It is really a subject with mixed views.  For some moms, the social
drink or drink with a special dinner is an important part of her
culture/lifestyle and she may feel she has missed that throughout
her pregnancy.  I would hate to see moms avoid breastfeeding
entirely because they feel they can't have a drink now and then.
When a mom asks about alcohol, I tell her that opinions vary, but in
general it is not the "zero tolerance" approach it is in pregnancy.
An occasional drink with dinner or occasional social drink is
probably not a concern.  If mom has several drinks, or uses alcohol
to excess, we would be concerned not only about any effect directly
on baby via the milk, but the concern regardless of how she feeds is
whether she is in condidtion to care for her infant!  There are some
who say only drink right after nursing and don't nurse for 1-2 hours
per drink.  I personally feel this is a little extreme.  I like the
approach that if mom still feels the effects of the drink, she might
want to use some stored EBM until she feels it is "out of her
system".  In all cases, one needs to consider not only what
theoretical effect the small amount of alcohol will have on baby vs
the known effects of formula on baby.
One misconception is that once alcohol is in the milk, that milk
must be discarded or the alcohol goes to baby.  As I understand it,
it is a 2-way street.  When blood levels are greater than milk
levels, it goes into the milk.  When milk levels are greater than
blood levels, it goes back into the blood.  (Please correct me if I
am wrong-I'm not sure where I got that info over the years.  I think
transfer back and forth from blood to milk can occur in the alveoli,
but not sure if this can occur with milk in the ducts.)  Therefore,
a mom may not need to "pump and dump" just to get rid of the
alcohol, but only if she skips a direct feeding, is feeling full and
uncomfortable and wants to be sure she doesn't make her breasts
"think" it is time to cut back because they have not been "emptied".

Winnie

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