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.
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