Drinking Alcohol and Breastfeeding

Breastfeeding mothers often receive conflicting advice about whether alcohol consumption can have an effect on their baby. While women are often warned not to consume alcohol during pregnancy due to evidence that it could cause damage to an unborn child, the risks of consuming alcohol while breastfeeding are not as well defined.

La Leche League’s The Womanly Art Of Breastfeeding (p. 328) says:

“The effects of alcohol on the breastfeeding baby are directly related to the amount the mother ingests. When the breastfeeding mother drinks occasionally or limits her consumption to one drink or less per day, the amount of alcohol her baby receives has not been proven to be harmful.”

If consumed in large amounts alcohol can cause drowsiness, deep sleep, weakness, and abnormal weight gain in the infant, and the possibility of decreased milk-ejection reflex in the mother. Mothers who have been drinking should not bed-share with their babies as their natural reflexes will be affected.

Dr. Jack Newman MD, FRCPC and Thomas W. Hale, R.Ph. Ph.D, are both members of La Leche League International’s Health Advisory Council. They believe that a mother can drink some alcohol and continue breastfeeding as she normally does.

Dr. Jack Newman, says this in his handout “More Breastfeeding Myths”:

“Reasonable alcohol intake should not be discouraged at all. As is the case with most drugs, very little alcohol comes out in the milk. The mother can take some alcohol and continue breastfeeding as she normally does. Prohibiting alcohol is another way we make life unnecessarily restrictive for nursing mothers.”

Thomas W. Hale, R.Ph. Ph.D, says this in his book Medications and Mothers’ Milk (17th ed.):

“Alcohol transfers into human milk readily, with an average plasma/ milk of about 1. This does not necessarily mean the dose of alcohol in milk is high, only that the levels in plasma correspond closely with those in milk. The absolute amount (dose) of alcohol transferred into milk is generally low and is a function of the maternal level. Older studies, some in animals, suggested that beer (or more likely barley) may stimulate prolactin levels. Significant amounts of alcohol are secreted into breastmilk although it is not considered harmful to the infant if the amount and duration are limited. The absolute amount of alcohol transferred into milk is generally low.

Excess levels may lead to drowsiness, deep sleep, weakness, and decreased linear growth in the infant. Maternal blood alcohol levels must attain 300 mg/dl before significant side effects are reported in the infant. Reduction of letdown is apparently dose-dependent and requires alcohol consumption of 1.5 to 1.9 gm/kg body weight (1). Other studies have suggested psychomotor delay in infants of moderate drinkers (2+ drinks daily). Avoid breastfeeding during and for 2 – 3 hours after drinking alcohol. Heavy drinkers should wait longer.

In an interesting study of the effect of alcohol on milk ingestion by infants, the rate of milk consumption by infants during the 4 hours immediately after exposure to alcohol (0.3 g/kg) in 12 mothers was significantly less (2). Compensatory increases in intake were then observed during the 8 – 16 hours after exposure when mothers refrained from drinking.

Adult metabolism of alcohol  is approximately 1 ounce in 3 hours, so mothers who ingest alcohol in moderate amounts can generally return to breastfeeding as soon as they feel neurologically normal. Chronic or heavy consumers of alcohol should not breastfeed.”

References:

  1. Cobo E. Effect of different doses of ethanol on the milk-ejecting reflex in lactating women. Am J Obstet Gynecol 1973; 115(6):817-821.
  2. Mennella JA. Regulation of milk intake after exposure to alcohol in mothers’ milk. Alcohol Clin Exp Res 2001; 25(4):590-593.

Important Considerations

  • Your baby’s age
    • A newborn has an immature liver, and will be more affected by alcohol
    • Up until around three months of age, infants metabolize alcohol at about half the rate of adults
    • An older baby can metabolize alcohol more quickly than a young infant
  • Your weight
    • A person’s size has an impact on how quickly they metabolize alcohol
    • A heavier person can metabolize alcohol more quickly than a lighter person
  • Amount of alcohol
    • The effect of alcohol on the baby is directly related to the amount of alcohol that is consumed
    • The more alcohol consumed, the longer it takes to clear the body
  • Will you be eating
    • An alcoholic drink consumed with food decreases absorption.

Can drinking an alcoholic beverage help me relax and stimulate milk production?

Alcohol consumption has not been shown to stimulate milk production. Studies have found that babies nurse more frequently, but consume less milk in the 3-4 hours after an alcoholic beverage is consumed.

Do I have to pump and dump after drinking an alcoholic beverage?

As alcohol leaves your bloodstream, it leaves your breastmilk. Since alcohol is not “trapped” in breastmilk (it returns to the bloodstream as mother’s blood alcohol level declines), pumping and dumping will not remove it. Pumping and dumping, drinking a lot of water, resting, or drinking coffee will not speed up the rate of the elimination of alcohol from your body.

What if I get drunk?

Mothers who are intoxicated should not breastfeed until they are completely sober, at which time most of the alcohol will have left the mother’s blood. Drinking to the point of intoxication, or binge drinking, by breastfeeding mothers has not been adequately studied. Since all of the risks are not understood, drinking to the point of intoxication is not advised.

Can alcohol abuse affect a breastfed baby?

Yes. Alcohol abuse (excessive drinking) by the mother can result in slow weight gain or failure to thrive in her baby. The let-down of a mother who abuses alcohol may be affected by her alcohol consumption, and she may not breastfeed enough. The baby may sleep excessively, or may not suck effectively leading to decreased milk intake. The baby may even suffer from delayed motor development. If you are concerned that you or someone you know is drinking alcohol excessively, contact your healthcare professional.

Weighing the Risks and Benefits

Many mothers find themselves in a situation where they may want to drink. Maybe you are going to an event where wine will be served. Or perhaps you are going out with friends, or on a date. No matter the reason, you may have concerns about drinking and any possible effects on your baby. It is a good idea to weigh the benefits of breastfeeding against the benefits and possible risks of consuming alcohol. You might find the following suggestions helpful.

  • Plan Ahead
    • If you want to drink, but are concerned about the effect on your baby, you can store some expressed breastmilk for the occasion
    • You can choose to wait for the alcohol to clear your system before nursing
    • If your breasts become full while waiting for the alcohol to clear, you can hand express or pump, discarding the milk that you express
  • Alternatives
    • If you’re concerned about consuming alcohol while breastfeeding  you might prefer to stick to non-alcoholic drinks instead.
  • If you are sober enough to drive you should be sober enough to breastfeed.

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