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.