The Safest Ways to Drink While Breastfeeding

There may be a special occasion coming up during which you would like to have a few drinks. Learn how alcohol affects breast milk, the effects this can have on a breastfed baby, and the steps you can take to minimize any risk to your baby.

Is it safe to drink while breastfeeding?

While the harmful effects of drinking alcohol while pregnant have been well documented, the effects of small to moderate amounts of alcohol on breastfed babies remain uncertain. Serious side effects have been noted if alcohol is consumed in large amounts.

Although occasional drinking while breastfeeding has not been associated with measurable harm to babies the possibility of harmful effects has not been ruled out. Therefore, the general consensus seems to be that limiting consumption to 1 or 2 drinks and carefully timing the next feeding to minimize the baby's exposure to alcohol is a safer option where a nursing mother chooses to drink.

How to minimize the risk

The amount of alcohol consumed and timing in relation to breastfeeding will affect the amount of alcohol your baby receives. If you choose to drink alcohol, minimize your baby's exposure by....

Limiting your alcohol intake to 1 or 2 standard drinks (or less).
Avoid drinking on an empty stomach.
Drink after nursing and not before.
Delay the next breastfeed for several hours after drinking, until the alcohol has been eliminated from your body (including your milk).
If you are planning on having a few drinks, plan ahead and have expressed breast milk stored for the occasion.

Just how long before it's safe to breastfeed again following alcohol consumption depends on how many drinks you have. Variations in timing are subject to many individual differences. (See 'What influences blood alcohol concentration' further below.)

1 drink = 2 to 3 hours
2 drinks = 4 to 5½ hours
3 drinks = 6 to 8 hours
4 drinks = 9 to 11½ hours
5 drinks = 11 to 14 hours

Please note: These time frames are estimations for 'standard' drinks, each equivalent to 10 grams of alcohol.

Effect on babies

An occasional alcoholic beverage (1 - 2 drinks or less) by a nursing mother has not been found to be harmful to her baby.

Daily moderate to heavy alcohol consumption (more than 2 drinks) by a nursing mother may result in slow weight gain, delayed muscular and motor development and delayed early learning. In large doses, alcohol can act as a depressant on a baby's central nervous system causing drowsiness, deep sleep, weakness and depression of the respiratory system.

Binge drinking may reduce a mother's ability to be aware of her baby's safety needs. Mothers who have consumed moderate to large amounts of alcohol should not take their baby to bed with them.

How to measure alcohol content in different drinks

Because different alcoholic beverages contain varying amounts of ethanol (alcohol) they are often measured or compared as 'standard' drinks. 1 standard drink = 10 grams of alcohol. The following contain approximately 10 grams of alcohol:

A 12-ounce (340 ml) bottle or can of regular beer.
A 5-ounce (140 ml) glass of wine.
1½ ounces (45 ml) of 80 proof distilled spirits (either straight or in a mixed drink).

Myths

1. Alcohol increases lactation

FALSE: For centuries many different cultures have encouraged nursing mothers to drink beer or other alcohol shortly before nursing as it was believed to help the mother relax, aid her let-down (milk-ejection reflex) and increase her milk supply. Contrary to these beliefs, studies have shown that alcohol consumption may interfere with a mother's let-down. This may mean her baby receives less milk and consequently decrease the mother's milk production. While this may not be problematic when a nursing mother drinks only occasionally, regular alcohol consumption has been shown to negatively affect babies' growth.

2. Maternal acohol consumption increases the risk of SIDS

TRUE & FALSE: Although heavy alcohol consumption may increase the risk of SIDS (Sudden Infant Death Syndrome), because it will depress the baby's 's central nervous system and ability to respond, several studies published in the August 1999 edition of the 'Archives of Disease in Childhood' showed no increased risk of SIDS from small to moderate alcohol consumption (1 or 2 drinks).

3. Alcohol can help a baby to relax

FALSE: Nursing mothers are sometimes advised to consume small amounts of alcohol based on the assumption that the alcohol in breastmilk will relax and calm a fussy baby and/or promote the baby's sleep. However, research has found that exposure to alcohol in mother's milk alters an baby's sleep-wake patterns, resulting in significantly shorter sleep periods in the hours following nursing.

WARNING: Alcohol should NEVER be given directly to babies or children. Alcohol contained in breastmilk is very dilute compared to that in a bottle. Giving alcohol directly to an baby or child is extremely dangerous.

Is it necessary to 'pump and dump'?

The common practice of pumping (expressing) the breast and then discarding the milk immediately after drinking alcohol will not eliminate alcohol from your milk, as newly produced milk will still contain alcohol for as long as your blood contains measurable levels of alcohol.

The concentration of alcohol in your breast milk matches the concentration of alcohol in your blood. As your blood alcohol concentration falls so to will the concentration of alcohol in your milk. So there is no benefit to the practice of pumping and dumping your milk after drinking alcohol other than to allow for your comfort and reduce the risk of engorgement if you need to delay breastfeeding due to alcohol consumption.

If your baby usually breastfeeds during the time period that it takes for your body to remove the alcohol from your blood (and milk), you may want to pump your milk and discard it. Then again, if your baby doesn't normally breastfeed during the time it takes your body to remove the alcohol there is no reason to pump and dump.

