Should a Nursing Mother Drink Alcohol?
November 1999
Many women choose breastfeeding because they want their babies to have “the
best.” This is a commendable motive, but it carries the implication that a woman might
have to give up a “normal” life in order to breastfeed. As pediatrician Ruth Lawrence
puts it, mothers get the idea that “You mustn’t drink! You mustn’t smoke! You mustn’t
listen to a dirty joke!” We don’t want women to avoid breastfeeding because they think
it means they’ll have to miss all the “fun.”
Advice about alcohol use has a long and varied history. For centuries, folk
wisdom has assured nursing mothers that beer or wine would help them relax and might
actually increase milk production. After identification of the Fetal Alcohol Syndrome,
health professionals began to be more suspicious of alcohol use by women of
reproductive age. There are three concerns specific to nursing mothers: Does alcohol
affect the process of lactation? Does it enter the mother’s milk? And most importantly,
does it affect the nursing infant? In addition, there is a general concern about a caretaker
becoming impaired from alcohol use.
Effect on Lactation
Alcohol has been shown to decrease suckling-induced prolactin (in rats), but the
pups compensated by increasing sucking time and gained the same amount of weight as
pups whose mothers were not drinking alcohol. A dose-related effect on oxytocin release
has been noted in humans, leading to an inhibited milk ejection reflex. Less than 0.5
gm/kg had no effect, while doses between 1.5 and 2 gm/kg decreased milk ejection by an
average of 80% in all subjects. (A standard “drink” contains about 12 gm of alcohol.)
Transfer Into Milk
Alcohol enters breast milk rapidly, and milk concentrations closely follow blood
levels. Milk alcohol peaks 30-60 minutes after ingestion (or 60-90 minutes if the alcohol
is taken with food). After the peak, alcohol quickly diffuses from the milk back into the
mother’s bloodstream as her serum alcohol level falls. Thus, the mother has no need to
“pump and dump” to get ride of alcohol in her milk; her own metabolic processes will
break it down.
Infant Outcomes
Problems associated with heavy alcohol use stick in our memory. These include a
case of pseudo-Cushing syndrome in a four-month-old whose mother regularly drank
more than 90 grams of alcohol a day. A 15% deficit in gross motor development was
found in one-year-olds whose mothers routinely consumed six or more drinks per day.
The effects of moderate use are much more subtle. Mennella and her colleagues studied
the effects of a 0.3 gm/kg dose (one drink) and found that:
Babies took in almost 25% less milk at the first nursing that followed the mother’s
alcohol ingestion.
These same babies slept for shorter periods over the next few hours.
They spent less time in active sleep.
Simply by smell, a panel of adult testers could reliably distinguish milk expressed
after alcohol ingestion from control milk samples. Presumably this means that the taste
of the milk was also affected. But it is unclear why the babies took less of the alcohol-
containing milk. It could be because of an alcohol-inhibited milk release in the mother,
or the taste, or direct behavioral effects of alcohol ingestion on the baby.
Practical Recommendations
Drinking alcohol in moderation is a legal activity used for recreation and
relaxation by many adults in our society. Unfortunately, excessive alcohol consumption
is all too common. Here is what a nursing mother needs to know about consuming an
occasional alcoholic beverage:
Alcohol is a choice, not a necessity. The best choice for the baby is for the
mother to abstain.
A woman may find that she is more sensitive to alcohol while lactating.
Moderate drinking is less disruptive to her breasts and to her baby than heavy
drinking.
If the nursing mother chooses to drink, she should adjust the timing and amount
that she consumes in order to minimize the effects on her baby. She should nurse
the baby before having a drink, then wait two hours per drink before nursing
again. For example, if the mother has two drinks at a party, she should wait fours
hours after the last drink before nursing again.
There is no need to “pump and dump” unless the mother’s breasts become
uncomfortably full during the two-hours-per-drink waiting period.
To maintain exclusive breastfeeding, the mother can express and store milk for
the baby ahead of time. If she does not want to express milk, the baby can have an
age-appropriate alternative feeding—formula, juice, cow’s milk, solid foods—
during the waiting period.
For more information:
Anderson PO (1995) Alcohol and breastfeeding. J Human Lactation 11(4), 321-3.
Lawrence RA & RM Lawrence (1999) Breastfeeding: a guide for the medical profession, 5th edition, p.
371.
Menella JA & GK Beauchamp (1991). The transfer of alcohol to human milk: effects on flavor and the
infant’s behavior. NEJMed 325, 981-985.
Menella JA & CJ Gerrish (1998) Effects of exposure to alcohol in mother’s milk on infant sleep. Pediatrics
101:5, p. e2 (electronic article).
Newman J (1996) Is alcohol so bad for breastfeeding mothers? (letter) J Human Lactation 12(2), 93.
Shulte P (1995) Minimizing alcohol exposure of the breastfeeding infant. J Human Lactation 11(4), 317-
19.
Breastfeeding Cues is published quarterly by Kennedy’s Women’s and Children’s Services in cooperation
with the WIC Breastfeeding Initiative, a program of the Southern New Jersey Perinatal Cooperative.
Editor: Chris Mulford, RN, IBCLC
Editorial Advisors: Robert Block, MD; Robin Clemmons, MD; Gwen Heaney-Cutts, RN;
Shirley Himeback, IBCLC; Diane Reynolds, CNM; John Tedeschi, MD;
Donna Whyte-English, MSN,FNPC; Lori Winter, MD.