Tuesday, 11 December 2007

Christmas Spirits


It's that time of year again. Town Centres as filled with harassed people rushing to and fro, office parties are packing out the pubs and large pine trees are being stuffed into small cars.

Magazines are filled with advice and hints and tips: how to baste the turkeys, pre-prepare the veg and survive the relatives. Oh yes, and how long to pump and dump for if you are the mother of a breastfeeding baby and off for a night out with the girls.

So how long do you pump and dump for? Answers vary from 12 to 48 hours, depending on the source. Other answers abound, including the seemingly standard one in the UK lower end mags: feed formula whilst you've been drinking.

Because as we know, breastfeeding babies are at risk from alcohol exposure from their mothers having a good night out.

Except we don't know that, actually. What we know is the opposite. What we know, as opposed to what we think we know, is that there are no adverse effects reported on breastfeeding babies whose mothers are drinking alcohol in moderation.

You may be forgiven for not knowing, we know this, as so many sources tell us otherwise. From the aforementioned advice columns, to Government hand outs and your own Health Visitor. Many of them will go on about risk of transfer, liver damage in the infant and reduced motor development in toddlers.

They'll say this, because they read guidelines, and scan to the bottom of them, and see names like "Mennela" and "Little" and think "Oh yes, that's those studies that proved...." and then they'll tell you that the info is correct and You Cannot Have A Drink Like A Normal Person. You Are The Mother Of A Breastfeeding Baby And You Must Suffer For Your Cause.

Complete hogwash. :-) You Are The Mother Of A Breastfeeding Baby And You Too Can Have A Drink If You Want One.

Let's look at why you can go out with the girls and have some Christmas Spirits if you want some:

Both the Menella and the Little studies have been widely discredited. Little actually discredited Little. This is quite important, as this is the 'main' study that stated there was health risks to children for mother's drinking. She did a baby study, and said that babies of mothers who drank alcohol, were one point behind on a scale of motor development at 12 months. One point.

She then redid the entire sequence a few years later, and could not replicate her results. She herself found she was wrong. She couldn't find any difference between breastfeeding babies whose mothers had drunk alcohol, and those who hadn't.

But still, her original research is endlessly quoted as The Reason to restrict mothers of breastfeeding babies in their enjoyment of alcohol.

This link is a nice debunking of both the original studies.  Edit: try this one instead.

So where does this lack of evidence leave us? Well, it leaves us, as always, with us knowing the facts and making our own informed choices.

So what are the facts on breastmilk and alcohol?

Well, simply, your blood alcohol level is your breastmilk alcohol level. And alcohol goes into the blood quite quickly, and leaves at a steady rate. How fast it goes in, depends on your weight and if you have eaten near the time you drank the alcohol.

If you are quite skinny, and had an empty stomach, a glass of wine will hit your bloodstream, and your milk, at its highest point in about 30 minutes. If you are heavier, or had a meal, it could take between 60 and 90 minutes to hit you, with the 60 minutes being the most probable.

So, between 30 and 60 minutes after you swallowed the glass of wine, the highest alcohol rating would be in your milk.

Alcohol filters out via your liver, at the rate of approx one unit of alcohol, per one hour. So, an hour later - no alcohol in your blood, or your breastmilk. None. Zilch. Nada. Zip.

So, if you drink a glass of wine with one unit of alcohol in it - anywhere between 90 and 120 minutes later, it will have disappeared from your blood, and your breastmilk.

If you were binge drinking, and had five units of alcohol in that one quick drink - it would take 5 hours to process out. So, between 5 hours 30 minutes later, and 6 hours later - those five glasses of wine you had within a couple of minutes, would all be gone! Note how unrealistic this is. :-)

Where does this info leave you if you want to go out and party? Well, you have two choices if you've decided you're going to drink. Space the drinks and time the next feed, around the alcohol processing rate, and ensure baby doesn't get a drop of alcohol. This may be important to you if you have a very young baby. Immature livers are immature livers, and a liver that's still growing... it's up to you if you want to introduce any alcohol to it at all. But you can drink some, and make sure your milk is clear of any alcohol at all. Do the arithmetic. Not quite the moment they always told you about in school, where algebra would save your life one day - but another very useful moment in the life of add, multiply and subtract.

If your baby is older, say over 3 or 6 months, and you don't mind it getting a smidgen of alcohol - and that's all it gets, a smidgen - then go ahead and drink. For, although your breast milk has your blood alcohol level, it also has to go into the baby and be digested along with its food (your breastmilk) and only a tiny amount goes through into the baby. In fact, the real issue on you drinking alcohol isn't the alcohol, it's... Are You Safe To Care For The Baby? If you're over the drink drive limit - are you too pissed to be the caregiver? I'd say yes - your mileage may vary, but really, shouldn't you have someone else to bring the baby over for a feed and then take it off you whilst you sleep it off? I think so. :-)

There are two issues, really, with mothers drinking. One minor, one major.

