Here in the United States, authorities warn against having even one alcoholic drink during pregnancy. That’s not the case during breastfeeding. Certainly, having no alcohol eliminates certain risks. But many mothers long for an occasional social drink, and they deserve some evidence-based facts about breastfeeding and alcohol consumption.
1. What’s a “drink”?
The CDC uses the Dietary Guidelines for Americans to define a “drink” as:
- 12 ounces of 5% beer
- 8 ounces of 7% malt liquor
- 5 ounces of 12% wine
- 1.5 ounces of 40% (80 proof) liquor
According to the CDC, all of these drinks contain the same amount of pure alcohol — that is, 14 grams, or 0.6 ounces.
2. Are most “common” drinks just one drink?
Actually, no! As the CDC explains: “12 ounces of 9% beer contains nearly the same amount of alcohol as two (1.8) standard drinks. Consuming one of these drinks would be the equivalent of two standard drinks.”
3. Does alcohol get into the mother’s milk?
Absolutely. All authorities agree on this point.
4. How is alcohol in the bloodstream related to alcohol in the milk?
Ever since da-Silva’s seminal study, more than 25 years ago, we have known that the amount of alcohol in the mother’s bloodstream is about the same amount as is in her milk.
5. How soon does the alcohol enter the mother’s milk?
After consuming a drink, the alcohol rapidly enters the mother’s bloodstream, and then, her milk. Within 30 minutes to two hours, one drink is fully absorbed into the bloodstream. In general, the body can metabolize about 0.25 ounces per hour.
6. What factors affect the speed of alcohol metabolization?
There are several factors, including:
- having an empty stomach, or a full stomach
- having a fast or a slow metabolism, in general
- consuming more than one drink
- sipping or guzzling the drink
- the mother’s weight (A good reference is this detailed, user-friendly table.)
7. What about the baby’s age?
In general, younger babies are less able to metabolize a substance than older babies. Older babies have more mature organs (especially the liver and kidneys) that are more able to excrete a substance, and they have more body mass.
8. Does “pump and dump” speed up the elimination of alcohol in the milk?
The answer to that is a resounding NO! Understand, pumping to keep the milk moving and to improve comfort is a good idea. But it doesn’t make the alcohol disappear from the milk any faster.
9. How soon can you breastfeed after having alcohol?
Remember, now, we’re talking about “a” drink, as described above. Most researchers and experts agree that waiting about 2-3 hours after having one drink is wise and prudent.
10. What effect does alcohol have on milk let-down?
I’ve seen that tense mothers can have a better milk ejection reflex (MER) (aka “let-down”) after they have consumed one alcoholic drink, or even less. However, as Coiro et al. and Cobo showed years ago, having two or more drinks inhibits the MER. What’s more, as explained in the LactMed database, breastfeeding after 1 or 2 drinks can reduce the infant’s milk intake by around 20 percent, and cause infant agitation or poor sleep patterns.
11. Does beer help a woman to make more milk?
Oh, hold on! I’ve heard those rumors, too. I have plenty more to say on that in a separate post.
12. How does alcohol affect breastfeeding behavior?
- Nursing frequency and milk intake: If mothers have had a drink 3-4 hour prior to nursing, babies nurse more frequently, BUT they take in less milk. (Mennella & Beauchamp)
- Taste of the milk: Moderate evidence suggests that the flavor of the alcohol does transfer to the milk during lactation.
- Milk volume: While many mothers believe that drinking alcohol while breastfeeding results in a greater volume of milk, there is no evidence for this. To the contrary, Mennella and Beauchamp showed a 23% decrease in milk volume after the mother had one drink.
- Sleep-wake patterns may change after short-term exposure to small amount of alcohol, for both the mother and the infant. (It’s important to note that alcohol is a contraindication to bedsharing.)
13. What other adverse effects have been noted?
Other short-term adverse effects might not be immediately obvious, and long-term effects have not been clearly studied. However, alcohol can have some problematic effects everyone should be aware of.
- While “one drink” per day may not pose a problem, consuming alcoholic drinks every day might. One study showed that daily consumption of alcohol was associated with slow infant weight gain. Similarly, daily consumption of one or more drinks per day has been associated with a delay in gross motor development.
- Overconsumption of alcohol can lead to impaired decision-making and sleepiness.
- All infants are at higher risk for SIDS when the mother has been drinking alcohol.
- Alcohol doesn’t “mix” with some or many medications.
Here’s my take-home message. In most cases, having a drink in a social context is probably not a big deal. Becoming inebriated is entirely different, and daily consumption also has its risks. Now that you have the information, you can make informed choices for yourself about consuming alcohol while breastfeeding.
Stay tuned for Part 2 where I’ll discuss minimizing the effects of alcohol when breastfeeding.
Social drinking is a cultural thing, and I’ve stuck strictly to the American guidelines. What do you think about all of this? Let me know your thoughts on breastfeeding and alcohol in the comments below.