Breastfeeding and Alcohol

Understanding the Facts This Festive Season

The festive season is here - a time for joy, celebration, and creating memories with loved (and not so loved) ones. But here’s the catch, you are breastfeeding, and you are wondering whether you can join the festivities or be a mere observer from the sidelines. As a breastfeeding parent, you might wonder whether enjoying a glass of wine or a Christmas cocktail is safe. All too often, breastfeeding advice focuses on what mothers "shouldn’t do" instead of equipping them with the knowledge to make informed decisions. Let’s change that.

Now, I’ll admit, whenever I share what I think is sensible advice about alcohol and breastfeeding, I feel like I’ve accidentally walked into a debate I didn’t sign up for. I’m told I’m being too strict and scaremongery or, on the other hand, too lenient. But here’s the thing- unlike most politicians, I am not in this business to be a people pleaser or to tell you what to do. My aim is to arm you with the facts so you can celebrate confidently and safely, knowing what works best for you and your baby. So, grab a cup of tea (or that glass of wine you’ve been contemplating), and let’s dive into this judgment-free, but information-filled adventure!

How Alcohol Transfers Into Breast Milk: The Science Made Simple

When you drink alcohol, it passes from your bloodstream into your breast milk through a process called passive diffusion. This means the alcohol concentration in your milk will match your blood alcohol level. Alcohol peaks in your milk about 30–60 minutes after drinking, but this can vary from person to person and can be influenced by eating food which can delay the peak.

Your body gradually clears alcohol from your milk, just like it clears alcohol from your blood. On average, it takes about 2–2.5 hours for a standard drink to leave your system. Only time reduces alcohol in your milk - no amount of water, rest, or pumping and dumping speeds up the process.

In the early days after birth, milk-producing cells are more permeable, meaning substances like alcohol can transfer more easily. After the first week, these cells tighten, reducing the amount of alcohol that passes into your milk.

What the Research Says: Effects of Alcohol on Breastfeeding and Babies

Impact on Milk Production

Alcohol interferes with oxytocin, the hormone that helps milk flow during letdown. This can delay milk release and temporarily reduce milk supply. Heavy drinking can further lower milk production. Beer contains ingredients that may raise prolactin levels, a hormone linked to milk production, but this effect isn’t enough to offset alcohol’s overall negative impact on milk supply.

Effects on Babies

Infants exposed to alcohol through breast milk may drink about 20% less milk in the hours following maternal alcohol consumption. They may also become more fussy, sleep for shorter periods, and wake more often. While casual drinking (1 drink/day) is unlikely to harm your baby’s long-term development, heavy or frequent alcohol consumption can affect infant growth and motor skills. If you drink one standard drink (e.g., a small glass of wine), your baby will be exposed to only 2–5% of the alcohol you consume. Premature or very young infants are more sensitive to alcohol due to their immature liver and slower ability to metabolize substances.

What Studies Show

Long-term heavy drinking during breastfeeding may be linked to poorer academic performance and slower growth in children, though occasional, moderate drinking does not show these effects: Emerging research highlights a dose-dependent relationship between maternal alcohol consumption during breastfeeding and later academic outcomes in children. A comprehensive study using data from the "Growing Up in Australia" longitudinal study examined this connection, focusing on academic performance measured by standardized literacy and numeracy tests in Grades 3 and 5.

The findings showed that greater maternal alcohol intake during breastfeeding was associated with reduced scores in spelling, grammar, punctuation, and writing. These reductions were dose-dependent, meaning that the more alcohol consumed by the mother, the greater the observed decline in the child’s academic outcomes. Importantly, these effects were not seen in children who had never been breastfed, suggesting that alcohol exposure through breast milk likely played a direct role rather than being influenced by broader environmental factors.

Although the observed differences were small and may not be clinically significant for mothers who consume alcohol moderately, the relationship underscores the potential risks of heavy or frequent drinking. This study reinforces the importance of understanding the impact of alcohol exposure through breast milk, offering parents evidence-based insights to help make informed decisions about alcohol use while breastfeeding.

Is There an Association with ASD/ADHD

There is growing interest in understanding how alcohol consumption during breastfeeding might influence conditions like Autism Spectrum Disorder (ASD) and Attention Deficit/Hyperactivity Disorder (ADHD). Recent research sheds light on these associations, offering a nuanced perspective.

A study published in the Journal of Autism and Developmental Disorders analysed data from over 5,000 infants in the "Growing Up in Australia" cohort. Researchers explored whether alcohol exposure through breast milk had any association with a later diagnosis of ASD or ADHD in children at ages 6–7 and 10–11 years. The study found no significant association between alcohol use during breastfeeding and these developmental conditions, providing reassurance to parents who may occasionally consume alcohol while nursing.

While this research does not show a causal link between alcohol use during breastfeeding and ASD or ADHD, it is still important to consider alcohol’s broader effects on breastfeeding. Alcohol can disrupt feeding patterns, reduce milk supply, and delay milk letdown. These immediate effects emphasize the importance of moderation and timing in alcohol consumption while breastfeeding.

Understanding these findings helps parents make informed decisions, with the knowledge that occasional moderate alcohol use is unlikely to impact child development in this way. Empowered with evidence-based information, parents can confidently navigate their breastfeeding journey while supporting their own well-being and that of their child.

