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    Ethyl Alcohol, Breastmilk And The Drinking Breastfeeding Mother
    By Cher Stewart | August 30th 2009 11:31 PM | 48 comments | Print | E-mail | Track Comments
    About Cher

    "Fables should be taught as fables, myths as myths, and miracles as poetic fancies. To teach superstitions as truths is a most terrible thing. The...

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    I am consistently shocked, on a daily basis, of the information that is spread through our society. With the internet being a convenient, copious source of information, and ways to instantly check sources and original data if needed, I cannot understand why so many people believe incorrect information so vehemently.

    Most especially, it would seem, when they know little to nothing on the topic, scientifically.

    It is ok while breastfeeding given that you don't get drunk. Telling women they can't drink until they wean leads to unnecessarily short breastfeeding spans. There is absolutely no reason not to have a glass of wine while breastfeeding - it isn't going to hurt the baby. DO YOUR RESEARCH.

    The most frustrating part of a statement like this isn't that this woman uses that women would rather drink than breastfeed, it's that she got her information from multiple websites, and didn't bother to do any actual interpretation of studies and data - or check what their sources were.

    An infant's brain is still developing, and while alcohol does not do any permanent damage as long as an adult doesn't drink too much and too often, it's because the brain cell repair mechanisms are fully developed and able to fix problems that alcohol causes.

    BAC is Blood Alcohol Concentration. Basically, having a .08% BAC means that for every 1000 parts blood supply in a person’s body, there is about 4/5 of a part of alcohol. (0.8/100 g/mL = 4/5 cg/mL.) ABV is Alcohol by Volume, but since you're not feeding your infant straight blood, the BAC would be varying, depending on how your body metabolizes alcohol and how fast.

    Let's do some math, based on the worst possible scenario regarding one drink. You drink one 5 ounce glass of wine, which contains around .6 ounces of ethyl alcohol ~ 12% ABV. If you weigh around 140 pounds, on average your BAC will be around .03 (based on the Widmark
    formula). If your infant needs to be fed within the hour, the maximum the ABV would be in 4 ounces of your breastmilk ~ .03% (based on 118.294118 mL of breastmilk; .3/100 g/mL = 3/10 cg/mL) or 3.55 centigrams of ethyl alcohol.

    What would your infant's BAC be? Let's say she's a 6 week old little girl, who weighs about 10
    pounds. The Widmark "r" value, or reduced body mass value, is a complex empirical measure that takes into account both body water percentage and water concentration in blood. Using the Widmark formula, the BAC for a 6 week old girl who weighs about 13 pounds and is about 23 inches long, will be at LEAST .00024. It may be negligible for an adult, but it's higher than zero, and therefore, can cause detrimental affects in a developing infant.

    That is a generous estimate for the ABV, because ethyl alcohol is a water-soluble non-polar compound that easily passes through the biological membrane (biomembrane). The average water content of breast milk is 87.5% and that of blood is 85%. For this reason it is expected that the ethanol concentration at equilibrium would be slightly higher in breast milk.

    Depending on how the infant metabolizes the alcohol (an infant is still developing, and there is no way to find out if the enzymes that break down ethyl alcohol are mature enough to do so properly), it could stunt the growth of brain and liver cells. 0.0013 Ounces of alcohol may not sound like much, but studies have shown that babies sleep less and eat, on average, 20% less when there is any detectable level of alcohol in the breast milk.

    These results are supported in a study by Vilaro et al. (evidence level--NHMRC V, animal study) in which the pups of alcohol-treated dams demonstrate a significant reduction in combined weight compared with control pups. This decrease is associated with reduced milk production in the alcohol-fed dams despite their milk having a higher energy content due to a greater lipid appearance of the cerebellum control pups nursed by non-alcohol consuming dams were compared with pups nursed by alcohol-consuming dams (evidence level--NHMRC V, animal study). Pups exposed to alcohol opened their eyes several days later than pups in the control groups and had a lower average litter weight and brain weight that was evident until alcohol was removed from the diet. These degenerative changes were independent of the pups' weight. That study highlights the considerable growth and developmental problems occurring in pups as a result of alcohol intake in the lactating dams and the potential similar harm that could take place in humans with continued alcohol intake during lactation.

    Lactational performance, brain and liver composition, circulating metabolites, plasma nutrients and metabolites were investigated in pups fed by ethanol-treated lactating dams. The dams in the alcohol-treated group had a decreased milk yield that was associated with a decreased collective weight gain of their pups. These pups also exhibited a decreased brain weight and brain protein. The amount of deoxyribonucleic acid indirectly reflects the number of cells, and when expressed as DNA per total brain weight the alcohol-exposed pups had reduced values, possibly indicating a lower number of brain cells. This was also apparent in the liver of the alcohol-exposed pups, who also experienced a lower liver weight, lower liver protein and liver glycogen concentration than the control pups.

    It is proposed that these lower levels of protein and glycogen are metabolic adaptations in response to the malnutrition being experienced by the alcohol-exposed pups. It is known that the lipid content increases in the milk of alcohol-treated rats. This high lipid content partially compensates for the alcohol-induced malnutrition occurring in the alcohol-exposed pups and allows the proper metabolic adaptations to prevent severe hypoglycaemia and maintain minimum liver stores of glycogen. However, these adaptations are not enough to protect against impaired brain development, evident in the alcohol-exposed pups.

