Date:   Sept 28, 1996
     From:   Gladys Mason, MS RD IBCLC
     Subject:Response re alcohol & breastfeeding

     Working with a mother with a strong hx of alcohol and cocaine use is
     difficult and there is no one right answer.  I cannot answer all of
     your questions, but offer you this bit of info.

     In the case you describe, it does not appear that this mother is in
     any rehabilitation program, and nobody has identified what her
     current alcohol and or cocaine intake is. You have identified several
     red flags that make me suspicious of current alcohol use, including
     avoiding talking to health professionals whenever possible, living
     with  and allowing the maternal grandmother to care for her baby,
     pumping most of her milk rather than the baby, including, sleepiness,
     lethargy, not interested in latching on and hyperbilirubinemia. how is
     the baby's weight gain? I suspect that the mother's self esteem is at
     a low point and probably quite depressed.

     In "Nutrition During Lactation", Institute of Medicine, 1991, the
     recommendation for clinical practice about alcohol consumption is:
     "If alcohol is used, advise the lactating woman to limit her intake to
     no more than 0.5 g of alcohol per kg of maternal body wt per day.
     Intake over this level may impair the milk ejection reflex.  For a 60
     kg (132-lb) woman, 0.5 g of alcholper kg of body weight corresponds to
     approximately 2 to 2.5 oz of liquor, 8 oz of table wine, or 2 cans of
     beer."


     This statement does not talk about the dangers to the baby, but high
     levels of alcohol in breastmilk can cause lethargy, inability to suck,
     neuro-muscular dysfunction, brain damage, and with high enough levels,
     death.

     In addition, to telling women the info from the Institute of Medicine,
     I like to counsel women who plan for binge drinking, to pump and dump
     after heavy drinking,  for several feedings after the drinking, to
     avoid passing alcohol on to their baby.

      For this mother and baby that you are working with, it is very
     important for you to keep in contact with both the mother and the
     baby.  Phone calls, in this case, are not good enough, because you
     need to physically see both. Talking just to the grandmother is not
     good enough.  The mother needs to have time with you and her other
     health care providers without the presence of the grandmother. If you
     are really worried about the baby tell the mother that you are
     worried, and your reasons.  See if she will give you permission to
     call the babies' physician for an appointment, rather than waiting for
     3 1/2 weeks for the appointment. The CPS caseworker can also call the
     babies doctor and arrange for an appointment. In addition to helping
     to get this baby feeding better, and thriving, you, the caseworker,
     and other people who are trying to help this mother and baby, might
     need to explore with the mother, ways to build a life without living
     in the same household as the grandmothers'.

     I hope this info will be a little helpful to you.  Good luck.