Alcohol & Breastfeeding

So in this episode, today, I am chatting to the lovely Julie Blandthorn, all about alcohol during pregnancy and breastfeeding. So Julie is a clinical midwife consultant at the Women’s Alcohol and Drug Service otherwise known as WEDS and that’s based at the Royal Women’s Hospital in Melbourne. So Julie is a registered nurse. She’s completed midwifery training. She’s completed postgraduate Maternal and Child Health qualifications. She’s done further study in immunization and family planning. And she has worked at the women and alcohol drug service for the last 15 years as well as being involved in pregnancy research throughout the hospital. So in this episode, we will be discussing the effects of drinking alcohol in pregnancy and while breastfeeding, and it is a really confusing area around guidelines for drinking during this time. And recently, the guidelines NHMRC guidelines, which is backed by vigorous research, they’ve recently been updated in 2020. So in this episode with Julie today, we will be discussing safe ways of drinking low levels of alcohol occasionally whilst breastfeeding, and we’re going to discuss how long it takes for alcohol to get into the milk when women are breastfeeding. Julie is going to provide some strategies around how a woman can undertake breastfeeding her baby whilst having a drink of alcohol. And she’s also going to discuss the potential effects that alcohol can have on a baby when they’re breastfeeding. So it is an important topic today. And I hope that this episode helps to provide a bit more clarity around this historically quite a confusing area where there are so many mixed messages. So let’s dive into this episode.

Hello, Julie, thank you so much for joining me on the podcast today. So to start off with, could you introduce yourself and let us know who you are, what you do, and why.

JULIE BLANDTHORN

So my name is Julie blank dawn. I’m a midwife at the Royal Women’s Hospital at the Women’s alcohol and drug service. So it’s a specialized service for pregnant women who use drugs and alcohol at the very pointy end during pregnancy. So I’m a nurse and midwife and the maternal and child health nurse. And I’ve also got other qualifications in alcohol and other drugs, immunization, family planning. And now I’m doing a garden design course.

KATH BAQUIE

Pretty varied there.

JULIE BLANDTHORN

Yes.

KATH BAQUIE

So when did you last work as a maternal and child health nurse?

JULIE BLANDTHORN

Quite a while ago. So when I did that, I was just doing relieving when my children were little. And I also worked at the Women’s on the nurse bank, or in the midwife bank so I could actually have all the school holidays off. And I did that for 16 years. And then when my children, my youngest one started school, I actually started coming back and working at the Women’s on the weekends and I started getting into what somebody asked me to fill in for the holidays. In wards that’s what we call the Women’s Alcohol and Drug Service. And I was a bit daunted by it because it is a very specialized service. But I absolutely loved it. And I loved the team and the people that I was working with. And I can honestly say it’s made me a better person.

KATH BAQIUE

Wow. Can you explain that a little bit more?

JULIE BLANDTHORN

Everybody can be having their own prejudices and judgments and particularly growing up in the area that I’ve grown up in and having the opportunities that I’ve had in life I think sometimes it’s quite difficult to see, perhaps you know that other people haven’t had those opportunities and the sorts of lives that some people have had very, very difficult lives. And when I started working in wards, I started to become very aware of what those lives have been like. And I thought to myself, if that had happened to me as a child, or as a young adult, or whenever, I think I’d be on the heroin as well, and I’m not going to go into it. But you know, people don’t just go out one day and say, you know what, I’m going to start using heroin today, and I’m going to become addicted to it. It just doesn’t happen like that. Often, really, people use drugs, because they’ve been exposed to a lot of trauma, to poverty, to disadvantage to a lot of abuse, if you have poor attachment with people who love them into that. But sometimes, some people don’t have anyone in the world who really cares about them, you know, and we’re there to help them in wards. I think one of the really, really good things about wards is that everybody who comes here has their own midwife and their own social worker who works with them throughout the whole pregnancy. So they’re not seeing different people. Because when you come to the hospital, usually, you know, there’s not that continuity of care. But at wards there is and we also, it’s a quite a big multidisciplinary team that we have. We have an addiction specialist, the pediatrician, the dietitian, obstetrician, midwives, social workers, the neonatologist, so it’s quite a big team.