    These results are supported in a later study by Oyama et al. (evidence level--NHMRC V, animal study) who found that pups suckled by alcohol lactating dams (5%, 10% and 20% ethanol) had significantly lower body weights compared with controls. However, only pups of lactating dams exposed to higher alcohol levels experienced a significant decrease in brain weight suggesting a preservation of the pups' brain or a profound reduction in overall body growth as possible hypotheses for the difference between alcohol groups.

    A study of 400 lactating and breastfeeding mothers found that gross motor development was slightly, but noticeably, altered in infants who were exposed regularly (i. e., at least 5 ounces of 12% ABV daily) to alcohol in their mothers milk. Additionally, experience with the sensory qualities of alcohol in the mother's milk may affect the infant in other important ways. Animal studies have revealed that young animals (including presumably humans) form memories based on orosensory experiences during nursing and retain these memories for a considerable time.

    Moreover, the context in which the infant experiences alcohol that is, with the mother and during breastfeeding consists of numerous elements that reinforce early learning, such as tactile stimulation, warmth, milk, and the mother's voice. This is an important thing to take note of because a more recent study of children aged 3-6 showed that the children who had a mother who drank very lightly while breastfeeding liking the odor of alcohol. Studies have found infants who had more exposure to alcohol behaved differently in the presence of an alcohol-scented toy than did infants with less alcohol exposure. Specifically, infants who had more exposure to alcohol demonstrated more mouthing of the alcohol-scented toy, but not of the other toys, than did infants with less alcohol exposure.

    This finding is consistent with animal studies indicating that rat pups exposed to the flavor of alcohol in milk increased their mouthing rates in response to alcohol odor and were more willing to ingest alcohol-flavored solutions. These results suggest that at least some of the early learning about alcohol is based on sensory experiences and is anchored to experiences with the parents.

    Caffeine is just as bad, and worse if both are being consumed. Studies found that like alcohol, caffeine is excreted to a limited extent in breast milk and the dose presented to the infants is generally less than 2 percent of the maternal dose. Breast-fed infants are at greater risk for accumulating caffeine, however, than are older children and adults. This accumulation may be due to a lower activity in infants of an enzyme system in the liver called the cytochrome P-450 system, which is involved in caffeine break-down. Because the same enzyme system is involved in alcohol metabolism, its reduced activity in infants could result in alcohol accumulation.

    Is it possible your infant will be fine? Absolutely. However, if you cannot help yourself but to have a drink or two, instead of considering the affects of ethyl alcohol on an infant, you probably should seek some alcohol dependency counseling. Furthermore, if you know you will want to drink, even lightly, while breastfeeding, pump ahead of time and bottle-feed your milk while you are enjoying the affects of that alcoholic beverage.

    Comments

    When Dr. Ruth Little repeated her study
    PEDIATRICS Vol. 109 No. 5 May 2002, pp. e72 "Alcohol, Breastfeeding, and Development at 18 Months" , she was "unable to replicate the earlier deficit in motor skills associated with lactation alcohol use. One reason may be that the dose of alcohol reaching the lactating infant is small, and tests of infants and toddlers have limited ability to pick up small effects. Studies of older children may resolve the question of the safety of drinking while nursing."

    Her first study had shown a 1-point difference in motor skills. The alcohol use was 1 drink a day. The only case report in the literature of an infant suffering as a result of maternal drinking during lactation was a baby whose mother drank 50 cans of beer a week plus several bottles of spirits. This is excessive drinking, and is harmful to anyone.

    As for caffeine, Dr. Chestin Berlin showed that one's uptake is individual. In other words, give 6 nursing mothers an equal dose of caffeine and their babies will all have different blood levels. Caffeine is given to some babies in NICU.

    Breastfeeding makes life easier with a baby. The risks of human milk substitutes are substantial: death, diabetes, cancer, allergies, and gut disease. The idea that a mother might wean because she wants to enjoy a glass of wine with her dinner is really throwing the baby out with the bathwater!!

    We are in far more danger as a result of all the chemicals and plastics that are ubiquitous in our lives now, that our bodies can not metabolize and that will never biodegrade.

    heterotic
    The fact that the study has not been repeatable yet, means little to me as of yet. The chances of damage being done are higher than 0, therefore it is wide to wait until the ABV of your breastmilk is zero or keep some clean pumped breastmilk on hand.

    Alcohol consumption also causes hormonal disruption, decreasing lactation performance and diminished milk supply.

    "As for caffeine, Dr. Chestin Berlin showed that one's uptake is
    individual. In other words, give 6 nursing mothers an equal dose of
    caffeine and their babies will all have different blood levels.
    Caffeine is given to some babies in NICU."

    The fact that it is individual (as stated in my article) should tell you that it is possible to do damage to the infant. To me, the odds of zero harm being done to an infant are the only acceptable odds when facing a shows of whether or not to drink something that I have choice in. Maternal consumption of 3 cups of coffee per day can affect iron concentrations in milk and affect infant iron status.

