Alcohol and breastfeeding

Alcohol passes through your breast milk to your baby, so the American Academy of Pediatrics recommends avoiding drinking alcohol while breastfeeding ¹⁾. The concentration of alcohol in your blood is the concentration of alcohol in your milk. Alcohol includes beer, wine, wine coolers and liquor. If you do drink alcohol, don’t have more than two drinks a week. Wait at least 2 hours after each drink before you breastfeed.

The effects of repeated alcohol exposure to your breastfed baby:

• There are increasing concerns about long-term, repeated exposure of infants to alcohol via the mother’s breast milk, so moderation is advised. Chronic consumption of alcohol may also reduce milk production.

If you choose to have an alcoholic drink:

• If you are going to have an alcohol containing beverage, it is best to do so just after you nurse or pump milk rather than before.
• Breastfeeding or pumping breast milk is okay 4 hours after your last drink. That way, your body will have as much time as possible to rid itself of the alcohol before the next feeding and less will reach your infant.

Drinking alcohol while breastfeeding what you should know:

• Drinking beer does not increase your milk supply, as urban myth(s) suggests.
• Consuming alcohol of any kind may decrease the amount of milk your baby drinks.
• Alcohol can change the taste of your milk, and some babies may not like it.
• Breastfeeding your baby while consuming alcohol can pose a risk to your infant if he or she consumes breast milk with alcohol.
• Expressing or pumping milk after drinking alcohol, and then discarding it (“pumping and dumping”), does NOT reduce the amount of alcohol present in your milk quicker. As your alcohol blood level falls over time, the level of alcohol in your breast milk will also decrease. Breast milk continues to contain alcohol if alcohol is still in your bloodstream.
• Drinking alcohol could impair your judgement and your ability to safely care for your baby. If you drink excessively, arrange for a sober adult to care for your baby during this time.

Drinking alcohol while breastfeeding key points

• Breastfeeding is important for your baby’s physical growth and emotional and mental development.
• You can have up to 2 standard drinks, but not every day, once your baby is a month old.
• Breastfeed before you have alcohol.
• Eat before and while you are drinking.
• Plan ahead if you think you may occasionally have more than 2 standard drinks.
• It is better to give a breastfeed with a small amount of alcohol than to feed artificial baby milk.
• There are risks in feeding your baby artificial baby milk.

You also can pass street drugs, like heroin and cocaine, to your baby through breast milk. If you’re breastfeeding, don’t use marijuana. It’s not safe for your baby. You may pass THC and other chemicals from marijuana to your baby through breast milk. If you breastfeed your baby and smoke marijuana, your baby may be at increased risk for problems with brain development. Marijuana also may affect the amount and quality of breast milk you make. Even if marijuana is legal to use in your state, don’t use it when you’re breastfeeding.

How does alcohol get into my breastmilk?

Alcohol gets into your breastmilk from your blood, moving freely from your blood to your breast milk and back out again. Alcohol will be in your breastmilk 30–60 minutes after you start drinking.

How much alcohol gets into my breastmilk?

A number of factors affect how much alcohol gets into your breastmilk, including:

• the strength and amount of alcohol in your drink
• what and how much you’ve eaten
• how much you weigh
• how quickly you are drinking.

It is important to know that the amount of alcohol in your blood is the amount of alcohol in your milk.

Can I reduce the amount of alcohol in my breastmilk?

Only time will reduce the amount of alcohol in your breastmilk.

Once you stop drinking, and the amount of alcohol in your blood drops, the amount in your milk will too. ‘Pumping and dumping’ (expressing breastmilk and throwing it away) will not reduce the amount of alcohol in your breastmilk.

How much can I drink?

It is best to avoid alcohol in the first month after the birth, until breastfeeding is going well and there is some sort of pattern to your baby’s feeding.

When your baby is very young, life can be busy. Your baby may have frequent breastfeeds without any pattern. You may not be able to tell when the next feed will be so you need to be aware that your baby could need another feed while there is still alcohol in your milk.As babies get older they fall into a more regular feeding pattern. You can often tell when their next feed will be. This makes it easier to enjoy a drink knowing that the next feed will contain little or no alcohol. However, sometimes babies don’t always stick to their routine. Be aware if your baby is a bit ‘out of sorts’ or ‘not their usual self’ and allow for this.