KATH BAQUIE

To be honest, I didn’t know much about it all. And I’ve even done some casual work at the Royal Women’s Hospital and do you have to get referred to that service?

JULIE BLANDTHORN

Yeah. So we see people at the very pointy end. So that’s the first thing. So when people come into our normal pregnancy clinics here at the Women’s, we do what we would call the dragon alcohol screening, and we do this for everybody. So we ask people, have they ever used any drugs? Have they ever drunk any alcohol? Are they smoking cigarettes? And if they say yes to any of those things, then we will ask them further. So okay, so you’ve been used heroin in the past? When did you use it last, and if they say one week ago, then that is obviously a concern. And then they would be referred to us in wards. If someone’s smoking Satan, cannabis, somebody might be smoking, say, one joint a day, and they would not be necessarily referred towards a we would see them that they would not be part of our service. And we would usually see those people talk to them about stopping if they wanted to do that. And what other supports that they might be able to, we might be able to put in place to help them do that blood, such as linking them to a drug and alcohol service in their local area for some counselling. Women can also refer themselves and also GPS and other doctors. And anyone really can refer to us. So through the hospital for all service, or they can ring us up in wards and have a chat as well.

KATH BAQUIE

So we’re talking about alcohol and breastfeeding specifically. But it would also be good to chat about alcohol during pregnancy. What are the guidelines and have they changed recently?

JULIE BLANDTHORN

The National Health and Medical Research Centre have said that not drinking alcohol in pregnancy is the safest thing. So it’s not recommended to drink alcohol at all in pregnancy. And the reason for that is that they used to say one or two drinks probably wouldn’t hurt you. And a lot of doctors and midwives even might say that that’s still the case. But what they found and I could talk about this research a little bit later, but the found that even small amounts of alcohol do affect the developing fetal brain. So when people drink alcohol, it’s metabolized or gotten rid of out of your body by the liver, but babies even newborn babies, their liver is only working at a 50% rate of what the adult liver does. So when they’re exposed to alcohol, when they’re first born say just through breastfeeding, they have a lot more trouble getting rid of that alcohol than what the adult does. And during pregnancy, say in the first trimester, that baby’s liver is only working at about five to 10% of the rate of the adult liver. So when you drink in pregnancy, that baby is this sort of swimming almost it just can’t get rid of that alcohol that it’s been subjected to. And it is a little bit different in breastfeeding and in pregnancy. So when you are pregnant and say I have a glass a couple of glasses of wine, say and my blood alcohol level is .05 then that baby is blood alcohol level is .05. When you’re breastfeeding, my blood alcohol is .05 which means that my breast milk is .05 so it’s quite different and they’d be drinking the breast milk which would have an alcohol level say 0.05%. Whereas in pregnancy say that alcohol is 12% Alcohol. They’re getting the full 12% of the alcohol. Can you see what I mean? It’s sort of diluted in breast milk because it’s in the milk. So the milk level, the blood alcohol level, and the milk level is exactly the same. So people sometimes think, Oh, if I express and, and get rid of all this milk, then that will reduce the amount of alcohol in my breast milk. But that isn’t the case. It’s not stored in breastmilk and as soon as you start expressing, it’s sort of like a dam and a creek, it just flows straight back into it. So expressing will not reduce the alcohol levels in your breast milk any quicker than if you didn’t express.

KATH BAQIUE

So the only reason you’re saying to express it’s not to get rid of the alcohol, it’s like the equivalent of a feed while you feed your baby in other ways.

