Do You Really Have to ‘Pump & Dump’?
The guidelines on drinking alcohol during pregnancy are pretty clear. But what about after the baby arrives? A lot of parents want to celebrate the new arrival with a glass of Champagne/a cold beer/an enormous mojito — and woe betide anyone who tries to tell 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 parents? Your baby may not be sharing your blood supply anymore, but they are drinking your breast milk. So we decided to cut through the contradictions and old wives' tales (sorry, beer doesn't increase milk production) to establish whether you really have to "pump and dump."
Breastfeeding moms have enjoyed alcohol in moderation throughout history (and at some stage, probably to excess; remember, 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 your breast milk at the same level as in your 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 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 the organization states, "[I]t’s best for women to avoid habitual use of alcohol while breastfeeding." The AAP also points to studies suggesting that consuming alcohol of any kind may decrease the amount of milk the baby drinks — and alcohol can potentially change the taste of breast milk, "making breastfeeding objectionable to some babies and decreasing the known positive effect associated with breastfeeding," says the AAP. It also recommends that a breastfeeding parent who wishes to drink alcohol does so just after nursing or expressing milk rather than before — and allows at least two hours per drink before the next breastfeeding or pumping session, to give the body as much time as possible to rid itself of the alcohol before the next feeding.
Although keeping in mind the timeframe around drinking and nursing is valuable, the most important factor is really the quantity of alcohol. Research has shown that small amounts of alcohol are considered to be unharmful to nursing babies — the key here is "small amounts." Again, there are no hard-and-fast rules, but the American Academy of Pediatrics recommends limiting 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." Seems reasonable enough.
It's also important to remember that a person’s size has an impact on how quickly they metabolize alcohol (a 160-pound person can metabolize alcohol more quickly than a 130-pound person). So 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 sober. If you're sober enough to drive, you're 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 3 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 parents with their eye on a glass of red at the end of a long, exhausting day comes from Dr. Jack Newman, 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."
Dr. Thomas W. Hale, another La Leche League International Health Advisory Council member, agrees that nursing parents can drink some alcohol and continue breastfeeding as usual without the need to "pump and dump." A better approach is to "pump and store" — express breast milk ahead of time and use it to feed the baby if you are concerned about how much alcohol you've 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 (remember all this from high school health class?). "Adult metabolism of alcohol is approximately 1 ounce in three 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 minimize 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 watching the clock is key, but moderation is even more important. If you go out to dinner and have a glass of wine, you’re absolutely fine to nurse your baby when you get home a couple of hours later. Cheers to that!