Breastfeeding & Alcohol

With the upcoming holiday season, we want to take a moment and discuss the facts and myths surrounding breastfeeding and alcohol. Many mothers wonder if it is safe to consume alcohol while nursing because let's be honest - mama wants a glass of wine too! So, what is the truth? Is alcohol safe? Do you have to pump and dump? Does it have any effects on milk supply or baby? Let's find out. 

 

THE SCIENCE:

Does alcohol get into my breastmilk? Yes. When we drink, less than 2% of the alcohol we consumed can be found in our blood and in our milk (2). Well, that seems like a pretty small amount right? YES - depending on how much and how often we drink.

Alcohol has a 1:1 blood plasma to milk ratio in your body AKA your blood alcohol level (BAC) = your milk's alcohol content. Some of you may have heard the guideline: if you're good to drive, you're good to nurse. This is because across the U.S. the BAC level for driving has to be under .08%, higher than that and driving becomes dangerous. Generally, it takes a few drinks to get to this .08% level and you can use an online calculator to see where your threshold may be. With this recommendation, if you're alcohol level is under .08% that also means the alcohol in your milk is under the concentration of .08%...less than eight one hundredths of a fraction - teeny tiny. From there, your baby's body starts to metabolize the milk and the alcohol, so that .08% concentration drops even further. By the time the alcohol goes into the baby's mouth, into the stomach to be digested, then into baby's bloodstream and lastly, baby's organs there is hardly any alcohol actually reaching your baby.

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Another way to think of it. If you were to binge drink (4 drinks of 12g alcohol per drink) and nurse your baby when your BAC was the highest (probably 30-60 minutes after consuming the drinks), your baby would have a blood alcohol level of less than 0.005% (3). Now, we don't recommend heavy drinking as this can have impacts in other areas such as you and your child's safety and lactation long term. But we use this example to emphasize how minimal the transfer of alcohol to milk to baby actually is - primarily when we drink conservatively and responsibly. 

What goes in, must come out. While alcohol does have a direct 1:1 ratio, it also has a very fast half-life meaning it starts leaving our body pretty quickly after we drink. We're talking about a mere 1-2 hours for the alcohol to start metabolizing out of the body. Alcohol concentration peaks about 30-60 minutes after we drink and then starts dropping as the alcohol is broken down (4, 5). The total time it takes for alcohol to completely be out of our system will depend on the amount of alcohol we consumed along with other factors like our weight. The takeaway - as we start sobering up, so does our milk. This is important to understand because this means, we cannot speed up the process by eating special foods or pumping/dumping, none of that is necessary we have to wait for our bodies to metabolize or breakdown the alcohol for the alcohol to fully leave our bodies.  But remember, the amount that gets to our milk is so minimal (depending on how much alcohol you've consumed and over what period of time you drank that amount) that research shows us we can safely drink a serving or two of alcohol (Wine 4oz, Beer 12oz, or Spirits 1oz) and nurse our babies. So go ahead mama, have that much deserved glass of wine. 

Does alcohol affect lactation? Yes, temporarily. Research shows us that alcohol can inhibit the hormones in our body that work together for the lactation process - prolactin and oxytocin. (Remember our post on breastfeeding hormones?) When you drink alcohol, oxytocin is inhibited which means you may have a harder time having a let-down (6). A let down is when the little muscles around your mammary glands squeeze those glands and push out your milk - i.e. help you to eject your milk from your breast into baby or into your pump. As a result, some moms may see a temporary dip in milk output (12). 

Does alcohol affect my baby? While this will depend on how much you drink, if you drink conservatively (1-2 drinks per 1-2 hours) once in a while, the answer is no. There are two changes you may notice after you nurse your baby if you've recently consumed alcohol - how often baby nurses and how they sleep. We say may because most moms will likely not see any change but if you do, here is why. You may find your baby nursing more frequently and this is attributed to the lower milk output that is common after drinking and picks back up after a few hours once the alcohol has been metabolized from your body because your oxytocin is no longer inhibited and you can have that milk let down that helps us get out more milk (7,8). The second change you may notice is a temporary change in baby's sleep patterns. Baby may wake more frequently or may sleep for shorter periods of time, again this seems to only within a few hours of consuming alcohol and nursing and goes back to normal once alcohol is out of your system (7,9,10). 

Any long term effects? For light and occasional drinkers, no. For heavy and frequent drinkers, maybe. Long term effects on delayed motor development were seen in moms who consume more than one alcoholic beverage a day but this effect was not seen when comparing women who drank less than one alcoholic beverage a day compared to those who received formula (11). We recommend avoiding binge drinking and always having a back up plan (e.g., milk stash) in the event that you drink more than you expect and cannot nurse your baby. 

 

Alright so, THE SHORT ANSWER...

Occasional alcohol is a-okay IF you follow some guidelines.

 

WHAT ARE THE GUIDELINES?

Moderation. moderation. moderation. A standard US drink is 12 fl oz of beer, 8-9 fl oz of malt liquor, 5 fl oz of wine or 1.5 fl oz of distilled spirits.

