Guest Post: Breastfeeding and Alcohol Consumption

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By Jennifer Heisleman Ingalls

wineBreastfeeding and alcohol…it’s the season for a holiday beverage or two. What’s a nursing mama to do? Many breastfeeding moms wonder if it is safe for them to have an occasional alcoholic beverage. Controversy and misinformation surrounds this topic. The conventional wisdom is to pump and dump. Or buy the alcohol “test strips.” Or even, “If you are safe enough to drive, you are safe enough to nurse.” But what happens if mama has a few drinks and feels tipsy, maybe not safe to drive…then baby wakes up to nurse? Is that safe? Is it worth the “risk?”

The breastfeeding and alcohol question is just another way that the mother-baby dyad is consistently and insidiously undermined, or “booby-trapped.”  It is so hard to know where to look for information, especially for evidence-based advice.  Part of the blame lies with our consumer based economy, which needs to have a product for every situation.  Our consumer based economy is constantly frustrated by breastfeeding mamas.  Oh dear, they make their own perfect baby food, quick, how can we get them to buy something they don’t need?!?  Whether the advice is to pump and dump (which doesn’t work and what a waste of precious milk!) or to buy the test strips (someone needs to make money off breastfeeding mamas some way) the end result is that women who consider having an alcoholic beverage while nursing are faced with guilt or shame.  Each breastfeeding mother who is considering having a glass of wine is just like every other mother; she simply wants what is best for her baby!  So, with all of the misinformation floating around many mothers either abstain altogether out of fear, or gently imbibe with great foreboding.   But neither guilt nor abstinence is necessary if you examine the physiology and pharmacology of breastmilk and alcohol metabolism.

When we look at the way alcohol is processed by the body, it helps to first look at how it is transferred into the breastmilk. Some drugs and medications stay in the breastmilk until the milk that contains them is expressed or consumed. These substances are where the “pump and dump” advice comes into play.  Alcohol doesn’t work like this. Alcohol in the blood maintains approximately a 1:1 ratio with the alcohol contained in the breastmilk. This means that if your blood alcohol content (BAC) is 0.08 (over the legal limit in California) then your breastmilk alcohol content is approximately 0.08%. Only eight one-hundredths of a percent of the breastmilk would contain alcohol. This 1:1 ratio also means that as you get more sober, your milk gets more “sober.” The liver is continuously processing the alcohol as it filters your blood, and the consistently dropping blood-alcohol level is mirrored by a consistently dropping breastmilk alcohol level.  Many mothers will have a glass of wine or two with dinner, and then be so concerned about the alcohol content of her milk that she will pump and dump with the mistaken belief that it is necessary to rid the breastmilk of the alcohol content.  But the liver is already metabolizing the ethanol and reducing the ethanol content of the breastmilk in a 1:1 fashion.  So there is absolutely no need to pump and dump your milk after drinking, or the next morning.  Not even if mama were to go out and get trashed. (Which I am not recommending).

More confusion comes into play when people confuse the all the numbers involved.  The proof of the alcoholic beverage involved does not directly equal the blood alcohol content of the mama drinking it.  There are more complicated things to consider including weight, number of drinks consumed, and rate of consumption.

Compare the alcohol content of the breastmilk of a legally intoxicated mama (0.08 BAC) to the alcohol content of orange juice is approximately 0.09% ethanol-by-volume (aka ABV).  The legally intoxicated mama will have breastmilk which has an ABV concentration that closely mirrors her BAC, approximately 0.08.  That means that mama’s breastmilk when legally intoxicated is less alcoholic than orange juice! And for mamas who only consume one alcohol beverage, their BAC (and thus the ABV of their breastmilk) is considerably lower than that found in even the most innocuous of fresh juices.  I can’t tell you how many times I have heard mamas say “Well, I will just pump and dump to be sure…” And the abundance of caution is certainly understandable.  But really, if the mother would feel comfortable with a child imbibing the alcohol concentration found in fresh juice, why even blink at the alcohol concentration in milk after a glass of wine.  It’s not logical.

