Alcohol and breastfeeding

Safe levels of alcohol when breastfeeding

The NHS advice for breastfeeding mothers is the same as that for the general population: limit your alcohol consumption to 14 units per week. This should be spread out over 3 or 4 days and not consumed in one sitting. There is roughly 2 units of alcohol in a standard glass of wine, 1 unit of alcohol in a single shot of standard spirits, and 2-3 units of alcohol in a pint of beer, lager or cider.

Alcohol, like many other things that you consume during breastfeeding, can be passed into the breastmilk. However, drinking alcohol within the limits described above is unlikely to harm your baby. This is because when you drink alcohol the level of alcohol in your breastmilk is about the same as your blood alcohol level, not the alcoholic drink. The level of alcohol the baby is exposed to is therefore low and unlikely to be significant.

This is why the guidance for breastfeeding and non-breastfeeding women is the same. Complying with standard recommendations for alcohol intake does not result in breastfed babies being exposed to clinically significant amounts of alcohol. (1)

There is no need to “pump and dump” following alcohol consumption, because as the alcohol concentration in your blood goes down, so does the milk alcohol level. Alcohol is not stored in the milk. If you want to be cautious, it may be best to wait for 2 hours after drinking a unit of alcohol to allow the alcohol to metabolise before breastfeeding. It may be helpful to express before social occasions when you are going to have a drink so that you can give your baby a bottle of expressed milk whilst you wait for your alcohol levels to decrease.

The risks of alcohol when breastfeeding

The risks of alcohol when breastfeeding are difficult to assess. This is in part because the low levels of alcohol that breastfed babies are exposed to mean that we do not see any impact. No long-term impacts have been identified.

However, we do not know much about the impact of heavy drinking or binge drinking in breastfeeding. You should never care for your baby if you have been binge drinking or drinking heavily.

Bear in mind that you should never share a bed or sofa with your baby after drinking alcohol as doing this has a strong association with sudden infant death syndrome.

Alternatives to alcoholic drinks

Alternatives to drinking alcohol whilst breastfeeding are extensive. There are numerous soft drinks and alcohol-free alternatives. Alcohol free beer is a relatively new product and there is no research currently available as to its safety in breastfeeding. It would seem reasonable to assume that in a very low alcohol product, such as alcohol free beer, a breastfed baby is being exposed to almost no alcohol. However, this has not been clinically proven.

Caffeine and breastfeeding

Safe levels of caffeine when breastfeeding

Like alcohol, and other drinks, caffeine can be passed through your breastmilk to your baby. Most breastfeeding mothers find that they can consume a moderate amount of caffeine without it affecting their baby.

Caffeine is found in tea, coffee, chocolate, some soft drinks, energy drinks and some cold and flu remedies. Current NHS guidance recommends that breastfeeding women limit their caffeine intake to a maximum of 200mg per day. As a rough guide: an instant coffee contains 100mg of caffeine, a filter coffee contains 140mg of caffeine, a cup of tea contains 75g of caffeine, a 50g bar of chocolate contains up to 50mg of caffeine, and a can of cola contains 40mg of caffeine.

The amount of caffeine passed into the breastmilk is about 1% of what the mother consumes. It reaches a peak in the breastmilk about an hour after consumption.

The risks of caffeine when breastfeeding

The risks of caffeine when breastfeeding are poorly researched and understood.(2) Newborn babies can be sensitive to caffeine as it takes them longer than us to process the caffeine. If you notice that your baby is jittery or sleeps poorly it may be worth reducing your caffeine intake.

Alternatives to caffeinated drinks

You could try drinking decaffeinated tea and coffee. Be aware that these often contain some caffeine, although the levels of this are usually very low (decaf coffee contains around 8mg of caffeine). Herbal teas are also good alternatives.

Instead of drinking cola or energy drinks, try another soft drink, or better still, carbonated water which avoids the high sugar content.

References
1 Haastrup MB, Pottegard A, Damkier P. Alcohol and breastfeeding. Basic Clin Pharmacol Toxicol 2014;114(2):168-73
2 McCreedy A, Bird S, Brown LJ, Shaw-Stewart J, Chen YF. Effects of maternal caffeine consumption on the breastfed child: a systematic review. Swiss Med Wkly. 2018 Sep 28;148:w14665. doi: 10.4414/smw.2018.14665. PMID: 30294771.