“If you are sober enough to drive, you are sober enough to breastfeed”

The recommendation, “If you are sober enough to drive, you are sober enough to breastfeed,” (and its many variations) might seem like a helpful guideline at first glance, but it oversimplifies a much more complex issue. While blood alcohol concentration (BAC) under the legal driving limit might be safe for operating a car, alcohol’s impact on a breastfeeding infant is different. Alcohol transfers into breast milk at levels that mirror the mother’s blood alcohol levels as mentioned above, and even small amounts can disrupt an infant’s feeding and sleep due to their immature liver and slower ability to process alcohol.

Additionally, this rule focuses on extreme cases, suggesting that only very high blood alcohol levels—like 300 mg/100 ml—would harm an infant. This downplays the subtler effects of alcohol, such as its ability to reduce milk letdown, decrease milk intake, and impact sleep quality even at lower levels. By emphasizing extreme scenarios, the recommendation might mislead parents into underestimating the risks of regular or heavier drinking while breastfeeding.

Sobriety is also subjective. Feeling "sober" can vary from person to person, depending on tolerance and metabolism, and might not align with actual blood alcohol levels. A parent might feel capable of driving, yet their milk could still contain alcohol at levels that affect their baby.

Parents deserve better than oversimplified analogies. With clear, evidence-based information—such as understanding how alcohol peaks in milk and the importance of timing feeds—they can make informed decisions that work for their unique situations. Breastfeeding advice should empower parents, not oversimplify their choices.

A Practical Guide for Breastfeeding Parents

You deserve to enjoy the festive season while feeling confident in your decisions. Here’s how you can safely balance breastfeeding and occasional alcohol consumption. Stick to no more than 11 standard drinks in a week, spread your drinks out over several days, and include at least two alcohol-free days each week.

What is a standard Drink?

Here’s what counts as one standard drink:

• A single pub measure of spirits (35.5 ml)

• A small glass of wine (12.5% alcohol content)

• Half a pint of regular beer

• A 275 ml bottle of an alcopop

For reference, a standard 12.5% bottle of wine contains roughly seven standard drinks.

In the early weeks of your baby’s life, your milk supply is all about supply and demand: the more your baby feeds, the more milk your body produces. That’s why it’s so important not to miss any feeds during this crucial time. Newborns feed frequently and unpredictably, which can make it tricky to know when they’ll need their next meal. For this reason, it’s best to avoid alcohol entirely during the first month. Your baby might need to feed while there’s still alcohol in your system and missing a feed can disrupt the delicate process of establishing your milk supply. By the time your baby is around 4 to 6 weeks old, breastfeeding is usually well-established, making it easier to plan ahead if you choose to enjoy an occasional drink.

The advice below applies if you would like to minimise alcohol exposure in your baby if you plan to consume alcohol while breastfeeding:

1. Plan Ahead

Feed Before You Drink: Breastfeed or pump before consuming alcohol to minimize the amount your baby is exposed to.

Express and Store Milk: Pump and store milk in advance if you plan to have more than one drink. This gives you a safe supply to feed your baby while alcohol clears from your system.

2. Understand Timing

Wait After Drinking: Allow 2–2.5 hours per standard drink before breastfeeding again. If you have two drinks, wait about 4-5 hours. This ensures that most of the alcohol has cleared from your system before your baby’s next feed.

Know Your Limits: Heavier drinking requires longer waiting times. For example, after four drinks, it may take 8–10 hours for alcohol to leave your milk.

3. Be Cautious with Heavy Drinking

Arrange Childcare: If you plan to have several drinks, ensure a sober adult can care for your baby.

Avoid Bed-Sharing: Never sleep in the same bed or on a sofa with your baby if you’ve been drinking, as this increases the risk of sudden infant death syndrome (SIDS).

4. Express for Comfort, Not Alcohol Removal

If you’re waiting for alcohol to clear and feel engorged, pump your milk to relieve discomfort and maintain your milk supply. However, this milk should not be fed to your baby, as it will contain alcohol. This does not speed up the alcohol clearance but ensures you stay comfortable, and your supply remains stable.

5. Know the Signs

Watch for changes in your baby’s behaviour, like increased fussiness or disrupted sleep, if you’ve consumed alcohol. These can indicate sensitivity, and you may need to adjust your approach.

6. Make Empowered Decisions

Occasional moderate drinking is unlikely to harm your baby when you follow these guidelines. Remember, you’re in control. You don’t need to feel guilt or pressure - choose what works best for your family.

Final Thoughts

This festive season, celebrate knowing the facts. Breastfeeding advice shouldn’t feel like a never-ending list of “don’ts”—it should empower you with the knowledge to make decisions that work for you and your baby. With the right timing, planning, and moderation, you can enjoy the occasional glass of wine or cocktail without unnecessary guilt or worry.

Now, I know this advice might ruffle a few feathers. There’s something about alcohol and breastfeeding that brings out some very passionate opinions. So, if you’ll excuse me, I’m going to grab my own glass of orange juice, lock myself in a bunker, and wait for the outrage to subside. Remember, no matter what anyone says, you’re doing an amazing job—and that’s worth celebrating! Cheers! 🍹