JULIE BLANDTHORN

That’s right. So what we would say, if somebody really wanted to go and have a few drinks. And obviously, we don’t want people to stop breastfeeding, because they’re going to have a few drinks. So they did a study in Western Australia. And they found that about 50% of women who are breastfeeding, were also drinking alcohol at two, four and six months postnatally so after they’d had their baby. And some people actually stopped breastfeeding, because they wanted to go to certain events or have a few drinks. And, you know, this, this is something that we really want to discourage because breastfeeding is really such an important thing. And the NHMRC, they do recommend people breastfeed to babies about two and a half years old. Now, that’s something that we would be really encouraging. And if you wanted to go out and have, you know, like a big night out, or go to the Melbourne Cup, and you know, had quite a few drinks all day, you can do that. And what I would suggest is to plan in advance, so you can express milk before you’ve had any drinks. So you could actually afford one month a week, even before you had that event each night, you could just express some breast milk, say 100 meals, you know, they’re very easy just to pump that off and freeze it. And then you keep it in the freezer until you need it. And then if you have a few drinks, and you think, really, I don’t want to breastfeed my baby now, because, you know, I know I’m feeling quite tipsy, and I don’t want my baby to get that in the breast milk, then you can just defrost that breast milk that you’ve got in the fridge and give the baby that in a bottle. So that is the thing to prepare in advance.

So I can talk about the recommendations, but it’s probably better to talk a little bit more about the physiology. So when people drink alcohol, and they’re breastfeeding, it peaks in the maternal blood level at about 30 to 60 minutes. So this is sort of really important to know. So what we would really be encouraging people to do, if they are going to have a drink is breastfeed the baby first, and then have a drink. So breastfeed the baby when you don’t have any alcohol in your system, and then breastfeed the baby. Now, if you had say two glasses of wine in two hours. And the baby shouldn’t be waking up for four hours, but she does, or he does, which they do the Australian breastfeeding association so that if you’ve had a drink like that, it’s better to actually breastfeed the baby, than to keep the baby formula. So that’s what they think, because giving the baby formula, then, you know, might have its own problems as well. But as I said, it’s only a very low percentage of alcohol in breast milk. But of course, the NHMRC say that the safest thing is not to breastfeed more you are drinking alcohol, and particularly in the first four to six weeks, because that’s when your milk is really starting to establish and it does take four to six weeks for your milk to really establish and when you do breastfeed your baby and you’ve got some alcohol in your system, you do not let down properly. And studies have shown that that feed would be reduced by about 20 to 23% in volume, if you’ve got alcohol in your systems, you don’t let down. It inhibits the letdown reflex.

KATH BAQUIE

Okay. And I was a bit nervous talking to you, Julie, because I thought with my three children, I bet I’ve done things wrong. So quite regularly on a Friday night, I would start breastfeeding and my husband would bring me in a glass of wine and I used to think the good time to drink it while I was feeding, because it wouldn’t be in my system and till after they’ve finished feeding. But that might have been wrong. Given what you’ve just said that it takes 30 to 60 minutes for your blood alcohol levels to peak.

JULIE BLANDTHORN

Well, all depends how quickly a baby was faint because they can finish off in five minutes. You know, when they’re about nine months it pretty quick.

KATH BAQUIE

Let’s hope it was that quick. I can’t remember it’s a few years ago.

JULIE BLANDTHORN

You know what I don’t want people to ever feel guilty about things that they’ve done in the past because there’s no point worrying about something in the past that you can’t change. That’s the first thing and we’ve all done our best as mothers maybe even myself when I had my 30, I had a big party for my 30th birthday. It was a surprise party that my husband had so kindly put together. But my son, for about the last three or four nights have been in hospital with bone colitis. And my husband decided that no, he was still going to have it, because he had already bought the food. And so I came out of hospital here with this great big party, I cried, I went into his room and cried because he couldn’t feed because his nose was all blocked and things. And I had a couple of glasses of wine. And because we didn’t really have this information 30 years ago, and so I fed him and I did not let down. And I could feel it that and he was unsettled all night. And probably because firstly, he wasn’t, he wasn’t well, but also he wasn’t getting a full fee, because I was not letting down. So this is one of the things and they can be unsettled. There are some studies that have shown babies can actually react to that alcoholic breast milk. Never, ever feel bad about what we’ve done as, as mothers, because you know what, we’re trying our best, and we were all trying our best every time.

KATH BAQUIE

Okay, well, you’ve just given us some great information. So hold out until after you’ve fed your baby for your glass of wine or whatever it is. And then how long do you need to wait for that to be out of your system? That alcohol?

