Breastfeeding & wine

This is a good question for one of the doctors on the board. I am not sure I understand anatomically how alcohol would be passed on to the kid by breastfeeding.
As to your grandfather's brandy/pacifier story, I would note that at the ritual circumcision of a Jewish male at age 8 days (commonly called at Brit or Bris), no anesthesia is used, but it is common to have the kid suck a little on a clean cloth that has been soaked in a little wine. This tends to put the kid to sleep and stop any crying.
However, to my knowledge, no one has used a Two Buck Chardonnay for this purpose.
Anyway, congratulations on the little one.

Irwin

"Life is short.....start with the dessert."

Alcohol in a woman's diet appears in breast milk. One or two alcohol-containing beverages per day poses no harm to the breastfed infant, but heavy drinking during breastfeeding can expose infants to levels of alcohol that may harm their development. The development of the brains and nervous systems of infants born to chronic, heavy drinkers appears to be retarded.

por vino

To qualify, I am a mother of a 23-month-old who is still nursing and is very interested in the topic. I have given the same dirty looks to my husband when he has drunk good wine.

I have heard of giving a teething baby a bit of brandy/whiskey/whatever to numb the gums. Seems unlikely that the baby would get enough to do hard - I'm sure it tastes vulgar to a baby. I have never heard of a direct benefit to the baby when the mother consumes alcohol while nursing. However, it is commonly recommended that the nursing mother have a glass of wine or beer for relaxation during nursing. It seems incredibly unlikely that a glass or two of alcohol could have much effect on a baby - think of blood alcohol content. Wine is about 13% alcohol, and a drunk person has a blood alcohol of .1% or so. Unless alcohol really, really concentrates in the breastmilk, how much alcohol could possibly be there?

For any alcohol that is there, it's supposedly in the highest concentration about 1/2 hour after drinking it.

Now, drinking during pregnancy and drinking during breastfeeding are entirely different things, where you are sharing a blood and nutrient supply and the fetus is in a rapid developmental stage.

I think it's fine to drink a few adult beverages while nursing, and probably becomes a little bit more okay as you nurse less and your baby gets bigger. Of course, heavy drinking is a just plain bad idea, not only for nursing but while you're responsible for a child.

JMHO.

TinCup

Not sure about wine, bit when I was returning to work 3 months after having my daughter, and still nursing, I mentioned to my Dr. that I didn't seem to be able to produce as much milk as I had before going back to work- he suggested having 1/2 a can/bottle of beer in order to relax a little (also, supposedly something in beer prompts the body to produce milk, not to be too decriptive).
My Dr. told me that the amount of alcohol which would be passed onto the baby would be insignificant, although he also did not advocate multiple drinks, or hard liquor.

Good luck, and best wishes for your growing family!

Most people agree that a moderate amount of wine won't harm a baby ... but I expect it might do wonders for fussy parents.

Many comments on the board are accurate.
Wine is approximately 13% alcohol. To pass a sobriety test, the acceptible level is 0.8%.
Therefore, the alcohol content of breast milk is less than 1% (as stated) if taken in moderation. Though newborns have
immature livers, they are able to further metabolize the alcohol in breast milk to undetectable levels.
It is also true that obstetricians suggest drinking up to 2 bottles of beer per day for lactating moms. The darker the beer the better (port,stout).It stimulates milk production through a part of the pituitary gland. The same reason men "pee like race horses" after a few cold ones. It's effect is on anti-diuretic hormone. I don't think this forum wants details on endocrine physiology.
Since not enough is known about quantity, quality,type, or other factors in alcohol contributing to Fetal alcohol syndrome or fetal alcohol effects, the recommendation is to refrain totally from alcohol during pregnancy.
It is my practise to limit alchohol in lactating mothers to 2 beers per day, or 1 glass of wine per day. In 20 years, I have never had any problems that I am aware of.
For medical-legal purposes, I should state that these are my thoughts and may not represent the thoughts of the AAP/CPS.
I hope this is helpful.

Larry ,i'll provide you with a more comprehensive disclaimer. Just looking out for my friend.

DoktaP, not to be pedantic, but I think the correct percentage for blood alcohol is 0.08% as the legal driving limit (which does not, in fact, correlate well with the ability to pass a sobriety test), which means that at that level someone will have less than 0.1% alcohol in breast milk, assuming breast milk correlates with blood alcohol.

