How Bad Is It to Breastfeed After a Few Drinks?

The Scenario
Your friend is a first-time mom who’s four months into exclusively breastfeeding her newborn baby girl, Calliope Brushfire. On a rare evening out, she decides to hit up Moby’s new vegan brisket pop-up restaurant that serves craft cocktails made by mixologists who look like civil war medics. She orders a $22 turmeric martini and downs it hard and fast. The stress of 14 months of clean eating, a third-degree taint tear following 32 hours of unmedicated labor, and four months of breastfeeding a colicky baby through cracked nipples on three hours of sleep a night miraculously melts away.

A few minutes later, a Kombucha martini miraculously appears in front of her and your friend polishes the off the drink just before getting a text from her partner that he just spilled the entire breast milk supply she pumped earlier and now the kiddo is awake, hungry, and screaming. Your friend texts you in a panic. Should she rush home and offer C.B. a boozy boob? Should she pump, dump, and expose her paraben-free bundle of joy to a bottle of formula manufactured by the oppressive patriarchy? The other moms in her moon circle would surely stone her to death with obsidian crystals if they found out.

The Reality
There are two things to consider when it comes to breastfeeding after drinking: What’s your blood alcohol content? And how drunk do you feel?

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La Leche League International says: “When the breastfeeding mother drinks occasionally or limits her consumption to one drink or less per day, the amount of alcohol her baby receives has not been proven to be harmful.” The CDC defines one drink as 0.6 ounces of pure alcohol. That means 12 ounces of beer (5 percent alcohol content), 8 ounces of malt liquor (7 percent alcohol content), 5 ounces of wine (12 percent alcohol content), or 1.5 ounces of liquor (40 percent alcohol content). The National Institute on Alcohol Abuse and Alcoholism’s “Cocktail Content Calculator” puts a martini at 2.25 ounces of pure alcohol and a Cosmo at 2 ounces for a total of 4.25 ounces of liquor. (That means your friend is at almost triple the recommended amount for breastfeeding.) The American Academy of Pediatrics states that breastfeeding moms should wait two hours per drink before breastfeeding if they want to ensure alcohol has fully clearly their system.

Thankfully, she stuffed her face with $50's worth of farm-to-table carbs and proteins in between drinks. Eating before and during alcohol consumption is proven to slow the rise of blood-alcohol levels, so while that means it might take longer for your friend to hit her peak BAC, the concentration in her blood and breast milk will stay lower, putting her in a much better position to give Calliope her evening breast buffet.

The Worst That Will Happen
If your friend breastfeeds when she gets home from a three-drink evening, there could be some short-term effects on the baby, but the real danger of causing developmental delays for the baby comes from chronic alcohol use and abuse, says Cherie Richey, American Congress of Obstetricians and Gynecologists fellow and president of Columbus Women’s Care.

“The short-term effects on the baby may be lethargy, potentially poor muscle tone, or nothing,” Richey says. “The more important question is: What happens if a mom drinks two martinis daily, chronically, or multiple times throughout the week? I would suggest that the effects on brain development with chronic heavy alcohol exposure in breast milk may be severe and result in some form of developmental delay at minimum.”

Gladys Vallespir Ellett, nurse and coordinator of outpatient lactation services at NYU Langone Health, says that in most cases, women can afford to be a little more chill about drinking while breastfeeding. “Overall, it’s clear that occasional alcohol use is okay,” she says. Her biggest concern with alcohol and breastfeeding is less about the alcohol content in your friend’s breast milk, and more about whether she’s alert enough to handle her infant safely and not fall asleep with her baby in bed while she’s drunk.

“I think that probably the worst-case scenario would be that she co-sleeps with her baby in an unsafe manner,” Ellett says. “If you’re not sober enough to drive, then you really shouldn’t be breastfeeding, because you could fall asleep—you could pass out. That, to me, as a lactation consultant, as a nurse, as a mother, that is the most alarming thing. You do not want to fall asleep breastfeeding with your baby in bed.”

Co-sleeping (sleeping with your baby in your own bed) is a whole mom-panic dumpster fire of its own. While the practice has become more popular and widely acceptable in recent years, a 2015 study showed that 67 percent of infants in the US who died in their sleep in the first four months of their lives did so while sharing a bed with a parent.

What Will Probably Happen
By the time your friend’s Uber navigates through Friday night traffic and drops her off at home, it’s been over 90 minutes since that first drink, and the second drink is mingling with a belly full of food. If she is feeling alert by the time she gets home, the baby will most likely not suffer any long-term damage from her spiked milk.

There’s also

evidence

that lactating mothers who are exclusively breastfeeding have significantly lower BAC levels than non-lactating women, which also works in your friend’s favor. And it’s not like she’s carrying a full cocktail in each boob either: As Melinda Wenner Moyer

points out

in Slate, milk-alcohol levels are in lock-step with blood-alcohol levels. So even if your friend is, by definition, legally drunk with a BAC of .08 percent, her milk would be eight one-hundredths of a percent alcohol, which is less than the alcohol concentration in some fruit juices.

As far “pumping and dumping” goes, the experts say don’t even dream of wasting that liquid gold unless you absolutely have to pump for your own comfort and don't have a place to store the milk. Pumping doesn’t clear the alcohol out of your milk any faster. Only time can do that. “The only time we would tell a woman to pump and dump is if she has been drinking and she’s getting uncomfortable because she’s getting full,” Ellett says. “Then you’re going to express that milk just to feel comfortable.”

What to Tell Your Friend
If she absolutely can’t bear the thought of even a small amount of alcohol exposure for Calliope, she should wait a full two hours after drinking to feed her. In most cases, a drink or two is not going to cause any serious issues, especially since the baby's liver is more fully developed after three months, Ellett says. If your friend can’t wait, she can bust out that bottle of organic formula she secretly hid in the back of the cabinet in case of emergency. And after that? She should give herself a break.

Ellett says all new moms make mistakes. “Give yourself permission and also forgive yourself if you think you’ve made a mistake along the way. You’re learning. When you were pregnant, you were restricted to not drinking—we know that’s bad for the baby. Now it’s a little different. If you want to have a glass of wine, if you want to have a martini, you can do that.”

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