Does Breastfeeding Mean the End of Happy Hours?

Giving beer to a baby is bad. Giving breast milk to a baby is good. Giving beer to a breastfeeding mother… well, let’s talk about that.

In March, a woman in Arkansas was arrested on the basis of child endangerment for breastfeeding in a restaurant after consuming two beers. In September, a Virginia woman was kicked out of Big Woody’s Bar & Grill for — yep, you guessed it — sipping a beer (only one sip, she says) while breastfeeding her 11-month-old. I know, I know… “What was she thinking bringing a child to a bar?!” A bar & GRILL, actually. You know, more Chili’s, less Coyote Ugly. (And the particular establishment bills itself as “family friendly”). The woman also claims she is a degreed chemist who has done her research and knows how much alcohol she can have without affecting her breast milk.

Did these women deserve arrest and refusal? Were they misguided to think their behaviors were perfectly harmless, or do they know something their persecutors don’t? Let’s see…

Is it Legal for Lactating Women to Drink Alcohol?

A breastfeeding mother is not restricted by law from drinking alcoholic beverages, even in public (provided she’s of legal age to consume alcohol). If a woman’s alcohol intake has impeded upon her ability to safely care for her child, then she’s at risk of breaking child endangerment laws.

However, it should have nothing to do with her status as a breastfeeding mother because inebriated dads and formula-feeding parents are at equal risk of setting off CPS radars. I mean, I don’t picture it going very well for a drunken parent attempting to diaper a baby on the changing table, or holding a baby to bottle-feed. At least if you’re breastfeeding you could just kind of pass out on the floor with your top off and hope that today’s the day baby will finally learn to crawl (come on, you chuckled).

Jokes aside, drug abuse (including alcohol abuse) is slurry business for all parents, not just breastfeeding mothers. If a parent is unable to hold her liquor, she shouldn’t try holding a baby to breastfeed — or diapering a baby on the changing table, rocking a baby to sleep, giving a baby bottled breast milk or formula, or cooking dinner around the baby, etc. Wouldn’t really make the kind of childhood memories that get five star reviews, you know? (More on this later).

The truth is, neglect and accidental harm are greater risks to a breastfed baby of mother who is intoxicated than the effects of any alcohol in her milk.

What Do Health Authorities Say?

A self-stated “expert” quoted in one of the aforementioned news stories said that the amount of alcohol that passes through breast milk is an “imprecise science.” Actually, it can be rather precise, if you consult science not grayed with age before the millennium. But based on different interpretations of such data, you’ll find that not all experts and medical professionals agree.The general rule of thumb that most support is: If you’re sober enough to drive, you’re sober enough to breastfeed.

Here are the most recent positions of a few major health authorities:

The Mayo Clinic opines that alcohol use should be restricted while breastfeeding. 

The American Academy of Pediatrics Committee on Drugs is cool with mamas getting their wine on (maybe in hopes that they turn their whine off? It’ll never happen, AAP. Never!). The AAP says:

“Alcohol consumption during lactation is “usually compatible,” and breastfeeders “should simply follow standard recommendations on alcohol consumption.“

A review by the Nordic Pharmacological Society also concluded that “lactating women should simply follow standard recommendations on alcohol consumption.”

So, basically the same common-sense safe drinking guidelines as everyone else. For instance, we all know that binge drinking is not advised by any professional organization for ANYONE, including those without boobs. And heavy drinking while operating heavy machinery, motor vehicles, or as the sole responsible caregiver of a child (a task not exclusive to breastfeeding mothers) is never safe.

La Leche League breastfeeding experts have modified their position over the years. From La Leche League’s The Womanly Art Of Breastfeeding (p. 328):

“The effects of alcohol on the breastfeeding baby are directly related to the amount the mother ingests. 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.”

