Breastfeeding and Drinking Alcohol

The majority of parents are aware that it’s safest not to drink any alcohol during pregnancy. But what about breastfeeding and drinking alcohol? Most experts agree that drinking small amounts of alcohol won’t hurt your baby, however opinions can vary over the amount of alcohol that is safe for a breastfeeding mother to drink. This article looks at the recommendations around breastfeeding and drinking alcohol and answers frequently asked questions.

Does alcohol get into breast milk?

Yes. Alcohol passes into breast milk reaching the same levels measured in a mother’s blood. Alcohol levels peak in breast milk about 30-60 minutes after drinking or after 30-90 minutes if taken with food1. The amounts of alcohol moving into breast milk are very low compared to the alcohol consumed2. And the concentration gradually falls if the mother doesn’t have another drink. A couple of hours after having a single drink (i.e. one unit of alcohol), the alcohol will have mostly left the mother’s breast milk (and her blood) because alcohol is not stored in the breast. One unit of alcohol is approximately a single (25ml) measure of spirits, half a pint of beer or half a standard (175ml) glass of wine, although it depends on the strength of the drink—see this Alcoholic unit calculator (Drinkaware). The more drinks a mother has, the longer it takes for her body to clear the alcohol.

How does drinking alcohol affect my breastfed baby?

The Breastfeeding Network’s information sheet Alcohol and Breastfeeding explains that drinking small amounts of alcohol occasionally won’t affect your breastfed baby, but drinking more than two units a day may affect your baby’s development.

Sleepy baby?

Drinking regularly or heavily while breastfeeding may lead to drowsiness, deep sleep, weakness and decreased growth for your baby 3. Conversely, one study noted babies slept less after exposure to small amounts of alcohol in breast milk 4.

Less milk for baby

The Womanly Art of Breastfeeding explains that babies can’t metabolise (get rid of) alcohol as well as we can and they also seem to take less milk when there is alcohol in it which could affect your baby’s growth if you drink a lot:

…babies don’t metabolise alcohol nearly as well as adults do, and when there’s alcohol in the milk they seem to take less milk than they would otherwise. Combine that with the slowed milk release that can result from alcohol, and your supply and your baby’s growth can be compromised if you drink substantial amounts regularly. A beer or a glass of wine a couple of times a week is unlikely to matter, and the effects decrease as your baby gets older.

What you can do

If you want to minimise the alcohol your baby gets, try breastfeeding right before you have a drink—your milk will be alcohol-free again within two or three hours.

Drinking alcohol and caring for your baby

Drinking alcohol can affect a mother’s capacity to look after her baby. The BFN fact sheet reminds us of the dangers of drinking alcohol while in charge of a baby, irrespective of feeding method:

  • Mothers who have been drinking alcohol should never let themselves be in a situation where they might fall asleep with the baby; on a bed, chair or settee (this would also apply to other carers who have been drinking alcohol).
  • Drinking alcohol reduces the ability of the mother to be aware of her baby’s needs, whether she is breastfeeding or not. It is safest to ask someone else to care for the baby.

How can alcohol affect my milk supply?

Studies have shown that alcohol can affect the balance of hormones that control breast milk production with the potential to reduce a milk supply. Moderate consumption can reduce oxytocin levels affecting milk supply and let down 5. For this reason drinking alcohol has not been shown to increase a mother’s breast milk supply despite the fact that drinking beer was historically thought to be very good for helping a mothers’ milk supply. For further information see Beer and Breastfeeding.

Do I need to “pump and dump”?

There is no need to pump and throw away your breast milk after having an alcoholic drink—unless you are engorged and need to express for comfort. The alcohol will naturally leave the milk in your breasts of its own accord and pumping won’t hurry the process. Any milk you express during the waiting period will still contain alcohol (the alcohol won’t disappear from the milk as it does in the breast).

As alcohol leaves the bloodstream, it leaves the breast milk. Since alcohol is not “trapped” in breast milk (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.

How long does it take for alcohol to leave my breast milk?

