Ask Anne…

Question: I am 35 weeks pregnant with my second baby. I went back to work early with my first baby and didn’t try to nurse,  but this time I’ll be a SAHM and I plan to breastfeed. I like to occasionally have  a beer or glass of wine, but I’m not drinking while I’m pregnant.  What about after my baby is born? I’m also a smoker and I’m trying hard to quit.  I’ve cut way back on smoking during my pregnancy, but what happens if I smoke cigarettes while I’m breastfeeding?

Answer: I’m so glad that you are planning to nurse your new baby. Staying at home with him will make it a lot easier, because although many mothers do continue breastfeeding after they return to work, it does present a lot of challenges.

I wouldn’t worry about drinking occasionally while you are nursing. The American Academy of Pediatrics (AAP) has approved the use of alcohol in breastfeeding mothers. Alcohol does pass into breast milk more readily than some other drugs, but unless you drink several drinks or more a day, every day, there shouldn’t be a problem. Some studies have shown that drinking heavily over a long period of time can slow your baby’s motor development, and regular alcohol abuse can cause slow weight gain in the baby, but there is no evidence that having a few beers or glasses of wine will harm your baby.

Mothers who drink metabolize alcohol in about 1-3 hours, so if you want to be conservative, wait a couple of hours for each drink before you nurse. If you have 4 beers, wait 8 hours. Having a glass of wine or a beer or two should not cause any problems. In his book “Dr. Jack Newman’s Guide to Breastfeeding,” he says “Alcohol while breastfeeding? No problem, in moderation. No need to worry about “pumping and dumping.”

If you are a heavy smoker (a pack or more a day), your milk supply may go down and your baby may have an upset stomach. Nicotine can interfere with your letdown reflex, so it may lower your milk production or your baby’s weight gain if you smoke heavily over a long period of time.

The Breastfeeding Answer Book says that “if a mother smokes fewer than 20 cigarettes a day, the risks to her baby from the nicotine in her milk are small.” If you can’t quit, try to cut back, and smoke after you nurse and not before. Because of all the proven benefits of breastfeeding, it’s better to nurse and smoke after nursing than not to nurse at all, even if you do smoke more than a pack a day.  There is no research to prove that nicotine in your milk is going to cause any lasting harm to your baby, no matter how much you smoke.

Using the nicotine patch will usually result in less than half the amount of nicotine in your bloodstream than the amount found when you are actually smoking cigarettes, assuming that you use the patch correctly and don’t smoke while you are using the patch. If you do both, the levels in the milk could potentially cause be harmful to the baby.  If you do use the patch, you should take it off at bedtime to reduce the baby’s exposure to the nicotine. Nicotine gum can produce larger peaks in levels of nicotine when you chew it rapidly, so if you use large amounts of the gum, you should not nurse for 2-3 hours after using it. The patch is a better choice for nursing mothers, but only if you are able to stop smoking completely while you use it.

E-cigarettes (“vape pens”) are becoming more and more popular as an alternative nicotine delivery system. For more information about the pros and cons of vaping for nursing moms, read Are e-cigarettes safe for breastfeeding moms?

Breathing in secondhand smoke is worse for your baby than the small amount of nicotine that gets in your milk, so don’t smoke in the same room with the baby.

The protective benefits of breast milk are well documented. Breastfeeding helps protect your baby from SIDS, respiratory infections, and certain cancers. Try to quit, cut back if you can’t quit completely, smoke after nursing, and smoke outside, but don’t formula feed your baby because of this. Dr. Thomas Hale says in his book Medications and Mother’s Milk: “The risk of nicotine via breast milk is far less than the risk of formula feeding. Mothers should be advised to limit smoking as much as possible, and to smoke only after they have breastfed their infant.”

For more information about how drugs affect lactating mothers, see Drugs and Breastfeeding.

(Edited October, 2015)

Anne Smith, IBCLC
Breastfeeding Basics

References:
1. American Academy of Pediatrics Policy Statement: Breastfeeding and the Use of Human Milk, Pediatrics Vol. 129 No. 3 March 1, 2012

2.  Dr. Thomas Hale, Medications and Mother’s Milk, 15th Edition, 2012

3.  CDC. Current Cigarette Smoking Among Adults-United States 2005-2013. 2014; 63(47):1108-1112.4 3.

4. Jack Newman, M.D. The Ultimate Breastfeeding Book of Answers

5. La Leche League, Nancy Mohrbacher, The Breastfeeding Answer Book