Will stout improve my milk supply?

No. You may have heard that black beers like stout are good for your milk supply. What is actually happening is that the alcohol stops the milk flowing as freely. Milk stays in the breasts, giving the false impression that the breasts are making more milk.

Can drinking an alcoholic beverage help me relax and stimulate milk production?

Alcohol consumption has not been shown to stimulate milk production. Studies have found that babies nurse more frequently, but consume less milk in the 3-4 hours after an alcoholic beverage is consumed.

Do I have to pump and dump after drinking an alcoholic beverage?

As alcohol leaves your bloodstream, it leaves your breastmilk. Since alcohol is not “trapped” in breastmilk (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.

What if I get drunk?

Mothers who are intoxicated should not breastfeed until they are completely sober, at which time most of the alcohol will have left the mother’s blood. Drinking to the point of intoxication, or binge drinking, by breastfeeding mothers has not been adequately studied. Since all of the risks are not understood, drinking to the point of intoxication is not advised.

Can alcohol abuse affect a breastfed baby?

Yes. Alcohol abuse (excessive drinking) by the mother can result in slow weight gain or failure to thrive in her baby. The let-down of a mother who abuses alcohol may be affected by her alcohol consumption, and she may not breastfeed enough. The baby may sleep excessively, or may not suck effectively leading to decreased milk intake. The baby may even suffer from delayed motor development. If you are concerned that you or someone you know is drinking alcohol excessively, contact your healthcare professional.

Can you drink alcohol while breastfeeding?

The short answer is no. Alcohol passes through your breast milk to your baby. The concentration of alcohol in your blood is the concentration of alcohol in your milk. Alcohol gets into your breastmilk from your blood, moving freely from the blood to the breast milk and back out again. Alcohol will be in your breastmilk 30–60 minutes after you start drinking. Alcohol transfers into human milk readily, with an average plasma to milk ratio of about 1. This does not necessarily mean the dose of alcohol in milk is high, only that the alcohol levels in plasma correspond closely with those in milk. The absolute amount (dose) of alcohol transferred into milk is generally low and is a function of the maternal level. Older studies, some in animals, suggested that beer (or more likely barley) may stimulate prolactin levels. Significant amounts of alcohol are secreted into breastmilk although it is not considered harmful to the infant if the amount and duration are limited. The absolute amount of alcohol transferred into milk is generally low.

The effects of alcohol on the breastfeeding baby are directly related to the amount the mother ingests. When the breastfeeding mother drinks occasionally or limits her consumption to one drink or less per day, the amount of alcohol her baby receives has not been proven to be harmful. If consumed in large amounts alcohol can cause drowsiness, deep sleep, weakness, and abnormal weight gain in the infant, and the possibility of decreased milk-ejection reflex in the mother. Mothers who have been drinking should not bed-share with their babies as their natural reflexes will be affected.

A number of factors affect how much alcohol gets into your breastmilk, including:

• The strength and amount of alcohol in your drink
  • The effect of alcohol on the baby is directly related to the amount of alcohol that is consumed
  • The more alcohol consumed, the longer it takes to clear the body
• What and how much you’ve eaten
  • An alcoholic drink consumed with food decreases absorption.
• How much you weigh
  • A person’s size has an impact on how quickly they metabolize alcohol
  • A heavier person can metabolize alcohol more quickly than a lighter person
• How quickly you are drinking.

Your baby’s age

• A newborn has an immature liver, and will be more affected by alcohol
• Up until around three months of age, infants metabolize alcohol at about half the rate of adults
• An older baby can metabolize alcohol more quickly than a young infant

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.

Only time will reduce the amount of alcohol in the milk in your breasts.

Once you stop drinking, and the amount of alcohol in your blood drops, the amount in the milk in your breasts will too.

‘Pumping and dumping’ (expressing breastmilk and throwing it away) will not reduce the amount of alcohol in your breastmilk. You also do not need to do this once the alcohol has passed through your system – alcohol is not ‘stored’ in the milk in your breasts, just as it doesn’t remain in your blood. Once the alcohol is out of your blood, it will be out of your breastmilk.

When breastmilk with alcohol is expressed, that expressed breastmilk will contain and continue to contain alcohol.

The safest option when breastfeeding is to avoid drinking alcohol altogether.