According to the 2012 edition of Medications & Mothers’ Milk by a member of the LLLI Health Advisory Council, Thomas W. Hale, R.Ph. Ph.D.:

“Mothers who ingest alcohol in moderate amounts can generally return to breastfeeding as soon as they feel neurologically normal.”

Though this may not be the best marker as some evidence shows that it may take longer for a nursing mother to feel a buzz than her non-nursing peers, a phenomenon possibly related to low estrogen levels caused by lactation-induced amenorrhea. Hale also notes that “the absolute amount of alcohol transferred into milk is generally low.”

As for Dr. Jack Newman’s stance? “Take that shot, mama!” (Okay, not really a direct quote… I call it creative paraphrasing). Here’s his official position, taken from 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.”

Newman has shared some interesting experimental findings on this topic, supposedly gleaned from testing in a toxicology lab. In this particular experiment, it was concluded that:

“Drinking about 3 drinks in 1.5 hours resulted in higher numbers, but still negligible amounts of alcohol would be transferred to the child. One hour after imbibing in 3 drinks, the milk was the equivalent of 0.07498 proof beverage. That would be like adding 1 oz of 80 proof vodka (one shot) to 1066 oz of mixer (1066 oz is over 26 liters). Two hours after imbibing in 3 drinks, the milk was 0.01258 proof. That would be like adding 1 oz of 80 proof vodka to 3179 oz of mixer (over almost 80 liters).”

How Does Alcohol Reach the Milk, and How Much?

Drinking a beer doesn’t turn one’s bodily fluids into a beer. And although breasts are very effective at selling beer, this doesn’t turn them into beer either.

Julie Mennella, Ph. D of the Monell Chemical Senses Center states in a message approved by the National Institute on Alcohol Abuse and Alcoholism and Office of Research on Women’s Health:

“When a lactating woman consumes alcohol, some of that alcohol is transferred into the milk. In general, less than 2 percent of the alcohol dose consumed by the mother reaches her milk and blood. Alcohol is not stored in breast milk, however, but its level parallels that found in the maternal blood. That means that as long as the mother has substantial blood alcohol levels, the milk also will contain alcohol.

Let’s assume this: A woman consumes enough alcohol to warrant a BAC of 0.08. The alcohol content of her breast milk is theoretically about 0.016 (at peak levels), which is less than the ethanol content of orange juice.

“Because alcohol is excreted only to a limited extent in breast milk, many clinicians consider occasional exposure insignificant except in rare cases of intoxication in which the mother of a breast-feeding infant drinks heavily or in which a child is inadvertently fed large amounts of alcohol in a bottle.”

Though it’s recommended that breastfeeding mothers simply follow standard health recommendations for alcohol consumption, it shouldn’t be assumed that lactating and non-lactating mothers process alcohol the same way. One Brazilian study found that:

“When matched for age, size and ethnic group, they found that the lactating women had slower absorption of alcohol than the controls. In addition to the increased time it took for alcohol to be absorbed, the blood levels (which are comparable to the milk levels) of alcohol were significantly lower in the lactating women at last measurement. The rate of ethanol (alcohol) delivery to the liver appears to be different in lactating women, possibly resulting in less ethanol being circulated in the body.”

How Quickly Does Alcohol Leave Breast Milk?

Methods such as drinking water, consuming caffeine, exercise, pumping and dumping milk and so forth, don’t hasten the clearance of any alcohol present in breast milk. Only time can move any residual alcohol from breast milk.

Alcohol levels become present at the 30-60 minute peak time after alcohol consumption, then rapidly drop off as alcohol leaves the blood. However, women are advised to wait past the newborn period before having any alcoholic beverage, if they elect to do so — there may be more ethanol in a glass of orange juice, but you wouldn’t give that to a newborn either, would you?

What does this mean for the oft-suggested practice of “pumping and dumping”? Pumping and dumping is pointless; the necessity of such is a myth.

“Accordingly, the common practice of pumping the breasts and then discarding the milk immediately after drinking alcohol does not hasten the disappearance of alcohol from the milk as the newly produced milk still will contain alcohol as long as the mother has measurable blood alcohol levels…” – Menella, PhD.

