It’s easy to understand why breastfeeding mothers are being misinformed. The question about whether having a drink while breastfeeding has got the potential to cause problems, and doctors and nursing sisters may not want their professional opinion to lead to any negative effects. So, when in doubt, they rather just discourage mothers from drinking altogether.
And while some mothers may not really miss having a drink, for others this becomes another restriction that breastfeeding places on their lives. For many women a glass of wine at the end of a long day is truly a treat and a coping skill.
Part of the issue is the term ‘moderate’, and you will see that this article also refers to moderate drinking. Of course, many people with true drinking problems don’t feel that they are drinking that much at all. Plus, there aren’t many studies on binge drinking and breastfeeding, as this would be unethical.
So how much can you have?
It would be wonderful if you could simply have an amount to stick to. The general rule of thumb is that maternal blood alcohol levels must be higher than 300mg/dl before it significantly affects baby. Not that this is helpful at all.
The American Academy of Paediatrics states that an occasional intake of no more than 0.5g alcohol per kg of body weight is safe. For a mother weighing 60kg this translates to 60ml liquor, 240ml wine or 2 beers.
It is not quite so simple though, and these guidelines are still quite strict. It also doesn’t state exactly how often ‘occasional’ is, which most professionals define as 1-2 times per week.
According to Dr Thomas Hale, the author of the book Medication and Mothers Milk, fairly small amounts of alcohol actually reach breast milk. The alcohol levels in the milk will be similar to the levels in mom’s blood. And as mom’s body metabolises the alcohol and her blood levels fall, so the alcohol will move from the breast milk back into to her blood stream again. This means alcohol is not stored in your breast milk for baby to consume later. Once the effects of alcohol on your body have worn off, there will be nothing left in the breastmilk either.
Looking at the above levels and at how it actually works it is generally thought that if a mother’s blood alcohol level is low enough to drive, it will also be low enough for her to safely breastfeed.
Factors influencing how alcohol affects baby
There are some things that will influence how much you can drink and how it may affect your baby:
- Baby’s age: The older baby is, the better his body can metabolise alcohol. A baby is most vulnerable in the first 3 months of life as the liver is still so immature.
- Mom’s weight: A bigger, heavier person can handle more alcohol than someone who is small and lightweight.
- Taking food with alcohol: Generally, alcohol is absorbed less well if taken with food.
- The amount: The more you drink, the bigger the effect on baby.
What are the negative effects?
- Consuming large amounts of alcohol can lead to drowsiness and weakness in baby.
- Regular heavy drinking can cause abnormal weight gain and delayed motor development.
- Alcohol can reduce your let-down reflex, which may lead to baby taking longer to feed after you’ve had a drink.
- More concerning is that alcohol can affect mom’s natural reflexes and ability to care for baby. This perhaps explains moderate drinking best; drinking an amount of alcohol that impairs your coordination and discretion is dangerous for baby for obvious reasons, and is therefore no longer categorised as moderate.
- You should never co-sleep with baby if you were drinking. Many of the studies linking sudden infant death syndrome (SIDS) to bed-sharing were done on mothers who were intoxicated at the time.
So, what are the do’s and don’ts?
To use alcohol safely you should:
- Be more cautious if your baby is still very small.
- Eat before or with taking alcohol.
- Spread out your drinks over the evening, rather than drinking it all at once.
- Consider feeding baby before you have a drink. That way your alcohol levels will be down again by the time baby wants to feed again.
- Plan ahead. If you know that you really will be drinking too much you can express breast milk for baby ahead of time.
You don’t have to:
- Avoid alcohol completely.
- Feel guilty for having a drink. You should instead feel proud of yourself for breastfeeding baby and knowing that if you do it responsibly, drinking alcohol won’t cause harm.
- Pump and dump – as explained above, alcohol is not stored in breast milk but as long as there is alcohol in your blood stream it will be in your milk as well.
Christine Klynhans is a nursing sister and South African Certified Lactation Consultant (SACLC). She currently works at Parentwood Baby and Family Wellness Centre in Pretoria as a well-baby clinic sister and antenatal teacher. She also has a breastfeeding practice and a Breast Pump Demo Centre. She is passionate about supporting parents on the journey of pregnancy, breastfeeding and the early childhood years. Learn more about Christine Klynhans.