Breastfeeding mothers often receive conflicting advice about whether drinking alcohol can have an effect on their baby. This can leave them feeling like they have more questions than answers. While women are often warned not to consume alcohol during pregnancy due to evidence that it could cause damage to an unborn child, the risks of consuming alcohol while breastfeeding are not as well defined.
Breastfeeding and drinking are not against the law and mothers have enjoyed alcohol in moderation while breastfeeding throughout history. The effects of alcohol on the breastfeeding baby are directly related to the amount the mother ingests. When the breastfeeding mother drinks occasionally and limits her consumption, the amount of alcohol her baby receives has not been proven to be harmful. However, many mothers find themselves in situations where they want to drink, but have concerns about any possible effects on their baby.
Your baby’s age
- A newborn has an immature liver, and will be more affected by alcohol
- Up until around 3 months of age, infants metabolise alcohol at about half the rate of adults
- An older baby can metabolise alcohol more quickly than a young infant
- A person’s size has an impact on how quickly they metabolise alcohol
- A heavier person can metabolise alcohol more quickly than a lighter person
Amount of alcohol
- The effect of alcohol on the baby is directly related to the amount of alcohol that is consumed
- The more alcohol consumed, the longer it takes to clear the mother’s body
Will you be eating
- An alcoholic drink consumed with food decreases the absorption rate into the bloodstream
Alcohol is present in a woman’s milk at the same level as in her blood: it rises and falls along with it. If you know your blood alcohol level, you know your milk alcohol level. Alcohol passes freely into mother’s milk and has been found to peak about 30 to 60 minutes after consumption, 60 to 90 minutes when drunk with food.
Alcohol also freely passes out of a mother’s milk and her system so there is rarely need to express milk and throw it away. If the alcohol has gone from her blood, it will have gone from the milk. It takes a 140 pound (10 stone, or about 63.5kg) woman about two to three hours to eliminate the alcohol in one serving of beer or wine from her body … the more alcohol that is consumed, the longer it takes for it to be eliminated. For example, if the same woman had four drinks, it would take nine to ten hours for her breastmilk to contain no alcohol. (1) The effects of alcohol on the breastfeeding baby are directly related to the amount the mother consumes.
Studies have found that babies nurse more frequently when their mother has consumed alcohol. However they don’t metabolise alcohol nearly as well as adults do, and when there is alcohol in the milk they seem to take less milk than they would otherwise in the 3-4 hours after an alcoholic beverage is consumed. Compensatory increases in intake have been observed during the 8 – 16 hours after exposure when mothers refrained from drinking. (2,3,4,5)
When this is combined with the slowed milk release that can result from alcohol milk supply and baby’s growth can be compromised if a woman drinks substantial amounts regularly. A beer or glass of wine a couple of times a week is unlikely to matter, and the effects decrease as your baby gets older. Maternal blood alcohol levels must attain 300 mg/100ml before significant side effects are reported in the infant. (80mg/100ml fails the police breath test).
You do not have to pump and dump after drinking alcohol when you’re breastfeeding, except for comfort.
As alcohol leaves the bloodstream, it leaves the breastmilk. Since alcohol is not “trapped” in breastmilk (it returns to the bloodstream as mother’s blood alcohol level declines), pumping and dumping will not remove it. 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.
Adult metabolism of alcohol is approximately 1 ounce in 3 hours, so mothers who ingest alcohol in moderate amounts can generally return to breastfeeding as soon as they feel neurologically normal. If a woman wants to minimise 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.
If a mother is regularly consuming large amounts of alcohol, this could harm the baby. It would be a good idea for a woman to consult a health professional if she has any doubts about the compatibility of her drinking habits with breastfeeding. Mothers who are intoxicated should not breastfeed until they are completely sober, at which time most of the alcohol will have left the mother’s blood. Drinking to the point of intoxication, or binge drinking, by breastfeeding mothers has not been adequately studied. Since all of the risks are not understood, drinking to the point of intoxication is not advised.
If consumed in large amounts alcohol can cause drowsiness, deep sleep, weakness, and abnormal weight gain in the infant, and the possibility of decreased milk ejection reflex in the mother (6). Mothers who have been drinking should not bed-share with their babies as their natural reflexes will be affected. Excessive drinking by the mother can result in slow weight gain or failure to thrive in her baby. The let-down of a mother who abuses alcohol may be affected by her alcohol consumption, and she may not breastfeed enough. The baby may sleep more and miss breastfeeds, or may not suck effectively leading to decreased milk intake. The baby may even suffer from delayed motor development.
Dr. Jack Newman MD, FRCPC and Thomas W. Hale, R.Ph. Ph.D both believe that a mother can drink some alcohol and continue breastfeeding as she normally does. Dr. Jack Newman says this in his handout More Breastfeeding Myths: “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.”
