3 Common & Controversial Breastfeeding Questions

The topic of breastfeeding can seem like a sea of endless questions with differing answers. Lately, I’ve been getting some repeated questions about issues apart from basic breastfeeding management that I thought I’d share here.

woman drinking wine

Alcohol: when do I have to stop pumping and dumping?

According to experts, drinking in moderation is compatible with breastfeeding. The AAP says, “Nursing should take place 2 hours or longer after the alcohol intake to minimize its concentration in the ingested milk.” Because alcohol moves in and out of your breast milk just as it does in your bloodstream, if you don’t feel drunk, then there’s not enough alcohol in your breast milk to adversely affect your baby. If you are feeling tipsy, pumping won’t eliminate the alcohol from your milk any faster - only time can do that. For one drink, that’s about two hours (depending on your weight and whether you’re eating with your beverage). If you’re interested in more detailed times until the zero alcohol level in breastmilk based on maternal weight and number of drinks, this study has a handy chart.

If you don’t feel drunk, then there’s not enough alcohol in your breast milk to adversely affect your baby.

If you have had enough drinks to feel intoxicated, you shouldn’t breastfeed until you feel sober. In the meantime, you may miss a feeding or two (depending on how much you’ve had to drink) and your breasts may get engorged. You should pump if this is the case in order to maintain your milk supply. Once the milk is out of your body, though, your liver isn’t helping to metabolize the alcohol anymore. So, it’s best to dump it and not save it to feed your baby. If you know ahead of time that you will be drinking to excess, you may want to pump in the days leading up to your event so your baby has some breastmilk to drink while you’re unavailable.

What if you’re hungover the next day? As long as you’re no longer drunk, it’s safe to breastfeed. Even if you feel nauseous or are vomiting, it’s still safe to breastfeed. Just be sure you are staying hydrated and getting some rest. If you still feel a little tipsy, be sure to offer your baby milk you pumped beforehand (or formula, if necessary) instead of nursing.

woman taking a pill

Should I breastfeed if I’m on antidepressants?

Breastfeeding and postpartum mood disorders are sometimes complicated. They’re kind of a chicken/egg problem - which came first, the depression or the feeding difficulties? If breastfeeding is going well, then continuing to breastfeed may be the best thing you can do to help. But if breastfeeding difficulties are piling up, it could make your depression or anxiety worse.

If you are suffering from postpartum depression, anxiety, post-traumatic stress, OCD, bipolar or more, the best thing to do is seek treatment. While interpersonal therapy is likely an important part of your treatment, a pharmaceutical may be necessary, too. Many times, a drug compatible with breastfeeding can be prescribed. For depression and anxiety, the most commonly prescribed antidepressants are usually SSRIs and these seem most compatible with breastfeeding. In their review article, Kathleen Kendall-Tackett, an expert in the field of breastfeeding and mental health, and Thomas Hale, a breastfeeding and pharmacology expert, conclude:

‘the exposure of breastfeeding infants to paroxetine, sertraline, and nortriptyline is unlikely to produce detectable or elevated plasma drug levels. ... infants exposed to fluoxetine may have higher levels of exposure … Citalopram may lead to elevated levels in some infants, whereas escitalopram produces a lower relative infant dose…. breastfeeding mothers should be advised to observe for any possible signs of adverse reactions including irritability, poor feeding, or major changes in sleep patterns. Premature babies or other unstable infants should be closely monitored for adverse effects.’

If you have been prescribed an antidepressant, or if your doctor plans to prescribe one but would like more information, individual medications can be reviewed in the online database LactMed.

If a breastfeeding-friendly medication cannot be found for your diagnosis, you will need to weigh the importance of getting treated against your personal feelings about breastfeeding. Taking the medication is probably going to win out, as it may be dangerous to leave your condition untreated. And since formula offers a safe alternative (especially in the United States), your baby will still thrive. This can be a painful decision, though, and working through those feelings with a counselor or therapist is important.

Is it safe to sleep with my baby?

As a breastfeeding mother, it’s likely you’ve fallen asleep with your baby nursing. Those nighttime feedings may have been easier lying in bed, and you may have awakened with a jolt later in the night, feeling guilty because your baby is still sleeping beside you in your bed.

The current recommendations from the American Academy of Pediatrics state that babies should sleep in the same room as their mom for the first several months (at least) to prevent SIDS, but that they should not bed share, as this poses a danger to babies.

This blanket prohibition, though, is countered by experts who have studied breastfeeding and infant sleep. According to baby sleep expert, James McKenna, co-sleeping is a ‘biological imperative’ - babies and mothers are hard-wired to be together, and this doesn’t stop with sleep. For babies, sharing sleep with their mom regulates their breathing, temperature, heart rate, and more, and they respond to their mom’s movements, keeping them safe as they sleep. They are able to feed frequently and fall back to sleep easily, sometimes barely waking at all.

Mothers across cultures and times have shared a sleep space with their children without adverse effects. Researchers conclude that half of parents report sharing sleep with their babies by age 3 months and that among breastfeeding parents, 70-80% sleep with their baby at least part of the night.

The best thing to do if you plan to sleep with your baby is to make deliberate choices to make the sleep space as safe as possible. Only bedshare if:

● You are breastfeeding. If you are formula feeding, your baby should sleep in a cot or crib near you.

● You are not a smoker

● You have not been drinking alcohol and are not taking medications that would limit your arousability

● Your baby is healthy and was not born early

● Your baby is lightly dressed and always placed on their back to sleep

● You sleep on a firm mattress that has no places where the baby could become entrapped

● You do not have any pillows or fluffy bedding that could cover baby

● You and your partner agree to bedshare

● You do not let any older siblings or pets into bed with you

The most dangerous place to fall asleep with your baby is on a sofa or upholstered chair. So if you feel like you might fall asleep nursing your baby, it's better to bring your baby into bed with you and make the sleep space safe.

If you are expecting or are supporting someone who is expecting and would like to prepare themselves for breastfeeding success, prenatally, I highly recommend taking our online breastfeeding course. Check out a free chapter here. This course comes with 9 months of access and a live Q&A with Naiomi Catron RNC, IBCLC.

If you have more specific questions and would like expert advice from an IBCLC for your individual breastfeeding questions, check us out!

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