So what’s the bottom line here?  It is safe to have a drink and breastfeed. Moderation in everything is key, and this should in no way be construed as encouraging mothers to become intoxicated. But the reality of the science is that even when legally intoxicated, the mother would only pose a threat to the infant through loss of motor function (dropping baby, rolling over on it, etc) and not through the alcohol content of her breastmilk.  Indeed, the motor impairment of an intoxicated mother is my major concern when mothers choose to drink, rather than the risk of exposing the child to miniscule, infinitesimal concentrations of alcohol.

If you would like to see what your BAC would be after that one glass of wine, for example, please check out this link.  I plugged a few of my personal numbers into the handy-dandy calculator for a real-life example (like the one right here: http://oade.nd.edu/educate-yourself-alcohol/blood-alcohol-concentration/bac-calculator/).

Personal Case Study: I am a 123# woman who loves to have a Guinness every now and then. After baby goes to sleep I have a 12 oz. bottle of Guinness and watch a movie with DH. She wakes up fussing two hours later.  Am I safe to nurse? Yes! My blood alcohol content is only 0.004948576955424729%… which is less than five-one-thousandths of a percent alcoholic. Infinitesimal.  No pumping and dumping (which doesn’t work anyway as the alcohol has to be metabolized out).  No spending money on test strips.  No fear-mongering.

 

About the Author: In real life, Crunchy Mama Jenn is Jennifer Heisleman Ingalls. A Registered Nurse, Jennifer obtained her M.S.N from the University of San Francisco, with a specialization in Clinical Nurse Leadership and also has a post-licensure certification in Oncology. Jennifer has worked in pediatrics, oncology, stem-cell transplant, infusion therapy, vascular access, and most recently as an Assistant Professor of Registered Nursing. But her favorite “job” and truest calling is as mother of Ashlin Hope, and wife to Kent, a career Merchant Marine officer.

[Image Credit: Live Strong]

Comments

  1. Jespren says

    And you’d have to be quite smashed, almost twice the legal limit, to equal the alcoholic content of that childhood favorite, apple juice, which clocks in at a *gasp* .14% alcohol.
    Great piece. :)

  2. Malia says

    I am from a family that makes alcohol for a living. I work in my families tasting room and have brought my LO along since she was born. My LO is 23 months old and a BF toddler. Alcohol consumption has always been a topic for me and my family. I am a strong believer in mothers intuition and knowing your body and your baby. My LO was strong, hearty, chunky and thriving without a doubt, my concern with consuming alcohol (wine) was very low on my priority list. I have consumed small to large amounts of alcohol and have never seen an effect on my child. The only effect noticed was on my milk production, if you are dehydrated you will not make milk. Of course safety is an issue but never did I ever feel that I was not attentive or in tune with my child. I grew up in the wine industry and alcohol is a part of our daily lives, I have a health respect for alcohol and also an understanding of how it negatively effects others with addiction. The bottom line is trust your gut and use moderation. Alcohol like many other things can be and should be used medicinally for relaxation, enjoyment and health. As for me I think it benefits my relationships as a mother and wife. Thank you for writing this article and making having a glass or two of wine a little less taboo.

  3. Jenna says

    I have never commented on article, but today I am making an exception. Thank you! Thank you! Thank you! Before I was pregnant, my family called me the wine princess, since I loved having a very nice (read expensive) glass of wine at dinner. After having my daughter, I have been frought with worry and guilt as I asked for a “splash” of wine, and I wouldn’t even finish it because I knew my high needs girl would need to nurse soon (she’s 4 months and going though teething and a miracle week). I tried those test strips and it seems if I have ANY trace of alcohol, they detect it and make you feel like a shitty mom for nursing your obviously hungry/upset baby. Thank you so much for setting my mind at ease! Y gut told me this was the truth, but I needed to hear it from someone else

  4. Anna says

    Where’s your source for these assertions? Without a source, this is just more advice not based on evidence, which is worthless, as you’ve pointed out.

      • Anna says

        Interesting article, thanks. I tried to go to the source website, and it’s unfortunately not available without a subscription. That’s a shame, because it looks like the “galactopharmacopedia” has a lot of interesting research. It’s too bad that information isn’t more freely available to the people who could use it to make real-world decisions. As pointed out here, it is very difficult to find evidence-based information on breastfeeding.

        The article uses the same information to come to the complete opposite conclusion, which is also interesting. Of note is a study mentioned that found a decrease in motor skills of infants in a test group, even when the mother was not a heavy drinker.