    "Breastfeeding makes life easier with a baby. The risks of human milk
    substitutes are substantial: death, diabetes, cancer, allergies, and
    gut disease. The idea that a mother might wean because she wants to
    enjoy a glass of wine with her dinner is really throwing the baby out
    with the bathwater!!"

    The differences in babies whose mothers' breastmilk with the presence of ethyl alcohol in detectable amounts and those who were only fed healthy breastmilk are comparable to the differences in breastfed babies and formula-fed babies. If you're going to commit to giving them breastmilk, I would think it would be a "duh" to keep it as healthy for the infant as possible.

    "We are in far more danger as a result of all the chemicals and plastics
    that are ubiquitous in our lives now, that our bodies can not
    metabolize and that will never biodegrade."

    Which is exactly why we should control what we can to reduce possible harm to our poor, helpless infants.
    "The differences in babies whose mothers' breastmilk with the presence of ethyl alcohol in detectable amounts and those who were only fed healthy breastmilk are comparable to the differences in breastfed babies and formula-fed babies."
    ------------------------------------------------------------------------------------------------------------------------------------------------------------------
    Upon what evidence do you base this statement?

    heterotic
    Ethyl alcohol increases cortisol levels, a steroid hormone that in humans is the major circulating hormone of the cortex of the adrenal gland. Adrenal dysfunction can lead to hypothyroidism. Since milk-production in a drinking woman is reduced, the infant feeds for a shorter period of time and sleeps less, and this can cause a lowered metabolic rate than the infant would have developed without the presence of ethyl alcohol in its food.

    Reseach does, in fact, point to the increase in obesity among babies who are fed formula instead of breastmilk. There is a tendency for parents to control the amount of food the baby is getting. In contrast, breastfed babies end their own feedings when they are satisfied. Parents who see even the smallest amount left in the bottle will nearly always encourage the baby to finish the formula that is left. In contrast, formula-feeding parents can also control the amount of food in a secondary negative way, by underfeeding, causing the infant's metabolic rate to be slowed.

    Evidence is easy to find.
    Gerhard Adam
    Sorry but this seems like a rationalizing argument.  Alcohol is completely unnecessary in any form, so if someone can't abstain, then perhaps there's another problem at work here.

    Why incur any risk?  Not consuming alcohol cannot be considered a hardship under any circumstances.
    Mundus vult decipi
    heterotic
    Exactly!
    Cher, do you have children and if so how long did you breastfeed for???
    Gerhard, I presume you have never had to abstain due to pregnancy or breastfeeding so I don't presume that you can make a judgment either!
    Cher you sound fairly self righteous to me. Perhaps this attitude will change when you actually have to live your propaganda? I have had three children and never touched a drop of alcohol during their pregnancy but during the many months of breastfeeding I have occasionally had a glass of wine. I certainly don't think this means I should join the ranks of AA just yet. The many positive aspects relating to health that breastfeeding gives an infant certainly outweigh negligible health risks of an occasional glass of wine. Breastfeeding is still better than formula.

    I do have a child. I have a preschooler. Yes, I stayed away from alcohol while I was pregnant and breastfed. Why? Because even before I did this research, I knew that when my doctor used the word "probably" and I signed a document saying I couldn't sue them if something DID go wrong that it was not a good idea.

    Breastfeeding is better than formula when there isn't any ethyl alcohol in it. You can't pump some in case you want to drink? And, unlike formula, it is an alternative for people who cannot breastfeed. I wonder how many mothers would accept breast milk with ethyl alcohol in it as an alternative if they were unable to breastfeed on their own. My guess is that formula would still win the market share.

    Obviously you didn't read this article, because you certainly would not be arguing that it's perfectly safe. My opinion is coming from research, and quite frankly, I don't care if I sound self-righteous. I am in this regard. If I would have really needed alcohol while I was breastfeeding, I would have stored some breast milk to ensure my infant did not suffer because of my need to drink alcoholic beverages.

    But when Little repeated her study, not only was she unable to replicate her results, but she showed an statistically significant increase in ability in both motor skills and brain functioning among infants (18 months) of mothers who had at least one alcoholic drink/day. So, based on your opinion of research this new information should lead to INCREASED drinking among breastfeeding mothers.

    And in both studies, formula fed babies were much more delayed than breastfeeding mothers who drank. Mothers who rented a house instead of owning were likewise much more delayed in motor developments skills than mothers who drank while breastfeeding.

    The alcohol question is not about alcoholism vs. being a caregiver (if you want to drink, you must love booze better than your baby)... it's about reasonable risk. If you drive with your baby in the car, there is a risk of injury due to an automobile accident. Of course, we all still drive. And when don't only drive when necessary, but also when we want to meet friends and socialize. Reasonable risk means understanding the difference between having wine with dinner and taking tequilla shots with your girlfriends. It also means understanding that having a reasonable life that includes good food, good friends, and maybe even good wine presents a lifestyle to your child that is full and not based on fear.

    I've breastfed my son who is 10 months drank coffee everyday and drank lightly occasionally and he is in the 90% head circumference 95 in weight and 93 in height. Women work hard and deserve to relax and act human we are not robots and I know that moderation is key when breast feeding my doctor and lactation consultant both say this is fine. They even say women who smoke cigs need to breastfed because it's the best ring for the baby and I any secondhand smoke gets to baby the breast milk is better than formula. I think it's messed up women can be so hard and judgmental on one another I mean yes if u are are falling down drunk there is a difference than enjoying a glad of wine with dinner and nursing and hour or more later. The men that made comments once u go thru labor or c section and sleepless nights of exclusive breast feeding feel free to comment.