How Soon After Birth is it Safe to Have a Drink?

You might want to wait for that celebratory post-delivery glass of champagne until your baby is no longer a newborn. The livers of newborns are too immature to easily break down, well, just about anything (which is one reason why we breastfeed, remember?). Plus, you’ll have just lost a significant amount of blood and even a wee little glass will make you loopier than the Percocet that the labor nurses keep tempting you with (especially after 9 months of tee-totaling), which won’t help you focus on your main task — learning to breastfeed!

However, if you end up feeling like it’s time to feel good with a glass of wind-down wine once those crazy post-birth weeks fall away in the wake, don’t wrack yourself with worry that you’re poisoning your child. Drinking as a breastfeeding mother is not equivalent to drinking as a pregnant woman.

What Effects Might Regular Maternal Alcohol Use Have on Breastfeeding Babies?

Yep, it’s supported on the biophysical front that alcohol technically passes into breast milk in insignificant enough amounts to not detriment a full-term, healthy baby. However, chronic and heavy alcohol use hasn’t been studied with such an unforgiving magnifying lens. Part of the reason for this is lack of willing study subjects; another reason is that the definition of “heavy alcohol use” is purely dependent upon each individual mother’s history, health and metabolism, and individual perception. Heavy alcohol use by breastfeeding mothers hasn’t been adequately studied, so all the risks to the mother and her baby are not yet fully understood.

Heavy alcohol use may have the following possible side effects in an infant, according to the American Academy of Pediatrics Committee on Drugs: drowsiness, deep sleep, weakness, and abnormal weight gain. It also raises the likelihood of decreased milk-ejection reflex in the mother.

Here is a finding from one study of the effect of alcohol on milk ingestion by infants. This study is frequently cited to demonstrate that infants may consume less milk after a mother has imbibed. However, given that the study gleaned this information from only twelve women, the conclusions cannot survive as fact. I don’t personally doubt the findings though, so I’ll leave it here:

“… 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 (7). Compensatory increases in intake were then observed during the 8 – 16 hours after exposure when mothers refrained from drinking.” – Hale

Notable flaws in this next study: the breastfeeding group included babies who received up to 16 oz. of formula or milk supplements per day, and binge drinking wasn’t qualified accurately. Still, the researchers did conclude after waffling through the worrisome implications that, so it appears, it’s “more plausible that the findings are more correlation rather than causation.”

“The study assessed the relationship between the mothers’ alcohol use during lactation and their infants’ development at 1 year of age… The study found that gross motor development was slightly, but significantly, altered in infants who were exposed regularly to alcohol (i. e., at least daily with multiple drinks) in their mothers milk. No significant correlation existed, however, between maternal drinking and the infants’ mental development. Furthermore, the motor and mental development of infants whose mothers drank less than one drink per day did not differ significantly from the development of infants whose mothers did not drink at all or who were formula fed.” – Little et al. 1989

Okay, okay, but… how does alcohol in breast milk affect an infant’s sleep?? (Another scientific fact: An uninterrupted stretch of sleep is worth more than a cellar full of vintage wines to a new mom).

“One study showed changes in the infant’s sleep-wake patterning after short-term exposure to small amounts of alcohol in breastmilk — infants whose mothers were light drinkers slept less.” – Mennella & Gerrish, 1998

Well… shit.

Then again, it’s only one study.

Herein I find the fatal flaw in Mennella & Gerrish’s study. The subject mothers were light drinkers, you see! Perhaps they came to the wrong conclusion. Instead: “Infants who sleep less have mothers who drink only lightly, as they have less opportunity for exposure to alcohol.” It’s so obvious.

But Doesn’t Beer Boost Milk Production?