The minor one is... if you've booked the night off, and partner is doing the babysitting, and has some expressed breast milk to feed the baby whilst you're off... be aware your breasts will likely become engorged if you skip too many feeds. Think ahead, plan ahead. Pack extra breastpads, so you can change frequently in case you start to leak. You may want to also pack some old muslin cloths, for if your get too uncomfortable, you can always slip away to the loo , and hand express some milk off into the cloths, then throw them in the bin. A true 'pump' and 'dump'. After all, few mothers go out on the Xmas razz with a breast pump, storage containers and a cool bag in their handbags.

Although, I have seen some seriously big handbags in my time. :-)

The major issue, is if you are a mother who is drinking regularly. Are you exceeding your 14 units per week? Are you having those 14 units is a short space of time (binge drinking)? If you are, you need to look at what you are doing. But not for the baby... for you. For the issue with a mother who is drinking over this amount on a regular basis... is the health of the mother.

Alcohol and health IS a serious issue. I'm not advocating alcohol, I'm advocating informed choice. If you are drinking over the recommended amounts, regularly, you need to look at yourself, and ask some hard questions. Not to satisfy me, or some Government official, or your GP, but to satisfy yourself about what you're doing why you're doing, and if it's an acceptable risk. And it's your risk, and your life. But you do have a baby to think of... because babies do better with healthy mothers. :-)

And also, please note, the discussion of breastfeeding babies and alcohol is completely different that that of being pregnant. Consuming too much alcohol in pregnancy does damage babies. If you are pregnant, you really will need to go out and do the work, and the thinking, for yourself.

So where, does this leave us? Well, it leaves me with a rather nice Shiraz. Whatever your decisions, and your choices, enjoy the season!

(Oh yes, and let's just deal with the formula one shall we? Put it like this.. you've gone out, intending to have a couple of drinks, spaced out over the evening. But, somehow, that went for a burton, and you've staggered in the door so pissed you can barely stand, with your breasts about to explode and wondering where both Hubby, and the baby are. Hubby stands there, holding your hair out of the toilet bowl, whilst you throw up, and you both debate the fact that as you've been gone for several hours longer than you thought, all the EBM is gone. What to do with hungry baby? Utterly pissed mother's breastmilk, or formula? Breastmilk. Less risk. Okay? Glad we cleared that up. :-)

"A mother should not drink alcohol while breastfeeding? Not true! Reasonable alcohol intake should not be discouraged at all. As is the case with most drugs, very little alcohol comes out in the milk. The mother can take some alcohol and continue breastfeeding as she normally does. Prohibiting alcohol is another way we make life unnecessarily restrictive for nursing mothers."

Dr Jack Newman

9 comments:

Evelyn said...

Might forward that on to my mum as she tried to tell me off for having a drink a couple of weeks ago. Thanks :-)

cAt said...

You realise that a sensible approach to breastfeeding and alcohol really isn't the way you're supposed to do things, don't you? Paranoid and histrionic is the way to go. ;)

Seriously, thanks for a fantastic post on the subject; and for a great link to bookmark.

Morgan said...

Won't be the first time I'm in trouble for down to earth practical approaches to seemingly esoteric and 'spiritual' subjects... won't be the last time either! :-)

Emily said...

Completely pissed? Husband holding hair out of way whilst vomiting?

Where did you get the inspiration for that I wonder? Heh heh...;-)

Morgan said...

These things come to me in my sleep... ;-)

Gill Joseph said...

Excellently (and entertainingly) written post - thanks for that! I've bookmarked it in case anyone tries to tell me I'm Being A Bad Mother if I fancy a glass of wine after my baby's born.

'Course, then they'll just blame you instead. No pleasing some people. ;-)

Morgan said...

As I'll be immune to all the other criticism "You're holding that baby wrong." "You're spoling that baby." "Don't you think you should let hubby have a feed, you're being selfish." "You'll kill that baby, sleeping with it." "It's not fair on everyone that we can't feed the baby." "Let the baby cry, it's good for them." I'm more than happy to take the flak for the wine! You'll have enough to do! ;-)

Arwyn said...

Brilliant!

Although, this link is coming back with a 404 now: any chance of fixing? "This link is a nice debunking of both the original studies." (I'd love to post this article around, and it'd be nice to have all the links in order!)

Anonymous said...

I know this is an old thread, I was just having a look around, but I just found these and thought I'd share.

According to:

http://www.french-paradox.net/book/fpbksb1.html

OJ contains 0.1% alcohol

According to:

http://www.bloodindex.org/Blood_Alcohol_Level_Calculator.php

Blood contains 0.08% when too drunk to drive and 0.55% is lethal.

According to:

http://en.wikipedia.org/wiki/Gripe_water (sorry it's wiki, I couldn't find much with the answer)

Gripe Water traditionally contained 3.6% alcohol.

So 225ml of breastmilk of an over the limit mother is equivalent to 5ml of traditional gripe water. That's about 6 hours of breastmilk to a 14lb baby.