Thursday, June 19, 2014

When breastfeeding arguments aren't actually about breastfeeding (Part 1: Alcohol and breastfeeding)

What do the following headlines all have in common?

Drunk Mom's Baby Dies During Breastfeeding

Breastfeeding Mom Kills Baby While Drunk

Mom Suffocates Baby While Breastfeeding, But It Could Have Been Prevented

"They all describe incidents that are about alcohol and breastfeeding," might seem like a reasonable response. Actually, the funny thing is that they all describe incidents that are indeed about alcohol but not really about breastfeeding at all. Here's why.

From the first story:
...for a mom from Maryland, breastfeeding her baby turned to tragedy over the weekend. Cops say Yadina Indira Morales was both breastfeeding and "highly intoxicated." Together the two proved to be dangerous for her 2-month-old daughter, who was found unresponsive and later pronounced dead at a nearby hospital. Most respectable pediatricians will tell a breastfeeding mom to pump and dump if she's going to drink. Baby should either get formula or some breast milk expressed before the alcohol was consumed. However, it doesn't seem like the alcohol in mom's milk was the worst part here; it was mom's drunken state. Cops indicate Morales passed out while breastfeeding and that the baby was found underneath her, unresponsive.
In fact, the "alcohol in mom's milk" was not even an issue here. The tragic death of this little baby was due to suffocation when her intoxicated mother collapsed on top of her.

Second story:
Imagine a mom's worst nightmare. She settles in to breastfeed her baby girl for the last time for the night, baby snuggled at the breast, happy and content. Then she falls asleep. When she wakes up, the baby's dead. Would you judge her? Now what if she had an entire bottle of wine in her system? ...A glass of wine, one mug of beer, when you're breastfeeding, and most of us will look the other way.  But I've yet to meet a doc who'd suggest the best way to build up your milk supply is to chug that wine... Just like pregnancy, breastfeeding requires a mom to keep baby in mind as she eats and imbibes throughout the day. 
Well I'd agree that you shouldn't drink a bottle of wine and get into bed with your baby... but that's something you shouldn't do regardless of whether you are feeding your baby from breast or bottle. Like the first baby, this poor little girl died because she was suffocated, not because of alcohol-laced breastmilk.

Story No. 3:
It's a mother's nightmare come true. A 1-month-old baby boy recently died via suffocation while his mother was breastfeeding him. The 32-year-old new mom had reportedly gone out for a night of drinking, and when she returned to nurse her baby, she fell asleep while doing so. The next morning when she woke up... she realized her brand new baby had passed away. I will say, probably not the best idea to go out imbibing all night -- if this is true -- when you're breastfeeding. ...You have to give up things. And "nights of drinking" are among those things. If you really, really can't do that -- honestly? Switch to formula... And, please, don't co-sleep if you're wasted.
The writer is right on the money with that last comment. It is not, however, clear how feeding a baby with formula (or expressed breastmilk in a bottle, or Cheetos, for that matter) would have prevented the baby from suffocating as he lay in bed with his mother.

Alcohol and breastmilk
There is a paucity of really good data on breastfeeding and alcohol, but Linda Geddes' book Bumpology (which is well worth a read, by the way) does a good job of rounding up and analyzing what evidence there is. As far as we can tell, about the worst thing that can be said about breastfeeding while imbibing is that babies whose mothers have drunk heavily (we're talking several drinks, mind you, not a glass of beer with a meal) show subtle changes in their sleep/wake patterns: namely, they sleep more frequently but in smaller doses, and spend less time in active sleep. That, for me, is a reason to refrain from feeding for the next four hours or thereabouts (and use expressed milk or formula in the meantime if the baby needs feeding) if one has had more than a couple of drinks and is actually buzzed.

But even if you neglect to take this precautionary stance, your baby is not going to die or even get sick, and it really is deceitful for writers and editors to imply that this could happen. There are rare reports of long-term health issues (obesity, elevated cortisol levels etc.) in babies who are being breastfed all day every day by mothers who are chronic heavy drinkers, but I've been unable to find a single case of acute alcohol poisoning resulting from breastfeeding while drunk.