 
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It is advised to drink no more than 1-2 drinks in a day and avoid habitual drinking. 

To be on the conservative side, wait 2 hours per standard drink before nursing.

Try planning your drinking after a nursing session this way you allow yourself more time between consuming alcohol and when you'll have to nurse again. 

American Academy of Pediatrics says avoid habitual consumption of alcohol but when drinking - occasional drinking in moderation and waiting two hours per drink before nursing baby is advised. 

Other considerations:

How old is your baby? The newborn body takes longer to metabolize alcohol than an older baby. This does not mean you cannot drink with a newborn, it simply means you want to be extra aware of how much you're consuming if you have a young infant or preterm baby and make sure you give yourself time for the alcohol to metabolize out of your milk before nursing.

Consider your weight. Women who are petite will be affected more by large quantities of alcohol and may need a little more time for the body to metabolize the alcohol out so give yourself more time in between drinks. 

 

Do I have to pump and dump?

The pump and dump recommendation, we know it well. No breastfeeding mom happily tosses milk - whether you forgot the bag of milk in the fridge, left it on the counter too long or spill it on the floor. No one likes to lose milk. So do you have to pump and dump if you've consumed alcohol?

Generally, no. Let's clarify. 

We've discussed how alcohol processes out of our body and unfortunately, nothing can really speed that process up. So pumping your milk and dumping it will not help rid your milk of alcohol faster. If you've consumed more than 1 standard drink over 2 hours you may want to give yourself more time to allow the alcohol to leave your body before you nurse baby and in the meantime, you may want to pump for your comfort. 

 

LET'S RECAP.

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  • Occasional and controlled drinking - this means avoid binging but feel free to enjoy that glass of wine or margarita every now and then. Breastfeeding doesn't have to come with unnecessary restrictions. 
  • Keep your drinking to 1 serving (12 fl oz beer, 8-9 fl oz malt liquor, 5 fl oz wine, or 1.5 fl of distilled spirits) per 2 hours and allow yourself some time for the alcohol to start leaving your body.
  • Alcohol does inhibit lactation and you may, whether you notice or not, have a temporary dip in your milk supply but it bounces back once the alcohol is out of your body.
  • Research seems to be at a consensus - light, occasional drinking is harmless to baby when breastfeeding. 
  • Avoid heavy drinking and habitual/frequent consumption of alcohol. Basically, don't drink daily and don't get wasted.
  • Pumping and dumping will not get rid of the alcohol faster but you may need to pump to maintain your supply and for comfort (no one likes engorgement!) as you wait to sober up. 
  • Be responsible and always plan ahead. Regardless of how much alcohol you plan on drinking, always have a backup in the event you drink more than you intended. Pump or hand express some milk before the festivities begin to hold baby over while the excess alcohol is processing through your body. 

 

References:

(1) Lauwers, J. & Swisher, A. (2015). Counseling the Nursing Mother: A Lactation Consultants Guide. Burlington, MA: Jones & Bartlett Learning.. 

(2) Mennella, J.A. (2001). Alcohol's effect on lactation. Retrieved from  https://pubs.niaaa.nih.gov/publications/arh25-3/230-234.htm

(3) Haastrup, M. et al. (2014). Alcohol and breastfeeding. Basic & Clinical Pharmacology & Toxicology, 114, 168-173. 

(4) Lawton, M.E. (1985). Alcohol in breast milk. Aust N Z J Obstet Gynaecol, 25, 71-73. 

(5) Kesaniemi, Y.A. (1974). Ethanol and acetaldehyde in the milk and peripheral blood of lactating women after ethanol administration. J Obstet Gynaecol Br Commonw, 81, 85-86. 

(6) Mennella, J.A. (1998). Short-term effects of maternal alcohol consumption on lactational performance. Alcohol Clin Exp Res, 22, 1389-1392. 

(7) Mennella, J.A. & Beauchamp, G.K. (1991). The transfer of alcohol to human milk. Effects of flavor and the infant's behavior. N Engl J Med, 325, 23-28. 

(8) Mennella, J.A. (2001). Regulation of milk intake after exposure to alcohol in mothers' milk. Alcohol Clin Exp Res, 25, 590-593. 

(9) Mennella, J.A. & Gerrish, C.J.  (1998). Exposure to alcohol in mothers' milk on infant sleep. Pediatrics, 101, E2. 

(10) Mennella, J.A. & Garcia-Gomez, P.L. (2001). Sleep disturbances after acute exposure to alcohol in mothers' milk. Alcohol, 25, 153-158.

(11) Little et al. (1989). Drinking and smoking at 3 months postpartum by lactation history. Paediatric and Perinatal Epidemiology, 4,  290- 302.

(12) Hale, T. (2003). Medications in Breastfeeding Mothers of Preterm Infants. Pediatri Ann, 32(5), 337-347. 

(13) NIH. (n.d.). What is a standard drink? Retrieved from https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/what-standard-drink