The Boob Group
Breastfeeding and Drinking Alcohol
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SUNNY GAULT: This episode of The Boob Group is brought to you by RuminaNursingwear. Hands-free pumping and nursing tanks and bras to support your breastfeeding goals. Visit www.pumpandnurse.com and save 20% with promo code BOOBGROUP20.
DR. MURPHY: You have probably heard conflicting information about drinking alcohol while breastfeeding. Is it safe to occasionally drink a beer or a glass of wine when breastfeeding? How long should you wait? How will it affect your baby? Should you pump and dump? I'm Dr. James Murphy, a pediatrician here in Solana Beach, just north of San Diego. Today, we're talking about breastfeeding and drinking alcohol, the dos and don'ts. This is The Boob Group.
LEILANI WILDE: Welcome to The Boob Group, broadcasting from the Birth Education Center of San Diego. The Boob Group is your weekly, online, on the go support group for all things related to breastfeeding. I'm your host, Leilani Wilde, I'm also an IBCLC and owner of Leilani’s Lactation and Doula Services. Are you a member of The Boob Group club? Join today and receive exclusive bonus content, transcripts and discounts from our partners.
Visit the members' section on our website, newmommymedia.com for more information. While you're there, check out all our direct links to download our free apps available in the Android, iTunes and Windows marketplace. Now sunny is going to tell us more about our virtual panelist program.
SUNNY GAULT: Hi everybody, I'm on Facebook and twitter right now, checking our account. I'm going to be posting some of the topics that we're talking about here in the studio. We welcome you guys to be part of it, and I usually post some stuff before we start recording as well. Follow us on Facebook, follow us on Twitter, look for the hashtag #BoobGroupVP, that VP stands for Virtual Panelist, and you can join the conversation. Let's meet some of the people that are joining us here in the studio.
I'm actually going to participate in this conversation, so I'll tell you a little bit more about myself. I'm Sunny, and I own New Mommy Media which produces The Boob Group, Parent Savers, Preggie Pals and Twin Talks. I have four children of my own, they're currently all age 4 and under. A 4 year old boy, a 3 year old boy and identical twin girls who are about 19 months old. Jennifer, tell us a little bit more about yourself.
JENNIFER: My name is Jennifer, I am probably 32, I might be 33. My husband keeps track of that, I don’t. I'm a stay at home mom, I have two kids. My son is 4.5 and my daughter who you can hear is 9 months today.
SUNNY GAULT: Nice.
SUNNY GAULT: All right, before we start today's conversation about breastfeeding, drinking alcohol, we're going to talk about this headline. The headline kind of just stops you in your tracks. The headline is "Should moms be paid to breastfeed?" My answer is Yay! I would love to be paid. No, I want to know, since I'm breastfeeding twins do I get double the money? That’s the big question that I have.
DR. MURPHY: We want paid maternity leave.
SUNNY GAULT: Yes, exactly, let's start with the basics first. Okay, so this is interesting. These UK researchers are testing a program, I guess they’ve tested in a couple of small cities over the last few years. They're saying it's "Showed promise," but this is it. Their program gives women 310 dollars in vouchers for free food, toys and household goods if they agree to breastfeed for 6 months. The big question is, would something like that work here in the US? Like I said they're still testing it in the UK, would that work here in the US? As you guys know we do have Wick, which offers financial assistance.
DR. MURPHY: Food coupons.
SUNNY GAULT: Food coupons, yeah. Wick offers vouchers, food coupons, things of that sort for low income families. We kind of have something in place for that, but this would be something that really expands that and it's not just based on low income anymore. The idea behind it is because breast milk is so good for a baby, the baby is going to have less problems in the long run, saving them money then, if they just tried to encourage it wherever possible.
LEILANI WILDE: I'm curious as to where that money is coming from. Is that from our tax dollars? We're paying women to feed their children?
SUNNY GAULT: Well I think it is in England, I think that’s what they're doing over in England. How would we do that here? Obamacare?
JENNIFER: Remember that when the mommy is breastfeeding, it's reducing breast cancer, ovarian cancer, colorectal cancer, so by having patients live longer and better lives, utilizing less medical care, you're saving a great deal of money. A little bit of money invested up front can really reap dividends.
LEILANI WILDE: That's the idea, yeah.
DR. MURPHY: Getting the mother to breastfeed for six months is predicated on having a system that can support the mother to do that.
LEILANI WILDE: That’s right. I just read someone was told they had to pump in the bathroom at work. I'm just like "That’s crazy!" That’s still happening and it's against the law. We do have a long ways to go I believe. Anything to promote breastfeeding, I'm all for it.