How the body absorbs & eliminates alcohol

When alcohol is consumed it passes from the stomach and intestines into the blood stream, a process referred to as absorption. Once absorbed, alcohol does not remain solely in the blood stream but spontaneously distributes into body organs, tissues and fluids (including breast milk). However, alcohol remains there, only temporarily. The amount is directly related to the concentration of alcohol in the blood stream. As blood alcohol concentration rises and declines so to does the amount of alcohol in body organs, tissues and fluids.

The liver detoxifies 90 to 95% of alcohol in the blood stream. The remaining 5 to 10% is excreted through sweat, saliva, urine and breath. As blood enters the liver, enzymes begin to metabolize (break down) the alcohol. However, the liver can only metabolize a limited amount of alcohol per hour regardless of the amount that has been consumed. It doesn't breakdown faster with increased volumes. Therefore the more alcohol consumed, the longer it takes for it to be eliminated from the body.

Since alcohol is eliminated more slowly than it is absorbed, consumption needs to be controlled to prevent accumulation in the body and intoxication. When alcohol is consumed in excess, blood alcohol concentration can reach toxic levels causing permanent organ damage. There can be considerable individual differences in both the timing of peak levels of blood alcohol concentration as well as alcohol elimination rates. (See 'What affects blood alcohol concentration' further below).

After alcohol consumption has ceased, the liver is eventually able to able to catch up. Only after all the alcohol has been absorbed from the digestive tract into the blood stream and then metabolized by the liver does the person sober up.

Contrary to common belief that some activities may speed up the elimination process, such as drinking water, showers, fresh air, resting or even 'pumping and dumping', these activities will not accelerate the removal of alcohol from the blood stream or breast milk.

How this affects a breastfed baby!

The alcohol concentration of breast milk will match that of the mother's blood alcohol concentration. Alcohol does not go into breast milk and stay there; it goes in and comes out. As blood alcohol concentration rises and decreases so too does the concentration of alcohol in breast milk.

If a mother limits alcohol consumption, drinks after feeding and allows sufficient time for the alcohol to be eliminated from her body before the next feeding, she can significantly minimize her baby's expose to alcohol. Even at peak levels an baby is exposed to only a fraction of the alcohol the mother ingests. 1 standard drink may raise a mother's blood alcohol level and her breast milk to approximately 0.03% - 0.04%, which is far less than the proof on the bottle.

A baby's body goes though the same process of alcohol elimination as does an adult's. However, the baby's level of maturity will affect his/her ability to detoxify alcohol. In their first weeks of life a baby's liver can only break down the alcohol at half the rate of an adult. A young baby (less than 3 months) will be affected more by alcohol than an older baby due to difference in elimination rates.

What influences blood alcohol concentration?

The concentration of alcohol in your breast milk will closely match that of your blood (not the proof in the bottle). Your blood alcohol level is influenced by many different factors...

1. The amount of alcohol consumed

Obviously the amount of alcohol consumed will affect blood alcohol concentration. It's not the size of the glass that counts; it's the total amount and percentage of alcohol in the drink. 1 standard drink = 10 grams of alcohol. (See 'How to measure alcohol content in different drinks' further above).

2. Length of time over which alcohol is consumed

Your liver is only able to metabolize (break down) a limited amount of alcohol per hour; therefore, consuming multiple drinks within a short space of time will increase your blood alcohol concentration to higher level than if drinks were consumed over a number of hours.

3. Food

The presence of food and the type of food in your gastro-intestinal tract when alcohol is consumed will affect how quickly alcohol is absorbed into your blood stream. Food (in particular high-fat foods) slows down the rate at which alcohol is absorbed from your intestines. The slower alcohol is absorbed, the lower the blood alcohol concentration level reached.

When consumed on an empty stomach peak blood alcohol concentration from 1 drink may be reached in as little as 30 to 40 minutes. When large quantities of food are eaten with the alcohol it can take up to 90 minutes for peak levels to be reached. (The slower the absorption, the lower the level reached.)

4. Gender

Water content affects the rate at which alcohol is metabolized. The higher the water content the lower the alcohol concentration. The difference in blood alcohol concentration between women and men has been attributed to women's smaller amount of body water.

5. Body tissue

Different body tissues absorb alcohol at different rates; e.g. muscle tissue absorbs alcohol more rapidly than fat tissue. The absorption into muscle tissue would mean there is less alcohol circulating in the blood stream. Since women generally have more body fat than men, a woman would have a higher blood alcohol concentration than would a man of the same weight.

6. Body weight

The lighter you weigh the longer it will take your body to metabolize the same amount of alcohol; e.g. if you weighed 100lb (45kgs) it will take approx 3.1 hours to metabolize 1 standard drink. If you weighed 160lb (72kgs) it will take approx 1.9 hours.

7. Hormonal changes

It has been claimed that a women's menstrual cycle can influence the rate of absorption of alcohol. Low levels of estrogen have been associated with a higher blood alcohol concentration. When a woman has stopped menstruating due to breastfeeding, her estrogen levels are low.

However, a Brazilian study that compared alcohol absorption in lactating and non-lactating women demonstrated that even when matched for age, size and ethnic group, lactating women had slower absorption rates than non-lactating women.

8. Emotional state

Fear, anxiety or stress can all affect absorption and elimination rates.

9. Medications

Use of aspirin products can increase intoxication by interfering with the break down of alcohol.

WARNING: Additional care needs to be taken if you are currently taking any medications. Many medications react with alcohol. Protect yourself and your baby by avoiding alcohol if you are taking a medication and don't know its effect. Talk to your pharmacist or health care provider if you are currently taking medications, before you drink.

Written by Rowena Bennett