Alcohol and breastfeeding

Although the guidelines around drinking alcohol whilst pregnant are very clear e.g. there is no considered “safe” level, the recommendations when breastfeeding are not so clear cut. Because whilst most researchers still defer to the safest position and say that it is best to avoid any alcohol, many acknowledge that some women will still choose to drink even though they are breastfeeding.

The National Health and Medical Research Council (NHMRC) recommend that the safest option for breastfeeding mothers is not to drink alcohol.

Alcohol is rapidly absorbed by the human body. In breastfeeding mothers, the concentration of alcohol peaks within 30-60 minutes after they have been drinking. If the mother eats food at the same time as drinking alcohol, then it takes longer to peak e.g. 60-90 minutes.

Facts about alcohol and breastfeeding

• Breastfeeding and alcohol do not mix.
• There can be long standing health and development issues in babies/children whose mothers drank alcohol whilst they were breastfeeding.
• Alcohol crosses the bloodstream into breastmilk and is not filtered out. The mother’s blood alcohol level closes matches the alcohol level in her breast milk.
• A mother’s weight and size has a direct effect on how quickly her body metabolises alcohol. Essentially, the smaller the mother’s stature, the longer it takes for her body to process any alcohol intake.
• Babies do not have the physical size or metabolic maturity to filter out any alcohol to which they are exposed. This magnifies the effects of alcohol within their body.
• There is no safe time during breastfeeding when alcohol exposure is considered less risky.
• However old the breastfed baby, there are benefits to them when their mother stops drinking.
• Individual babies react uniquely to alcohol exposure. It is impossible to predict how each baby will be affected by their mother’s alcohol intake. For this reason it is safest to adopt a “no drinking” stance.

How will alcohol affect me if I’m breastfeeding?

• Alcohol may reduce the amount of milk which you are producing for your baby.
• Alcohol can inhibit (stop or slow down) the let-down or milk ejection reflex.
• Many women find their tolerance for drinking alcohol changes after they have had their baby. Your taste of alcohol, enjoyment and ability to relax and unwind may not be at the same level as before you had your baby.
• You may not be able to care for your baby in the same way or with as much attention as if you had not been drinking alcohol.
• If you have been drinking alcohol you will not be able to drive or transport your baby to hospital or for medical care if they need it. It is important to organize another responsible adult to be available if necessary.

How will alcohol affect my breastfed baby?

• Alcohol can affect the feeding behaviour of a breastfed baby. They may become sleepier and not feed as actively. This can impact on the mother’s milk supply.
• Over time, your baby may not be able to reach their developmental milestones at the appropriate age.

Recommendations if you choose to drink alcohol

• Avoid drinking in the first month of your baby’s life. Alcohol can impact on the establishment of breastfeeding and reduce milk supply.
• Do not exceed two standard drinks each day and even then, aim not to drink every day.
• Measure your intake and plan beforehand how much you will be drinking.
• Avoid drinking alcohol just before you feed your baby as this will maximise the amount of alcohol they are exposed to. Allow between a couple and a few hours from when you have finished your drink until when you need to breastfeed again.
• You may consider expressing your breastmilk before you drink and not breastfeeding if you plan to drink.
• If you are concerned about your baby breastfeeding after you have been drinking alcohol, you could consider expressing your milk and discarding it. Feeding them previously expressed breastmilk or formula is an alternative.
• Some health professionals believe that when a mother is faced with a choice, it is better for her baby to have breastmilk which has a small amount of alcohol in it than for them to have formula milk.
• Eat meals and snacks when you are drinking alcohol and breastfeeding. It is important not to drink “on an empty stomach” and to keep your blood sugar level within a healthy range.

What is a standard drink?

A standard drink is one which contains 10 grams of pure alcohol. The information labels on bottles and cans of alcoholic drinks state how many standard drinks each one contains. However, there is no consistent serving glass size in Australia and therefore, the amount of alcohol contained in each drink is dependent on how it is served.

It takes around 2 hours for a woman of a standard weight to process the alcohol in one standard drink. For each subsequent drink, it takes another 2 hours e.g. for 1 one standard drink 2 hours; for 2 standard drinks 4 hours and so on.

The amount of alcohol that passes to breastmilk is roughly equivalent to the mother’s blood alcohol level. It appears that acetaldehyde (the toxic metabolite from alcohol) may also pass into breastmilk. Studies show that within 30 minutes just one standard drink alters breastmilk and can have a mildly sedative effect on baby as well as reducing mother’s letdown reflex. Alcohol may interfere with the release of oxytocin in many lactating women. Also, a sleepy infant is less likely to be able to suck and, of course, drowsiness in babies is not ideal with concerns about SIDS.

Research suggests that motor development is also impaired in infants exposed to alcohol through breastmilk and with the reduced ability for infants, particularly very young infants, to detoxify alcohol, the ramifications for development are potentially huge.

Other concerns with alcohol consumption include its possible link with mother’s inability to cope and potential depression – alcohol has a depressive effect on our systems. Being nutritionally empty, alcohol can reduce appetite and replace food; combining these effects we begin to see a potentially negative spiralling effect on the mother-baby relationship.

While breastfeeding it is best to avoid alcohol intake (particularly in the first three months) and, at most, lactating mothers should consume no more than two standard drinks in a day. However, if mother wishes to have a small drink or requires a drink for whatever reason (personal, religious or other), some strategies that can be provided to her to reduce the effects include:

• Choosing a low-alcohol drink.
• Eating before drinking.
• Avoiding breastfeeding for two to three hours after a drink.
• Expressing and storing a feed for baby instead of breastfeeding.
• Diluting the alcohol with juice, water or ice.

Guidelines (endorsed by the Ministerial Council for Drug Strategy) suggest if you choose to drink you should have no more than seven standard drinks a week and no more than two a day. But some health groups believe that this is too lax, and may send the wrong message. The New Zealand Government updated its policy recently and now recommends a zero alcohol intake for breastfeeding mothers.

For more information on alcohol and breastfeeding

• Speak with your child health nurse or GP.
• Ring the 24 hour National Breastfeeding Helpline on 1800 6862686
• Check www.alcohol.gov.au
• Check the breastfeeding and alcohol guidelines