Guest Post: Breastfeeding and Alcohol Consumption By Jennifer Heisleman Ingalls Breastfeeding and alcohol…it’s the season for a holiday beverage or two. What’s a nursing mama to do? Many breastfeeding moms wonder if it is safe for them to have an occasional alcoholic beverage. Controversy and misinformation surrounds this topic. The conventional wisdom is to pump and dump. Or buy the alcohol “test strips.” Or even, “If you are safe enough to drive, you are safe enough to nurse.” But what happens if mama has a few drinks and feels tipsy, maybe not safe to drive…then baby wakes up to nurse? Is that safe? Is it worth the “risk?” The breastfeeding and alcohol question is just another way that the mother-baby dyad is consistently and insidiously undermined, or “booby-trapped.” It is so hard to know where to look for information, especially for evidence-based advice. Part of the blame lies with our consumer based economy, which needs to have a product for every situation. Our consumer based economy is constantly frustrated by breastfeeding mamas. Oh dear, they make their own perfect baby food, quick, how can we get them to buy something they don’t need?!? Whether the advice is to pump and dump (which doesn’t work and what a waste of precious milk!) or to buy the test strips (someone needs to make money off breastfeeding mamas some way) the end result is that women who consider having an alcoholic beverage while nursing are faced with guilt or shame. Each breastfeeding mother who is considering having a glass of wine is just like every other mother; she simply wants what is best for her baby! So, with all of the misinformation floating around many mothers either abstain altogether out of fear, or gently imbibe with great foreboding. But neither guilt nor abstinence is necessary if you examine the physiology and pharmacology of breastmilk and alcohol metabolism. When we look at the way alcohol is processed by the body, it helps to first look at how it is transferred into the breastmilk. Some drugs and medications stay in the breastmilk until the milk that contains them is expressed or consumed. These substances are where the “pump and dump” advice comes into play. Alcohol doesn’t work like this. Alcohol in the blood maintains approximately a 1:1 ratio with the alcohol contained in the breastmilk. This means that if your blood alcohol content (BAC) is 0.08 (over the legal limit in California) then your breastmilk alcohol content is approximately 0.08%. Only eight one-hundredths of a percent of the breastmilk would contain alcohol. This 1:1 ratio also means that as you get more sober, your milk gets more “sober.” The liver is continuously processing the alcohol as it filters your blood, and the consistently dropping blood-alcohol level is mirrored by a consistently dropping breastmilk alcohol level. Many mothers will have a glass of wine or two with dinner, and then be so concerned about the alcohol content of her milk that she will pump and dump with the mistaken belief that it is necessary to rid the breastmilk of the alcohol content. But the liver is already metabolizing the ethanol and reducing the ethanol content of the breastmilk in a 1:1 fashion. So there is absolutely no need to pump and dump your milk after drinking, or the next morning. Not even if mama were to go out and get trashed. (Which I am not recommending). More confusion comes into play when people confuse the all the numbers involved. The proof of the alcoholic beverage involved does not directly equal the blood alcohol content of the mama drinking it. There are more complicated things to consider including weight, number of drinks consumed, and rate of consumption. Compare the alcohol content of the breastmilk of a legally intoxicated mama (0.08 BAC) to the alcohol content of orange juice is approximately 0.09% ethanol-by-volume (aka ABV). The legally intoxicated mama will have breastmilk which has an ABV concentration that closely mirrors her BAC, approximately 0.08. That means that mama’s breastmilk when legally intoxicated is less alcoholic than orange juice! And for mamas who only consume one alcohol beverage, their BAC (and thus the ABV of their breastmilk) is considerably lower than that found in even the most innocuous of fresh juices. I can’t tell you how many times I have heard mamas say “Well, I will just pump and dump to be sure…” And the abundance of caution is certainly understandable. But really, if the mother would feel comfortable with a child imbibing the alcohol concentration found in fresh juice, why even blink at the alcohol concentration in milk after a glass of wine. It’s not logical. So what’s the bottom line here? It is safe to have a drink and breastfeed. Moderation in everything is key, and this should in no way be construed as encouraging mothers to become intoxicated. But the reality of the science is that even when legally intoxicated, the mother would only pose a threat to the infant through loss of motor function (dropping baby, rolling over on it, etc) and not through the alcohol content of her breastmilk. Indeed, the motor impairment of an intoxicated mother is my major concern when mothers choose to drink, rather than the risk of exposing the child to miniscule, infinitesimal concentrations of alcohol. If you would like to see what your BAC would be after that one glass of wine, for example, please check out this link. I plugged a few of my personal numbers into the handy-dandy calculator for a real-life example (like the one right here: http://oade.nd.edu/educate-yourself-alcohol/blood-alcohol-concentration/bac-calculator/). Personal Case Study: I am a 123# woman who loves to have a Guinness every now and then. After baby goes to sleep I have a 12 oz. bottle of Guinness and watch a movie with DH. She wakes up fussing two hours later. Am I safe to nurse? Yes! My blood alcohol content is only 0.004948576955424729%… which is less than five-one-thousandths of a percent alcoholic. Infinitesimal. No pumping and dumping (which doesn’t work anyway as the alcohol has to be metabolized out). No spending money on test strips. No fear-mongering.
About the Author: In real life, Crunchy Mama Jenn is Jennifer Heisleman Ingalls. A Registered Nurse, Jennifer obtained her M.S.N from the University of San Francisco, with a specialization in Clinical Nurse Leadership and also has a post-licensure certification in Oncology. Jennifer has worked in pediatrics, oncology, stem-cell transplant, infusion therapy, vascular access, and most recently as an Assistant Professor of Registered Nursing. But her favorite “job” and truest calling is as