JULIE BLANDTHORN

So at the Australian Breastfeeding Association, I’ve got a really, really good app that you can download on your phone. So we say in general, it takes about two hours to get one standard drink out of his system. So I’m not talking about a fishbowl, wine glass, you know, I’m talking about 100 mils is a standard glass of wine, which actually isn’t that much. It takes about two hours. But it all depends on your weight. So if you’re a bigger person, you actually get rid of it quicker. So probably in about an hour and a half. But if you’re quite a small person, it will probably take closer to the two hours. And this app is quite good because you can put in how much alcohol you’ve had at the time, and when you breastfeed and so on. And then it will be until you your breast milk is now alcohol free.

KATH BAQUIE

Yeah, that’s great. And what’s the app called?

JULIE BLANDTHORN

Australian Breastfeeding Association Alcohol app. If you just Google that becomes up.

KATH BAQUIE

Thank you. So can we take a step back to pregnancy? What are the potential effects on your baby if you drink alcohol during pregnancy?

JULIE BLANDTHORN

So possibly the worst time to probably drink alcohol is in the first trimester. So that’s in those first three months. And unfortunately, a lot of people don’t even know they’re pregnant, you know, until quite well on. So the alcohol is very toxic to the developing fetal brain. And it can cause quite a severe, it just depends on what is forming at that time. So in those that first trimester, all the major organs are all forming, including the brain. And as I said before, because the liver is so immature, that they that fetus is having trouble metabolizing and getting rid of that alcohol, so it tends to sit in their system for longer. So that’s not good. If you’re in the last trimester, and you’re 36 weeks and you have some alcohol, I wouldn’t say it’s not as bad but all the major organs have been developed. But that fetal brain is still extremely sensitive to alcohol and the toxic effects of alcohol well into really the developed the baby a child’s brain doesn’t really stop developing until they’re 25. So I’m not saying that, you know, obviously the legal age of drinking here is 18 but if you’ve read studies and things, it does tell you that really it’s better if kids don’t drink alcohol until they are 25, just because of the effects of does have on their brain, which is still developing, we just want to try and minimize that harm as much as we can to babies.

KATH BAQUIE

So are there any specific conditions that your baby might be more at risk of with alcohol?

JULIE BLANDTHORN

Well, there’s actually a condition called fetal alcohol spectrum disorder. And you can look that up. And often these children have particular facial features. So they have a very thin upper lip, that little dent between your nose, the lip, the philtrum, they don’t have that at all. It’s really old changes in the midline of their face. And this is what they did a study on at the Children’s Hospital and the women’s and things not long ago. And they recruited a really lot of women in Victoria who were pregnant and they filled out surveys about how much alcohol they were drinking in pregnancy, and quite candid about it. It was all anonymous and so on. And then those children were followed up and looked at developmentally was very much affected when people were drinking alcohol with pregnancy and you can look the study up if you like. So the surname of the person who wrote it is Muggli, M-U-G-G-L-I, I can send that to you, it is a very scientific thing. But what they found is even when people had had just a couple of drinks and alcohol, there were changes to the midline, facial formation, so and what they found is this midline, that seems very significant. But what does it really mean? We don’t know, does that mean that that child’s more likely to have a brain affected by the toxicity of alcohol? We don’t really know. But what we do know is that it was affected by very, very small amounts of alcohol, affecting the development of the scar.

KATH BAQUIE

And moving on to breastfeeding, do we know of any effects on the baby from even just a small amount of alcohol?

