Mary Wagner-Davis echoes concerns some of us have stated before, and I don't think it is off topic for LN.  When informing lactating women about such things, we need some perspective.   In order for the alcohol content of a mother's milk to present an imminent threat to the baby it must be extremely high, all the time - so high, in fact, that the woman might not even remember she has a baby who needs feeding, and such a woman might well be discovered and lose custody of her children even in the most lax of social welfare systems.  Certainly her MER would be affected long before the baby got a toxic level of alcohol.  Remember, in order to achieve a blood alcohol level over the legal limit for driving, an adult must drink something whose alcohol content is measured in parts per hundred.  Alcohol levels in blood are measured in parts per thousand and that is the concentration in the milk the baby is getting, which is then distributed throughout the baby's entire system.  Alcohol leaves the milk just as it leaves the blood so expressing milk to discard is not necessary for the child's sake; when the mother is sober, her milk is free of alcohol too.  However, if she is away from the baby for a longer time than the usual interval between feeds, she may choose to express to maintain supply or to reduce pressure - and I'm not sure I even have an opinion on what she ought to do with the milk in that case.  If she is sober enough to express, how drunk can she be?

So the alcohol content of the milk is not my prime concern in most cases either; I want to make sure that the parents take into account a child's continuous need for a responsible caregiver whose judgment is not impaired by any ingestible substance, and I particularly want parents to know that a safe sleep environment for a child definitely does not include the presence of an adult with measurable blood alcohol content.   

I haven't read any new research on alcohol while lactating, and the old research really didn't tell us anything about the possible effects of being breastfed for several years by a woman who may have a beer or a glass of wine oftener than once a week.  Would it be better for that child to go without breastmilk on those occasions?  I'm not convinced.  The one thing I recall from one study that used to get cited was that *any* breastfeeding for more than three months was defined as 'long term breastfeeding'.   How relevant is that to me in my community where lots of babies are exclusively breastfed for twice that long?  Nonetheless, our health authorities did not distinguish between pregnancy and breastfeeding in their last propaganda campaign, and they advise complete abstinence from alcohol as long as a woman is breastfeeding, or abstinence from breastfeeding for a period of hours after a single unit of alcohol :-(

Rachel Myr
Kristiansand, Norway

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