Vertical transmission of hepatitis C: Testing and health-care engagement.

AIM: To investigate hepatitis C virus (HCV) testing patterns and engagement with health care for women positive for HCV antibodies (anti-HCV) in pregnancy and their children through pregnancy and the first 2 years of the child's life. METHODS: At a large inner-city Australian hospital from 2010 to 2012, anti-HCV positive pregnant women were recruited into a cohort study from pregnancy to 2 years post-delivery. Maternal and child data were collected by questionnaire and medical record extraction. RESULTS: During the study 29 women participants delivered 31 children. HCV RNA was detected in 64% (18/28) of pregnancies, with injecting drug use, the most likely route of maternal infection. Relatively high maternal health-care engagement during pregnancy reduced after delivery. There was evidence of ongoing illicit drug use in the majority of women. Of the children, 58% (18/31) had some HCV testing confirmed but complete testing was confirmed for only 10% (3/31). Largely, testing was incomplete or unknown. No vertical transmission was identified. Forty-two percent (13/31) of children were placed in out-of-home-care. CONCLUSIONS: Potentially, there is a high risk of inadequate or incomplete HCV testing of vulnerable children. Ongoing maternal drug use, poor maternal health-care engagement and placement in out-of-home-care may increase the risk. Complete testing of all children at risk of vertically acquired HCV needs to be ensured.

Experiences of mothers with substance dependence: Informing the development of parenting support.

AIMS AND OBJECTIVES: To understand the experiences of women with a history of substance dependence when they attempted to gain parenting support. BACKGROUND: Becoming a mother provides a window of opportunity to support women with a substance dependence make changes to their lives and the way they will parent their infants and young children. Yet there are many barriers and a constant fear of the removal of their children from their care. DESIGN: Focus groups were conducted using a qualitative interpretive descriptive approach to enable exploration of the women's experiences as mothers with infants and young children. METHOD: A series of three focus groups were facilitated with three to six women per group. Thirteen women who were substance dependent participated in this study. Semi-structured interviews guided the collection of data. Thematic content analysis was used to work with the data. RESULTS: Four themes were identified: (1) feelings of guilt, (2) judged by others, (3) normalising and (4) support and learning to be a mother. CONCLUSION: The mothers expressed alienation from mainstream health services. Providing parenting and child health services, which avoid mothers feeling judged by the staff and other mothers, is an important step to enabling these women to appropriately and sensitively care for their infants and young children. RELEVANCE TO CLINICAL PRACTICE: Midwives and nurses working with mothers and their infants and young children are well positioned to support women who are or have experienced substance dependence. Working with this group of mothers requires the development of a therapeutic relationship to provide optimum support, education and, if necessary, intervention.