by Amy Spangler
December 14, 2008

Holiday spirit(s) takes on new meaning when you’re a breastfeeding mother being offered an alcoholic beverage. Yes, please, or no thank you can be a difficult choice when you consider all the conflicting information.

It’s okay, but…
The American Academy of Pediatrics (AAP) Committee on Drugs lists alcohol as usually compatible with breastfeeding, but cautions mothers about possible side effects in babies including “drowsiness, diaphoresis (heavy sweating), deep sleep, weakness, decrease in linear growth, and abnormal weight gain.” Not exactly a list of benefits.

In its 2005 policy statement, the AAP Section on Breastfeeding states, “Breastfeeding mothers should avoid the use of alcoholic beverages, because alcohol is concentrated in breast milk and its use can inhibit milk production. An occasional celebratory single, small alcoholic drink is acceptable, but breastfeeding should be avoided for two hours after the drink.”

“When the breastfeeding mother drinks occasionally or limits her consumption to one drink or less per day, the amount of alcohol her baby receives has not been proven to be harmful,” says La Leche League International in its book, The Womanly Art of Breastfeeding.

Yahoo! Answers states, “Choosing not to drink alcohol at all is always a positive, healthy choice. But be assured that 1–2 units of alcohol will not cause harm to your breastfeeding infant.”

Then and now
For years women were told to drink alcohol to increase their milk supply. In 1895, Malt Nutrine, a low-alcoholic beer made of barley malt and hops was sold exclusively in drugstores and prescribed by physicians as a means of increasing milk production. Recent research, however, suggests that rather than increasing milk production, alcohol may actually have the opposite effect.

Mennella and colleagues found that when women consumed the equivalent of 1–2 drinks, the milk ejection reflex was delayed and overall milk production was reduced.

Concerns have also been raised about alcohol’s long-term effects. A study published in the New England Journal of Medicine found that children whose mothers drank at least one drink a day while breastfeeding had lower motor development at 1 year of age compared to children whose mothers consumed less alcohol.

According to Thomas Hale, author of Medications and Mothers’ Milk, adults metabolize alcohol at the rate of 1 ounce in three hours, so mothers who drink moderate amounts can usually resume breastfeeding as soon as they feel “neurologically normal,” but chronic or heavy drinkers should not breastfeed.

The scope of the issue
How many breastfeeding moms actually drink? In a survey of breastfeeding mothers, each with a 3-month-old baby, 36 percent reported drinking alcohol, compared to 40 percent of non-breastfeeding mothers. Given this high incidence, it’s essential that breastfeeding mothers understand the facts associated with drinking so that they know what actions to take to keep their babies safe.

The facts

• When a breastfeeding mother consumes alcohol, about 2 percent is transferred from her blood into her milk.

• Alcohol is eliminated from breast milk and blood at similar rates. The amount of time it takes to eliminate all of the alcohol from breast milk depends on the amount of alcohol consumed and the mother’s body weight. Mothers are advised to wait 2–3 hours for each alcoholic drink consumed.

• Alcohol is not stored in breast milk. Pumping the breasts and discarding the milk, commonly referred to as “pumping and dumping,” does not lower the level of alcohol in the milk. The level of alcohol in a mother’s milk depends entirely upon the level of alcohol in her blood. Only time will lower the alcohol content of the blood and therefore the milk.

• Breastfed infants consume, on average, 20 percent less milk during the 3–4 hours after their mothers drink alcohol. The lower intake is thought to be caused by lower milk production by the mother during this time period, and not shorter periods of breastfeeding or changes in the composition or flavor of the milk, as was previously suggested.

• Infants sleep for shorter periods of time during the 3–4 hours after their mothers have had a drink, and spend less time in REM (rapid eye movement) sleep, the sleep stage when dreaming occurs.

• Less alcohol is better than more. Motor development at 1 year of age was slightly but significantly less in children whose mothers consumed one or more drinks a day. There was no difference in motor development between children of mothers who drank less than one drink a day compared to those who did not drink.

• Alcohol, like caffeine, may be metabolized (broken down) more slowly in babies compared to young children and adults. This would allow the alcohol to accumulate in the baby’s body and could explain why even small amounts of alcohol affect infant development (motor and mental).

• Age makes a difference. Babies born preterm are less able to metabolize alcohol than full-term babies. The same is true of young babies (those less than 6 months of age) compared to older babies (those 6 months of age and older).

Armed with the facts, breastfeeding moms can enjoy the spirit(s) of the holiday and keep their babies safe at the same time. It’s less about “no thank you” and “yes please” and more about “how much” and “how long”—how much alcohol you drink and how long you wait after drinking before breastfeeding. To be on the super safe side, consider the AAP recommendation and limit your intake to an occasional, single drink and wait at least two hours after drinking before breastfeeding.

Breastfeeding moms can have it all. They just can’t have it all at once.