Podcast: Ep 22 - Breastfeeding and alcohol

Making decisions about alcohol and breastfeeding

Should you have a glass of wine at dinner? Or enjoy a couple of drinks at a celebration? Jessica and Naomi break down what to consider when deciding whether to have a drink or not while breastfeeding. We also hear from Dr Lisa Amir on how alcohol as a drug impacts breastmilk.

Links to resources and information discussed in this episode:

• Alcohol and breastfeeding information
• Alcohol and breastfeeding: a guide for mothers brochure
• Feed Safe app, available for Apple iOS and Android
• An interview with Dr Lisa Amir on medications and alcohol
• Breastfeeding: diet, sex and more booklet, available for purchase as an instant download or order in print format
• Breastfeeding and medications information, including contact information for the NPS Medicines Line or the Medicines Information Centre(s) in your state or territory.
• Hand expressing information
• Expressing and storing breastmilk booklet, available for purchase as an instant download or order in print format
• A caregiver's guide to the breastfed baby leaflet
• Breastfeeding and co-sleeping information

Credits: This episode is presented by Jessica Leonard and Naomi Hull. Featuring Dr Lisa Amir. Audio editing by Jessica Leonard. Additional reporting by Nicole Bridges. Show notes by Belinda Chambers. Transcription by Caitlin Sabjan. Produced by Belinda Chambers, Jessica Leonard and Eleanor Kippen.

NAOMI: It's always extremely important to have as much information as you possibly can about any decision that you're making and, and when you're weighing up risks and benefits of something, absolutely, particularly when it comes to feeding your baby.

JESSICA: Welcome to breastfeeding with ABA, a podcast brought to you by volunteers from the Australian Breastfeeding Association. Breastfeeding with ABA is a podcast about breastfeeding made by parents, for parents. In this episode we’ll be talking about alcohol and breastfeeding. This podcast records in different parts of Australia. We acknowledge the Traditional Custodians of the lands we're recording on, and the lands you're listening on. We pay our respects to elders past, present, and emerging, and to any Indigenous people listening. We also acknowledge the long history of oral storytelling on this country and of women supporting each other to learn to feed their babies. My name is Jessica, my pronouns are she/her and I'm a breastfeeding counsellor with the Australian Breastfeeding Association, today I'm speaking to you from the lands of the Boonwurrung and Wurundjeri people of the Kulin nation.

NAOMI: Hi, I'm Naomi, I'm the senior manager for Breastfeeding Information and Research at the Australian Breastfeeding Association and I'm also a breastfeeding counsellor. And have been for around 15 years and my pronouns are she and her. I am from Brisbane, the Land of the Yuggera and the Turrbal people.

JESSICA: We'll also be hearing from Doctor Lisa Amir, a GP, and lactation consultant. She's a principal research fellow at the Judith Lumley Centre at La Trobe University and editor in chief of the International Breastfeeding Journal. 

So today we are talking about breastfeeding and alcohol, so it's a really common question that we get asked a lot about and people have really strong opinions about it. So today we're just going to break down a few things, so that everyone can have all of the information that they need so that they can make the choices that they are most comfortable with. So Naomi, the first question that I'm going to ask is, ‘What are the recommendations around alcohol and breastfeeding?’.

NAOMI: Thanks Jess, yeah the current recommendations around alcohol and breastfeeding are to avoid alcohol while breastfeeding, particularly in those very early days of your baby's life; this is safest for health and development of your baby.

JESSICA: Yeah, and I think that a lot of people know that avoiding alcohol is the kind of safest and healthiest thing to do all together, but they want more information about whether there's a way that they can do it safely. So that's what we aim to provide is, so that people can have that informed choice. So, we know that when babies are really young, their breastfeeds are both frequent and unpredictable. They can feed around the clock. They can wake up when you thought that they wouldn't and want to feed again. But as they get older it does change and babies become a bit more predictable with when they're feeding, so some people might choose to consume alcohol at this stage when their babies a little bit older. If they do decide to do that, how can they reduce the risk?

NAOMI: Definitely by planning ahead, that's the key, and something that I heard said the other day was: ‘It's really about abstinence for the baby as opposed to abstinence for the mother’, and I thought that is a really excellent way of looking at it because we don't like being told we can't have something, particularly something that we enjoy. With a younger baby when they're feeding and sleeping, timings are a bit unpredictable. It can actually be easier just to avoid having any drinks yourself, but as they get older that can get easier absolutely and then and that planning is what really makes it possible to be able to combine the two.