Despite popular lore, the alcohol in beer does NOT boost milk production. The ingredient found in beer that can increase milk supply is called brewer’s yeast, which is also present in non-alcoholic beer and available by itself from nutrition stores. Thomas W. Hale, R.Ph. Ph.D., wrote in his book Medications and Mothers’ Milk (12th ed.):

“Beer, but not ethanol [alcohol], has been reported in a number of studies to stimulate prolactin levels and breastmilk production. Thus it is presumed that the polysaccharide from barley may be the prolactin-stimulating component of beer (4). Non-alcoholic beer is equally effective.”

Alcohol actually has the ability to slow milk production by more than 20% as it hinders activity of milk-making hormones, therefore causing nurslings to consume that much less milk in the feeding session (though the milk’s caloric content remains unaffected). Per Julie Mennella, PhD., author of a small study that showed subjects producing less milk on days when they consumed alcohol:

“If a mother is drinking alcohol just to improve the quality or quantity of her milk, she needs to know that there is no evidence to support this claim.”

Nursing mothers aren’t often aware of this short-term decrease in supply. Many mothers still swear by drinking a specific brand of beer every night to facilitate milk flow while pumping (and for Nursaholics, it’s hard to ignore and perhaps even ignorant to dismiss such insistent anecdotal claims). Others might just be fooled into thinking they’re making more milk as a result of drinking:

“Because of the back-up of milk, the breast feels fuller, fooling the mother into believing she is  producing more. And because her baby drinks longer (milk flow is reduced, so it requires more time for baby to remove milk from the breast) the mother believes that her baby is drinking more.” – Hilary Jacobson, author of “Mother Food”

How Common is Postpartum Alcohol Use, Really?

You mean at my house, among breastfeeding mothers, or among all postpartum mothers? In any case, the answer is… not uncommon! A 2006 Norwegian study reported that 80% of women were drinking alcohol and breastfeeding at six months postpartum. Nearly a third of breastfeeding women in various postpartum stages confirmed regular binge drinking (as defined as greater than or equal to five drinks per occasion). Whoa, mama!

A separate scientific review found:

“[A]lthough lactating women were less likely to report occasional binges of heavy drinking, the regular drinking patterns at 1 and 3 months after giving birth ( i. e. , postpartum) did not differ significantly between women who elected to breastfeed and women who never breastfed ( Little et al. 1990) . In contrast, breast-feeding women limited their use of other drugs ( e. g. , were less likely to smoke cigarettes or marijuana or to use cocaine). In the same survey approximately 10 percent of lactating women reported consuming at least one drink daily.”

Of course, just because something is popular doesn’t mean it’s always good. The rate of postpartum depression has been steadily increasing in the United States, and not ironically, so has the rate of postpartum alcohol use. As alcohol is a depressant, women with a history of or currently suffering from postpartum mood disorders (including postpartum depression, anxiety, psychosis and so on) should thoroughly discuss use of social drugs such as alcohol with a doctor and carefully monitor any future use.

The marketing industry has also noticed alcoholism rates rising among the freshly postpartum, enough to turn “the drunk mom” into a cultural trope. Have you seen an alcoholic product or service that panders specifically to new mothers? Did you pass it off as a normal sight? A necessity? A blessing? Or did you stop to question why so many mothers seem stressed enough to clear the shelves of “mommy’s magic medicine”? Here’s what I think we’re desperately inclined to translate:

Moms, housewives — aren’t you mad? You’re mad, aren’t you? A damn mad housewife. And you deserve to quell that rage. Chardonnay? How about Chardon-NOW!

Back in the day, it was all about giving the kids a time-out. Nowadays, forget about the kids… it’s Mommy’s turn for time-out! Especially because kids can’t keep adult-sponsored corporations afloat with their Lemonade Stand earnings.

Don’t worry, Mom. You can “Mother On” so long as you’re calm. Empty a glass and you’ll get there. Mothering = Calmness. (If it’s anything else, you’re doing it wrong).

