Diet
There are no special foods to eat or to avoid. It is important that you eat a well-balanced diet which includes lots of vegetables, fruit and whole wheat cereals, including bread.
To help with itching you may find the following suggestions from other mothers helpful:
- Have frequent cold baths
- Try not to get too hot
- Use lotions such as calamine and aqueous cream with menthol
- Wear loose cotton clothing
- Gently scratch your skin with a baby’s hairbrush.
Can I drink alcohol?
OC is not caused or made worse by alcohol. However, the Department of Health recommends
that if you are pregnant or are planning a pregnancy, you should avoid drinking alcohol to
minimise harm to your baby.
If you still wish to drink, try to limit this to no more than one or two units of alcohol one or twice a week. You should avoid getting drunk.
Will OC damage my liver?
OC is not thought to cause any lasting liver damage. However, it may leave your liver more sensitive to normal changes in the level of your hormones and a few women report what is known as ‘cyclical itching’ during the menstrual cycle. This can happen just before ovulation or just prior to a period.
This type of itching is usually only mild and stops either when ovulation has taken place or your period has started.
What about future pregnancies?
It is highly possible that you may have OC in future pregnancies. The risk is generally estimated to be greater than 50%. If OC does recur, it may not necessarily follow the same pattern.
It is important that any future pregnancies are carefully managed by a consultant obstetrician who is familiar with the condition.
If you are worried that you may have OC, you must contact your doctor or midwife.
Aftercare
After the delivery the itching should disappear relatively quickly. It is thought that there is no
damage caused to the liver of either mother or baby.
There are no developmental problems for the baby. The risk of developing neonatal jaundice is the same as for other babies.
Ideally you might have a post natal check related to your OC at around six to twelve weeks. This
should not be any sooner than three weeks so that you have had plenty of recovery time. At your appointment your doctor will be keen to establish that the itching has gone away.
They should also carry out an LFT and serum bile acid test. If there are any abnormal results
you will need to have further tests. These are to determine whether your liver is taking extra time to settle down or, more rarely, whether you have an underlying liver problem.
If this is the case you may be referred to a hepatologist, or perhaps a gastroenterologist with
knowledge of liver problems.
You and your baby should receive the standard health checks after birth.
Contraception
Until it is proven that the hormones estrogen and progesterone have an effect on the liver in OC,
it would seem sensible to approach hormonal contraception (the ‘pill’) with caution or avoid it
completely.
However, this may not be realistic or practical for all women and it may be best to discuss the options with your doctor or a suitable healthcare professional. Use of contraception after OC is still a new area and may involve some trial and error in choosing what is right for you.
There is anecdotal evidence that a number of women can tolerate the mini pill and that others
are also able to use a low dose combined oral contraceptive pill.
You might also consider intrauterine contraceptive devices (IUCDs). These release a lower dose of hormones which avoid the liver by going directly into the womb rather than into the bloodstream.
If you do proceed with hormonal contraception, an LFT should be undertaken beforehand to establish that your liver function is normal. You should have the test followed up with another six weeks later. Otherwise there are other forms of contraception available.
In general, if you continue to itch after six months a referral to a liver specialist should be sought.
OC should not influence your ability to breastfeed.
Because they have the potential to cause cholestasis it may be advisable to avoid the antibiotics erythromycin and augmentin following an OC pregnancy as other treatments are likely to prove just as effective. The use of antibiotics should be weighed against the risk of irritation to the womb caused by a urinary tract infection.