JESSICA: When would expressing and storing breast milk be part of that planning ahead?

NAOMI: I think the easiest examples to think about, are when you know that you have a function coming up, so it might be your friends 30th, It might be a wedding, it might be a special family celebration where it's part of your usual thing to have a couple of drinks. Expressing and storing ahead of time just gives you that safety net of knowing that you do have some breast milk that doesn't have any alcohol in it for if your baby does need a feed when you weren't expecting, or if you have a few more drinks than what you thought you might have.

JESSICA: So how will people know if their breast milk might have some alcohol in it, how can they manage that and plan around that?

NAOMI: Well, first of all, I might just explain that alcohol moves in and out of breastmilk quite easily, and the blood alcohol concentration will equal the percentage of alcohol that's in your breastmilk, and that's because it does move backwards and forwards so easily. So, while you have alcohol in your blood, you will have alcohol in your breastmilk, but we know that your liver is working away to filter that alcohol and remove it from your body. So, over time that amount of alcohol will decrease. It's usually around 1 to 2 hours per standard drink and we’re all very well informed about how to combine drinking alcohol with driving, and we know that it's usually around one standard drink an hour is considered acceptable, and that's what will keep blood alcohol levels quite low. 

If you're ever not sure about where your body might be at after having a couple of drinks we, or even for planning, actually we have the Feed Safe app, which is a free app downloadable from wherever you normally get apps from. And it enables you to put in your age and your weight and when you had your first drink and it is basically like a timer and it will just let you know and help you track when you can consider your blood alcohol and therefore your breastmilk to be free from alcohol.

JESSICA: Yeah, great, so it does actually work a little bit differently than the way that drugs and alcohol work during pregnancy, so let's hear from Doctor Lisa Amir.

DR LISA AMIR: I wanted to explain the difference between taking medications in pregnancy and breastfeeding, because many people are aware that we need to be careful about medications that we take in pregnancy and there's a couple of things to understand that are quite different about breastfeeding. So, during pregnancy the fetus is developing so a mother may take a medication and this can cause some congenital anomalies in the infant. And a lot of people are aware of the example of thalidomide where mothers took this in early pregnancy, and it resulted in severe problems with their child. So because it's well known people have this fear of taking medications, but we need to understand that now that the child is breastfeeding we don't need to consider a problem such as teratogenicity, so some medications that were not suitable for pregnancy are going to be okay for breastfeeding. And then the other point is that during pregnancy the fetus receives a much higher dose of any medication that a mother is taking. So many medications or other things like alcohol that are in the mother's bloodstream can cross the placenta and go straight into the baby's bloodstream. But with breastfeeding that if a mother ingests some medication, then if it gets into her bloodstream, it then goes into the breastmilk and then the baby ingests it… goes into the baby stomach and then into the baby's bloodstream. So there's quite a few stages in between that we don't see in pregnancy, and this is why some medications don't cross from the mother’s bloodstream into the milk, or they may go into the baby’s stomach but are not absorbed. So, this is why we need to think carefully about where the path of that medication is. You realize that if the baby is ingesting the milk, whatever is in that milk, that is getting a much smaller dose than they would get if it was going straight into their bloodstream. 

We often think about the example of alcohol because it's a very small molecule, so it does cross from the bloodstream straight into the milk, so the mother's milk alcohol will be the same as the blood alcohol. Whereas some other drugs may have a large molecular size and they're actually too big to cross into the breastmilk, so we can work out that they're just not going to be in the milk and the baby won’t get them. We recommend that mothers don't drink alcohol, particularly in the first month and after that obviously it's better not to drink alcohol, but if a mother is going to drink alcohol, if she understands what's going on, that she can have a drink of alcohol, say after she's fed the baby for the last feed in the evening and then after two hours, after one alcoholic drink, her blood alcohol will be back to zero, so her milk alcohol will be back to zero and then it will be safe.

JESSICA: And I think that's something that people really want to know. They want to know how long will it take for my breastmilk to be free of alcohol so I can feed my baby, and it's really helpful to have that information. So going back to the example that you gave of, say, someone going to a wedding, and they might be having quite a few drinks. Does that mean that we should be encouraging people when they've had a lot of drinks to come home and go about everything as normal and care for their baby.

