Tuesday, March 15, 2011

Booze & Boobs (Yup, That's What I'm Going With)

In an informal poll I recently looked at, about 70% of breastfeeding mothers say that they drink alcohol. What I wonder though is how many of them actually have all the facts about drinking while breastfeeding. Because I've been doing it for 9 months and apparently I didn't have a fucking clue this whole time.

Truth is, I'm still not sure I have a fucking clue.

After a particularly social weekend, I realized I never did look up how, exactly, breastmilk production works and how alcohol enters and leaves it. Following the majority belief that "pumping and dumping" is the only way to deal with tainted milk, I went on that way this entire time. I had purchased some alcohol test strips for breastmilk before the baby was born, (which I highly recommend, by the way), and they worked really well to confirm what I often already knew about my milk supply.

Until one day, when I had pumped and dumped the night before and gone to bed. 5 hours later the baby woke up and needed to be fed. I felt off, but wasn't sure if it was from alcohol in my system or lack of sleep. I really hadn't drank that much the night before, but just to be on the safe side I decided to test my milk before feeding the baby. The result was positive. WHUCK???

From that point on I became pretty paranoid about drinking, never having enough to even earn a buzz, especially not unless the baby was asleep for the night and I knew he wouldn't be waking up. But it bothered me that I didn't really understand how it all worked. I read that alcohol would be out of your milk about 1-2 hours after having a drink, and you should never feed your baby if you feel even slightly buzzed, and that pumping and dumping was an alternative to waiting the 2 hours. I personally just never understood the waiting thing - where did it go? Any nursing mom can tell you that when you don't feed your baby, your boobs get bigger and bigger and more full as time goes on. There is certainly no physical evidence to suggest that milk cycles out of your boobs as time goes on. (Unless you're weaning of course, but that's another story altogether.) So to me, pumping and dumping just made sense. Get rid of the "bad" milk and let the "good" milk come back in.

But it turns out that's wrong. 

A little research on the internet turned up the info that alcohol enters breastmilk through the blood, and so the amount of alcohol in your blood is what affects the amount in the milk. As long as the alcohol is still in your bloodstream, it's still going to be in your milk. But if it's clear from your blood, it's clear from your milk because your body has metabolized it all out.

Supposedly, anyway.

I just still don't get it. And two of the claims from the same site just don't sit right with me. First, it says that most milk is made on-demand for the baby while he/she is nursing. But again, see what I said above about your boobs in between nursing sessions. That suggests otherwise, wouldn't you say?

And second, it says that drinking alcohol to increase milk supply is a bogus old-wives tale. Now I have no access to research that might show this to be false or whatever, but my anecdotal evidence is solid. When I pump after having a drink or two, I pump WAY more milk than I normally get after the same amount of time has passed when I haven't had anything to drink. And second, Bethenny Frankel's well-paid, live-in baby nurse gave her a glass of beer to help her with milk production. The woman was a NURSE, for pete's sake.

And of course, in case this all wasn't enough for you, here's some more conflicting information. Wait 6-7 hours before nursing again after a few drinks? Wait 2 hours for every drink you consume?

Fuck that. No one has any freaking clue. I think I'll just stick to my test strips, thankyouverymuch. 

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Alyssa said...

I've seen/heard from many sources that Guinness in particular helps with milk production. Interesting stuff! I do have an occasional drink, but never more than 1/2 - 1.

Becca said...

Relaxation helps with letdown. Between that and confirmation bias, I think "alcohol helped my breastfeeding" effects might be entirely accounted for. Of course, I *have* also heard that hops from beer can help, but just like that 'mothers milk' tea, it doesn't have anything like a doubleblind trial to back it up. Modest amounts squarely in the 'probably won't hurt, might help' range, as far as I could tell.

I heard... not good things about the test strips, but then, that was mostly from judgemental aholes who were all 'why breastfeed if you're a lush?', so I was actually really pleased to hear another take.

Anonymous said...

My pediatrician (and MD friends) confirmed that milk enters and leaves your milk from the bloodstream. The American Academy of Pediatrics also confirms this idea. Their site also refutes the "beer increases milk supply" idea...probably a secondary relaxation effect like Becca suggests.

The biggest thing I've done is have a pumped bottle on hand if I choose to drink in the evening. If I feel at all buzzed when Monkey wakes, even if I only had one glass of wine, I use that bottle. I pump to relieve engorgement, but not to "get rid" of the alcohol.

I also had the occasional half glass of wine (~ once a month) while pregnant, and my Mom drank small amounts while pregnant and breastfeeding with me. She also put whiskey on my gums to soothe teething pain. I wouldn't ever go so far myself, but I did turn out okay. So I figure if Monkey gets a tiny amount from time to time, it won't hurt him.

