Monday, September 26, 2011

What's on Tap, Mom?


The day J.J. was born, my loving husband prepared cosmopolitans to celebrate the birth of our first child as well as the fact that I wouldn't have to abstain from alcohol anymore.  (This was back when Sex and the City was big).  Having endured a 36-hour labor, followed by a C-section, I was in no shape to partake, but we still got dirty looks from our nurse as she eyed our vodka.  Honey, couldn't you have gone with the socially acceptable champagne bottle?

I knew from brief Internet searches that while there is "no safe amount" of alcohol to drink during pregnancy, the expert advice on drinking during breastfeeding ran the gamut.  Some lactation specialists actually recommend alcohol to relax the mother and infant, while others think even one drop is too much.  I'm no longer nursing, but let's see if I can find evidence to support my habits retroactively.

Let's put to rest one old wives' tale, that alcohol facilitates nursing.  Multiple studies have found that alcohol actually reduces milk production. In one trial, women who drank a screwdriver produced on average one less fluid ounce compared to when they drank OJ alone. ("The transfer of alcohol to human milk.") So why do some women think alcohol improves breastfeeding?  Well, when milk production goes down, infants suck for longer, creating the impression that they're eating more.  Another, similar study done by the same authors found that 78% of women who consumed alcoholic beer noticed fullness in their breasts after nursing, making them think that they were producing a lot of milk, and lending empirical evidence to the existence of beer goggles.  ("Beer, breastfeeding and folklore.") Finally, infants just like the taste of alcohol-flavored milk.  They will suck down bottles of it, compared to virgin milk. ("Infants suckling responses to the flavor of alcohol in mothers' milk.") So in effect, a nursing mom who drinks is producing Milker Lite -- tastes great, less filling!

Alcohol does enter breastmilk, at the same or higher concentration than in the mother's blood.  One study recruited nursing mothers to "drink as much alcohol as they could manage in the form they preferred in as short a time as possible."  ("Alcohol in breast milk.")  Let's hope their babies had a designated parent.  One enthusiastic mom enrolled in the study twice, getting legally drunk both times.  Based on the alcohol content in her milk, the investigator then estimated that her infant's blood alcohol level would be 0.006% -- meaning Baby could drive Mama home. 

What most moms want to know is whether this miniscule exposure will affect development.  And here the research is as muddled as a mint julep.  One observational study of 400 nursing women found that mothers who drank an average of one drink a day had children who scored slightly lower on a motor development scale at 12 months of age.  There were no differences in mental development.  ("Maternal alcohol use during breast-feeding....") A follow-up study of 915 women found that the more mothers drank, the higher their children scored in general intelligence, motor development and personal-social development at a year and a half.  ("Alcohol, breastfeeding, and development at 18 months.") It's pretty unlikely that alcohol is good for babies, so there are probably unmeasured factors that influenced the results of both studies.  The other flaw in these studies was that few women drank more than 2 drinks a day, so the effects of truly excessive drinking are unknown -- and would be hard to sort out from generally bad parenting.


Based on these iffy studies, the American Academy of Pediatrics, ever the party-poopers, state in their guidelines, "An occasional, celebratory (what, postpartum women can't wallow?), single, small alcoholic drink is acceptable (if you must), but breastfeeding should be avoided for 2 hours after the drink."  For the anally compulsive, a nomogram is available to tell you when it is safe to nurse after a night of carousing.*  ("Alcohol and breastfeeding: calculation of time to zero level in milk.") I have very helpfully reproduced it here, so you can tuck it into your little black bag before hitting the clubs:
According to this chart, any alcohol would have disappeared from my milk 2.36 hours after one drink.  Dang it, I could have downed 6 shots a day on my every 4 hour nursing schedule!


But I didn't.  So, please, those dirty looks are completely uncalled for.


*By the way, girls, no need to pump and dump.  Alcohol will diffuse out of your milk at the same rate as it does out of your blood.





88 comments:

  1. Great post, and (as a pediatrician) I completely agree. Let me add an observation about food restrictions, which are equally silly: nursing moms get blamed for the fussiness of their babies, and are often told "don't eat tomatoes" or "don't drink coffee". The lists of foods and drinks to avoid, if you believe everyone, is so long that it looks like nursing moms should only be allowed to drink water and eat rocks.

    Nursing moms: you're working hard, and you deserve an enjoyable meal and (if you'd like) an alcoholic drink now and then. Have some chocolate. Have a beer. Eat what you'd like, and you (and your baby) will be happier!

