Boobs or Booze? What you must know about breastfeeding and alcohol (before you pour a drink)

It’s your first festive season since you had your baby. You haven’t had a drink since you knew you were pregnant but now you are wondering, how much can I drink while I am breastfeeding? Will alcohol pass through my milk to my baby? And, how can I drink safely if I do have a glass or two?

Despite worldwide research, a safe limit of alcohol consumption can’t be determined during pregnancy and breastfeeding – there are potential risks to babies, especially newborns or premature babies whose immature livers aren’t able to process the alcohol transmitted through the placenta or their mother’s milk.

The Academy of Breastfeeding Medicine state in Clinical Protocol #21 (2015) that consuming alcohol during lactation has several negative effects ranging from mild to severe. This is dependent on the amount of alcohol the mother/lactating parent has consumed and other factors related to how quickly their body processes alcohol.

As alcohol is completely water-and fat-soluble, it enters the bloodstream and human milk very easily. However, according to leading researcher (Medications and Mother's Milk) Dr Thomas Hale PHD, only very small amounts of alcohol actually pass into your milk. This means a drink or two occasionally is unlikely to harm your baby if you are breastfeeding.

Before you pour that drink, there are some things to consider:

Known Adverse Effects on Baby…

Consumption of alcohol by breastfeeding mothers has been shown to affect baby’s sleep patterns (with babies falling asleep more quickly but waking more often), increasing crying, agitation and startling. Depending on the amount of alcohol you drink while breastfeeding, risks can include slow weight gain, delayed motor development and potentially impaired cognitive development.

Consider also, the effects of alcohol in relation to the age of your baby –newborns have very immature livers and babies detoxify alcohol at about half the rate of adults until they are at least 3 months old.

So, the younger the baby, the more vulnerable your baby is to the effects of alcohol. Older babies and toddlers will detoxify more quickly, but still much slower than adults.  

….and You

Although many people may tell you that a glass of alcohol will help you relax and increase your milk supply, this isn’t the case. In fact, alcohol can disrupt your lactation hormones and inhibit your milk letdown reflex, meaning that as your baby can’t empty your breasts effectively this will signal your body to slow milk production, reducing your milk supply.

According to LactMed Drugs and Lactation Database, a single drink can decrease your milk volume by around 23% and even small doses of alcohol can alter the taste of breastmilk. Babies dislike this, so, although they tend to feed more frequently after mum has drunk alcohol, babies take in less milk in the 3-4 hours after you have a drink, so they may not drain the breast. 

If your breasts aren’t well drained after a feed, this can also result in temporarily reducing your milk supply and it could also increase the likelihood of mastitis.

Alcohol Levels in your Milk

Although current research suggests that an occasional alcoholic drink (no more than one drink a day) shouldn't harm the breastfeeding baby, there are some sensible precautions to be aware of:

As your blood alcohol level rises, so does the level of alcohol in your breast milk. The good news is that as your blood alcohol level drops, so does the level of alcohol in your milk.

Alcohol peaks in your blood approximately half an hour to an hour after drinking (this varies among individuals, depending on factors such as how much food was eaten in the same time period, your body weight and percentage of body fat).

The Australian Breastfeeding Association advises, "as a general rule, it takes 2 hours for an average woman to get rid of the alcohol from 1 standard alcoholic drink and therefore 4 hours for 2 drinks, 6 hours for 3 drinks and so on. The time is taken from the start of drinking. The Feed Safe app can help you work out these times more accurately.”

According to Thomas Hale, author of Medications and Mothers Milk, “mothers who ingest alcohol in moderate amounts can generally return to breastfeeding as soon as they feel neurologically normal.”

Rodney Whyte, head pharmacist at Monash Medical Centre Information Centre explains, "serum levels of alcohol in breastmilk will be the same as the levels in your blood. For instance, the legal blood alcohol limit for a driver is .05% which translates to .5ml of alcohol per litre in your breastmilk.  This would equate to 3 or 4 mls of wine in a litre of breastmilk.  So, with each feed at this level your baby would be getting less than 1ml of wine." 

A reasonable rule of thumb is that if your blood alcohol level is low enough for you to drive safely, you will probably be safe to breastfeed.

Safe Milk

Obviously, the safest option if you are breastfeeding would be to avoid alcohol but if you want to have a drink, most advice suggests limiting to one (preferably) or two glasses of wine or beer and be aware that you will be a pretty ‘cheap drunk’ at first, seeing you have abstained during pregnancy.

Plan ahead: ideally, express before drinking so you can feed your baby this expressed ‘alcohol-free’ milk if she needs a feed before your blood alcohol level is safe to breastfeed directly.

Should I pump and dump?

Expressing after you drink will not reduce the alcohol level in your milk – if it’s in your blood, it’s in your milk.  However, if you have left your baby with a sitter and you are planning to miss a feed, you will need to express at times you would normally feed your baby, so you maintain supply or at least express enough to keep your breasts comfortable, so that you don’t risk blocked ducts and mastitis.

You may hear advice that if you pop this milk in the fridge and keep it for 24 hours, it will now be alcohol free so safe to feed to your baby. The premise is that because breastmilk is a living fluid like blood, it will metabolise the alcohol. According to Rodney Whyte, this advice is incorrect. He says, "alcohol needs to be metabolised by your liver, so it won't disappear from breastmilk after it has been expressed."

So yes, if you pump your ’alcoholic’ milk you need to dump it - don’t give it to your baby to drink.

Reducing the Risks

Bear in mind that alcohol will affect your responsiveness to your baby so whether you are breastfeeding or not, if you are a parent and you plan to drink, it is wise to have a designated parent (one parent stays sober and in charge of the baby) just as you would have a designated driver. Or leave your littlies with a safe carer while you party.

Also, please remember safe sleeping guidelines: if either you or your partner have been drinking – even a single drink - it is unsafe to sleep with your baby.