Alcohol & Breastfeeding
by Susan Miller

You carefully avoided alcohol during pregnancy and now you are a nursing mother. Especially now that the holiday season is here, you may wonder if it is OK to indulge in the occasional alcoholic drink. Over the years there have been various recommendations and cautions around the consumption of alcohol while breastfeeding. Today you will also find conflicting information on this subject.

A reliable source of up-to-date information is the MOTHERISK Program at the Hospital for Sick Children in Toronto. Since 1985, MOTHERISK which is also affiliated with the University of Toronto has been providing guidance and evidence-based information on the risks to the developing fetus or infant from exposure to drugs, chemicals, diseases and environmental agents. In regard to alcohol consumption and breastfeeding, MOTHERISK provides a desk reference for health care providers with pertinent information on breastfeeding and alcohol consumption. This information was first published in the Canadian Family Physician. Here is a summary of the latest information on alcohol consumption and breastfeeding.

Less than 2% of the alcohol consumed by the mother enters her breastmilk. The alcohol content in breastmilk is the same as in the mother’s blood (blood alcohol level). If a breastfeeding mother has an occasional alcoholic drink, this has not been shown to be harmful to her breastfed infant. A single alcoholic drink may alter the odour or taste of the mother’s breastmilk and the alcohol that passes into the breastmilk may have a mildly sedating effect on the baby. One to two drinks a week is considered a reasonable intake of alcohol for a breastfeeding mother. In his book The Ultimate Breastfeeding Book of Answers, Dr. Jack Newman, a pediatrician and Canada’s leading authority on breastfeeding, states that “Reasonable alcohol intake should not be discouraged at all... Prohibiting alcohol is another way to make life unnecessarily restrictive for nursing mothers.”
 
Ideally it is best to drink right after breastfeeding, and to avoid breastfeeding for about 2 to 3 hours after one alcoholic drink. The concentration of alcohol in the mother’s blood and breastmilk peaks at 30-60 minutes after consumption. Alcohol does not stay in the mother’s milk over time. The process that clears alcohol out of her bloodstream over a few hours also clears alcohol out of her milk. In the hours immediately following consumption of alcohol, mom may want to pump and dump her milk to relieve the overfull feeling in her breasts and to avoid the risk of developing a plugged duct or mastitis.

It is also important to consider the age of the infant who could be receiving some alcohol through breastmilk. Newborns and babies under three months of age have an immature liver and metabolize alcohol at about half the rate of an adult. Older babies and toddlers can metabolize the alcohol much more quickly than a baby of less than three months. Mothers of very young babies need to be especially cautious about alcohol consumption and breastfeeding.

The weight of the mother has an effect on how quickly her body clears alcohol from her blood and breastmilk. As an example, it will take 2 hrs and 36 min for a 110lb woman to clear the alcohol from one drink from her blood and breastmilk while it only takes 2 hrs and 1 min for a 180lb woman to clear the same amount of alcohol. If this same 180 lb woman consumed three drinks in one hour it would take 6 hrs and 5 min for the alcohol to clear her system. Simply put, the more drinks mom has, the longer it l takes for the alcohol to be cleared from the breastmilk. If mom drinks a lot of alcohol over a few hours she cannot safely breastfeed her baby for many hours. If mom knows ahead of time that she will be having a lot to drink, she should have an alternate feeding plan in place for her baby. If her baby takes a bottle, he could have feedings of stored expressed breast milk or formula.

One drink is defined as 12oz of 5% beer, 5oz of 11% wine or 1.5 oz of 40% liquor. For a detailed table on mother’s body weight, number of drinks and alcohol metabolism over time, go to the MOTHERISK website and look under “Drinking Alcohol while Breastfeeding.”

Eating food before and during the consumption of alcohol will help to slow down the absorption of alcohol into the blood and breastmilk. Moderation and pacing is the best way to enjoy the occasional drink if you are a breastfeeding mother. Make sure your drinks are measured when poured, as using the “eyeball” method usually results in a drink being about double that of a measured drink. One easy way to know if it is safe to nurse your baby is to ask yourself if you can still feel the effects of the alcohol. If you are not feeling “tipsy” then it is likely fine to feed your baby. The more you have to drink over time, the longer you will have to wait before it is safe to breastfeed your baby.

You may have heard the old advice that having a drink will help with milk production or the let-down of your milk. This is false. Alcohol does not increase milk supply. In fact, one study showed that there was a 23% decrease in the breastmilk volume after just one drink. Mothers who have two or more drinks a day may experience an inhibited let-down of their milk, and their babies can be at risk for impaired motor development, changes in sleep patterns, slow weight gain due to decreased milk intake, or hypoglycemia. These effects or risks to the baby are directly related to the amount of alcohol the mother consumes. Excessive or daily intake of alcohol can also greatly impair a mother’s ability to care for her baby, and there is also the risk of fetal alcohol spectrum disorder if the nursing mother happens to become pregnant again.

Having the occasional drink is a reasonable approach for a breastfeeding mother. The key is to know how to do this safely in order to reduce your baby’s exposure to alcohol through your breastmilk. Planning ahead is the best way to be able to have that festive drink without guilt or concern. Happy Holidays!

Susan Miller R.N. BScN is a Perinatal Educator and Certified Breastfeeding Counsellor. She teaches, coordinates and develops prenatal, post-natal and early parenting programs in the Greater Victoria area.