JULIE BLANDTHORN

Yes, yes, we do. And this is not just one or two glasses of alcohol. This is, you know, like quite a bit of drinking every day, and so on. Some studies have shown that there’s sedation, that the babies are a little bit sedated. Another study shown is also altered milk that the taste and milk tastes different, the babies don’t like the taste of the milk, and it tastes different, that they have more crying. And they’re more likely to have heightened startle, you know, like B, BB to have anxious, that’s after exposure to alcohol in milk who breastfeed some of these studies. So these are people who are drinking a really lot. They’re not drinking, you know, one or two glasses here and there. And even when people are breastfeeding, we would recommend that people not drink every day that they just drink, you know, occasionally, perhaps every second day, or if they do have a drink every day, just to make sure that they do it safely, particularly not in those first four to six weeks, because you will really be, you know, establishing at that time. Also, you should try not to drink every day while you’re breastfeeding. And it’s been such showing that people who have babies who are premature, are particularly exposed to more toxicity in the brain, they have other problems with breathing, and sometimes they have chronic illnesses. So I mean, the guidelines say that those babies should not be exposed to any alcohol in breast milk, we would recommend here that heavy drinkers not breastfeed. So of course, we have some women come to our surface who, you know, I’m drinking a lot when I’m talking, you know, I’m talking about like Bob and Bob for a day, and they have addiction problems, they should not be breastfeeding. You have to remember that this is our guide guidance, you know, we would suggest or recommend that they not breastfeed, but if people want to breastfeed, then that is a choice. We can’t tell people you cannot, you should not do this, it is their choice, we just give people the information. This is the medical evidence that we have, and then they can make the decisions that they want to that they feel is the best thing for them.

But the other thing that’s really important is that when you know when you’ve had a few drinks, you know, you can feel quite sleepy, and you can sleep very heavily. So when people sleep with babies in their bed, which is not recommended, but it’s particularly not recommended if the parents are drowsy in any way. So if you sleep with your baby, after you’ve had a few drinks, or after you’ve been smoking or using any other substances at all over the counter or illegal, even antihistamines can make you feel very, very sleepy. You should not sleep with your baby because you’re not aware of them waking up and wriggling around because you are so heavily sleep, and you can roll on to them and suffocate them. And they can also go right down the end of the bed. You don’t know that that there. And that is something that happens to women in our service sometimes. Yep. So it’s really recommended that you do not sleep with the infant in your bed, if you have been using any substances and drinking or drink.

KATH BAQUIE

So I think you’ve provided some great information. And we will link in the show notes, all those important things you talked about in terms of the guidelines, the breastfeeding Association details.

JULIE BLANDTHORN

I’ve got some other recommendations.

KATH BAQUIE

Oh, go for it!

JULIE BLANDTHORN

Yeah. So some of the other recommendations are that you ate before and while you’re drinking, because that actually pulls out the time of peaking. So you know, if you’ve had a few drinks and on an empty stomach, you tend to feel much more intoxicated than if you’ve had a meal. So eat before and while drinking, breastfeed before drinking alcohol. Allow two hours for every standard drink for milk to be alcohol free. So that’s, you know, on average, but if you get this effort put you put in your weight and things, it’s better to breastfeed with a small amount of alcohol in the system, then feed formula infant formula and know that you’re new to breastfeed your baby if it’s got a bit of alcohol in the breast milk that your baby will be getting about 20% less of the feed, and we wouldn’t really recommend that unless you really need to feed the baby in and screaming and you haven’t got anything else and remember to express and store milk prior to drinking. Do not sleep with the baby in the bed, if you’ve been drinking. Download the Australian Breastfeeding Association app. Also if you’ve been having a few drinks and you don’t feel so you’re capable of looking after the baby because remember that you could trip it While holding the baby, if you’ve had a lot to drink, have a safety plan. And that would be around getting your mum over or getting someone over to look after the baby who hasn’t been drinking, and who knows how to look after that baby, as far as asleep, a safe sleeping environment, because we don’t want babies being put to bed on the couch and things like that, because that’s dangerous.

KATH BAQUIE

Yeah.

JULIE BLANDTHORN

So yeah, there are ways of having a drink and still breastfeeding safely.

KATH BAQUIE

Such important information. And to finish off with what final words of wisdom do you have for any pregnant or new mums who might be listening today?