    Gerhard Adam
    The men that made comments once u go thru labor or c section and sleepless nights of exclusive breast feeding feel free to comment.
    Oh don't play that game.  You're certainly free to do as you like, but equally if a problem develops you don't have any basis for complaint either.  Everyone is different [including infants] so if only one experiences a detrimental effect out of a thousand, then it becomes a case of individual choice.  But even then, no one should complain if they discover that they're the exception.
    Mundus vult decipi
    Hank
    Obviously the generation of researchers doing most studies (the average age for an R01 grant is 42) were born from mothers who drank alcohol, coffee and smoked. In moderation, it is not harmful.

    The issue becomes that people see outlier results and draw correlations from behavior and make a sweeping generalization that changing the behavior will eliminate outlier results.
    Gerhard Adam
    Most things, in moderation, are not  harmful to most people.  However, I think people need to be clear that if they have a concern, then the onus is on them to make their own decisions and not look for authorities to excuse or rationalize behavior.

    If there's a 1 in a million chance that something can happen, then it becomes informed consent.  However, the individual has no basis for complaint if they happen to be the exception to that.  Someone is going to be the outlier. 

    Where I have the problem is that people want to excuse their personal behaviors even when someone gives them a risk analysis [even that is highly unlikely] and yet when something negative occurs, then they'll willingly climb on the bandwagon to blame everything else whether it be vaccines or pollutants in the environment, etc.  I get that it's easier to blame some nameless, faceless entity, but when issues like this are raised, then it is incumbent on people to recognize the risks [real or perceived] and act accordingly instead of making excuses as to why it shouldn't apply to them.
    Mundus vult decipi
    Gerhard Adam
    Gerhard, I presume you have never had to abstain due to pregnancy or breastfeeding so I don't presume that you can make a judgment either!
    If you're telling me you can't abstain, just on principle (no moral judgment), for nine months, then I would suggest you do have a problem.  I'm not opposed to drinking, nor do I care how much people want to drink.  What does raise questions to me, is when someone behaves as if they can't do without it, for whatever reason.  I'm not suggesting that someone is an alcoholic, or has an addiction problem, but for something that is non-essential, one has to question the rationale in not being able to stop.
    Mundus vult decipi
    I think the point is, women should be made aware that you can enjoy the occasional glass of wine or beer while breast feeding because we can plan ahead & do so without harming the baby. If women are educated about how to go about doing it SAFELY, it will reduce the chances of unnecesarily early weening. No one is suggesting that a woman should drink WHILE breast feeding, or that you should breast feed within the hour of drinking. That's absurd. You can plan ahead, you can pump & store breast milk before ingesting any alcohol if you anticipate your baby will need a feeding before the alcohol has had time to leave your system. if you have a single drink, plan ahead & wait until the alcohol has left your system before resuming any breast feeding, then there is no need for complete & total abstinence "while" breast feeding. morons.

    Obviously there is no issue with storing milk or waiting until the alcohol is out of your breast milk to feed your child. Assuming you aren't the one planning to drive if need be or care for the infant if you drink too much.

    For someone referring to geniuses as morons, you're fairly unintelligent yourself.

    Well, I'm glad that fact seems obvious to you. However the writer of the original article seems to have completely ignored that possibility in her argument.

    And even geniuses can be extremely myopic and quite judgmental in their assumptions, as many of the above comments demonstrated. Although I concede that calling them morons was an emotional knee-jerk reaction and completely unnecessary, my basic point still stands.

    I am the writer.

    I was talking about women who drink and breastfeed, not the ones who wait until the alcohol has cleared and not the ones who store it to ensure they give their infants healthy breast milk.

    Perhaps I did not point out that I was only referring to women who breast feed while there is still alcohol in their milk, but I assumed that it was implied. I had just come from a conversation specifically about the topic and didn't think to add that disclaimer.

    OK, I do appreciate that clarification because not having had witnessed the conversation you had just come from, it was not clear to me in the original article. You quoted the other side as saying, in part, "Telling women they can't drink until they wean leads to unnecessarily short breastfeeding spans." I agree with that statement, however I cannot speak to whatever else that person said to you on this issue. Women should most certainly be told that they should not breast feed until the alcohol has cleared their system, but my point was in regards to women who mistakenly believe they cannot drink at all until they have weaned their babies completely off the breast milk.

    Gerhard Adam
    Aside from the issue of breast feeding.  I'm interested in the rationalizing arguments that seem to recur because there's a sense that people can't abide abstinence.  As I said before, I've never had a problem with drinking, nor do I have a problem with others drinking, and I certainly have no moral position on the subject.  That being said, it is intriguing that so many people think that it is an imposition to not drink. 

    For such a non-essential part of life, I can't imagine why that should be. 

