Alcohol, Anti Depressants and Breastfeeding: Is it safe?

If you're a breastfeeding mum it can be really difficult to know what is and isn't safe, and what the guidelines are. I highly recommend checking out this interview with Lactation Consultant Katie James to understand the risks so you can make informed decisions. We talked about alcohol, coffee, medications and smoking while breastfeeding (article below).

Grab a cuppa and enjoy! 

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Alcohol, Caffeine, Anti Depressants, Smoking and Breastfeeding: Is it safe?

Alcohol

There is some mixed information about alcohol and breastfeeding out there. The government recommends abstaining from alcohol during pregnancy and breastfeeding, however we know that alcohol will go through the milk and be in your bloodstream for a certain amount of time, but then it will be gone from your system and your body.

If your baby is brand new, in the first few weeks, then it is a good idea to abstain from alcohol as much as possible because at this age they are very unpredictable with when they are nursing and it is difficult to time when you will be consuming alcohol with when they won’t be nursing.

Once your baby is past 4 to 6 or 8 weeks a glass of alcohol can be quite nice! We’re not talking about going out and binge drinking, but responsible drinking over the festive season is ok. You probably haven’t had any alcohol in quite a while, so a small amount is probably going to go a long way. When you know your baby is in more of a pattern, you can time your intake to avoid nursing after drinking. It takes about 2 to 3 hours to come out of your system.

If you’re concerned because you’re going to a wedding or event and you know you’ll be having a couple of glasses, then you can prepare in advance and check the guidelines on the Australian Breastfeeding Association website to work out how long it is likely to take to get through your system. There is also an App called Feed Safe that you can use to work out when you’re safe to breastfeed again, based on how much you've had to drink.

We have to acknowledge that we want women to breastfeed for as long as possible, ideally for 6 months and beyond, and for many women the idea of not having even a sip of wine or beer can be quite daunting! So it’s more about being sensible and knowing your limits and knowing when your baby is likely to be nursing.

Should you ‘pump and dump’ your breastmilk?

It depends how much you’ve had to drink. If you know that you’re going to have more than a few, then it might be wise to pump in the days leading up to the event so that there is some in the fridge or freezer to give to your baby. If you think you’ve had one extra glass and baby wakes up, only a small amount, about 1% of the alcohol will actually go through your breastmilk, so it’s absolutely fine to feed your baby.

What we don’t want is regular alcohol intake because that can reduce your milk supply. We also don’t want baby to be feeding if you’ve had a really high alcohol intake because that can be dangerous for the baby as it makes them particularly sleepy which we want to be careful about as well.

If you’ve had just one extra glass and your baby wakes up unexpectedly you will be fine to just breastfeed! However if you’re planning to have a big night out, then prepare beforehand, and express and discard if you’ve had a lot of alcohol.

What about coffee? How much coffee is safe while I'm breastfeeding?

Keep your caffeine intake to about the same as when you were pregnant. Ideally, a maximum of 300mg of caffeine a day is recommended. Remember that caffeine is in coffee, tea, green tea, chocolate and some sodas. If you’re having one barrista coffee a day then that will probably hit your limit, however instant coffee at home could be 2-3 cups. If you’re drinking cola or energy drinks, they have quite a lot of caffeine in them.

A high caffeine load can make your baby quite irritable, and become quite unsettled, they don’t sleep as well. Caffeine will go through babies at different rates for all of us. Some babies can be quite sensitive to caffeine. In addition, high caffeine intake over time can reduce your milk supply.

Caffeine during pregnancy can increase your babies sensitivity to caffeine, so if you’re planning to drink coffee after pregnancy it might be best to maintain a consistent caffeine intake rather than cutting it out completely. In addition, babies don’t metabolise caffeine as quickly as adults. So if you’re having a coffee a day your baby’s liver will take a couple of days to filter the caffeine out. This is also true of anything that goes through your bloodstream, including medications and alcohol. That’s another reason why just one coffee a day can make your baby quite irritable, as it could be the cumulative effect.

Also remember different babies have different levels of sensitivity to drugs, pre-term babies will take even longer to filter toxins out of their blood stream.

Are there any medications we should be aware of while breastfeeding?

We know that about 99% of all drugs are safe with breastfeeding. With the remaining percentage there is normally a safe alternative that you can take.

People are often really worried about anti-depressants with breastfeeding, and there are some anti-depressants that aren’t safe with breastfeeding, but there is usually a safe alternative that you can take. This is a good thing to discuss with your health provider. They will have a huge amount of information available to them. They can also call a tertiary hospital who often will give drug information as they’re the experts.

Things to be aware of are cold and flu tablets which can affect your milk supply. The pseudoephedrine and phenylephrine in them can dry up your milk supply or cause your baby to become irritable and restless. You might also need anti-histamines, and some are safe and some are not. Some may be ok for you to take if you’re breastfeeding an older baby, but not a newborn, as the age of your baby may mean that they are able to metabolise the small amount of toxins easily. Always check with your pharmacist. If you’re not getting the information you need you can always contact a lactation consultant to check, or check with a tertiary hospital yourself.

Cigarettes and Social Smoking: Should I stop breastfeeding if I'm smoking?

Ideally you abstain from smoking. We know however that there are women smoking through pregnancy and breastfeeding, so in this situation it’s about limiting the risks. A lot of women will ask: is it safer to formula feed because I’m a smoker? The answer is that all of the research tells us it’s still safest to breastfeed, despite being a smoker, but we want to limit the exposure and toxins. The smoke lingers on your fingers, hair and clothes and your baby can breathe that in. If you are a smoker it’s always best to smoke outside, away from baby completely. Have something like a smoking jacket that you wear to go outside, and take it off when you come in, and wash your hands and brush your teeth to take away as much of the smoke as possible. If you’re about to have a cigarette then ideally breastfeed before, and then have a cigarette afterwards.

It’s really important to promote that breastfeeding is still the preferred option in all sorts of real life situations, and it doesn’t all have to be perfect, even though there are a lot of ideals that are promoted.

As mums we have to do the best job we can, and breastfeeding is normal for us as human beings. If we can incorporate that for as long as possible, trying to avoid all of the pitfalls of everyday life, then we’re doing a marvellous job. It’s not always the easiest road. But never be frightened to ask for help. Those bumps crop up every few weeks or months you get a new thing that you need to deal with. Always seek help, there is always a way around it. Not everything is black or white, most of our lifestyles are in the grey area, so we want to do what is best for our families and ourselves, and what’s safest.