Alcohol and medications when nursing

You may have heard different things about the safety of having a few drinks when breast or chestfeeding, or you may be wanting to celebrate abstinence from alcohol during pregnancy. Here are some facts about medications and substances and their passage through human milk.

Nearly every medication or substance you ingest will transfer to your milk. However, how much and for how long depends on the properties of the substance, which can have an effect on baby's safety. Many medications are safe to take because the concentration that passes to baby is very small, and is cleared by mom and baby's body. This includes any pain relievers or antibiotics you may have been prescribed. Other safe and necessary medications include many used for managing high blood pressure, thyroid imbalances, or mental health. The likelihood is that medications you had the green light to take during pregnancy are then also safe to take when nursing. If moms need surgery while still nursing, pumping and dumping milk is no longer recommended. 

Some substances are harmful if the amount that is passed to baby is very high and has a long half-life to clear from the system. This includes nicotine from smoking and vaping, which should be avoided. Smoking cigarettes (by anyone in the home) increases risks for damage to baby's brain, lungs, and other tissues, and increases childhood cancer rates. 

Caffeine (tea, coffee, chocolates) should also be taken in small or less concentrated amounts as passage is immediate and takes longer to clear from baby's system. 

Cannabis should be avoided due to issues with babies' sleep, behaviour, memory, attention, hyperactivity, and problem-solving skills. Ask your doctor and use mothertobaby.org to learn more. 

Alcohol is one of those substances that has high transfer to babies of up to 20%. Alcohol takes 2 to 2.5 hours to clear from the parent's system. In other words, concentration to milk is highest if you nurse your baby while drinking or right after drinking. Alcohol also decreases human milk production. 

If you plan to have a drink, some parents choose to have a small drink right AFTER breastfeeding to minimize the amount that passes to baby during the next feed. You can also choose to have drinks of no or lower alcohol content. Spirits and liqueurs have much higher percentage of alcohol than wine, followed by light beer being the lowest. 

Drinking alcohol regularly, heavily, and/or binging increases the chances for fetal alcohol syndrome which includes intellectual, learning, and behaviour problems. If exposed to high amounts in pregnancy, baby may be born small and with a small head size. 

The bottom line: Just as with medications in pregnancy, there is always a baseline risk of birth defects of 3-5% for all babies, regardless of exposure to medications or drugs. An occasional celebratory drink or cup of coffee or tea right after nursing isn't something you have to feel guilty about. If you are interested in reducing smoking or other social substances and drugs, please connect with your doctor or local harm reduction program. Take everything in moderation! 

What can I eat and drink while feeding? by Caitlin Black Allen, IBCLC