When I was born in the early 1960s in England my mother was specifically told by her doctor to drink a pint of Guinness a day while nursing. I had understood that it was for the vitamins and minerals in the Guinness.

Irwin for my two boys i opened a bottle of Mouton and watched them suck on that cheesecloth. My 11 year old to this day gets a craving for mouton once in a while, i wonder why.

ffrp: thanks for the math correction.

The point is, the concentration of alcohol in breast milk is significantly lower than what's in the bottle. And, further metabolized by the newborn to negligible amounts. Your mothers obstetrician was obviously savvy enough back then to appreciate the benefits and safety.

According to her training from the Nursing Mother's Counsel -

It's prudent to wait at least a couple of hours after you have consumed an alcoholic beverage to breast feeed. If you have more than one drink it's recommended that you pump and throw the milk away.

There you go....

-DRAB

So much wine.....so little time!!!

Hmmm that's not what our lactation consultant told us.... In fact, she noted that a glass of wine for the mom before bed time can help put the baby to sleep.

Many times my wife had a glass of wine or two when breastfeeding, and our baby (now 8 mos) is terrific. Its all about moderation.

Thanks everyone. I just read all of these posts to my wife. She's happy (generally) abouot the advice, but I don't think she'll start drinking Guiness anytime soon.

Semper ubi sub ubi!

The legal ramifications of recommending alcohol are not going to please risk management. I don't believe these are in guidelines by the ACOG ot the APA.

The suggestion that occasional alcohol contributes no ill effect is reasonable, though I doubt any good studies have proven this completely safe; and, a daily 1-2 drink load is a different story.

Alcohol is not stored by glandular or muscle cells and is metabolized at a relatively constant peak rate, so timing is relevent. Waiting is logical. Surprisingly enough, studies still show a correlation between alcohol intake and breast cancer, though no optimized randomized large number studies are available.

Further, assuming no harm because presumed concentration less than the BAL limits is faulty reasoning that any good lawyer could find malpractice in. Anecdotal advice is fine, but the ALARA concept is useful. SO, all physicians just be smart in your wording to patients.

And, all breast feeding patients use common sense.

Give me a break!! There is no doctor-patient relationship created on this forum. Any good defense lawyer would be able to completely eviscerate any idiot who brought a law suit on the grounds that "Well, some doctor guy on Wine Spectator's wine conversation forum said my wife could drink while she was breast feeding."

Jeez!! I sincerely think that the only thing worse than frivolous law suits is the irrational fear of frivolous law suits.

If my wife goes to her doctor and says, "I'm going to drink wine, so I want you to help me decide when it is I should drink," should her doctor respond, "well, my risk management team tells me that I shouldn't give you any advice about that." I'd smack him if he said that to me.

Semper ubi sub ubi!

Have any "good studies" proven that ANY ACTIVITY IN LIFE is completely safe?

Just damn!

Semper ubi sub ubi!

golf&zin nut:
There are some frivolous lawsuits to be sure, but as a lawyer who sometimes defends lawsuits for insurance companies, I can tell you that the frivolous suits are:
1) Few and far between;
2) Really fun to defend;
3) Really easy to defend;
4) Really inexpensive to defend.

At least in the conservative state of Maryland.

Doctors are very concerned and worried and paranoid about being sued, and it is completely understandable. Just like we non-doctors are concerned, worried and paranoid about going for any kind of invasive test.

By the way, my mother smoked while she was pregnant with me, drank alot of coffee, but didn't drink alcohol when she breast fed me, and other than the fact that I have three eyes, 12 toes, and my ears are on the same side of my head, I am fine.

Irwin

"Life is short.....start with the dessert."

Irwin --
Your mother did all of those things (as did mine), and the worst possible thing happened -- you turned out to be a lawyer! (same thing happened to me, by the way).

You know, I do insurance defense, too, and I too love frivolous cases. (Seems we have lots in common). My clients don't like them much, though.

Semper ubi sub ubi!