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  2. Hi! I really appreciate your post! I actually recently finished up a similar review of the facts I could find; you can read it here:
    http://michiganmugsandmeals.wordpress.com/2011/07/14/drinking-for-two-2/
    We basically both came to the same conclusion. So as a still-nursing mom, cheers!

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  3. Good old Jack Newman says it's OK to indulge in a drink (or 2!) while breastfeeding, and that adding one more thing to the list nursing moms "can't do", will discourage more moms from breastfeeding. Bottom line (in my opinion): breastfeeding after (or while) enjoying my nightly glass (or 2) of wine is FAR better than switching to formula. And my baby & I just passed 24 months nursing. And he is CLEARLY doing just fine developmentally! ;-)

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  4. Well said...as an IBCLC, I agree with the not adding any more "can't dos" to the lists!! AND yes, far better than switching to formula, which is easy to do when you are getting told all of these negatives! Our clinical practice revolves around EBM, it was great to stumble upon this site, which will now be in my favorites!!

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  5. Wait, why the heck were you nursing on a schedule? Babies need to eat when they are hungry, not when the clock says eat.

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  6. I too, love this! I am nursing my 3yo and I drink wine occasionally. I didn't drink in the early days. I felt bad if I did...that is my own mom's guilt playing in my mind. "Mom's don't drink. You have to be a good role model for your kids." Yes I do, but sometimes wine helps me relax in the evening when the cluster feeding begins. And with colicy babies (I had 4 of them) you need something to relax you when taking a bath for that 15-20 minute break from crying. lol

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  7. Mommy's little helper without any guilt. I love it!

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  8. Very informative article. I wished I had more wine while I was breastfeeding.

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  9. I'm still skeptical. It doesn't feel right to drink and take care of a baby.

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  10. I agree. What if you fell down because you were drunk and squashed your poor baby.

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  11. This misconception exists to perpetuate a male-dominated society where women have to be perfect.

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  12. Too bad my husband didn't know about this.

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  13. Why didn't I find you earlier. I really like your blog post about rear-facing carseats.

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  14. Could you do more research that correlates the volume of alcohol to see if it gets in the milk.

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  15. That's great news. Men get off easy. At least now we can have a little drink without getting the dirty looks.

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  16. You should write a book, like Mommynomics.

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  17. I drank even before reading your article. After all, my mom got a shot of whiskey when she wouldn't go to sleep.

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  18. I hope this article gets more press so I can have just 1 Corona once in a while and not feel guilty.

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  19. Let's all get together and have a drink with our babies latched on. It would make a terrific poster and probably get printed in all the newspapers.

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  20. How did the whole negative stigma surrounding drinking and breastfeeding even start? I'm sure it was by a bunch of white men who thought their wives should stay at home.

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  21. Just finished reading your blog. Would you be interested in writing a book together? I have a degree in child psychology.

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  22. Where do you find the time to be a doctor, mom and writer?

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  23. I don' think the data are correct. I had a glass of wine and noticed my baby was noticeably drowsier after she nursed. I stopped drinking and breastfeeding after that.

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  24. I'm having a shot of tequila tonight. I'll print out your article in case any of my friends want to know.

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  25. A little off the subject… my son was born with a tooth and now he has a couple. I can't get him to stop biting me when I nurse and it really hurts. Any suggestions?

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  26. Not anything witty to say, other than I love this post and I'm not even a mom.

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  27. Any research on smoking? I never smoke while I was pregnant. Does the nicotene get in the milk?

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  28. If alcohol doesn't stimulate milk production, any suggestions on what can. I have very little output and I’m worried that my baby is underfed.

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  29. Breastfeeding has been one of my greatest pleasures as a mother. Even if there's a 1% chance that alcholol can be transferred from me to my baby and impair her in any way, I won't take that risk.

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  30. Nice read. I can't wait to see your other articles.

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  31. Why is everyone so Freudian. Just use formula and drink without guilt or shame.

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  32. You just shattered my husband's dream, a breast-dispensing beer shake.

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  33. Cool stuff. You should also post on babycentre

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  34. Don’t know about anyone else, but I had noticed when b-feeding DD that if I had been out for a few Guinness of an evening, the next day she’d be all over me looking for some Guinnessy milk (alcohol free of course – plenty of time left between last pint & first feed).

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  35. It's no good to me at the mo cause I'm 24 weeks pregnant, but looking forward to having a few malty beers after baby is born....

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  36. I would have loved to be in the Alcohol in breast milk study. Do you get paid?

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  37. Remember the Sex and the City episode where Samantha dated a guy who had bad tasting spunk?