NAOMI: Well, there's a few things to consider there. So, of course in that situation, when you know you're going to have a few drinks or you think that you will, you ideally might express a bit ahead of time to have enough for about two or three feeds stored away in the fridge or the freezer. And also letting someone else know where that milk is stored and how to prepare it for a feed.

JESSICA: And what about would it be then safe for someone to say co-sleep with their baby or to look after their baby when they’ve had quite a lot of alcohol.

NAOMI: That's definitely the other thing to consider, yeah, just ensuring that you are able to provide safe care, and if that's not going to be possible that you have a backup person to provide care for your baby.

JESSICA: Cool, so I get asked a lot of questions about this thing called pumping and dumping, so I'm sure you've heard of it. I know a lot of our breastfeeding counsellors get asked about pumping and dumping. So pumping and dumping is when you might express milk and discard it and not keep it to feed your baby. When is that necessary? Because there are sometimes when a mum might decide to pump and dump where it's a good idea to consider that, when would that be?

NAOMI: Absolutely, there is a lot of misinformation about pumping and dumping out there. Because of what I said earlier about how the alcohol moves in and out of the breastmilk, pumping and removing milk from your body doesn’t remove the alcohol from your body. So, while you're removing milk, you're not actually reducing the amount of alcohol in your body. So, pumping and dumping doesn't help in that regard, but it does definitely help you to be able to stay comfortable if you are going to have to miss feeding your baby a couple of times because you can get quite full and uncomfortable, and of course that can predispose you to some blocked ducts or mastitis which is not going to be a great outcome.

JESSICA: It's pretty nasty, and I feel like as well, you're not going to be comfortable at your friend’s wedding if you've had a couple of drinks, that's fine, and your baby is being looked after by someone else, they've got their expressed breast milk. But you, you're there and you've missed a couple of breast feeds your boobs are going to be possibly huge and possibly quite painful, and you're possibly going to leak over your lovely outfit that I'm sure you've spent ages planning.

NAOMI: I have to say I've had that experience myself! When my first baby was nine months old my best friend got married and I actually went to the wedding and forgot to take my pump, and I had to go back to my hotel room and attempt to hand express because I was extremely uncomfortable. So, that's where it is important to have that hand expressing skill. I must admit it wasn't something that I had really practiced very often, unfortunately. So I was able to express enough to just feel a little bit more comfortable but yeah, it is certainly a predicament that some people find themselves in.

JESSICA: Yeah, absolutely, I think that's really the key is when it comes to pumping and dumping if you know that you don't want to give that breastmilk with a little bit of alcohol In it to your baby, but you're uncomfortable and you feel like you need to express, that's the time for it. We know that breastfeeding works on supply and demand, so removing that milk from your breast is important for that, but it is also important as you said to, one, be comfortable and two, prevent engorgement which can lead to some other issues down the track.

NAOMI: The key take-away there, is really that it doesn't remove the alcohol from your body.

JESSICA: Yep, yeah, it's your body that's doing that already. 

NAOMI: Yeah, that’s right. 

JESSICA: and you're just keeping yourself comfortable.
So I want to talk a little bit about things like risks and benefits. So this is something that we do in our everyday lives; we’re weighing up the risks of one thing versus the other, and we're weighing up the benefits of something versus the other. So tell me a little bit about that when it comes to making these sorts of choices for parents about whether they're going to, you know, have a glass of wine here or there. How important is having all of the right information?

NAOMI: It's always extremely important to have as much information as you possibly can about any decision that you're making, and, and when you're weighing up risks and benefits of something, absolutely, particularly when it comes to feeding your baby.

JESSICA: And what about, what would you say to people who if someone approaches them and has something to say and maybe disagrees with their choices about, you know if they're having a glass of wine, and they know that they've got a young baby, and they’re breastfeeding and someone says something to them. What advice would you give to people in that situation?

NAOMI: I guess that's where it's important to know that you have found the information that you need to make that decision, and it helps you feel confident that you are doing the best you can for your baby and that you've made an informed decision. So there are often people that want to provide advice and they won't know the full situation, so I guess just being able to say to them that you have prepared and you do understand and you've weighed up the risks and balances, and that you're confident with the decision that you've made.

JESSICA: So, we've talked about breastfeeding and alcohol. Does the exact same advice apply to other drugs and medications?