SUNNY GAULT: Yes, exactly. Jennifer, what do you think about this?
JENNIFER: I think it's a great idea.
SUNNY GAULT: Where's my 310 dollars?
JENNIFER: Yeah. I'm 9 months in so I'm already owed that. Yes, it would obviously be based off of taxes, and do I want my taxes to be higher to support that? Maybe not.
SUNNY GAULT: Yeah.
JENNIFER: I think it's a double edged sword. Yeah I'd love to have the money, but I don’t want to end up paying the money either.
SUNNY GAULT: Right.
LEILANI WILDE: Today on The Boob Group we're discussing breastfeeding and drinking alcohol. Our expert, Dr. James Murphy, pediatrician here in San Diego, California. Thank you for joining us, Dr. Murphy and welcome to the show.
DR. MURPHY: I'm pleased to be here.
LEILANI WILDE: There seems to be a lot of misconceptions about drinking alcohol and breastfeeding. Is it safe to have a drink or two while breastfeeding?
DR. MURPHY: It's difficult to give an absolute answer to that question, because the studies that we have are suggestive of deficits in many areas in infants when the mother has 1-2 glasses a week of alcohol. But can we modify that in such a way that we have food introduced along with the alcohol to keep the level lower, but longer?
Can we time it so that the mother can begin drinking when she's beginning nursing, so that the peak alcohol level in the blood will go down and the breast milk, which is relatively the same will go up and then down again? Roughly two hours later it's down to a very safe level to nurse. It all depends on how much alcohol the mom takes in and how soon the baby demands to be breastfed next. Safe is a relative term.
LEILANI WILDE: And the type of alcohol too, right? It makes a difference.
DR. MURPHY: No, it's the absolute amount of alcohol. The recommendation has been that the mom take in no more than 8 ounces of wine, two beers or the equivalent in one drink of hard liquor.
LEILANI WILDE: Okay.
DR. MURPHY: It's the absolute amount of alcohol in whatever you're taking. The particular wine, beer or hard liquor doesn’t make a difference.
LEILANI WILDE: Okay. Jennifer, what have you heard in regards to drinking and breastfeeding?
JENNIFER: Everything that I've heard was, the slogan right now is "If you can drive you can breastfeed." I don't know why people kept saying that. Where does this come from? There has to be some science behind this new slogan that everyone is talking about. I asked where it came from or why people think this, and I was given a link to a scientist, a woman who had a baby and she actually did her own research where she tested her milk and her blood with her own equipment at home while she was breastfeeding.
I thought that was really interesting. I actually didn't drink at all after I had my first child. I breastfed him for 14 months and I never had any alcohol the entire time, but I read her research and I actually started having wine since I've had this baby. That's my experience, this woman had actually done the research herself, which most places I think won't support that kind of research, because you're talking about giving infants alcohol essentially. I don’t think it's well studied at this point.
LEILANI WILDE: Right. Well it's true. I know that some people do consider drinking beer to increase their milk supply, what do you think about that?
DR. MURPHY: That’s a fallacy, that milk is a galactagogue. It actually impairs the secretion of prolactin and actually over time can decrease the amount of milk you produce, as well as increasing the milk dejection. One physician in our ABM group has suggested that the babies that drank less milk and slept a shorter period of time and got less rest might have been because of the taste.
That the babies had exquisite taste and exquisite smell, that's how they find the breast in the first place. That just might be interfering with the baby's enjoyment of eating and may stop sooner, that could be causing the problem as opposed to alcohol at low doses, which has a stimulant effect, makes you hyper rather than suppressed, and that the alcohol can interfere with sleep.
We know people who drink a lot go to sleep very quickly, but they don’t stay asleep long and they don’t sleep well. It's the active phase of sleep that is impaired, and that is the phase that really gives us the most rest for our essential nervous system and prepares us to get up and get going for the next interval. For us it would be the next day, for the baby it's whatever comes next.
LEILANI WILDE: Right. If you had a patient that came in and asked you if it's okay or if it's safe to have a drink, because they’ve gone 9 months knowing that it's different when you're pregnant vs when you're breastfeeding, what do you usually tell them?
DR. MURPHY: I hand out the protocol #21 from the Academy of Breastfeeding Medicine, guidelines for breastfeeding and substance use or substance use disorder. It was revised this year. It states quite clearly on there that alcohol interferes with the milk ejection reflex, alcohol levels generally parallel the blood level in the mother, so that if the mother feels buzzed, the milk is buzzed, and that most sources advise limiting alcohol intake to 8 ounces of vine or equivalent, 2 beers and waiting 2 hours after the beginning of consuming that alcohol until resuming breastfeeding.