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  38. Just read the comments on ejaculate… too funny. Evidence based mommy, perhaps you should become Evidence Based Wife and do the research.

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  39. I maintain that a little alcohol consumption is a must for breast-feeding mommas. It helped me with my milk production and calmed down my baby.

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  40. My mother drank a glass of wine and smoke a cigarette every night I can remember and I turned out just fine. This world is too big brother.

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  41. How about drugs and breast milk? For example, I wouldn't even take a benadryl because I was afraid it would transfer to my child. Does that mean I could have taken sleeping pills?

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  42. I went to your blog and saw the picture with this article. What drink are you giving your son? It looks tropical.

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  43. I like the snarky tone in your writing. Well done.

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  44. I loved the bonding experience, but I still wish that men could breast feed. It was a convenient excuse for my husband to get some sleep.

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  45. The body is your temple. You should not drink or consume any drugs, including caffeine.

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  46. I had a boob job several years ago. Do you know if that's going to impact my milk production?

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  47. The only way I could get my son to sleep was with warm breast milk. I miss those days when I could create a milk coma.

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  48. Who was your pediatrician, Marcus Welby?

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  49. Every pediatrician should read this article. My pediatrician is very old school and told me not to drink at all.

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  50. Another research topic for consideration: why do some boys miss the toilet more than others? Is it genetic, intentional, or just bad aim?

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  51. SRibeiro said...

    Another research topic for consideration: why do some boys miss the toilet more than others? Is it genetic, intentional, or just bad aim?

    Believe it or not, I started looking into this last week when I yelled at my 8 year old for spraying the toilet for the umpteenth time. Couldn't find any studies, but there are a lot of patented "toilet target" ideas when I searched Google Scholar! I like the genetic idea, though. My son has taken the blame in the past for some of his dad's mishaps.

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  52. Remember our mom's generation when it was recommended to use formula instead of breast milk. How times have changed for the better.

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  53. I had major post partum and really needed a drink to be sane. I put my wine in a Snapple bottle. Too bad most people don't know the real facts.

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  54. The comments are funnier than the article, even though the article is very funny.

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  55. In a weird sort of way, I'm sheepishly curious about the transmission of edibles to bodily fluids.

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  56. Never heard the term ejaculate, but I can guess what you're referring to. I insist that my husband drink green tea before… you know.

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  57. Looks like you're researching taboo subjects. Something I've wondered about, but never seen researched… What my husband eats or drinks and how it transfers to his ejaculate.

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  58. Kind of off the subject, but my husband made real cheese from my milk. I refused to eat it. He said it was delicious!

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  59. What happens if you free your breastmilk? Will the alcohol content decrease or stay the same in the freezer?

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  60. Is this a joke? I feel like I'm reading an article from The Onion.

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  61. Does it really matter what other people think. We have the right to reproduce. Then, don't we have the right to raise our children as we see fit as long as we don't break any laws?

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  62. Yeah, who pays for these studies and do they supply the alcohol? Sign me up!

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  63. I don't trust any research from the American Academy of Pediatrics. It's all bogus stuff that's created from the drug companies.

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  64. What kind of doctor are you? Your bio says general internist. What does that mean?

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  65. I still watch the reruns of Sex and the City and drink a nightly cosmopolitan.

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  66. Ok ladies, let's not let this article get out of hand. Drinking in moderation is always the rule, especially with small children.

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  67. I want to see the research on 2+ drinks per day.

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  68. Don't tell my husband this. He thought he was getting a buzz off my milk.

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  69. This is the kind of stuff that they should publish in parenting magazines, instead of the flowery stuff that's not useful.

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  70. Why is this even an issue? Our husbands are allowed to drink when they perform their end of the deal, which lasts about 30 seconds. :)

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  71. Very well written and informative.

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  72. Isn't Sex and the City still big?

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  73. Nice husband. I wish mine would make me cosmopolitans.

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  74. 36-hour labor! I thought mine was long at 18 hours. Yours was twice as long as mine.

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  75. Fortunately, my lactation consultant recommended that I drink a little to relax me. She's ahead of the curve.

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  76. Good thing I didn't drink. My milk production was already low.

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  77. I must have had beer goggles. I thought when I drank a little, my breasts had more milk.

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  78. Another reason not to drink and breastfeed -- perhaps it creates an inclinination for the fondness of alcohol and could promote early drinking or dependence on your child.

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  79. Let's not undermine the evidence that says drinking and breastfeeding has a negative effect on motor development.

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