That is that no one knows for sure of the "benefits" of drinking alcohol while breast feeding. My wife is about to give birth to our second child and we both enjoy wine as well. (Poor her, she has not had a drop in three years-btw pregnancy, birth, breastfeeding and then again pregnancy only months after finishing the feeding of our first). However, even while breast feeding our first, she never touched a drop. The reason is simple. Why take the chance with your children? Studies today often reverse the studies of yesterday. Science seems to have become a world of "what I tell you today is true, while what I tell you tomorrow is more true." Fat bad, some fats good. Fiber bad, fiber good. History alone can tell us that much. Regardless, PLEASE DO NOT MISREAD MY INTENTIONS THAT FOLLOW:
I once read that the use of beer for lactating mothers stemmed back to WWII and the shortage of milk in war-starved Europe. That doctors prescribed the use of beer for mother's who would otherwise not have access to bottled milk to feed their babies. This could help stretch the breast-feeding period for a child and help with a rationing of milk. I am certain that I read that in print as a part of the (as listed here) misconceptions regarding the practice. My wife and I were also told of the waiting period as being the best method, yet.........

While IRWIN turned out fine, and others have, we simply prefer not to take the chance. It seems selfish, momentary and misguided. Have patience, let the wine age a little longer and know that you did ALL that you could to ensure that your child has everything he/she should expect while feebly trusting the guidance of their parent. Besides, If you simply ask why you want to indulge now instead of waiting, the answer is because "I" want to. You will get enough of the "I wants" when the child begins to speak.
And finally....at the risk of offending IRWIN and GOLF&ZIN NUT (and might I mention--simply for tongue in cheek argument's sake) you both became lawyers indeed, but could you have become the next Blackmon, Black, Holmes, Scalia, Rehnquist, O'Conner......who knows! Best wishes if you hopes are that you do.
Again, and simply put, why take the chance by simply being selfish? Wait.

There have already been some excellent comments - I won't add much.

Moderation is the key- 1-2 glasses is about the limit per day.

My 1-year old daughter has a rather disturbing taste for wine... she will crawl across the room to try to get to a wineglass. She likes the taste, and I suspect that some of that was due to the wine-flavored milk she occasionally had.

Made zero difference to her sleep habits - she was a rotten sleeper whether or not I had a glass of wine.

I can understand the point of DR Tannin and escape, which is why take any chances at all. But there are levels of background risks in vitually everything. Occassionally having a glass of wine is probably less risky (an uneducated guess I will admit) than putting your kid in a car seat and driving. I believe the key is common sense and moderation. We were very very careful never to breast feed if my wife would be drinking more than a glass or so.

Godo luck with your child, GolfZin.

quote:

---

Originally posted by escape:

However, even while breast feeding our first, she never touched a drop. The reason is simple. Why take the chance with your children?

---

The air we breath is polluted. Don't breathe for the sake of your baby. You could get in a car crash on the way to work. Don't drive for the sake of your baby. There are chemicals in the foods we eat. Don't eat for the sake of your baby.

A glass or two of wine while breast feeding is not going to hurt your child.

On a side note- but somewhat related... Studies have shown kids that eat dirt have more robust immune systems. It seems that exposure to pollutants, allergens, etc are important in creating resistance to them. Funny how life works.

Hmmm, women are passing along alcohol through their breast milk.
So where does the line form?



(Ah come on! Like you weren't all thinking it! )

"In America, first you get the sugar, then you get the power, then you get the women!" --Homer Simpson

Escape: Why would I want to be the next "Blackmon, Black, Holmes, Scalia, Rehnquist, O'Conner?"

You think I'd look good in a robe?

Irwin

"Life is short.....start with the dessert."

I actually fear the thought of you in a robe, just as I fear the appearance of some of these justices in robes. Simply making a point. As for our SERIOUSWINEDRINKER I do not see the comparison between avoiding the use of cars, the air we breathe, etc. The obvious seperation point here is the willingness to take the chance. Unfortunately these other instances do not offer the same flexibility in choice. Just as I would not "drug" my kid to help him sleep. The drugs should be left to me.......