Exactly how quickly the alcohol will clear from your breast milk depends on how many units of alcohol you have drunk, your body weight and whether you have eaten food with the alcohol. The Academy of Breastfeeding Medicine 6 refers mothers to the Motherisk Program’s table which gives estimated time intervals for alcohol to clear from breast milk depending on units consumed and body weight. The less you have drunk and heavier you are, the quicker your body can metabolise the alcohol. Examples from the table:

  • A nine stone woman (125lb/57kg) is estimated to metabolise one unit of alcohol from her breast milk in 2.5 hours and four units in 10 hours.
  • A twelve stone woman (170lb/77kg) is estimated to metabolise one unit of alcohol from her breast milk in about two hours and four units in just over eight hours.

As a general guide, some experts advocate waiting two hours before breastfeeding for every unit of alcohol consumed 7. Other breastfeeding experts feel this may be overly cautious as the actual amounts of alcohol moving into breast milk are very low (see below).

How can I reduce the effects of alcohol on my baby?

Denise Fisher IBCLC makes the following recommendations to reduce your baby’s exposure to alcohol:

  • minimising alcohol exposure to the infant for at least the first 3 months of life
  • choosing low alcohol [or non alcoholic!]drinks
  • eating before and while drinking
  • avoiding breastfeeding for 2 to 3 hours after drinking
  • storing alcohol-free breast milk for use after moderate or heavy drinking

There is no requirement to pump and dump (see above) however if your breasts become full during the waiting period for the alcohol to clear,  hand express or use a breast pump, and throw away the milk that you express.

How much can I safely drink?

The Breastfeeding Network and UK’s National Health Service (NHS) advise that drinking more than two units of alcohol per day may impact on a baby’s development.

  • Chronic exposure to more than 2 units per day may have an effect on development.
  • Maternal blood levels have to reach 300mg/100ml before mild sedation is reached in the baby (this compares with a level of 80mg/100ml needed to fail the police breath test)

There’s some evidence that regularly drinking more than two units of alcohol a day while breastfeeding may affect your baby’s development. But an occasional drink is unlikely to harm your breastfed baby. It’s recommended that breastfeeding mothers have no more than one or two units of alcohol once or twice a week.

What if I drink more than this?

Jack Newman (Canadian paediatrician and author) feels there may be unnecessary caution regarding the amount of alcohol a breastfeeding mother can drink safely, and Carlos González (Spanish paediatrician and author) takes the view that even if a nursing mother drank three units in one day, breastfeeding is still better than feeding formula.

Depending on the jurisdiction, you are considered too drunk to drive with more than 0.05% to 0.1% alcohol in your blood. Alcohol behaves differently from other drugs. The concentration of alcohol in blood and breastmilk is about the same. So, if the mother has 0.06% alcohol in her blood, she will have 0.06% alcohol in her milk—one-tenth that of de-alcoholized beer! This is not a concentration of alcohol that is going to make the baby sick or cause brain damage (as some have suggested).

Too much alcohol is bad for your health, and it is a good idea for both mothers and fathers not to exceed two glasses.

However, if you are someone who likes to drink three or four glasses a day, and you can’t or don’t want to stop, I don’t think you are harming your child. You are harming yourself, not your baby. Even if the mother drinks three glasses a day, breastfeeding is still better for her baby than bottle feeding. It is very unlikely that this amount of alcohol will affect the baby

Summary

Small amounts of alcohol move into breast milk when a breastfeeding mother has an alcoholic beverage. The concentration of alcohol peaks in breast milk about 30-60 minutes after the drink is consumed and then the levels gradually fall if the mother doesn’t have another drink. A couple of hours after having one unit of alcohol, the alcohol will have mostly left your breast milk. Drinking small amounts of alcohol occasionally won’t affect your baby, however drinking regularly or heavily may affect your milk supply, make your baby sleepy or affect their growth. Drinking more than two units a day could affect your baby’s development.

*Book extracts reproduced by permission from Pinter & Martin.