Breastfeeding and Alcohol: From Theory to Practice
A Look at the Known Data
It is well documented that the alcohol level in breast milk is similar to that in the mother's blood and that the ethanol molecule circulates rapidly between the two. After consumption, it takes between two and three hours for the alcohol to be eliminated from the mother's body and therefore from breast milk.
The impact of alcohol consumption
Although the alcohol content in breast milk is very low, it should be kept in mind that the newborn baby metabolizes it more slowly than an adult and is also more sensitive to its effects. Effects such as sleep disturbance and motor development have been noted in breastfed babies whose mothers drank alcohol regularly or excessively. As the baby gets older, these effects tend to diminish.
However, alcohol consumption appears to have an especially significant impact on milk production and the ejection reflex. Indeed, it seems that the milk ejection reflex is blocked due to a hormonal imbalance. This results in a decrease in the transfer of milk to the baby, which can lead to a decline in milk production and growth of the baby in the long term. In some cases, the baby may also take less milk because of the alcohol-induced changes in the odour and taste of the milk.
It should also be kept in mind that, in most situations, the benefits of breastfeeding outweigh the risks associated with low alcohol consumption by the mother. They also far surpass the advantages associated with commercial infant formula, in cases where the mother chooses this option for fear of harming her baby by having a drink.
The importance of staying in control
According to Dr. Jack Newman, it is not so much the concentration of alcohol in the milk that causes a problem for the baby, but rather the ability of the mother to take care of her child if she is under the influence of alcohol. Even in the case of a one-time excess, or regular alcohol abuse, the risks of neglect or accidental injury can be more of a problem than the consumption itself.
It is the regular or excessive consumption of alcohol that is associated with negative effects in breastfed infants and on milk production. Research suggests that occasional and moderate alcohol consumption is compatible with breastfeeding. You can therefore have a drink with family or friends, without fear, guilt or additional worries.
Keeping your baby safe
Many parents practice co-sleeping (sharing the same sleeping surface) with their baby. If this applies to you, make sure adults sleeping with the baby are not under the influence of alcohol, which could pose a risk due to reduced reflexes. Think of a safe alternative for more festive evenings (sharing a bed with a sober parent only, playpen or crib in the parents' room, etc.).
Moreover, it is important to make sure that the breastfeeding mother who consumes alcohol is able to take care of her baby. If you are planning on having a few extra drinks one evening and your alertness may be affected, consider arranging for someone to care for your child. As the alcohol level in the blood may be too high, it is preferable to provide previously expressed milk, rather than breastfeed. You can express a little milk as needed (and throw it away) if you feel uncomfortable. If in doubt, you can obtain teststrips that evaluate the alcohol content in milk.
Applying the principles on a daily basis
There are often many occasions for having a drink: birthdays, the Holidays, dinner with friends, an afternoon on a terrace, dinner in a restaurant ... For many people, such occasions represent little pleasures in life. Nursing mothers are no exception! Occasional and moderate consumption has been shown to be generally compatible with breastfeeding. Here are some tips on how to safely enjoy the moment.
Limiting the baby's exposure to alcohol
Given that the alcohol level in milk is similar to that in the mother's blood, you can minimize your baby’s exposure to alcohol if you drink around the time of a feed. Some sources say just before, others just after, and most mothers will tell you that it's nice to comfortably sip an aperitif on the sofa while breastfeeding!
It takes about 2 to 3 hours to eliminate alcohol from the mother's milk and blood. This is why it is recommended to wait about 2 hours before the next feeding (which is not always possible!). In the past, mothers were told to express their milk and throw it away, thinking that they would remove the alcohol from the breast. Fortunately, knowledge has evolved, and it is well known now that this practice is no longer necessary. Alcohol is released rapidly from the milk as the maternal blood alcohol level decreases.
Interestingly, eating a meal or expressing milk right before drinking decreases the availability of alcohol in the mother's body. And even more interesting, these two effects add up! For those who would like to do their utmost to limit a baby's exposure to alcohol, there are even tables that give a more precise idea of the time required for the complete elimination of alcohol, taking into account the weight of the mother and the number of drinks. (Example on Best Start)
In other words, moderation and good time management will help limit the baby's exposure to alcohol.
What “moderate consumption” means
Do you know the “low-risk drinking limits 2-3-4-0” presented by Éduc'alcool?
If you don’t, now is the time to learn about them! For women, in general, it is recommended to have no more than 2 drinks per day, no more than 10 per week, to limit consumption to 3 drinks in a more "festive" evening, and not drink every day. So, to be careful when breastfeeding, you have to limit yourself to these maximum amounts, or rather aim for less.
The volume of a drink should also be considered to ensure moderation: we generally tend to serve quite generous glasses! You should also remember that for drinks of higher alcohol content, the consumed volume should always be smaller. Here are the examples of Éduc'alcool for standard drinks :
- 1 bottle or glass of 5% beer (340 mL / 12oz)
- 1 glass of 12% wine (140 mL / 5 oz)
- 1 glass of 20% fortified wine (85 mL / 3 oz)
- 1 glass 40% spirits (45 mL / 1.5 oz)
- 2 glasses of 6% cider (140 mL / 5 oz)
Keeping breastfeeding simple is one of the best ways to reap its benefits. If the idea of not being able to enjoy a drink on occasion represents a barrier to breastfeeding for you, we hope that this article has been able to reassure and guide you!
If you have any other questions about alcohol consumption while breastfeeding, do not hesitate to consult a health professional who is comfortable with the subject (IBCLC, nutritionist, and nurse among others).
By Sophie Morel, Dt.P. IBCLC
Date of publication: December 11, 2018 - Republication: December 3, 2019
BEAUDRY, M., CHIASSON, S. et LAUZIÈRE, J. Biologie de l’allaitement maternel : le sein, le lait, le geste, Ville, Presse de l’Université du Québec, 2006, 581 p.
BLUCHEAU, Judith. Alimentation, nutrition et grossesse – Tout ce que vous devez savoir de la préconception à l’allaitement, Ville, Éditions La Semaine, 2015, 175 p.
ÉDUC’ALCOOL. Les niveaux de consommation d’alcool à faible risque, [En ligne], 2018.
FÉDÉRATION NOURRI-SOURCE. Le Petit Nourri-Source, 6e édition, L’Assomption, par la Fédération, 2015, 304 p.
INSPQ. Mieux vivre avec notre enfant de la grossesse à deux ans : Composition du lait maternel, [En ligne], 2018.
LLL INTERNATIONAL. The Womanly Art of BreastfeedingI, 8e édition. New York, Ballantines Books, 2010, 552 p.
MOHRBACHER, Nancy. Breastfeeding answers made simple: a pocket guide for helping mothers, Amarillo (États-Unis), Hale Publishing, 2012, 317 p.
NEWMAN, Jack et PITMAN, Teresa. Dr. Jack Newman’s Guide to Breastfeeding, 2e edition, Toronto, HarperCollins Publishers, 2014, 383 p.
WAMBACH, Karen et RIORDAN, Jan. Breastfeeding and Human Lactation, 5e edition, Burlington (États-Unis), Jones and Bartlett Learning, 2016, 966 p.