Problem w posting is the tone /tenor is lost.
First of all,

I am referring to patient-doctor interactions, not board "advice" or "opinion." It is clear there is no such relationship here, nor do most people here have a clue who other are. What doctors tell patients is privy, and the content varies depending on what relationship and perceptions are established. In a trusting relationship, all kinds of advice is passed on. That said, recommending drinking alcohol in the absence of published studies or professional society recommendations requires some forethought by physicians. A better approach would be to fall short of recommending alcohol but to suggest that in the experience of that doctor some patients have done fine/benefitted from a drink or two. Anecdotal evidence should be presented as such. I am being facetious using "risk management" in my discussion, but don't discount the ability of bad people to create unbeleivable problems...none of whom I presume exist here.

Second, while the medicolegal issues this country faces w/r to its' health care system are certainly complex, be careful of discounting opinions when you have little knowledge of the issues from all sides. I'm definitely not a big advocate of being wishy washy unnecessarily. But failing to understand the conditions is also a mistake. Frivolous lawsuits may be easy to defend, but plaintiffs have won hundreds of millions with them. Frivolous lawsuits may inexpensive to win. For the legal team maybe. But,even the cost of nonsuit/dismissal is in the tens of thousands just to have legal representation, let alone time involved which is also money. Malpractice insurance costs OB-GYNs up to $100,000/y or more on avg and many areas and groups no longer are insureable. Let's pick a city. Payouts in Philadelphia last year exceeded those in California. More physicians are fleeing Pennsylvania then any other state in history. The state senator's wife won a $49 million dollar suit there!! Further,it is Bar Association who have fought the sensible concept that the plaintiff and his councillor pay for bringing up a frivolous lawsuit or pay for a defeated case. So let's keep perspective.

It is estimated that 20% of the costs of medical care are performed to cover one's ass, to perform uneccessary or unlikely needed care or tests. Unlike companies who deal with many frivolous harrassment and employee issues, doctors can't raise prices to cover increasing malpractice costs. These costs contribute to the 15% annually increasing costs of medical care that will have a massive toll on anyone 40 and younger.

While I doubt too many doctors have been sued over advice given through false monikers on internet web sites, some sites, companies, and/or doctors have been sued for bad or false internet advice as for cocktail party or curbside consult advice. While I may not manage postpartum patients, I do medicolegal work and practice and have a pretty good grasp on many of these issues. I am not so sure the participants above do.

[This message was edited by dr.tannin aka x-man on Jan 13, 2004 at 08:28 PM.]

If a plaintiff has expert testimony to support a claim, and the testimony passes the threshold for admissibility, and the defendant has contrary testimony, and the jury or judge determine to believe one versus the other, neither position can be said to be frivolous.

Irwin

"Life is short.....start with the dessert."

And we know where that threshhold can lie.

Dr. T:
This may not be any consolation to you, but I sue other lawyers too.

Irwin

"Outside of a dog, a book is probably man's best friend; inside of a dog, it's too dark to read."
-Groucho Marx

irwin-

I've always enjoyed your posts. Even on "delicate" issues.

All vocations have their skeletons. This topic gets my dander up. I rationalize it as the cost of doing business. But like the mafia, it's basically barely controlled extortion. People are leaving medicine and fewer are entering. And with fewer and fewer doctors in an aging demographic, the s--- will hit the fan sooner or later.

Frivalous lawsuits?

One example... the idiot that spilled hot coffee on him/herself and sued McDonald's (I believe it was McD's), and won.

I'll echo that the breathing/car/etc comparison is lame. Why risk it? There is no link to health risks w/ drinking water, is there? While there are benefits to drinking alcohol, there are downsides as well.

LJ

"Drink up, me hardies, YO HO!"

Parkside Church

Griffin House

My sister had a baby a little while back. Her doctor told her "This is completely off the record, and you never heard it from me...but, if your child is having trouble sleeping, have a glass of wine, wait 1/2 an hour, and then breast feed her."

I guess this gives new meaning to the term "drinking wines too young"!

"We are the people our parents warned us about"
-J. Buffett

Dr T,
Water isn't harmful? What happens to the byproducts of the halogens in water (chlorine) in breast-milk? Sorry, just being facetious!

Escape is doing the right thing for his children, as he sees it. It is also the absolutely safe thing to do.