Thomas W. Hale, R.Ph. Ph.D. says this in his book Medications and Mothers’ Milk (17th ed.): “Alcohol transfers into human milk readily , with an average plasma/ milk of about 1. This does not necessarily mean the dose of alcohol in milk is high, only that the levels in plasma correspond closely with those in milk. The absolute amount (dose) of alcohol transferred into milk is generally low and is a function of the maternal level. Older studies, some in animals, suggested that beer (or more likely barley) may stimulate prolactin levels. Significant amounts of alcohol are secreted into breastmilk although it is not considered harmful to the infant if the amount and duration are limited. The absolute amount of alcohol transferred into milk is generally low.
Excess levels may lead to drowsiness, deep sleep, weakness, and decreased linear growth in the infant. Maternal blood alcohol levels must attain 300 mg/dl before significant side effects are reported in the infant. Reduction of letdown is apparently dose-dependent and requires alcohol consumption of 1.5 to 1.9 gm/kg body weight (7). Other studies have suggested psychomotor delay in infants of moderate drinkers (2+ drinks daily). Avoid breastfeeding during and for 2 – 3 hours after drinking alcohol. Heavy drinkers should wait longer.
In an interesting study of the effect of alcohol on milk ingestion by infants, the rate of milk consumption by infants during the 4 hours immediately after exposure to alcohol (0.3 g/kg) in 12 mothers was significantly less (8). Compensatory increases in intake were then observed during the 8 – 16 hours after exposure when mothers refrained from drinking.
Adult metabolism of alcohol is approximately 1 ounce in 3 hours, so mothers who ingest alcohol in moderate amounts can generally return to breastfeeding as soon as they feel neurologically normal. Chronic or heavy consumers of alcohol should not breastfeed.”
When a breastfeeding mother drinks occasionally and limits her consumption to one drink, the amount of alcohol her baby receives has not been proven to be harmful. While we constantly review research, present studies indicate that although significant amounts of alcohol are secreted into breastmilk it is not considered harmful to the infant if the amount and duration are limited. The absolute amount of alcohol transferred into milk is generally low.
If a woman wants to drink but is concerned about the effect on her baby, expressed breastmilk could be stored to use for the occasion. Alternatively, a mother can wait for the alcohol to clear from her system. 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.
If consuming alcohol while breastfeeding is something that concerns a mother then she may choose to enjoy non-alcoholic drinks instead. However, many women already worry that breastfeeding is something that will not be easy to fit into their lives. Feeling their choices will be restricted, especially if they feel they will be committing an offence to have an occasional drink while breastfeeding could possibly deter women from breastfeeding, thus denying both themselves and their baby the many benefits they would get from it.
Compiled by Anna Burbidge
Safe sleep and the breastfed baby
Alcohol and breastfeeding
Dr. Thomas Hale Medications and Mothers’ Milk, 2017
Dr. Jack Newman More Breastfeeding Myths
NHS: Breastfeeding and drinking alcohol
Haastrup, M. B., Pottegård, A. and Damkier, P. (2014), Alcohol and Breastfeeding. Basic Clin Pharmacol Toxicol, 114: 168–173.
1. Koren, G. Drinking alcohol while breastfeeding. Motherisk Update. Canadian Family Physician 2002; 48:39-41
2. Mennella JA, Beauchamp GK. The transfer of alcohol to human milk: Effects on flavor and the infant’s behavior. New England Journal of Medicine 1991;325: 981-985.
3. Mennella JA, Beauchamp GK. Beer, breast feeding and folklore. Developmental Psychobiology 1993;26: 459-466.
4. Mennella JA. The human infant’s suckling responses to the flavor of alcohol in mother’s milk. Alcoholism: Clinical and Experimental Research 1997;21:581-585.
5. Mennella JA. The transfer of alcohol to human milk: Sensory implications and effects on mother-infant interaction. In: Hannigan JH, Spear N, Spear L and Goodlett CR, eds. Alcohol and Alcoholism: Brain and Development . New Jersey: Lawrence Erlbaum Associates, Inc., 1999. pp. 177-198.
6. American Academy of Pediatrics. The Transfer of Drugs and Other Chemicals Into Human Milk. Pediatrics, September 2001, Volume 108, Issue 3.
7. Cobo E. Effect of different doses of ethanol on the milk-ejecting reflex in lactating women. Am J Obstet Gynecol 1973; 115(6):817-821.
8. Mennella JA. Regulation of milk intake after exposure to alcohol in mothers’ milk. Alcohol Clin Exp Res 2001; 25(4):590-593.
Copyright LLLGB 2017