Breastfeeding and Alcohol

There is an abundance of information in the community regarding alcohol consumption when pregnant. Many studies have been carried out on pregnant women who consume alcohol and the damaging effects on the developing foetus are conclusive. However, the risks associated with drinking alcohol whilst breastfeeding a baby are not as well defined or understood. It can be very confusing to new mothers as to whether it is safe to drink alcohol whilst breastfeeding or not.

An online search indicates a wide range of conflicting articles related to breastfeeding and alcohol that unfortunately only leave mothers more confused and this, according to Dr Jack Newman in his book “ Dr Jack Newman’s Guide to Breastfeeding“ creates pressure on the breastfeeding mother and thus is nether helpful to the woman or supportive of her breastfeeding relationship. It is well known through the research that good support is closely associated with longer duration of breastfeeding.

So, what do breastfeeding mothers need to know to feel informed and supported?

The thinking in this area has really come full circle, in the past, drinking alcohol whilst breastfeeding was not thought to be an issue at all and women were in fact often told that drinking beer would help to boost their supply. We now know that is not really true and in fact not only are there are many other mutually beneficial ways to increase milk production, alcohol has actually been found to hinder the letdown process.

Thinking around alcohol and breastfeeding gradually changed and by the early 2000s women were told that consuming any alcohol could be   potentially detrimental to their baby. Many women were and continue to be encouraged to abstain completely. Advocates of breastfeeding believe this is prohibitively restrictive and not conducive to protecting and promoting healthy initiation and establishment of breastfeeding.

Research shows that there is a significant difference between consuming alcohol when pregnant and consuming alcohol when breastfeeding.

Studies show us that alcohol passes freely into the mother’s milk and can be found in breastmilk between 30 to 90 minutes after intake and at similar levels to that of maternal blood. There are a few factors to consider as alcohol intake is individual and maternal weight, the speed with which the alcohol is consumed and whether it is consumed with food all play a part in how much alcohol can be detected. So whilst the mother may be consuming a beverage that is 10-12% alcohol, the baby is not. The amount of alcohol taken in by a breastfeeding baby is estimated to be 5-6% of the maternal, weight adjusted dose.

This means that a woman would have to consume large amounts of alcohol and be well over the legal limit for her breastmilk levels to be high. This is important for a breastfeeding mother to know as the research indicates that whilst it is said that the safest thing is to avoid alcohol altogether no actual long term harm has been found to occur when the alcohol intake is moderate and infrequent, as under these conditions the amount of alcohol in breastmilk would not be clinically significant.

What happens if alcohol consumption is frequent or excessive?

There is a very big difference between moderate and excessive intake of alcohol. Consuming alcohol at a rate greater than 1 standard drink per day, or 2 standard drinks every few days and not allowing time for effective maternal excretion has been shown to be associated with poorer outcomes for babies, in fact studies have shown delays in gross motor development in infants whose mothers drank 2 standard drinks each day. So whilst moderate intake is now not considered to place a baby at risk, excessive and regular intake of alcohol whilst breastfeeding is a concern and should be avoided if at all possible.

Alcohol consumption can impair judgement and make it more difficult to rouse from sleep and because of this breastfeeding mothers who have consumed alcohol should not bed share with their baby. Alcohol consumption has been shown to interfere with the letdown mechanism. Latest research indicates that alcohol, rather than increasing supply, actually inhibits the letdown process by interfering with the release of oxytocin from the pituitary which is critical to release of milk. Therefore it is not advised to drink alcohol regularly or in large quantities if you are concerned about your supply.

So what should women do?

Dr Hale, in his book “Medications and Mother’s Milk” explains that alcohol is not stored in the milk but instead is excreted by the liver and thus reduces in concentration at the same rate as the mothers blood as it enters and exits in line with the blood alcohol levels.

This means there is no reason to pump and dump, rather women can enjoy a drink and should then wait to feed their babies till their blood levels have lowered with the average time being approximately 1.5-2hours after each drink based on the individual’s weight and metabolism.

It is beneficial to find a comfortable, middle ground for the safety of babies and the wellbeing of breastfeeding mothers.

So it all comes down to moderation and planning. Consuming 1 or 2 standard drinks from time to time has not been found to cause problems. It’s known that alcohol is present in the maternal blood and breastmilk within an hour of having a drink, thus if alcohol is going to be consumed, plan ahead and feed the baby prior to having an alcoholic drink and then wait for 2-3 hours before baby is fed again. This approach will usually provide enough time for maternal blood alcohol levels to return to normal.

It is also a helpful guide to know that if you are legally allowed to drive and you can safely handle and care for your baby then you are most likely safe to breastfeed. Breastfeeding mothers need to know that they can relax and enjoy an alcoholic drink from time to time and that with some simple planning they too can enjoy a glass of bubbles or relax with a beer at a BBQ.