The idea is that if you drink it relatively quickly, you'll reach the peak and it'll go down. If you sip it, it'll go at a lower level for a longer period of time, but at the end of 2 hours it should be below the .02 percent blood level, which is considered relatively safe. Is anything absolutely safe? I don’t know, I don’t think anybody knows, but we know that If we get it down below .02 percent blood level, then it's .02 percent level in the milk supply, and we think that that's relatively safe.
For somebody who has to have their alcohol, we have to counsel them on how to do it in the safest manner possible. We do counsel abstinence of alcohol while breastfeeding, and pediatricians are not dumb. We know that mothers tell us what we want to hear. We know that they don’t tell us that they're drinking alcohol, it's not going to be well received so we give them a way to deal with the issue if they have to have the alcohol. Do it this way, it's the safest way to do it if you're going to do it at all.
LEILANI WILDE: Okay, good. Jennifer, how old was your baby when you had your first drink?
JENNIFER: She was 6.5 months I believe.
LEILANI WILDE: Did your baby ever respond differently when you breast fed?
JENNIFER: From drinking?
LEILANI WILDE: Yes.
JENNIFER: I actually had my first drink on mothers' day this year, we were in Las Vegas of all places and I had a glass of wine in Las Vegas, which is probably like half the size of a glass you'd pour yourself at home I would think. She slept all night, through the night for the first time in her life. It was a good mothers' day present.
DR. MURPHY: So with a study of 1...
JENNIFER: You should start drinking because your baby will sleep through the night! No, don’t do that. That was my experience. I had another glass the next night and she did not sleep through the night.
LEILANI WILDE: Did she act like... you know, because the flavor, did it alter? Did you have that drink and then feed right away?
JENNIFER: No, I had the drink at dinner time, which was around 5 and she goes to bed around 7. Although, we were in Vegas so she probably went to bed around 8, so it was 3 hours later before she ate.
LEILANI WILDE: Okay.
JENNIFER: She didn't act any differently, it was a very normal experience. She nursed the same amount of time.
LEILANI WILDE: Dr. Murphy, does it matter how old the baby is before we consider having a drink?
DR. MURPHY: The one thing that we're concerned about is toxicity to the central nervous system, so the more well developed the baby is, the older they are, the less the risk of toxicity. This is why absolutely no alcohol during pregnancy is necessary, while the central nervous system and the rest of the body is forming.
The later, the older the baby the better it is. The more you can delay introduction of alcohol into the diet, the better it would be. There's a big difference between men and women in metabolizing alcohol. Men seem to metabolize it very quickly, and women much more slowly.
On one television show in which they had a bartender pour drinks for 3 women, and then they measured their blood alcohol level until it was done. One woman was down to a safe level below .02 in two hours, the other one took four hours and the last one was not allowed to leave until 8 hours. They had to keep the studio open late.
LEILANI WILDE: Did that have anything to do with the BMI of the women?
DR. MURPHY: They didn't correlate it, we don’t have any studies I know of that do correlate that, but we do know that women have different tolerance for alcohol. The one who can drink a man under the table is not going to be at risk for having high blood levels of alcohol. The one who drinks one drink and has to sleep in the car on the way home from dinner, that would be a problem.
SUNNY GAULT: That would be me.
LEILANI WILDE: Sunny, what about you? What's your experience?
SUNNY GAULT: Obviously I didn't drink during pregnancy, but having a glass of wine or a glass of beer is something that my husband and I like to do, just to kind of relax, and honestly the more kids we have, the more I felt like I needed to. Obviously you have to do that within reason, so I'm probably one of those people that did it a little bit sooner than most. My twins were premies, so I did take that into consideration.
That was something I didn't mess with in the beginning, I wanted to make sure that once they got past the regular due date and they were breastfeeding find, all that kind of stuff, that’s when I considered it. I never really thought about doing it to increase milk supply or anything like that, for me it was just a nice way to relax and spend time with my husband.
LEILANI WILDE: What kind of research did you do? Did you just go off what your friends were doing?
SUNNY GAULT: You know, I really didn't do a lot of research on it to be honest. I was really freaked out with my first baby, but these are babies 3 and 4. With my first baby I bought those test strips, do you know what I'm talking about?
LEILANI WILDE: Yes.
SUNNY GAULT: Because I was totally freaked out about it, and then I really looked at how my babies reacted to it. I think that was the biggest thing.