The AAP site confirms this thinking - occasional exposure in small amounts is likely not a problem, while repeated exposure can cause lots of issues. Bottom line - if you're trying your best to avoid passing alcohol onto D, you're likely doing fine. Too many things out there to make us moms feel guilty already. I say the occasional drink (or two) is well deserved.

Daily Dose of Dahl said...

I've never heard of test strips, but man, what a great idea. I could so totally have had that margarita I'd been craving when I was breastfeeding Sara.

I used to work with a guy whose wife was a nurse, and she used to have the occasional half glass/glass of wine when she was pregnant and when she was breastfeeding. I'd trust her with my life, so I agree with Micro Dr. O that the occasional drink isn't going to cause any major damage.

Now, a margarita in a baby bottle? That's just a bad idea no matter how you look at it. Besides, where would you put the salt? ::Snort!::

JLK said...

I have really got to stop mentally writing blog posts but then not actually writing them until 24 hours later because I tend to lose my original focus and then miss a bunch of stuff I meant to say.

Lest you guys be concerned that I am a frequent drinker and breastfeeder, please rest assured that I am not. At all. The questionable morning I referred to in the post was after a wedding awhile back. This past weekend we had some friends over whom we hadn't seen in awhile, and I had a few drinks with them once the baby was in bed for the night.

Before the morning after that wedding, I had always assumed that the next morning you would be good to go. But since everyone's metabolism is different (and mine is apparently much, much slower now), that is not always the case.

As for the test strips, it is important to note that they register BAC of .02 and higher. In most states, the legal limit for driving is usually .10 or .08. The test booklet states that the cutoff amount of BAC that is potentially harmful to infants is unclear, and therefore it is recommended that levels of .02 and higher be avoided.

Yet several reputable sources say that as long as you're fine to drive, you're probably fine to nurse your baby. But that is obviously not the case, since the legal limit is about 4x higher than the cutoff on the test strips. Unfortunately, the color indicator on the strips doesn't really tell you what your BAC is, it just gives an estimate.

What this means is that I can be feeling totally stone-cold sober and still get a positive result on the strip. I avoid nursing when this happens because I don't want to risk it, even if I don't feel any effects at all.

I do recommend using them though. For me, it helps me feel more informed and possibly more responsible. I have probably dumped several bottles of breastmilk that I didn't need to, just because I didn't want to take the risk.

I just can't stand all the conflicting information given to moms out there, and I especially hate the LACK of information on certain subjects such as this one. We're all trying to do what's best for our babies - but the all-or-nothing approach to self-sacrifice that seems so prevalent is just unnecessary.

On a side note: LMAO @ DDofDahl!

Comrade PhysioProf said...

If you are completely obliterated drunk off your asse, let's say your BAC is 0.2%, and let's say that your milk is also 0.2% alcohol. And let's say that the baby drinks 24 ounces of milk (I think that's a lot more than a baby drinks at a time, right?). 24 ounces of 0.2% alcohol is the same as 1 ounce of 4.8% alcohol (reasonable beer alcohol content). So 24 ounces of milk if you are completely obliterated is like giving your baby 1 ounce of beer. While it's probably not a good idea to do that all the time, I find it hard to believe that it could be harmful once in a while. And if you just have a drink or two, the amount of alcohol is much lower.

leigh said...

this is a good pharmacokinetics question. (for background: http://lalaleigha.wordpress.com/2009/03/06/fun-with-pharmacokinetics/)

as you clear alcohol from your bloodstream, it will begin to equilibrate out of breastmilk and back to the blood. (much like it would out of any body compartment- brain, fat tissue, all that great body stuff.) while you maintain the volume of milk in the boobs, the composition of that milk can change, and that includes getting rid of the alcohol.

while there are ways to roughly calculate how long it will take you to metabolize a given amount of alcohol enjoyed over a give period of time, (the 2 hours per drink is one rough estimate) it never hurts to dump if you're unsure.

by the way- i love that you're thinking scientifically about this. and i guess i never thought explicitly about the topic myself, given that it hasn't applied to me yet!

JLK said...

"while you maintain the volume of milk in the boobs, the composition of that milk can change, and that includes getting rid of the alcohol. "

Thank you, Leigh, for finally explaining to me how this works! It never occurred to me that breastmilk would act the same as fat tissue when it came to alcohol.


Natalie said...

I never understood how the alcohol got out of the milk either, interesting. I've always gone on the 1 drink per 2 hours thing, and since it's so rare I just don't really worry about it.

viagra online said...

Thanks this post actually gives me a clue about how to do it!

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