NAOMI: Well, in some ways it's quite similar because what we've talked about today is how alcohol behaves in the body and how it moves in and out of breast milk and yes, that is the same for other drugs. All medications act in different ways in the body. Some move into the breastmilk and some don't, so there isn't a simple or straightforward answer that covers all drugs. With any medications or drugs, whether they're legal or illegal drugs, will have different interactions and different ways to be managed around breastfeeding.

JESSICA: So how can people check If they've taken some medication, or if they've taken recreational drugs, whether or not they're wanting to plan ahead and do either of those things; or they've done it, and then afterwards realised that they haven't considered the implications of that on whether it will pass through their breastmilk, who did they speak to?

NAOMI: There are some really great sources of information, and it varies from state to state, so we have a web page. and we have all of those state based medicine lines listed out in a table there with their numbers and their hours. You can also call our Breastfeeding Helpline. The breastfeeding counsellors won't be able to give you specific information based on that medication, but they can provide support with your decisions and your planning, helping you work around the situation, manage your breastmilk and feeding your baby, and help you find the right medicine line to call if you need some help with that. 

JESSICA: Yep, so those medicine info lines will connect you with specialist pharmacist and drug information experts. Some of them are run through the pharmacies of big maternity hospitals and some are dedicated lines. It does depend where you are in Australia, but all of the ones that we have listed on our website, the phone number there is for people in the general public to call, and health professionals can call as well. It's very different to what we do in the National Breastfeeding Helpline, but it is one of those things where the services we offer kind of work together. But I find that when I'm speaking to mums as a breastfeeding counsellor and they're asking about medications or things like that, and they've already spoken to someone, and they know that maybe they might need to wait a few hours until medication clears from their breast milk, that my role is there to help them manage the breastfeeding and manage getting baby back to the breast when they need to, giving them inforrmation on expressing. But often we do just get people calling to ask, ‘Who can I talk to?. So I think that's a really, really key thing, we have put those links in the show notes as well. 

NAOMI: And when it comes to medications as well, it's important if you are ever told that you can't take this medication while you're breastfeeding, please get a second opinion. Because there are hardly any medications where you can't find a way to fit breastfeeding in around needing to take that. So, if someone tells you just flat out no, please seek a second opinion or contact one of our medicine lines that we have on the list.

JESSICA: Yeah, that's right, often it is just a case of needing to manage breastfeeding around the medication as opposed to needing to instantly stop breastfeeding, which is what a lot of mums seem to be told. As if it's somehow that easy somehow, there's a switch that you just turn your boobs off and then everything is fine. We can support you with that as well.

DR LISA AMIR: Message is we do need to be careful with medications and alcohol while women are breastfeeding, but it it's not the same situation as pregnancy. So we need to stop and think because sometimes the advice the drug companies give will say pregnancy and breastfeeding without differentiating. And sometimes doctors or pharmacists might do this kind of inadvertently and not really think about the difference between maybe a small pre-term infant breastfeeding, and someone who's breastfeeding a 12-month-old or 2-year-old or something, and they just give this advice about needing to avoid breastfeeding if the mother is having some sort of procedure or something. So we can just get more information If the mother has a question she can find out the details of the name of the medication, and as I said, contact one of those sources for more information.

JESSICA: Thanks heaps Naomi for chatting with me today, and a huge thank you to Doctor Lisa Amir, the audio of Doctor Amir for this episode is taken from an interview one of our volunteers did with Doctor Amir during COVID lockdown, so you can find a full link to the video of that in the show notes. You can check out the show notes for a link to this episode’s blog and to all of the other information as well. So there's some links in there that we've talked about throughout the episode. 

If you're in a position to support the work that ABA does financially, you can become a member by visiting breastfeeding.asn.au and that'll link you in with your local group as well. If you need some online support, you can join our breastfeeding with ABA Facebook groups, so there's three joining questions to get into that group make sure you answer those first. If you want to speak to a breastfeeding counsellor, you can call the National Breastfeeding Helpline on 1800 mum2mum or 1800 686268. So that's open 24 hours a day every day of the year. Our LiveChat service is another option as well, so you can check our website to see when that's open. 

Thanks so much for listening, if you like what we do, it would be really awesome if you can rate, review and subscribe to the Breastfeeding with ABA podcast wherever you're listening.

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