    I will also assume that the individual isn't looking to get intoxicated, so the issue around abstinence seems even stranger.
    Mundus vult decipi
    Abstinence itself is not necessarily an imposition. But it serves no greater good to fail to educate people in anything they do, and to actively mislead them does generally do more harm than good. In regards to breastfeeding, some women chose to breast feed for anywhere from a few weeks to several years. I personally hope to breast feed for approximately a year, while a close friend of mine breastfed her daughter for a full four years. And although my days of drinking to intoxication are firmly behind me, I actually do enjoy the taste of an occasional rich thick dark Guinness stout or a nice Merlot from time to time. Drinking in itself may be a non-essential part of life, but over the course of several years, I personally would miss the taste of the occasional drink, not to mention the camaraderie of a shared toast at a family wedding or that shot of whiskey we took together last year at my dear friend's wake, in his loving memory. Strictly speaking, it is not essential, but human social interactions often aren't. Is music and poetry “essential”? I would certainly give up dancing while breastfeeding if I believed it would harm my baby but why perpetuate a lie? In my opinion, the real issue is about perpetuating misinformation and seeking to rob the less educated of their ability to make informed decisions for themselves and their families.

    Gerhard Adam
    Perhaps I'm being naive, but I find it astounding that humans appear to be the only species that can't figure out their own biology.  They apparently know nothing about food, they know little or nothing about exercise, they next to nothing about birth control, and apparently they know little or nothing about the substances that they put into their bodies.

    I can't imagine how such a species can spent 12+ years educating it's young and be so fundamentally ignorant.
    Mundus vult decipi
    Let's see, I eat a healthy balanced diet, I weigh within the medically prescribed weight limits for my height, I exercise regularly, I am very physically fit, I successfully used birth control until I was 30 years when I decided to have children, I'm happily married and well educated... I'm sorry, but what evidence do you have that I am fundamentally ignorant? because I admit to occasionally drinking 1 to 2 servings of alcohol (though not to the point of intoxication), dancing & reading poetry? Nice try.

    Gerhard Adam
    Unless you're defining yourself to represent the entire species, I don't believe I singled you out.

    However, it was you that indicated that this was of concern because of less well-educated individuals that might unnecessarily abstain or misinterpret what was being said.
    Mundus vult decipi
    OK, good point. I'm sorry for personalizing your statement (ha, I am currently pregnant & a little hormonal). I do come from a Sociologist/Social worker perspective and I do feel it should be the duty of the more educated to give the less educated informed choices in a language they can understand. Breast milk is universally considered better for a developing baby than formula and many women would breast feed longer (or at all) and more safely (if alcohol consumption is a concern), if they were better educated about the day to day “How To's” of pulling it off.

    Gerhard Adam
    I understand, and my point was only to indicate that when we consider the various articles on this site and others with topics relating to educating our children about food, or when we read the statistics on teen pregnancies, or when we hear the issue regarding obesity and exercise, etc.

    One can't help but marvel about how a species so fundamentally ignorant about living could be as successful as they are.  I'm being somewhat sarcastic about it, because I'm really annoyed that people need guidance to get their act together regarding food, reproduction, etc..

    As I mentioned in the original post, how can this be explained given that even drop-outs are exposed to at least 9-10 years of education.  To be a member of the species that appears to have the largest brain (with respect to intelligence), humans should be ashamed that they know so little about living.
    Mundus vult decipi
    Yeah... I work in the social work field and providing guidance and assistance the less education, less fortunate and more vulnerable members of society is definitely an up-hill battle.

    Gerhard Adam
    Well, I won't pile on those that are "less fortunate" although it is a mystery.  When one considers that few people 100+ years ago had a fraction of the education we possess today, it is difficult to understand where society went wrong (which it clearly has). 

    How does one reconcile the difference in "life" intelligence between a modern city dweller and an Australian Aborigine?  I'm only asking as a rhetorical question, since I certainly don't have an explanation (at least not one that is very flattering).
    Mundus vult decipi
    my mother had once told me she had been in a study in the 80's when my youngest sister was born in which for several days she was supposed to get drunk on beer because it caused her body to produce some kind of chemical in the milk that was good for the baby. do you know of any thing like this? granted it may not have been the alcohol but a chemical in the beer which did this.

    Mmmmm. Cher.

    The conclusion of the Little paper of 2002 states:
    "We did not replicate the findings of the original lactation study showing that infant motor development was adversely associated by infant exposure to alcohol via breast milk. Instead, several facets of development were weakly but positively related to maternal drinking during lactation."

    Unfortunately you should have mentioned this - because it makes your analysis appear to be one based on reasonable prejudice (the a priori reasons why alcohol and babies shouldn't mix appear to be compelling) rather than published studies.

    If I was playing a cynical devil's advocate I would say that Little's paper (the most authoritative study published to date) suggests that if mothers drink while breastfeeding then they are giving their child a small but statistically significant leg up.
    (Reference http://pediatrics.aappublications.org/cgi/content-nw/full/109/5/e72/T4 )

    I understand the rest of this conversation happened months ago, so this seems a bit anti-climactic. However, I'd like to point out that EVERYTHING has a "higher than zero" risk for you and your baby and everybody else. A baby can die from eating and choking. A baby can suffocate while sleeping. Granted, eating and sleeping are both more necessary than drinking, but you can see where this is going - I hope. YOU draw a line at drinking alcohol. Do you walk across the street with your child? Do you ever watch TV with your child? Is your child ever allowed to consume candy or soda? Do you drive your child around in a car only for absolutely essential reasons? There are uncountable behaviors that are potentially as risky or riskier than drinking in moderation while breastfeeding and that are often just as unnecessary. For you to proudly state that you are self-righteous in your comments sums up your entire article.