Do you feel gross yet? I feel gross. I don’t want the limits of my mothering capabilities etched into a mass-produced wine glass for me, and I’m sure you don’t either. Is this marketing funny? Cute? Amazing? Relatable? Offensive? Perfectly real? Too damn real? Triggering?

It’s important to acknowledge the possible affects of a mother’s behavior on her babies, but it’s just as crucial to keep the mother herself in mind, too. Do her indulgent habits present on occasion with harmless nature, or by addiction and self-harm?

I can’t speak for everyone. So here’s a few links sharing experiences that speak for themselves:

• “An Alcoholic’s Response to ‘Drunk Mom’ by Jowita Bydlowska” – Jen McNeely
• “Drinking on the Rise Among U.S. Women” – Denise Mann
• “Mom, are you an alcoholic?” – Mary McCoy
• “Why She Drinks: Women and Alcohol Abuse” – Gabrielle Glaser

If you or a mother you know needs help with alcohol abuse, visit these links:

• Get Help – NCADD
• Need Help With a Drinking Problem? – Alcoholics Anonymous
• Signs and Symptoms – NCADD

So… Should You Take That Shot?

Like everything else, it’s up to you, mama! Give yourself a chance to cozy up to the facts.

You might end up feeling it’s safer to nurse your kid while you nurse your mojito than to risk him knocking it off the table (after all, spilled milk isn’t the ONLY thing people cry over).

You also might still feel “pregnant” for longer than you’d expect, and even more strongly feel you do not yet have or deserve full rights to your body (you do).

You might fear needing to explain to others that what you’re consuming is not a threat to your baby, or fear potential humiliation and harassment for imbibing in public. You might fear having to convince others that despite your love for drinks you don’t sip with a straw, you’re actually a very careful and loving mother. For you, overcoming these fears may be more of a hassle than simply avoiding alcohol.

Something I like to tell new mothers: If you’re worried that you’re a bad mom, by default you’re a perfectly normal and good mom because a “bad” mom wouldn’t give a damn about how she mothers. Ask yourself if you care. Like really, really care. Then you’re a good mom — one who deserves a glass of lush wine when it’s hubby’s turn to watch the baby!

Still, if you’re not comfortable breastfeeding and drinking because you can’t help but worry that your baby might get drunk on more than just milk, that’s okay too. Some careful planning can ease your mind and still allow you to join the girls for Happy Hour or enjoy limitless champagne toasts during wedding season.

Several things you can do:

1). Have a stash of expressed milk ready to give your baby during a special occasion.

2). Wind down with your drink after the last nursing of the night, before your baby goes to sleep. Maybe with an herbal bath and a sensuous back massage… don’t look at me, ask the hubby! (He knows what to do, I’m sure).

3). Some women feel most comfortable having a drink while they nurse, because theoretically blood alcohol levels will peak by the time the nursing session has finished.

4). Remember what I said about pumping and dumping? Don’t waste your precious gold (and time and energy)! Watch the clock if you must, but know that tossing perfectly pure milk away is like a virgin sacrifice to the ancient gods. Totally against ethical humanity, sense, and especially mammary morals.

5). Consider measures to slow alcohol absorption: Dilute your drink. Sip slowly. Drink while eating a meal that preferably contains high-fat foods.

6). You can also learn to love a virgin beer or cocktail if you want the taste without the buzz. (Just be warned — coupling non-alcoholic wine coolers with your whacky hormones and swollen breasts might entice memories of junior high pre-pubescence).

7). Download the free Feed Safe Alcohol and Breastfeeding app for iPhone, iPad and iPod Touch (made by ABA, Reach Health Promotion Innovations and Curtin University).

Other Resources:

• Alcohol and Motherhood, an article from LEAVEN
• The Breastfeeding Answer Book
• The Womanly Art Of Breastfeeding
• The Transfer of Drugs and Other Chemicals Into Human Milk
• More Breastfeeding Myths — Jack Newman, MD, FRCPC