Estimated reading time: 4 minutes
Updated May 2016
Carlos González, Spain
Photo: Shutterstock.com / Dima Sobko
Excerpt from Breastfeeding Made Easy by Carlos González Pinter & Martin
Alcohol and breastfeeding
Alcohol passes easily and quickly from the mother’s blood into her milk and vice versa, so that the concentration in both liquids is the same. The milk/plasma ratio is 1.
In Spain, the legal alcohol limit for driving is 0.5g per litre of blood, which is the same as 0.05g per 100ml or 0.05 per cent. A few decades ago the legal limit was 0.08 per cent (this is still the legal limit in the UK). If your alcohol level is higher than 0.15 per cent you are unmistakably drunk. If it goes above 0.55 per cent, you simply drop dead. Many die before.
Even habitual drinkers react the same way when they have the same levels of alcohol in their blood. The difference is they eliminate alcohol more quickly, and it takes them longer to reach these levels, but when they have 0.15 per cent alcohol in their blood they are drunk and when they have 0.55 per cent they die like everyone else.
Therefore, it is absolutely impossible for breast milk to contain more than 0.55 per cent alcohol, and for this to be so, the mother would have to be in hospital suffering from acute alcohol poisoning. Realistically, a mother who is inebriated could have 0.2 per cent or 0.3 per cent alcohol in her milk, but a mother who drinks in moderation won’t even have 0.05 per cent.
Wine contains on average 10–14 per cent alcohol. Liqueurs range from 30–40 per cent (sometimes more). Beer contains 4–6 per cent alcohol (sometimes more). Alcohol-free beer can legally contain up to 1 per cent alcohol. Someone with 1 per cent of alcohol in their blood would already be dead. Consequently, even the breast milk of a completely inebriated mother could be bottled and labelled ‘alcohol-free’. And the milk of a mother who has had a small drink, even if her blood contains 0.04 per cent alcohol and in some countries she fails the Breathalyzer test, could still be sold as ‘alcohol-free milk’, because 0.04 per cent is rounded down to 0.0 per cent (if we are purists, 0.06 per cent is rounded up to 0.1 per cent; I don’t know whether beer producers are so rigorous).
To sum up: at worst milk is a very mildly alcoholic drink, and it is almost impossible that drinking alcohol while breastfeeding will harm your baby.
I say ‘almost’, because newborns are very sensitive to alcohol, they metabolise it very slowly, and moreover they nurse like mad.
Drinking more than half a litre a day when you weigh a little over three kilos is the equivalent of an adult who weighs 60 kilos drinking ten litres a day. A friend of mine who is a midwife told me that in the hospital where she works in Barcelona, a newborn was brought to casualty suffering from excessive drowsiness and hypotonia; the only obvious cause was that the mother usually drank a small beer before each feed. The sad thing was that the mother was teetotal, and was forcing herself to drink beer because someone had told her it would boost her supply of milk.
Alcohol consumption is measured in grams per day, but for practical purposes it is usually measured in ‘glasses’. Traditionally, the higher the percentage of alcohol, the smaller the ‘glass’: beer is consumed from a tankard, wine from a large or small wineglass, liqueurs from a liqueur glass, brandy from a brandy glass and tequila from a shot glass. Each ‘glass’ of liquid contains more or less the same amount of alcohol. So it can’t be said that tequila is any more dangerous than beer, provided the dose consumed is one shot. Naturally, drinking a tankard of tequila would be extremely dangerous.
One study found that children whose mothers drank more than two glasses of alcohol a day showed a slight psychomotor retardation. Based on that information, many books recommend ‘a maximum of two glasses of alcohol a day’ while breastfeeding. Clearly, this is sensible rule not just during breastfeeding, but in general. Too much alcohol is bad for your health, and it is a good idea for both mothers and fathers not to exceed two glasses.
However, if you are someone who likes to drink three or four glasses a day, and you can’t or don’t want to stop, I don’t think you are harming your child. You are harming yourself, not your baby. Even if the mother drinks three glasses a day, breastfeeding is still better for her baby than bottle feeding. It is very unlikely that this amount of alcohol will affect the baby, and when the same scientists repeated their experiment a year later, they found no link between alcohol consumption and psychomotor development. It is far more likely that many mothers who drink during breastfeeding also drank when they were pregnant, and this is what affected their child’s development.
Consuming alcohol during pregnancy is dangerous. Extremely dangerous. No amount of alcohol is considered ‘safe’ during pregnancy. The aim should be zero consumption, no alcohol at all. Obviously one beer a week isn’t as bad as one beer a day,but no one can say with certainty: ‘one beer a week is fine’.
If you drink too much at a party one night, it might be wise not to breastfeed while you are visibly drunk, especially if your baby is only a few weeks old. When you sober up, it means the alcohol level in your plasma, and therefore in your milk, has gone down from 0.15 per cent. Remember, alcohol passes from blood to milk and from milk to blood easily; it doesn’t accumulate in the breast, so there is no need to express your milk and discard it (unless your breasts are too full and feel uncomfortable). Your milk is ‘self-cleaning’.
Little, R.E., Northstone, K., Golding, J.; ALSPAC Study Team ‘Alcohol, breastfeeding, and development at 18 months’, Pediatrics 2002;109:E72-2 pediatrics.aappublications.org/ cgi/content/full/109/5/e72.
Carlos González, a father of three, studied medicine at the Universidad Autónoma de Barcelona and trained as a pediatrician at the Hospital de Sant Joan de Déu. The founder and president of the Catalan Breastfeeding Association (ACPAM), he currently gives courses on breastfeeding for medical professionals and has talked at LLL conferences in several countries. His books Kiss Me and My Child Won’t Eat are published in English translations by Pinter & Martin.