    Singular studies can say whatever we want them to say. An un-repeatable study is no more informative than no study at all. That you are basing your argument on the notion that the risks of drinking while breastfeeding are "higher than zero, and therefore, can cause detrimental affects [sic] in a developing infant," is indeed moronic. You try so hard to convince the reader of the integrity of the evidence that you point to. Basing an opinion on proper research is the premise of your article. But it seems that David Pringle's post effectively points out that your argument is based on incomplete research.

    The next time you write an article like this make it succinct. Just say: "Hi. I am self righteous. I arbitrarily decided not to drink while I breastfed my baby. So should you or you are an alcoholic. Love, Cher."

    There will always be more studies. There will always be more research. No evidence will ever be fool proof. And NOTHING has zero risk. Stop being an ass.

    Darin, I felt compelled to write and say how much I enjoyed your post! It was so well written, intelligent, and funny. Good stuff. You managed to articulate exactly how I felt about this article and author. Thank you!

    I did the calculation for BAC of a 10 lb baby and got a different number. Assuming a newborn has 80 mg of blood per KG weight, than an 8 lb baby would have 9.8 fluid ounces and a 10 lb. baby 12.2 oz. 12.2 oz = 345 grams.
    Your number 3.55 centigrams of alcohol would imply a BAC of .0355/345= .0001 or 0.01%.
    The larger assumption you are making however is that all of the alcohol consumed by the baby would go into the blood, which is a faulty assumption. While the capacity of the liver is reduced compared to an adult, the quantity of consumed blood that actually works its way into the bloodstream is a fraction of that consumed (for adults it is 1/50). So even assuming that the infants ability to process alcohol is 1/5th that of an adult (it is more like 1/2), the BAC would be 0.001% or 1/20th of what you report.

    I think what bothers me about this post is it seems hypocritical, criticizing poorly done research while doing more of the same.

    Bonny Bonobo alias Brat
    I breastfed 2 babies on and off for several years about 14 to 18 years ago and tried to abstain from drinking alcohol during that time, however occasionally I succumbed to a bit of societal pressure to have a drink at Xmas, birthdays etc.

    I was also in a mother's group of 13 women and had another 10 or so girlfriends who were either pregnant or breastfeeding at the time and I would say that most of these women thought there was no problem having one or two glasses of wine a day both when they were pregnant and/or whilst breastfeeding. What is even more amazing looking back is that many of our doctors were saying the same thing and recommending these daily drinks. I can't remember why I felt strongly at the time that drinking alcohol, pregnancy and breastfeeding was not a good idea, but it was probably because I was aware of foetal alcohol syndrome from when I had studied psychology.

    The times I did drink I expressed milk down the sink afterwards, which brings me to my question which is, did I need to do that? In this article people have repeatedly said pump milk before you have a drink and wait until the alcohol has gone from your body before you next breastfeed but wouldn't there still be some well-preserved alcoholic milk still sitting in the breasts a few hours later even when the breastfeeding mother has finally reverted to a zero blood alcohol level?
    My latest forum article 'Australian Researchers Discover Potential Blue Green Algae Cause & Treatment of Motor Neuron Disease (MND)&(ALS)' Parkinsons's and Alzheimer's can be found at http://www.science20.com/forums/medicine
    Cher,

    Can you please reply to Matt and Darin's comment? I really want to know your take on this.

    I currently breastfeed and on occasion (once or twice a month-if that my last drink was in Nov) I have a glass of wine with my dinner right AFTER I breastfeed. My daughter doesn't eat again for 3.5-4 hours later. After my wine I drink a couple of glasses of water (not sure if it helps but I always feel a little more thirsty). I am 5'8 and am 165lbs. My baby is now about 20lbs. Is this also dangerous? When do you "know" that you are safe to drink again.

    Also, did you deliver your child with medication? Did you take pain relievers after delivery, if so what did you take? Have you given any medication to your child or taken any yourself while breastfeeding? When did you give your child candy, soft drinks, products containing aspartme or corn syrup if you have at all. What kind of beauty products did you use on your skin while pregnant and breastfeeding? What kind of beauty products do you put on your child's skin?

    Looking forward to your reply, thanks!

    Oh, I forgot to add,

    When did your child first sit up, crawl, learn to say words, etc? How is he or she doing in preschool?

    So, I am a breastfeeding Mom of of an 8 month old angel and I love to have a glass or two of wine several times a week after my baby has gone to sleep at night. She falls asleep while I nurse and sleeps for 4-6 hours before waking up to nurse again. The beginning of this span is when I allow myself to indulge. I never go out, have more than two drinks, or drink during the day. What does everyone think of this philosophy? Seriously, I thought I was being safe and having reasonable amounts of fun/me time. After reading some of these posts, I am nervous.