By the way, I think the proportions are wrong for BAL (and this of course is really irrelevent to breastmilk). As I recall it, it is 80mg of alcohol
per litre of blood ... very roughly 80/1000 ... and not expressed, generally, as percentages. I recall that we metabolise 10gm alcohol an hour (mean for m&f), the weight of alcohol in one glass (at 13% in 200ml = 26ml x 0.96 say) the effects after 2 hours will be close to zero.

I suspect that the beneficial effects for the woman would well out-weigh the risks to the child.

Incidentally Dr T, my cousin did some locums in the US whilst travelling. He was extremely well paid, but the insurance was so high that it really wasn't worth his time. His comments paralleled yours ... "No one can afford to go to the doctor as they have to charge so much to cover their butts ...." etc. He came back converted to the no-fault system used here, which was a major turn-around politically.

Dr. T: And I have enjoyed your posts as well. One of the big problems is the expectation/result issue. Everyone expects to be cured of everything. Everyone assumes current technology is perfect. When I started practicing law, everyone assumed that if you got cancer you were dead meat. Thus, there were no claims of missed cancer diagnosis with delay, since everyone thought it didn't matter. Now, this is one of the more prevalent kinds of suits. I have people who come to see me who have had a "delay" in diagnosis of a month. Rarely, if ever, would that delay be material.

I think we would agree far more than we disagree.

The real scoundrels are the people who will say anything for money. You know what I mean.

Irwin

"Outside of a dog, a book is probably man's best friend; inside of a dog, it's too dark to read."
-Groucho Marx

I misunderstood.
I was going to say: breastfeeding & wine, I'm 100% pro.

But I was thinking more in the line of replacing the silicons by a small bag-in-box (without the box, of course)...

Even water can be harmful. Read up on psychogenic polydipsia. I can see it now...doctor recommends drinking large amounts of water to help curb appetite. Patient takes advice to heart and ends up in hospital with a sodium of 110. Hires really "good" lawyer who wins him some money.

The modest water, awed by power divine, beheld its God and blushed into wine. - John Dryden

Medical literature is important to consider. Check out this recent article.
*British Journal
of Medicine* (vol. 327, pages 1459-1461).


The study is "Parachute use to prevent death and major trauma related to
gravitational challenge: systematic review of randomised controlled trials"
by Gordon Smith (Cambridge University) and Jill Pell (Glasgow Dept of Public
Health).

Here's an excerpt from the introduction: "The parachute is used in
recreational, voluntary sector, and military settings to reduce the risk of
orthopaedic, head, and soft tissue injury after gravitational challenge,
typically in the context of jumping from an aircraft. The perception that
parachutes are a successful intervention is based largely on anecdotal
evidence. Observational data have shown that their use is associated with
morbidity and mortality, due to both failure of the intervention and
iatrogenic complications. In addition, 'natural history' studies of free
fall indicate that failure to take or deploy a parachute does not inevitably
result in an adverse outcome. We therefore undertook a systematic review of
randomised controlled trials of parachutes."

The authors "conducted the review in accordance with the QUOROM (quality of
reporting of meta-analyses) guidelines. We searched for randomised
controlled trials of parachute use on Medline, Web of Science, Embase, the
Cochrane Library, appropriate internet sites, and citation lists. . . . We
excluded studies that had no control group."

Unable to locate any randomized controlled trials of parachute intervention,
the authors discuss at length the problems of trying to base conclusions
solely on observational data. For example, they write: "One of the major
weaknesses of observational data is the possibility of bias, including
selection bias and reporting bias, which can be obviated largely by using
randomised controlled trials. The relevance to parachute use is that
individuals jumping from aircraft without the help of a parachute are likely
to have a high prevalence of pre-existing psychiatric morbidity.
Individuals who use parachutes are likely to have less psychiatric morbidity
and may also differ in key demographic factors, such as income and cigarette
use. It follows, therefore, that the apparent protective effect of
parachutes may be merely an example of the 'healthy cohort' effect."

Irwin

"Outside of a dog, a book is probably man's best friend; inside of a dog, it's too dark to read."
-Groucho Marx

Irwin, that's brilliant. Thanks for the cite.

You may enjoy this one:

http://news.bbc.co.uk/1/hi/health/3159813.stm

Irwin,
Thanks or that, LOL

I particularly felt for the "control groups" as I'm sure this must have been a double blind trial.