What Research Says About the Safety of Drinking While Breastfeeding

Alcoholic drinks fit into many of our lives as part of meals and social occasions. While the recommendations are pretty clear as to alcohol during pregnancy, the recommendations during breastfeeding are less clear cut.

Traditionally, women were told that alcohol is a galactagogue—a substance that promotes the production of breast milk. However, research shows that, in fact, it has the opposite effect. Yet the perception that alcohol is not a problem once the baby is born has been persistent, so parents often make poorly informed decisions about drinking and breastfeeding.

Even though each person's relationship with alcohol is unique, its effects on the body are well known. For overall health (separate from pregnancy and breastfeeding), the American Heart Association suggests no more than one drink per day for women. Doctors recommend no alcohol at all during pregnancy, but about 10% of pregnant women do consume alcohol.

Some women who drank during pregnancy may breastfeed and continue to drink. Others who did not drink during pregnancy may consume alcohol while breastfeeding, but there is little scientific data available on this subject (estimates range from 20% to 70% of women consuming alcohol while breastfeeding).

If you drink alcohol while breastfeeding, it will be transmitted to your baby in your breast milk. The only thing that reduces the amount of alcohol in your milk is time. Pumping your breast milk (and then dumping it instead of giving it to your baby) does not get the alcohol out of the milk any faster.

Very little is known about the direct effects of drinking on breastfeeding; a 2017 study showed that over half of Australian women who breastfeed drink at low levels, and use strategies such as timing when they drink and breastfeed. Under these conditions, mothers' drinking does not seem to be harmful to breastfed babies at 12 months. However, the effects on the baby after 12 months have not been assessed.

Some breastfeeding advocates believe that the benefits of breastfeeding outweigh the risks of drinking and breastfeeding and that women should focus on combining breastfeeding and alcohol safely, rather than aiming for abstinence, which could be unrealistic. They suggest:

• Not drinking alcohol is the safest option.
• Women should avoid alcohol in the first month after delivery until breastfeeding is well established.

After that:

• Alcohol intake should be limited to no more than two standard drinks a day
• Women should avoid drinking immediately before breastfeeding
• Women who wish to drink alcohol could consider expressing milk.

Bear in mind that most people who pour their own drinks vastly underestimate how much alcohol they consume; one standard drink is probably a lot less than you would expect (it's one 12-ounce beer, four ounces of wine, one and a half ounces of 80-proof spirits, or one ounce of 100-proof spirits).

Remember that alcohol can impair your motor skills and judgment, making it more difficult for you to safely care for your baby. Obviously, you should not drive if you have been drinking, so be sure someone else is available to do so in case of an emergency with your baby. And never, ever co-sleep after drinking.

Newborn babies detoxify alcohol in their bodies at about half the rate that adults do, and the liver does not mature until the baby is about three months old. Therefore, alcohol consumed through breast milk will have a much more powerful effect on a baby than it would on an adult. This is especially true for babies born prematurely and those who have any underlying medical conditions.

Much more is known about the harmful effects on babies whose mothers drink during pregnancy than on the children of mothers who drink and breastfeed, but there are some risks we know about from research. Excessive consumption of alcohol during breastfeeding may be linked to:

• Risk of SIDS: Alcohol causes drowsiness and can, therefore, increase the risk of your baby dying of SIDS.
• Interrupted sleep: Although alcohol can cause drowsiness it may also interfere with babies' ability to sleep, according to research that reviewed 30 studies on alcohol and lactation.
• Mental functioning: Severe damage to mental functioning is known to result from prenatal exposure to alcohol. Less is known about exposure through breastfeeding only, although your baby's brain is still developing in infancy. One study of over 5000 children found cognitive deficits in those whose mothers drank regularly or binge-drank.

Alcohol is a part of many parents' lives. When that relationship needs to change due to pregnancy and nursing, it can feel stressful and complicated. During pregnancy, the recommendation is to avoid alcohol completely. During nursing, the general recommendation is to wait at least two hours after having a single drink to nurse and ideally, for your health and baby’s, to not exceed one drink per day at most.

If you feel like your relationship with alcohol is making it difficult for you to limit or stop your intake during pregnancy or nursing, seek help immediately. The U.S. Department of Health and Human Services has a free, confidential helpline that is available 24/7/365 in English and Spanish: 1-800-662-HELP (4357).