    This is indeed the safe way that a breastfeeding mother is able to drink and be certain that the alcohol is out of her milk by the next time the baby feeds. Read my posts above explaining how alcohol, even if it has got into the breasts is removed from there, just as it is removed from all the other parts of your body it travelled to. Just because some gets into your brain, does not mean that alcohol is never ever removed. In the same way, the alcohol that has reached your breasts is in close proximity to capillaries, and the alcohol is removed, as your body removes all the alcohol consumed.

    I totally agree with the opinion that alcohol should not be consumed if there is any possibility of breastfeeding while there still is alcohol in the milk. Research has (obviously) been done about the cinetics of alcohol in the breastmilk. Conclusions are that the concentration in the milk is about the same as or a little higher than in the mother's blood, and that alcohol is also removed from the milk as it is removed from the blood. So, if you can be sure that you have 0 % in your blood, then it is okay to breastfeed. Below is a summary of one study about this, and a reference to another interesting book section about the issue.

    Mennella JA, Beauchamp GK. The transfer of alcohol to human milk. Effects on flavor and the infant's behavior. N Engl J Med 1991;325:981-5:
    Summary: At fixed intervals after the ingestion of alcohol by 8 nursing mothers, sets of breast milk and blood samples were collected and their alcohol levels compared. One set of milk samples was solely hind-milk while the remainder were fore-milk samples. The results showed that alcohol appeared quickly in both fore- and hind-milk at a level equivalent to or higher than the corresponding blood samples. Elimination of alcohol from the milk was closely related to its elimination from blood and was unaffected by breast feeding. However, despite this, the large dilution of the alcohol contained in the milk by the baby's body water renders the baby's resultant blood alcohol level very low in all but the most extreme cases

    Julie A. Mennella. Alcohol use during lactation: the folklore versus the science. In "Current issues in clinical lactation 2002", ed. Kathleen G. Auerbach

    Sorry, the first reference in my previous comment was wrong. Here is the correct one:

    Lawton ME. Alcohol in breast milk. Aust N Z J Obster Gynaecol 1985;25:71-3

    Bonny Bonobo alias Brat
    The paper you referenced above is not generally available to the public. I have just found this free paper on a government website titled 'Drinking alcohol while breastfeeding. Will it harm my baby?' It contains a table and algorithm created by 'Motherisk' which shows the time from beginning of drinking until clearance of alcohol from breast milk for women of various body weights: Assuming alcohol metabolism is constant at 15 mg/dL and woman is of average height (1.62 m[5’4”]). 1 drink = 340 g (12 oz) of 5% beer, or 141.75 g (5 oz) of11% wine, or 42.53 g (1.5 oz) of 40% liquor.

    Example no. 1: For a 40.8-kg (90-lb) woman who consumed three drinks in 1 hour, it would take 8 hours, 30 minutes for there to be no alcohol in her breast milk, but for a 95.3-kg (210-lb) woman drinking the same amount, it would take 5 hours, 33 minutes

    Example no. 2: For a 63.5-kg (140-lb) woman drinking four beers starting at 8:00 PM, it would take 9 hours, 17 minutes for there to be no alcohol in her breast milk (ie, until 5:17 AM).

    I must admit I'm pretty amazed at how long it takes to clear the alcohol from the mother's breast milk. The paper also says the following :- 

    Alcohol consumed by a mother passes easily into her breast milk at concentrations similar to those found in her bloodstream. A nursing infant is actually exposed to only a fraction of the alcohol the mother ingests but infants detoxify alcohol in their first weeks of life at only half the rate of adults. 
    Several proven or potential adverse effects of alcohol on suckling infants have been reported, even after exposure to only moderate levels: impaired motor development, changes in sleep patterns, decrease in milk intake, and risk of hypoglycemia. 
    My latest forum article 'Australian Researchers Discover Potential Blue Green Algae Cause & Treatment of Motor Neuron Disease (MND)&(ALS)' Parkinsons's and Alzheimer's can be found at http://www.science20.com/forums/medicine
    As I have learned it, the rule of thumb for my size man (70 - 80 kg) is that it takes 2 hours to clear the alcohol of one drink from the body (assuming normal liver function). The numbers in your examples seem to be in line with that.

    The book chapter was freely accessible, and there is some pretty surprising information eg. of how common it has been that health care professionals recommend drinking to nursing mothers (in USA).

    I'm impressed by the thoughtful discourse in this comment thread. It's refreshing to see that even when people disagree they don't have to get all "internet comment section crazy".
    I'm surprised that everyone seems to be ignoring our evolutionary history. I feel it should always be considered. It's also difficult to study humans when you have to create standards and it's much easier to be biased in a human based study.
    No one has addressed that we have evolved the ability to process ethyl alcohol. Studies involving alcohol dehydrogenase in fruit flies are par for the course in introductory biology classes. Primates in particular are well adapted to consuming fermented fruit considering it is a large part of many of their diets. I'm pretty sure most monkeys and apes continue to breastfeed even when they get into a batch of rotting fruit. The idea that the infant consumes less while the mother has ethyl alcohol in her system could point to an adaptation to avoid larger amounts of alcohol. So sure it may be harmful in large amounts but I really think some perspective is in order. Periodic and Moderate alcohol consumption and breastfeeding are something we've been dealing with for many millions of years.

