Most breastfeeding women are "understandably confused" about how to minimise harm when consuming alcohol.
That's according to Roslyn Giglia, who has been researching how to reduce the health risks from drinking alcohol with a focus on breastfeeding for two decades.
Dr Giglia says her research published in 2018 shows some maternal health professionals don't have a "good grasp" of what is recommended by the National Health and Medical Research Council (NHMRC), or the consequences of drinking during lactation.
That can contribute to why some breastfeeding caregivers are using ineffective harm minimisation strategies, she says.
While not drinking alcohol is always the safest option if breastfeeding, planning ahead will reduce the risks if you do.
"I want women to breastfeed for as long as they possibly can, because the evidence shows the longer you breastfeed, the better the outcomes for the [child]," Dr Giglia says.
We hear from the experts and a breastfeeding mum about managing breastfeeding and alcohol.
Alcohol in breastmilk can be harmful
Jen from Canberra is feeding her 21-month-old and says it's been tricky with "Christmas parties everywhere".
Jen makes sure to "schedule" her drinking, so her son doesn't consume breastmilk containing alcohol.
"He's old enough to not need a feed every night, but I feel sad if I miss the feed sometimes," she says.
Jen follows the general rule that it takes two hours for an average woman to be free of the alcohol from one standard alcoholic drink, and therefore four hours for two drinks, and so on.
"The alcohol that's in your bloodstream is the same as in your breastmilk," explains Dr Giglia.
"It enters your breastmilk within 30 to 60 minutes of consuming alcohol."
She says if an infant consumes breastmilk containing alcohol, it can be harmful for their growth and development, and in the immediate term, affect their sleep, as well as the mother’s breastmilk flow.
"What you end up with is a baby that you think is feeding but not getting that much milk."
Dr Giglia developed the FeedSafe app, a collaboration between the Australian Breastfeeding Association (ABA) and Foundation for Alcohol Research and Education, to help breastfeeding caregivers know when it is safe to feed after drinking alcohol.
The app helps calculate when breastmilk will be alcohol free, by inputting height and weight and number of standard drinks, and a timer from when someone starts drinking.
It has been updated in line with the 2020 NHMRC guidelines.
Expressing milk and other strategies
Jen says if her son sees her, he'll want to feed, so she has strategies for when drinking over a longer period.
For example, Jen recently attended a party and didn't return home until after her son was asleep, so she was able to avoid feeding with alcohol in her system.
"If he needs resettling during the night, my husband is able to do that."
Lactation consultant and midwife Marie Hobden says planning ahead is the best thing you can do.
"If you can pump ahead of time so you have some milk available to the baby, great," she says.
"We know babies feed unpredictably; you don't always know when they will sleep or wake or feed, so it's important to have milk available to them."
For breastfeeding mums who are already mixed-feeding their infants, giving formula is an option while consuming alcohol, says Victoria Marshall-Cerins, ABA's executive officer.
"Whether it's expressed breastmilk or formula, having something on hand will make the mum feel more confident just in case baby needs a feed."
For women who need to pump while consuming alcohol to maintain supply, Ms Hobden says that milk should be discarded, as it will contain alcohol.
And it's not only alcohol in breastmilk that poses a risk to infants. A caregiver under the influence of alcohol while in the presence of their child can also be dangerous.
"If you are under the influence, you can have an effect on the safe care of your infant, and decision-making regarding that care," Dr Giglia says, noting that applies to all caregivers, not only those who are breastfeeding.
For example, you should not bedshare with a baby if you have recently consumed alcohol.
If things don't go to plan
Ms Hobden says things don't always go to plan, and women may wonder whether it's safe to breastfeed if their baby needs to be fed sooner than they anticipated.
If you are unsure about what to do, she recommends phoning the 24-hour Australian Breastfeeding Association's free hotline for advice.
Their volunteers can also help you come up with a plan if you have consumed more alcohol than you expected to.
ABC Everyday would like to acknowledge mothers who couldn't, or chose not to, breastfeed.
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