        I don’t have a dog in the fight, as I’m not a breastfeeding mother at this time, nor do I generally care what other mothers choose to do. I do have an opinion on the topic, but you know what they say about opinions. :) Interestingly, my opinion was not changed even though I have learned something I didn’t know before. That just tells me that my “gut” on this one was right.

        I think it illustrates a great point though, that when you make a decision like this, you shouldn’t take some one else’s conclusions at face value. Go to the source and read up on the facts, and make your own conclusion. Some may end up agreeing with the conclusion of this guest post, others may end up agreeing with the conclusion of the article.

        Statistics and study results can easily be manipulated to suit the agenda of whomever is citing them. It’s unfortunate that so many of us have been conditioned not to question medical advice in the US and we completely turn off our own reasoning when someone in a white coat tells us how things should be.

        I love that it’s popular right now to encourage breastfeeding and other “natural” parenting styles, and be more cautious about certain medical decisions that are publicly promoted by one agency or another (which shall not be named at risk of derailing the topic). Even if it’s still on the fringes, hopefully the spirit of making your own decisions based on what’s best for our individual families, and not on what we’re told, will catch on and be more widespread in the current and next generation of parents.

        I am interested in whether there’s been any more recent research on the topic. This was published in 1995 and I’m sure we have better technology for researching such things now, almost 20 years later.

        • says

          They’ve actually tried to replicate that one study on motor movement and no one has been able to (see http://pediatrics.aappublications.org/content/109/5/e72.long). There is the one issue here of how much during the first 3 months as the baby’s liver isn’t fully developed yet so it processes alcohol in lower rates than adults do, even considering their size. At 3 months it has developed but one must still take into account the infant’s weight.

          However, almost all things I’ve read from breastfeeding sources say not to worry at all about moderate amounts of alcohol, just don’t overdo it. More mainstream sources will try and tell you otherwise. However, I didn’t find the article cited coming to the opposite conclusion, just rather using the more “cover-your-ass” advice that public opinion pieces will share which is just to wait 2 hours per drink. That’s a common one and most people I’ve heard throw it out then privately tell you not to worry about it ;) However, the article didn’t say not to drink at all.

          One other thing about the Anderson article – if you check the references, many are from the late 80s early 90s when we had a panic over alcohol use around infants at all and much of which has been altered in more recent research – like the 2002 inability to replicate I just shared above.

          But you’re absolutely right to read the actual research (when possible, which is why I try to share it here) and come to your own conclusions. What you have spelled out for me is that I absolutely should do my own review of the research here on this topic :)

  5. Susie says

    I really enjoyed this article – thanks!!!! Can anyone shed light on whether the same rationale applies to caffeine? If not, why would it be different?

  6. says

    I don’t think if you as long as you keep it to one or two drinks it would be ok but just don’t go over board. That is just being a responsible parent. I enjoy a glass of wine every now and then but I could hold of until I was done breastfeeding.

  7. Astrid says

    Thank goodness, used to have a glass of wine in the evening when breast feeding my daughter for eighteen months. Still have the glass of wine when preparing dinner. Have done for the last eighteen years.

  8. andrea says

    So, I have a few questions. Not sure if I just didn’t understand from the article (it’s late!) or wasn’t mentioned.

    My understanding from my breastfeeding training tells me that breastmilk is converted from blood. Does this blood go through the liver first to be filtered (before milk is produced)?

    If not, milk is STORED in the breast, then can’t the milk that had alcohol from when you were first drinking be stored in the breast and the milk would still have alcohol? Obviously the milk that was produced after liver filter would be fine. The blood flows in a circular system in our body, which explains the alcohol dropping levels in the blood. However, breastmilk does NOT flow through the body repeatedly to be filtered. There would only be *one* filtering, and possibly none *if* the milk is produced from the blood before it has a chance to reach the liver. I’m not saying that IS what happens, I’m just curious, and I didn’t see the article address that. It just assumed that since blood alcohol content continuously drops, so does the content in the milk.

    Or does the alcohol kind of evaporate from the milk?

    • says

      I believe your understanding is off. From KellyMom (and an ICBC): “Alcohol does not accumulate in breastmilk, but leaves the milk as it leaves the blood; so when your blood alcohol levels are back down, so are your milk alcohol levels.”