    Gerhard Adam
    You're absolutely right, but there are two minor problems here.  Since other primates don't have our cognitive abilities, we don't know if even small changes might be more detrimental to humans [during select periods] than other primates.  In addition, humans want assurances and guarantees and as was mentioned regarding statistical outliers, there are some people [even if rare] that may experience negative effects from alcohol.

    So, it depends on how one approaches the issue.  If someone is informed and makes the decision for themselves, then there's no problem.  However, if negative consequences occur then there's also no basis for complaint. 

    One of my problems with this whole discussion is that some people claim that they "need" the break or they shouldn't be deprived.  OK, I can get that, but where it becomes baffling is when those same people want to pursue some regimen of organic foods, and vitamins, etc. etc. etc. because of healthy living and yet they can't abstain for a few months of breastfeeding.

    Maybe they aren't the same people, but there sure seems to be enough of them when it comes to discussing organic foods (or GMO foods) and vaccines. 
    Mundus vult decipi
    Under that argument the Rat study is out the window as well since it's not humans. Then you have the Little et al. study that was not reproducible so if those are our main bases of evidence then there is no indication that alcohol in breast milk is dangerous based on the evidence presented in this blog post. ??

    Gerhard Adam
    Well, I'm not sure that it is or is not dangerous [in the general sense].  My only point is that the more people exposed, the greater we will encounter statistical outliers.  So, if people are looking for safety guarantees, there will invariably be someone that will be disappointed.
    Mundus vult decipi
    Obviously none of you have dealt with alcoholism....is it better for a mother to breastfeed while being an alcoholic or give formula? Alcoholism is a real disease....I have felt it's grip. Yes, I have two little boys....I love them to death. I breastfed both my babies, and while I was never shitfaced when I nursed them, sometimes I had a couple of drinks....for me it was an issue of managing my alcohol consumption. If I drank heavily, I gave them previously pumped breastmilk in a bottle. In a perfect world, I would not need to drink. In a perfect world I would have quit drinking when I became a mother. I never got drunk while pregnant....but the nature of alcoholism is that stress can cause you to drink more. Being a mother of two young boys is stressful. My alcoholism has certainly improved since becoming a mother, but I don't know if it will ever go away. Both my children are very healthy. They eat all organic food (lots of raw food) and do not suffer from allergies, ADD, obesity, diabetes, or depression. How should I way the risks? Do you have the nerve to call me a bad mother? This a complex issue. Alcoholism is a very real disease....you cannot understand it until you have been there. Should I have never had my children? Should I have given then formula made out of hormone and antibiotic laced milk from a cow? There is no argument for me....it has been challenging to manage this disease while being a mother....but I feel I have done well for them. Scientific research is black and white...there are grey areas....walk a mile in my shoes and then write about this again.

    I know this is an old tread, but just wanted to comment. I am very happy to read all the informed argument from both sides. I came across this because I am a mother of two and currently breastfeeding...and I do like to have an occasional night out or a few drinks and was wondering what, if any, effects this has on my child. As many have said, there are just so many variables to the situation. Yes, research IS often too black and white in a greyscale world.
    The conclusion I have come to is that it just depends on what risks one is willing to take. You can back up almost any conclusion or idea with "facts and research" (i.e. research done by other people just like us!). And there are ALWAYS chances for one to be a hypocrite or inconsistent.
    For example: I eat almost exclusively organic, local foods...I try not to feed my son refined sugars, corn syrup, refined flours, fast food, tap water (we use spring we collect ourselves), artificial flavors, GMO produce and for the most part foods that don't look like the plant/animal they were when they were living. I also don't take medications or birth control and would sweat out a fever before I would ever take a pill. BUT I would breastfeed my child with a beer or two in my system LONG before I would ever resort to formula.
    Why? Because it's DEAD food. They have found lead in formula, it's freeze-dried milk, factory regulations allow a certain amount of rat feces into packaged foods, they feed cows terrible food that is not meant for their digestive systems (i.e. dead animals, soy and corn)...the list goes on and on. The reason they pasteurize milk is because there is POOP in it, And yes...I have worked on MANY farms and worked for a biological research team studying farm sustainability and know this to be true.
    On the other hand...I drank raw milk like it was going out of style when I was pregnant. Why? Because I knew where it came from and could see it being collected and processed. But...I sure got hell for it!
    I also choose not to immunize my children and let my 3 year old use knives. Those are the "risks" I a willing to take after making an educated CHOICE.
    Anyhow...enough about me. Point is, we need to decide for ourselves what is best. Do I recommend getting loaded and breastfeeding? Of course not. The best we can do as free-thinking humans is to make INFORMED decisions. Learn both sides of the matter then make a choice for OURSELVES.
    Basically, if you're checking out this discussion board, you care enough to be informed. That's a great step. I think it's great that people are discussing this. Blind faith (in a 'study', by word of mouth or in anything for that matter) can be very dangerous. The only thing we can really trust is ourselves and our intuition and do what we think and feel is best. And the only people truly out for the best interest of ourself and our children is...you guessed it...US as individuals! Not some funded research team or news study or even our doctors. They are all just made up of people who are just like us. Use their information as a tool and recognize that there is no one all-knowing expert on anything.