BREASTFEEDING AND SMOKING AND ALCOHOL

Beth: I am 35 weeks pregnant with my second boy. I didn't breastfeed my first because work wouldn't allow pumping on work hours. I am thinking of breastfeeding this one though because I'm not working. Question is, I like to have a drink every once in awhile, can I do that while I'm breastfeeding? And I'm a smoker that wants to go on the patch, can I do that while breastfeeding? I can't quit cold turkey, I have tried. Also, husband is concerned about feeding in public, what can I say to him to reassure him that it's ok to do?

Anne: Beth, I'm so glad that you are planning to nurse your new baby. Staying at home with him will make it a lot easier, because although many mothers do continue breastfeeding after they return to work, it does present a lot of challenges.

I wouldn't worry at all about drinking occasionally while you are nursing. The American Academy of Pediatrics has approved the use of alcohol in breastfeeding mothers. Alcohol does pass into breastmilk more readily than some other drugs, but unless you drink several drinks or more a day, every day, there shouldn't be a problem.

Some studies have shown that drinking heavily over a long period of time can slow your baby's motor development, and regular alcohol abuse can cause slow weight gain in the baby, but there is no evidence that having a few beers or glasses of wine will harm your baby.

Mothers who drink metabolize alcohol in about 1-3 hours, so if you want to be conservative, wait a couple of hours for each drink before you nurse. If you have 4 beers, wait 8 hours. Having a glass of wine or a beer or two should not cause any problems, and I would not even worry about it. In his new book "Dr. Jack Newman's Guide to Breastfeeding," he says "Alcohol while breastfeeding? No problem, in moderation. No need to worry about 'pumping and dumping.' Just put the baby to the breast, even while you have your drink - why not?"

If you are a heavy smoker (a pack or more a day), your milk supply may go down and rarely, your baby may have an upset stomach. Nicotine can interfere with your letdown reflex, so it may lower your milk production or your baby's weight gain if you smoke heavily over a long period of time.

The Breastfeeding Answer Book says that "if a mother smokes fewer than 20 cigarettes a day, the risks to her baby from the nicotine in her milk are small." If you can't quit, try to cut back, and smoke after you nurse and not before. Even if you smoke more than a pack a day, it's better to nurse and smoke after nursing than not to nurse at all. There is no research to prove that nicotine in your milk is going to cause any lasting harm to your baby, no matter how much you smoke. Using the nicotine patch will usually result in less than half the amount of nicotine in your bloodstream than the amount found when you are actually smoking cigarettes, assuming that you use the patch correctly and don't smoke while you are using the patch. If you do both, the levels in the milk could be harmful to the baby. If you do use the patch, you should take it off at bedtime to reduce the baby's exposure to the nicotine. Nicotine gum can produce larger peaks in levels of nicotine when you chew it rapidly, so if you use the gum, you should not nurse for 2-3 hours after using it. The patch is a better choice for nursing mothers, but only if you are able to stop smoking completely while you use it.

Breathing in secondhand smoke is worse for your baby than the small amount of nicotine that gets in your milk, so try not to smoke in the same room with the baby.

The protective benefits of breastmilk are well documented. Breastfeeding helps protect your baby from SIDS, respiratory infections, and certain cancers. Try to quit, cut back if you can't quit completely, smoke after nursing, and smoke outside, but don't formula feed your baby because of this. Dr. Thomas Hale says in his book Medications and Mother's Milk: "The risk of nicotine via breastmilk is far less than the risk of formula feeding. Mothers should be advised to limit smoking as much as possible, and to smoke only after they have breastfed their infant."

As far as your husband's feelings about nursing in public: this is something that the two of you will have to work out between you. Many dads are very uncomfortable with the idea of their wife exposing her breasts to strangers, and that is certainly understandable. I suggest that you practice nursing in front of him (you can use a doll to practice before the baby comes) so that he can critique your technique. Most people who haven't nursed a baby are surprised at how discreet you can be. If you wear a shirt that pulls up from the bottom (not one that unbuttons from the top), then the baby covers part of the breast and the shirt covers the rest. Throwing a blanket over your shoulder completes the coverage, and most people don't even know you're nursing unless they come up close and hear the little slurping sounds or pull the blanket off to get a better look!

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