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. 5
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.
9
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.
11
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
posed by models
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.
posed by models
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
17
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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20
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
Posed by models
referrals to people with hepatitis C,