Breastfeeding and Alcohol

In answer to the question “Will my breastfed baby be affected by what I eat and drink?”… The answer is yes, a mother’s milk will pass consumed substances such as food, alcohol and other chemicals through to her child. This can be either advantageous or detrimental, depending upon the mother’s awareness and her lifestyle habits…

Alcohol, caffeine, environmental toxins, recreational drugs and prescription and over-the-counter medications all pass through breast milk to our babies. These substances are mildly filtered by the mother’s metabolism but their harmful effects will still impact her child due to their small body-weight ratio. As breastfeeding mothers we need to be mindful of this. (Please see: Reducing Breast Milk Toxicity, Chapter 14, Well Adjusted Babies; and The placenta: Not the barrier we once thought)
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Right from the start let us be clear that the placenta marginally protects an unborn baby from infection but research now shows it does not act as a barrier for alcohol, drugs and other toxins. If your mother-in-law tries to coerce you into having a glass of red with her at the “weekly family get-togethers” and you are hesitant then trust that intuition knowing that there is now ample research telling us that alcohol, caffeine, recreational drugs, prescription and over-the-counter medications all pass through our breast milk to our baby.

Consider a pregnant woman who weighs 50kg (for ease of calculation) and takes a drug that crosses through the placenta undiminished. Her developing baby, when its weight is less than 100 g, has 500 times the drug exposure per kg of tissue than she does herself (Ref.: Morris). This example demonstrates how the dosage the mother consumes may have mild effects for her own physiology but enormous ramifications for a delicate and vulnerable developing baby.

Interesting facts about alcohol and breastfeeding

From the Australian Breastfeeding Association guide for mothers:

• Once consumed, alcohol will be passed via breast milk 30–60 minutes after you start drinking.
• How much alcohol gets into your breast milk depends upon the strength and amount of alcohol in your drink, what and how much you’ve eaten, how much you weigh, and how quickly you are drinking.
• As a general rule it takes 2 hours for an average woman to get rid of the alcohol from 1 standard alcoholic drink, thus 4 hours for 2 drinks, 6 hours for 3 drinks and so on.
• Once you stop drinking and the amount of alcohol in your blood drops, the amount in your milk will too. Only time will reduce the amount of alcohol in your breast milk.
• Because alcohol elimination follows zero-order kinetics, drinking water, resting, or “pumping and dumping” breast milk will not accelerate elimination. Unlike urine, which stores substances in the bladder, alcohol is not trapped in breast milk, but is constantly removed as it diffuses back into the bloodstream.

The Canadian Family Physician journal reports several proven or potential adverse effects of alcohol on suckling infants even after exposure to only moderate levels, including:

• impaired motor development
• changes in sleep patterns
• decreases in milk intake
• risk of hypoglycemia
• changes to a mothers’ milk flow following large amounts of alcohol

The safest option is not to drink

• If you are breastfeeding, the safest option is not to drink alcohol.
• Occasional drinking, however, does not warrant discontinuing breastfeeding, as the benefits of breastfeeding are extensive and well recognized (Koren, 2002)

If you choose to drink alcohol please:

• Try to avoid alcohol in the first month after your baby is born until breastfeeding is well-established.

• Newborns have frequent breastfeeds without any pattern. You may not be able to tell when the next feed will be so you need to be aware that your baby could need another feed while there is still alcohol in your milk. As babies get older they fall into a more regular feeding pattern.

• After that, alcohol intake should be limited to no more than two standard drinks a day. One standard drink contains 10 g of alcohol i.e.  100 mL of 13.5% wine, or 1 ‘stubby’ (375 mL) of mid-strength beer, or 1 pre-mixed bottle (alcopop 5%) (275 mL), or 30 mL of spirits.

• If you have 1 or 2 standard drinks a day, then time the drinks to have the least effect on your baby. Breastfeed your baby before you drink. You can then enjoy a drink knowing you’ll be unlikely to need to feed again within the next couple of hours. Eat before and while drinking. One way to reduce the amount of alcohol you drink is to alternate alcoholic with non-alcoholic drinks.

• You should not drink alcohol immediately before you breastfeed. You should consider expressing milk in advance if you want to drink alcohol.

• Drinking 3 or more drinks a day can be harmful to your health and that of your baby. Be aware that you may not be able to take care of your baby properly if you are affected by alcohol, that your baby may be slower to reach developmental milestones, and that alcohol may decrease the flow of your milk and thus reduce your supply.

What should I do if I am going to have a planned night of drinking?

Social events don’t stop just because we become “a parent”. Even for non-drinkers there may be times when you want to attend an event and you may want to have a few drink socially. Remember:

• Breast milk with a small amount of alcohol is still better for your baby than artificial baby milk.

• You can express some milk ahead of your night out so that your baby can have this milk if you miss a feed while drinking, or while you are waiting for the amount of alcohol in your milk to drop.

• You can also express and freeze extra milk just in case you may drink more than you plan to.

• If you miss a feed while drinking alcohol and your breasts are feeling uncomfortable, express some milk and throw it away. This will help with your comfort and will maintain your milk supply.

You may find that your milk flow is not as strong as usual while there’s still alcohol in your blood. Your milk flow will come back to normal again once your body has cleared the alcohol.

• Be aware that your baby may not sleep as well as usual.  He might fall asleep quicker, but wake up sooner, instead of having a deep sleep lasting for a longer time. Researchers Mennella and Garcia-Gomez (2001)state that short-term exposure to small amounts of alcohol in mothers’ milk produces distinctive changes in the infants’ sleep–wake patterning.

If you are someone heavily influenced by hangovers then arrange for someone else who isn’t affected by alcohol to look after your baby. Most importantly don’t sleep with your baby if you (or anyone else in the bed) are affected by alcohol.

In contrast to alcohol exposure during pregnancy, a breastfeeding mother who occasionally has alcohol can limit her baby’s exposure by timing breast feeds in relation to drinking. This is because alcohol peaks in a mothers’ bloodstream approximately 30-60 minutes after she stops drinking, and decreases from that point onwards (Lawton, 1985; Mennella & Beauchamp, 1991).

Note that contrary to popular belief, it has been shown that infants actually ingest less breast milk in the few hours following a mothers’ consumption of alcohol than normal, due to the direct effect that alcohol has on a mothers’ milk production (Mennella & Beauchamp, 1991, 1993).

 

References

For further information the Australian government has new national guidelines for alcohol consumption that have been developed by the National Health and Medical Research Council to help you reduce the risk of harm from alcohol to both your baby and you. The guidelines are based on the best available scientific research and evidence.