LEILANI WILDE: What about those test strips, Dr. Murphy?
DR. MURPHY: Among the AAP and the ABM, the opinion that has been expressed to me by many members is that they don’t rely on the test strips. They think that measuring the amount of alcohol and doing a correct timing is much more relevant to giving a safe level of alcohol in the breast milk to your baby than using a test strip. You can buy a breathalyzer to carry around with yourself, but they're nowhere near as accurate as the ones that the highway patrol uses.
LEILANI WILDE: Good to know. For other reasons.
SUNNY GAULT: This is with the person that falls asleep after one drink though.
LEILANI WILDE: Okay, when we come back we will discuss with Dr. Murphy how it affects the baby if you have too much to drink, and whether or not we should pump and dump. We will be right back.
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LEILANI WILDE: Welcome back to the show, we're here with Dr. Murphy, a pediatrician from San Diego. Dr. Murphy, is there a safe amount to drink while we're still breastfeeding our babies?
DR. MURPHY: Alcohol is a toxin, it can poison the central nervous system at any dose. The question is, at what dose level will it be a permanent effect, as opposed to the temporary effect for which everyone drinks alcohol. We don’t know for sure. The tests that have been done in the short term, from 12 months and 18 months have shown some deficits.
They have shown that there's impaired motor development and post-natal growth, decreased milk consumption by the baby and sleep disturbances. Not enough active sleep, so the baby is not getting the same quality of sleep. These are two studies that we have done, that have indicated that.
There are longer studies done in Seattle over many years, that have been able to document with higher levels of alcohol more significant deficits as the baby grows older. We should think of alcohol as a toxic insult. It's a one-time toxic insult each time alcohol is introduced to the baby. It does a particular level of damage that one time, and then it's gone. There's not an ongoing deficit.
There is a deficit as a result of a single insult or multiple insults at individual times, that can then accumulate over time to show that the baby doesn’t meet developmental milestones as expected. The lower the level of alcohol, the less there's going to be a detectable, and it may not be detectable from the average individual in the normal IQ range. When larger amounts of alcohol are consumed, then you can see that it does have a deficit that is different from the average individual.
LEILANI WILDE: From what I understand, when a mom drinks alcohol, and the same thing with medication, when it transfers through the breast milk it's in a smaller ratio. Is that correct?
DR. MURPHY: Well, relatively the blood level in the mother is the same as the level of alcohol in the breast milk. Very similar levels, so that’s why you can think that when you're feeling a blood level in yourself, you know that your milk is not safe.
LEILANI WILDE: That's kind of what Jennifer was saying, if you can drive you can breastfeed.
DR. MURPHY: That's saying that it's below the .02 level, but fingers crossed.
JENNIFER: Right, I don’t really subscribe to that.
LEILANI WILDE: If you're feeling clear headed...
DR. MURPHY: Most of the people who are stopped for DWI say they felt just fine.
LEILANI WILDE: Oh, that’s true.
DR. MURPHY: Doesn’t work.
LEILANI WILDE: So really you just have to watch your consumption, how much.
DR. MURPHY: Measure it and time it. That’s your best way to go.
LEILANI WILDE: Okay. What about pumping and dumping? We hear people think that that’s the answer to having a drink.
DR. MURPHY: If you have a high level of alcohol in your breast milk, then it's not good for the baby. It's a judgment call as to the value of breast milk and the things that it accomplishes in prevention and so forth. That value is lost if the breast milk is discarded, and then the damage that the alcohol might cause is also discarded. It's a judgment call as to how much alcohol you think is in there. If it's really high, if you're really very buzzed, you shouldn’t be breastfeeding that baby.
Baby needs to be given some alternate means of nutrition at that point. If you pump the milk out, you just lose it because the alcohol doesn’t go down when it's not in your body so that you can metabolize it. If you put it in the fridge, the alcohol stays at the same level. The only way to reduce the alcohol is to pump milk that doesn’t have alcohol and add it to the milk that does, to dilute down the alcohol level, that you could give at a later time.
LEILANI WILDE: Right, that’s actually one of the things that I have recommended to moms. I said if you ever have a date night, you go to a wedding or party, you're likely to have more than you normally would if you're going to have a drink. I tell them to go ahead and pump, and then store it in your freezer and mark it "Alcohol." Then later on when the baby is older you can divvy it up into smaller quantities and you can give it to them safely. Their body is older, more mature and can handle the smaller levels at that point because it is kind of mixed up.
