The guidelines on drinking alcohol during pregnancy are pretty clear. But what about after the baby arrives? A lot of moms want to celebrate the new arrival with a glass of champagne/a cold beer/an enormous mojito — and woe betide anyone who tries them they don’t deserve it after everything they’ve gone through to ensure their little ones make it safely into the world.
Where does that leave nursing moms? Their baby may not be sharing their blood supply anymore, but they are drinking their breast milk. We cut through the contradictions and old wives' tales — sorry, beer doesn't increase milk production — to establish exactly whether you have to "pump and dump."
Breastfeeding moms have enjoyed alcohol in moderation throughout history (and at some stage, probably to excess — it wasn't so long ago that pregnant women were allowed to smoke in maternity wards), but the risk of drinking while breastfeeding remains unclear. What we know for sure is that alcohol is present in a woman’s milk at the same level as in her blood (and rises and falls along with it.) So if you know your blood alcohol level, you know your milk alcohol level. Alcohol passes freely into mother’s milk and has been found to peak about 30 to 60 minutes after consumption. When an alcoholic drink is taken with food, the absorption rate into the bloodstream decreases, peaking about 60 to 90 minutes after consumption.
According to the American Academy of Pediatrics, alcohol is not a contraindication to breastfeeding, although they state that "it’s best for women to avoid habitual use of alcohol while breastfeeding", point to studies suggesting that consuming alcohol of any kind may decrease the amount of milk the baby drinks, and claim that alcohol can change the taste of breast milk, "making breastfeeding objectionable to some babies and decreasing the known positive effect associated with breastfeeding." The AAP recommends that a woman who wishes to drink alcohol does so just after she has nursed or expressed milk rather than before, and allows at least 2 hours per drink before the next breastfeeding or pumping session to give the body has as much time as possible to rid itself of the alcohol before the next feeding.
As well as the time frame between drinking and nursing, the quantity of alcohol is crucial. Research has shown that small amounts of alcohol are considered to not be harmful to your nursing baby, but the key here is "small amounts." Again, there are no hard-and-fast rules, but the American Academy of Pediatrics recommends limiting "occasional" alcohol intake to "no more than 0.5 g alcohol per kg body weight, which for a 60 kg [132 lbs] mother is approximately 2 oz liquor, 8 oz wine, or 2 beers."
It's also important to remember that a person’s size has an impact on how quickly they metabolize alcohol (a 160 lbs woman person can metabolize alcohol more quickly than a 130 lbs woman). It really comes down to common sense: don't drink to excess when you're nursing, and if you do, don't breastfeed your baby until you're completely sober. (If you're sober enough to drive, you're probably sober enough to breastfeed.)
The age of your baby is also important. A newborn has a very immature liver, so even tiny amounts of alcohol would be more of a burden. Up until around three months of age, infants detoxify alcohol at around half the rate of an adult, while an older baby or toddler can metabolize the alcohol more quickly.
Good news for nursing moms with their eye on a glass of red at the end of a long, exhausting day comes from Dr. Jack Newman MD, FRCPC, a member of La Leche League International’s Health Advisory Council. In his handout More Breastfeeding Myths, Newman writes: "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., another La League League International Health Advisory Council member, agrees that a mom can drink some alcohol and continue breastfeeding as she normally does, without the need to "pump and dump." A better approach is for a mom to "pump and store" — express breastmilk ahead of time and use it to feed her baby if she is concerned about how much alcohol she has consumed. "Alternatively, a mother can wait for the alcohol to clear from her system," suggests Hale. "If her breasts become full while waiting she can hand express or pump, discarding the milk expressed, but this will not speed up the elimination of alcohol from the body."
Just like 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. "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," says Hale. "If a woman wants to minimise the alcohol her baby gets she can try nursing right before having a drink: milk will be alcohol-free again within two or three hours."
The bottom line on drinking while breastfeeding is that moderation is key, but watching the clock is even more important. If you go out to dinner and have a glass of wine, you’re probably absolutely fine to nurse your baby when you get home. Cheers!
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