      • Andrea says

        Thanks Tracy but that still doesn’t answer my question (or I don’t understand).

        From the article posted here on this page, it says blood alcohol is filtered through the liver.

        If alcohol “leaves the milk as it leaves the blood” as stated from the Kellymom quote, then the question is what is that “same way” in which it leaves?

        Either one of two things is happening: either the body produces breastmilk AFTER the blood is filtered through the liver, and then there is no concern OR

        If the body produces milk from the blood BEFORE it has a chance to filter, then that means there could be a high content of alcohol in a portion of the breastmilk that was made and went to the breast before it had a chance to be filtered.

        Another possibility is the alcohol is filtered out some other way.

        I hope my question makes sense. Again, the key is *how* the alcohol leaves the body. Of course it wouldn’t *accumulate* because the alcohol levels would continuously go down as the alcohol levels in the blood goes down and new milk is made from it. But couldn’t it remain in the milk that is *first* produced before levels go down as how I explained above?

        • says

          Now I see your question – sorry I was confused before. I don’t know the answer of exactly how it metabolizes, but there is clearly a third option because measuring alcohol in breastmilk has shown us that it is metabolized at the same rate as it is in the bloodstream. It may be an issue of when the milk is made, but I couldn’t tell you!!

        • Louise says

          Alcohol moves /diffuses from an area of greater concentration to an area of lesser concentration. Like osmosis? As alcohol leaves blood via liver, then the alcohol will leave the milk into the blood.

  9. Jennifer Heisleman Ingalls, RN, MSN, OCN, CNL says

    • Tiffany says

      Fantastic topic & discussion, really got me thinking. I am on-board with the idea that we over-state the effects of a glass of wine to a lactating mother’s milk. But now I’m curious. If we apply the BAC caluculator to an infant, of only 10-20lbs, what does consumption of 4oz of a milk at 0.08% ABV imply for the baby’s blood alcohol? I ran the numbers & for a 15lb baby drinking 4oz in 1/2 an hour their theoretical BAC came out to 0.0164. What does this mean for a still developing infant? I’m certainly not qualified to make any assumptions. Just food for thought. There’s so much development in those first few months, is it a hugely moving target? The juice comparison is a great one, but most infants aren’t drinking juice in those early months anyway.
      Again, I don’t mean this to be negative, more as curiosity of what’s been considered. My scientific curiousity sometimes leads to overly nit-picking on subjects that are already over-simplified. I’m appreciate for this article, that it gives some MEANINGFUL + LOGICAL explanation to help Moms make their decisions.

      • Tiffany says

        *Apologies – Need to fix my numbers. The estimated baby BAC was done using a 4oz beverage at 1% alcohol by volume over 1/2 hour (when tried at 0.08% the estimation gave a negative output).

  10. A says

    Well written article but I would like to see more evidence based research on the long term effects on children whose mothers drink during breast-feeding. How can you tell if your baby is “all right” when you don’t know what’s happening to brain cells? Research needs to be done on older kids/ adults to see if there are any long term differences such as increased neuromuscular diseases, cancers, organ impairments, even IQ! Here’s a thought- obviously not going to be popular, but just don’t drink while you’re breast-feeding! It’s only six-months to one-year (per child of course) out of your life without drinking alcohol.

    • says

      Well, the issue is more complex. We know NOT drinking is associated with worse outcomes for people so there’s that to contend with. There’s also the fact that many people don’t breastfeed because they want to enjoy a glass of wine and so what is the detriment from that point of view? Then of course there’s the idea that it’s “only six-months to one-year” per child. My daughter will be 4 in June and is still nursing…

Trackbacks

  1. […] Jennifer Heisleman Ingalls wrote an article on alcohol consumption for Evolutionary Parenting, which stated: “The alcohol content of the breastmilk of a legally intoxicated mama (0.08 BAC) to the alcohol content of orange juice is approximately 0.09% ethanol-by-volume (aka ABV).  The legally intoxicated mama will have breastmilk which has an ABV concentration that closely mirrors her BAC, approximately 0.08.  That means that mama’s breastmilk when legally intoxicated is less alcoholic than orange juice! And for mamas who only consume one alcohol beverage, their BAC (and thus the ABV of their breastmilk) is considerably lower than that found in even the most innocuous of fresh juices.” […]

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