DR. MURPHY: As long as the breast milk stays in the breast, the alcohol is metabolized. Once it's excreted, it stays at the level that it's at when it's expressed.
LEILANI WILDE: A mom could think that she just pumped and then after she pumped out that initial amount of milk, then she's safe to breastfeed, but that’s not true because it's still in her blood stream.
DR. MURPHY: You have to wait until the time period where the alcohol is down to a safe level, and that depends on how much you drank and how quickly you ingested it, as to when you get down to a safe level.
SUNNY GAULT: Right. I had heard something, and I have a feeling now after listening to you guys talk, that this is false as well. I had heard that if you pump, let's just say you put them in the freezer, that after an extended period of time, I'm talking 6 months plus, then if you thawed the milk, then the properties would at least be lower. Have you guys heard...? No, that’s not true.
LEILANI WILDE: No.
SUNNY GAULT: Just something we tell ourselves. Right, but have you guys ever pumped and dumped?
JENNIFER: I have not. I don’t like pumping, first off. I'd rather not even drink, or I'd resort to formula. I just don’t like pumping, so it's not my first choice.
LEILANI WILDE: Right.
SUNNY GAULT: I have not pumped and dumped that I'm aware of, I don’t think I've done that, but I did do the thing that I was telling you about, where if you froze your breast milk and you put it in... I marked it "Alcohol" and after an extended period of time gave it to my kids. I had done that, but the kids were pretty old by the time that I did that. Again, I thought I was doing the right thing so I'm glad we kind of clarified it today.
LEILANI WILDE: Good. Okay, thank you so much Dr. Murphy and Jennifer for helping us all understand the dos and don'ts of breastfeeding and drinking alcohol, and some of the experiences that you have all had. For our Boob Group Club members, our conversation will continue after the end of this show as Dr. Murphy will discuss his recommendations on what to do in order to prepare for maybe an upcoming event when you plan on having a drink. For more information about our Boob Group Club, please visit our website at newmommymedia.com.
COURTNEY MELVETH: So here's a question from one of our listeners. This is from Lindsay, and this is what she asked: "I was diagnosed with polycystic ovary syndrome and put on Metformin and Spironolactone. No one told me that would increase my chances of conception, they said I was infertile and even IVF probably wouldn’t work for me.
Anyways, it's very important for me to breastfeed, and have been going for almost 8 months under the assumption that those meds are not safe during breastfeeding. I looked at Lactmed and don't really understand what it says. My doctor wasn't helpful with this either. Has anyone used these meds while nursing? I'd really like to go back on it if it's safe for my girl.
VERONICA TINGZON: Hi, this is Veronica Tingzon, international board certified lactation consultant and private practice and hospital based lactation consultant in the San Diego area. Everything that I've read on lactmed and other medications in mothers' milk by hail, I believe that there's no evidence that it's not safe.
A lot of times, pharmacists, doctors and even the packaging itself contains a warning for pregnant and/or breastfeeding women about whether medication is safe or not to use during breastfeeding or pregnancy. One of the things that I would look at, is does the benefit outweigh the risk? If it does for you, then you can go ahead and take it.
The studies show that very little of the Spirnolactone gets into the milk, so really not a lot is going to be passed through the milk. Metformin is actually a drug that's commonly used while breastfeeding. It's a drug that's used for moms with insulin issues who are diabetic. Usually a type 2 diabetic mom will use Metformin and it works great.
As a matter of fact, if you look at the book Making More Milk by Lisa Marasco and Diane West, it talks about how many moms with PCOS are asked to stay on the Metformin when they're experiencing low milk supply, so I don't know why that medication would be stopped. Really the Spirnlactone is the one that has the question mark behind it, because we just don’t know that much about it.
Metformin has been proven to be safe. Continue to use it if it helps you, and continue to breastfeed away, I think it's wonderful that you were able to have your "miracle" baby because that was not really in the cards for you at that time. I think that’s great, congratulations and keep doing what you're doing. You're a great mom.
LEILANI WILDE: That wraps up our show for today. We appreciate you listening to The Boob Group.
Don’t forget to check out our sister shows:
• Preggie Pals for expecting parents
• Parent Savers for moms and dads with newborns, infants and toddlers
• Twin Talks, for our show with parents of multiples.
Thanks for listening to The Boob Group: “Your judgement-free breastfeeding resource.”
This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.
SUNNY GAULT: New Mommy Media is expanding our line up of shows for new and expecting parents. If you have an idea for a new series or if you’re a business or organization interested in joining our network of shows through a co-branded podcast, visit www.NewMommyMedia.com .
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