The topic of breastfeeding can seem like a sea of endless questions, with differing answers depending on whom you ask. Lately, I’ve been getting some repeated questions about issues beyond basic breastfeeding management, so I thought I’d share a few here.
Alcohol: When Do I Have to Stop Pumping and Dumping?
According to experts, drinking in moderation is compatible with breastfeeding. The American Academy of Pediatrics (AAP) says, “Nursing should take place 2 hours or longer after the alcohol intake to minimize its concentration in the ingested milk.”
Because alcohol moves in and out of your breast milk just as it does in your bloodstream, if you don’t feel drunk, then there’s not enough alcohol in your breast milk to adversely affect your baby. If you’re feeling tipsy, pumping won’t eliminate the alcohol from your milk any faster. Only time can do that.
For one drink, that’s about two hours, depending on your weight and whether you’re eating with your beverage. If you’re interested in more detailed estimates of the time it takes for alcohol levels in breast milk to return to zero, based on maternal weight and the number of drinks, this study has a handy chart.
If you have had enough drinks to feel intoxicated, you shouldn’t breastfeed until you feel sober. In the meantime, you may miss a feeding or two, depending on how much you’ve had to drink, and your breasts may become engorged. You should pump if this is the case to maintain your milk supply. Once the milk is out of your body, though, your liver is no longer helping to metabolize the alcohol in it. So, it’s best to discard that milk rather than save it to feed to your baby.
If you know ahead of time that you’ll be drinking to excess, you may want to pump in the days leading up to your event so your baby has some breast milk to drink while you’re unavailable.
What if you’re hungover the next day? As long as you’re no longer intoxicated, it’s safe to breastfeed. Even if you feel nauseous or are vomiting, it’s still safe to breastfeed. Just be sure to stay hydrated and get some rest. If you still feel a little tipsy, offer your baby milk you pumped beforehand (or formula, if necessary) instead of nursing.
Should I Breastfeed if I’m on Antidepressants?
Breastfeeding and postpartum mood disorders can be complicated. They’re a bit of a chicken-and-egg problem: Which came first, the depression or the feeding difficulties? If breastfeeding is going well, continuing to breastfeed may be the best thing you can do to help. But if breastfeeding difficulties are piling up, they could make your depression or anxiety worse.
If you are experiencing postpartum depression, anxiety, post-traumatic stress, OCD, bipolar disorder, or another mood disorder, the best thing to do is seek treatment. While interpersonal therapy is likely an important part of your treatment, medication may be necessary, too.
Many times, a medication compatible with breastfeeding can be prescribed. For depression and anxiety, the most commonly prescribed antidepressants are usually SSRIs, and these tend to be among the most compatible with breastfeeding.
In their review article, Kathleen Kendall-Tackett, an expert in breastfeeding and mental health, and Thomas Hale, a breastfeeding and pharmacology expert, conclude:
“The exposure of breastfeeding infants to paroxetine, sertraline and nortriptyline is unlikely to produce detectable or elevated plasma drug levels. ... Infants exposed to fluoxetine may have higher levels of exposure ... Citalopram may lead to elevated levels in some infants, whereas escitalopram produces a lower relative infant dose.... Breastfeeding mothers should be advised to observe for any possible signs of adverse reactions including irritability, poor feeding, or major changes in sleep patterns. Premature babies or other unstable infants should be closely monitored for adverse effects.”
If you have been prescribed an antidepressant, or if your doctor plans to prescribe one but would like more information, individual medications can be reviewed in the online database LactMed.
If a breastfeeding-friendly medication cannot be found for your diagnosis, you’ll need to weigh the importance of getting treated against your personal feelings about breastfeeding. Taking the medication will likely take priority, as it may be dangerous to leave your condition untreated. And since formula offers a safe alternative, especially in the United States, your baby can still thrive.
This can be a painful decision, though, and working through those feelings with a counselor or therapist is important.
Is It Safe to Sleep With My Baby?
As a breastfeeding mother, it’s likely you’ve fallen asleep with your baby nursing. Those nighttime feedings may have been easier while lying in bed, and you may have awakened with a jolt later in the night, feeling guilty because your baby was still sleeping beside you.
The current recommendations from the American Academy of Pediatrics state that babies should sleep in the same room as their parents for the first several months, at least, to help prevent SIDS. However, they recommend against bed-sharing because it poses a danger to the baby.
This blanket prohibition, though, is countered by experts who have studied breastfeeding and infant sleep. According to baby sleep expert James McKenna, co-sleeping is a “biological imperative.” Babies and mothers are hard-wired to be together, and this doesn’t stop when it’s time to sleep.
For babies, sharing a sleep space with their mother can help regulate their breathing, temperature, heart rate, and more. They also respond to their mother’s movements, which can help keep them safe as they sleep. They are able to feed frequently and fall back to sleep easily, sometimes barely waking at all.
Mothers across cultures and throughout history have shared a sleep space with their children. Researchers conclude that half of parents report sharing sleep with their babies by age 3 months, and that among breastfeeding parents, 70–80% sleep with their baby at least part of the night.
The best thing to do if you plan to sleep with your baby is to make deliberate choices to make the sleep space as safe as possible. Only bed-share if:
You are breastfeeding. If you are formula feeding, your baby should sleep in a cot or crib near you.
You are not a smoker.
You have not been drinking alcohol and are not taking medications that would limit your ability to wake.
Your baby is healthy and was not born early.
Your baby is lightly dressed and always placed on their back to sleep.
You sleep on a firm mattress with no places where your baby could become entrapped.
You do not have pillows or fluffy bedding that could cover your baby.
You and your partner agree to bed-share.
You do not let older siblings or pets into bed with you.
The most dangerous place to fall asleep with your baby is on a sofa or upholstered chair. So, if you feel like you might fall asleep while nursing, it’s better to bring your baby into bed with you and make the sleep space safe.
Thanks for being part of the conversation and for continuing to seek out evidence-based information to support your breastfeeding journey.