However, planning ahead can allow you to express some milk for your baby ahead of time. Your baby can have this milk if you miss a feed while drinking, or while you are waiting for the amount of alcohol in your milk to drop.

If you are breastfeeding and plan to consume alcohol, it is best to plan ahead. However, if, on a single occasion, you have a little more alcohol than you had planned to or if your baby needs to feed sooner than you had anticipated it is OK to breastfeed your baby.

Carers who are under the influence of alcohol may make less safe decisions about where their baby sleeps, so it is important to plan ahead and ensure safe sleeping arrangements have been made and never to sleep with your baby if you have been consuming alcohol.

Weighing the risks and benefits

Many mothers find themselves in a situation where they may want to drink. Maybe you are going to an event where wine will be served. Or perhaps you are going out with friends, or on a date. No matter the reason, you may have concerns about drinking and any possible effects on your baby. It is a good idea to weigh the benefits of breastfeeding against the benefits and possible risks of consuming alcohol. You might find the following suggestions helpful.

• Plan Ahead
  • If you want to drink, but are concerned about the effect on your baby, you can store some expressed breastmilk for the occasion
  • You can choose to wait for the alcohol to clear your system before nursing
    If your breasts become full while waiting for the alcohol to clear, you can hand express or pump, discarding the milk that you express
• Alternatives
  • If you’re concerned about consuming alcohol while breastfeeding you might prefer to stick to non-alcoholic drinks instead.
• If you are sober enough to drive you should be sober enough to breastfeed.

How can I have a drink and still breastfeed?

If you have 1 or 2 standard drinks a day, then time the drinks to have the least effect on your baby.

• Breastfeed your baby before you drink. You can then enjoy a drink knowing you’ll be unlikely to need to feed again within the next couple of hours.
• Eat before and while drinking.
• One way to reduce the amount of alcohol you drink is to alternate alcoholic with non-alcoholic drinks.

What if I’m planning a bigger night out than usual or had more to drink than I had planned?

• Breastmilk with a small amount of alcohol is still better for your baby than artificial baby milk.
• Express some milk ahead of your night out. The baby can have this milk if you miss a feed while drinking, or while you are waiting for the amount of alcohol in your milk to drop.
• If you know that sometimes you drink more than you plan to, you can express and freeze some milk just in case.
• If you miss a feed while you are drinking alcohol, and your breasts are feeling uncomfortable, express some milk and throw it away. This will help with your comfort and will maintain your milk supply.
• You may find that your milk flow is not as strong as usual while there’s still alcohol in your blood. Your milk flow will come back to normal again once your body has cleared the alcohol.
• Your baby may not sleep as well as usual. He might fall asleep quicker, but wake up sooner, instead of having a deep sleep lasting for a longer time.
• Arrange for someone who isn’t affected by alcohol to look after your baby.
• Don’t sleep with your baby if you (or anyone else in the bed) are affected by alcohol.

How long does alcohol stay in breastmilk?

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 following table gives more accurate times for mothers, depending on their weight. To use this table follow these steps:

1. Find the body weight closest to your current body weight down the left hand column.
2. Decide how many drinks you might have or have had from the top row.
3. Read along the row where your weight appears and then down the column that equals the number of drinks.

Table 1. Approximate time taken for alcohol to be cleared from breast milk (hours:mins)

Footnote: Time is taken from the start of drinking. It is assumed that alcohol is cleared at a constant rate of 15 mg/dL and the height of the women is 162.5 centimeters.

Example 1: For a 59 kg woman who has had 3 standard drinks, one after the other, it would take 5 hours and 33 minutes from when she started drinking for there to be no alcohol in her breastmilk. For a 70 kg woman drinking the same amount, it would take 5 hours 5 minutes.

Example 2: For an 84 kg woman drinking 2 standard drinks starting at 8:00 pm, there would be a zero level of alcohol in her breastmilk 3 hours and 4 minutes later (ie at 11:04 pm).

What if I often have 3 or more drinks a day?

Drinking 3 or more drinks a day can be harmful to your health and that of your baby. Be aware that:

• You may not be able to take care of your baby properly if you are affected by alcohol.
• Your baby may be slower to reach developmental milestones.
• Alcohol may decrease the flow of your milk and thus reduce your supply.