JULIE BLANDTHORN

So if I was pregnant now, I mean, I like to drink. And I really do quite like a glass of wine. And this is what I said to myself, I have to say, when I was pregnant, I like a glass of wine. But this is just nine months or 12 months out of my life, that I’m not having a glass of wine or a drink. And I think that I can do that for the safety of my baby. That’s just me and my opinion. And I think that if you can possibly not drink alcohol during pregnancy, it actually is going to help your baby. And you’re going to feel good about that. If you do drink, and your baby has not had some learning problems or something at school, you’re always going to be thinking, Did I do that? Did I cause that because I was drinking? And you’ve got that information. And of course, it’s up to you to do what you want with it. This is my own personal opinion. But I would say alcohol is way worse than using heroin in some ways for the baby’s development in pregnancy, and that I’ve been working here for 16 years. And that is true, even though babies who are exposed to heroin can withdraw and things. But as far as affecting the developing fetal brain, alcohol is much worse than heroin say.

KATH BAQUIE

Wow.

JULIE BLANDTHORN

Horrifying isn’t it?

KATH BAQUIE

It is horrifying.

JULIE BLANDTHORN

And you know what the problem is that alcohol is everywhere. And people, like my mother says, you know, oh, God, have a drink, have a drink, have a drink when you’re pregnant. I had a drink. And so therefore, it’s okay. And I think this is something that we really have to be aware of, that people are always trying to get you to, you know, have a drink, have a drink. But we know that that’s not, that’s not the right thing. And people will use their own experiences and say, Well, I had a drink when I had my children look at them, they’re fine. And they may we’ll be fine. But don’t know, really. So I would just say if you possibly cannot drink in pregnancy, then that’s what I would seriously advise. And even to not if you’re planning a pregnancy, to even not drink in the second half of your cycle, because that’s when you might be pregnant. So have a few drinks for the first half of your cycle. But once you’ve ovulated really don’t have it, have another drink, and then till you might be pregnant, or you get your period. So just to be on the safe side.

KATH BAQUIE

Yep, great tip. And I had my first glass of alcohol free one for a long time. And I was pleasantly surprised compared to when I last had it. I can’t remember what brand it was. But I think it’s improved a lot.

JULIE BLANDTHORN

It has and there’s also some really good alcohol free gins. In fact, there’s a whole bar in the city now in Melbourne, that’s just having cocktails or mock tails, non-alcoholic ones. And it’s absolutely incredibly popular, well when we weren’t in COVID lockdown of course, but I think it is probably possibly becoming more acceptable, especially in pregnancy. I think that a lot of people do know that. I think breastfeeding is people aren’t quite so sure. But at the Women’s Hospital, if you get onto the Women’s Hospital website, we have fact sheets there. But all drugs and alcohol and all they talk about drugs and alcohol in pregnancy and breastfeeding. So there’s you know, heroine, and buprenorphine methadone and neonatal abstinence syndrome, tobacco, alcohol, every single thing and not just revised them all. So they’re all up to date. So I would suggest going and having a look at those fact sheets. So they’re written for the consumer. And I think that they are really, really useful.

KATH BAQUIE

Perfect. Well, I’ll put some of those links in the show notes. Thank you so much for joining me today. I really do appreciate your insights and just helping to clear up what is a very confusing topic.

JULIE BLANDTHORN

Yeah. And look, you know, there is information out there and just remember that just because it’s on the internet doesn’t mean it’s true. So, you know, try and get your information from sources that are reputable places like the Royal Women’s Hospital, for example. And you know, we’re here to help you in any way we can.

KATH BAQUIE

Brilliant. Thank you, Julie.

JULIE BLANDTHORN

Thanks, Kate.

KATH BAQUIE

And before I sign off, remember my team and I will be putting together the show notes for this episode with all the links that Julie mentioned at www.fitnestmama.com/podcast. Have a fabulous day everyone and I look forward to you joining me next week for another episode of the FitNest Mama Podcast.

Thanks for listening to the FitNest Mama Podcast brought to you by the FitNest Mama Freebies found at www.fitnestmama.com/free. So please take a few seconds to leave a review, subscribe, so you don’t miss an episode. And be sure to take a screenshot of this podcast, upload it to your social media and tag me, @fitnestmama, so I can give you a shout out too. Until next time! Remember, an active pregnancy, confident childbirth, and strong postnatal recovery is something that you deserve. Remember, our disclaimer, materials and contents in this podcast are intended as general information only and shouldn’t substitute any medical advice, diagnosis or treatment. I’ll see you soon!