids. If you have any concerns about

consult with Hepatitis SA to discuss

this, contact the Hepatitis SA Helpline on

how you might deal with this sensitive

8362 8443 or 1800 437 222.

Pregnancy, Birth & Beyond

Disclosure to children

issue.

With good planning and taking into account their level of understanding,

Discrimination

informed disclosure can ensure your

If you feel that you are receiving or

child understands about the virus and

have received less than full care and

its effects on the person and the family.

service, or have been treated unfairly

There are a number of things you might need to think about, and these include:

during your pregnancy, birth and beyond as a result of having hepatitis C, you can contact the SA Equal Opportunity

•

Why am I telling them?

•

The age and the maturity of the child

•

How much information you think they can understand

•

H ow you feel they might react

•

What support they may need

Commission. They will be able to discuss the issue of discrimination with you, and appropriate avenues of complaint and/or redress.

mentally and emotionally posed by models

15

Pregnancy, Birth & Beyond

Hepatitis C at Home Household transmission of hepatitis C is

A few simple points below will help keep

rare, however there are some simple

your family safe:

ways to keep your family safe.

•

Be aware of everyone else’s blood

•

Wash hands thoroughly if you come

Remember hepatitis C is transmitted through blood to blood contact and it

in contact with blood

can’t be transmitted through everyday general contact such as hugging, kissing

•

C lean up blood spills with paper

and eating or drinking from the same

towels, then clean the area with

plates or cups.

bleach and cold water •

Wear gloves for all first aid and cover cuts with a dressing

•

Don’t share toothbrushes, razors or nail clippers

•

Wrap pads and tampons in plastic bags and dispose of safely

•

Use condoms if there is likely to be blood to blood contact during sex

•

Dispose of sharps safely

For further information refer to the Family & Friends booklet available from the Hepatitis C Council of South Australia.

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16

Other Issues Treatment for hepatitis C

Drug use is an important issue during

There are highly effective anti-viral

pregnancy. If you are taking any type of

drugs for hepatitis C but some treatment

drug it is important to talk to your

regimes still require interferon and/or

pregnancy care provider as they may

ribavirin. If you are pregnant or are

have adverse effects on you and your

likely to become pregnant, you will not

baby’s health.

be able to start on these treatments.

All drugs taken during pregnancy will

If you or your partner are currently

reach the baby through the placenta.

undergoing, or have been on treatment

Different drugs will have different effects

with ribavirin or interferon within the

on the baby, depending on the type of

last 6 months, then you should take all

drug and the baby’s response to

precautions to avoid becoming pregnant

the drug.

at this time.

Pregnancy, Birth & Beyond

Pregnancy and drug use

If you are pregnant, it is important not to stop taking any drug which you

You will have been advised to use two

regularly take without first talking to

forms of contraception. This is because

your GP, pregnancy care provider or

the drugs that are used in the treatment

Alcohol and Drug Program worker.

of hepatitis C can cause serious sideeffects in the developing baby. Ribavirin causes severe birth defects and the effect of interferon on the foetus is unknown.

If you are considering starting hepatitis C treatment whilst breastfeeding, discuss it with your doctor or your viral hepatitis nurse posed by models

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Pregnancy, Birth & Beyond

Getting more information Hepatitis C Information and Support Hepatitis SA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8362 8443 Hepatitis SA Helpline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8362 8443 . . . . . . . . . . . . . . . . . . . . . . . 1800 437 222 Hepatitis SA online library . . . . . . . . . . www.hepsa.asn.au/library

Support Services Women’s Information Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8303 0590 (SA country callers) 1800 188 158 Womens’ Health Line . . (www.whs.sa.gov.au) . . . . . . . . . . . . . . . . . . 1300 882 880 Women’s Legal Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8221 5553 (SA country callers) 1800 816 349 (Hearing impaired) 1800 670 864 Women’s Shelters - Domestic Violence Crisis Service . . . . . . . . . 1300 782 200 info@dvcs.org Mental Health (24 hr Emergency Crisis). . . . . . . . . . . . . . . . . . . . . . 13 14 65 Lifeline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 11 14

Discrimination Contacts

18

Health and Community Services Complaints Commissioner

8226 8652

Equal Opportunity Commission (www.eoc.sa.gov.au) (SA country callers) TTY eoc@agd.sa.gov.au

8207 1977 1800 188 163 82071911

Pregnancy Care and Childbirth Queen Elizabeth Hospital - Maternity and Ante Natal . . . . . . . . . . . . . . . . 8222 7050

Flinders Medical Centre - Women’s Health Clinics (booking line)

8204 5197

Lyell McEwin Hospital - Women’s and Children’s Clinic . . 8282 1611 Women’s and Children’s Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8161 7000

Pregnancy, Birth & Beyond

Royal Adelaide Hospital - Women’s Health Centre. . . . . . . . . . . . . . . . . . . . 8222 5587

Postnatal/Parenting Contacts Parent Help Line (24 hr service) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1300 364 100 Parenting SA

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8303 1660

Parenting Network . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8243 5544 Parents without Partners . . . (www.sa.pwp.org.au) . . . . . . . . . . . . . . . . . . . . 8359 1552 Family Relationship Advice Line (www.familyrelationships.gov.au) . . 1800 050 321

Some useful websites Hepatitis SA (www.hepsa.asn.au) Hepatitis Australia (www.hepatitisaustalia.com) Australian Breastfeeding Association (www.breastfeeding.asn.au) Birth (www.birth.com.au) National Council for Single Mother & Her Children (www.ncsmc.org.au) Ninemonths (www.ninemonths.com.au) Parent Helpline (www.cyh.com) Women’s Centre for Health Matters

(www.womenshealthmatters.org.au)

Dads in Distress (www.dadsindistress.asn.au) Centrelink (www.centrelink.gov.au) 19

Pregnancy, Birth & Beyond

Good books to read

Available from Hepatitis SA

Baby Love, Robyn Barker.

Hepatitis C - information for family & friends

Breastfeeding I Can Do That, Sue Cox.

Eat Well for your Liver - Tips and Recipes

Breastfeeding Naturally, Jane Cafarella and NMAA.

Exercise for Healthy Livers

Having a Baby — The Essential Australian Guide to Pregnancy and Birth, Carol Fallows.

My Choice My Rights

Hepatitis C Treatment

Hepatitis C and Dental Care

Up the Duff, Kaz Cooke.

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Hepatitis C af fects people f rom all walks of life You are not alone We’re here to help

Hepatitis SA offers information, suport and and their families and friends.

Website

www.hepsa.asn.au

Hepatitis Helpline 1800 437 222

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referrals to people with hepatitis C,