 (Note: "Pump and dump" has been largely discredited. There are certain medications which if taken will stay trapped in breastmilk, requiring the milk to be pumped away; alcohol in breastmilk, however, is gradually wafted back into the bloodstream over the next few hours in a process known as "retrograde diffusion," leaving the milk clean. The only reason to P&D is if delaying the next feed causes you to become uncomfortably engorged.)


Because they stop short of actually saying "alcohol in breastmilk killed these babies," the articles and their headlines are not actually telling fibs. However, when you juxtapose these two ideas against the background of a social context in which most people are actually quite confused about whether drinking while breastfeeding is acceptable (partly because excessive anxiety about drinking during pregnancy has bled over into breastfeeding), you ensure that most people will come away from the article under the impression that drinking while breastfeeding is dangerous and poisons infants. Certainly the writer of the first two Cafemom articles seems to have got this idea, judging by her dippy comment about how "If you really, really can't [give up nights of drinking]--honestly? Switch to formula." As though a bottle of Similac would have somehow miraculously stopped the baby from, you know, suffocating to death.

I can see why sites like Cafemom choose to turn things into "breastfeeding arguments" when they're actually not: you get to stir up the mummy wars in the comment section, bring the sanctimummies out in force AND include the word "!!!Breast!!!" in your headline, all of which tend to generate more clicks and page views than titles like "Baby Dies Due To Failure to Follow Safe Bedsharing Guidelines" which would have been a lot more accurate. (I suppose I'm a bit of a hypocrite in this regard since my blog also brandishes the word "breast" around... but in my defense, I get about 600 page views a day whereas CafeMom probably gets several million.) Trouble is, before you know it you've then got this rumor buzzing around that There Was Once This Mum Who Poisoned Her Baby With Her Alcoholic Breastmilk, which in turn leads to breastfeeding mothers having a drink with a meal being judged and tutted at... or, in one case, having the cops called on them. (And check the poster in the Comments section who defends the police-calling waitress's actions on the grounds that "Considering that a mom just killed her baby (from alcohol poisoning) consuming large amounts of alcohol while breastfeeding is dangerous.")

The other problem with turning these kinds of tragedies into "breastfeeding topics" is that it distracts attention away from the real issues at stake here, like safe sleeping arrangements and social welfare problems. When you make out that a case of baby suffocation is actually a breastfeeding issue, you are sending out the message that as long as you are bottle-feeding it is completely fine to be drunk to the point that you are at risk of passing out while holding your baby. I personally feel that the safest sleeping place for a baby is a cot (crib) in the parent's room, but if parents must bedshare (and I do "get" that for some parents, it may literally be the only way anyone gets any kip), it's very important to follow safe bedsharing guidelines, including getting rid of blankets and pillows, and not being drunk or on drugs. And the Morales case (from the first story) is full of red flags indicating child welfare problems, including charges of child abuse inflicted on her other child by a former boyfriend. I doubt formula would have saved her child, but perhaps better support and education might have done so.

Further reading

Mulled wine? But you're breastfeeding...  Linda Geddes (Bumpology) on alcohol and breastfeeding

You should not be drunk while caring for your baby (from PhD in Parenting)

Alcohol and lactation: a systematic review  Quite interesting reading. One (plausible) argument often made against overly strict anti-alcohol guidelines for breastfeeding mothers is that they can form a barrier to breastfeeding by making it sound like you have to be a saint if you want to nurse; this review makes the case that giving mothers no guidelines at all could also become a barrier, on the grounds that drinking significant amounts of alcohol can subtly change babies' wake/sleep patterns and make them harder to care for, leading to maternal exhaustion. It's food for thought, that's for sure.


  1. Thanks for your balanced and well-reasoned post, which I hope will contribute to positive change. I am disappointed, though hardly surprised, at the behavior of mass media you describe nearly a decade after preparing a portion in this connection of a book I published in 2006.

    James Akre, Geneva, Switzerland

    12 November 2005, Oshkosh, Wisconsin, USA
    An avalanche of disapproving headlines about tragedy in America’s Dairyland whooshes in – 213 articles in the space of 24 hours – and not only from all over the USA but also from around the world, including Canada, England, Germany, India, Qatar and South Africa. They all recount the same terrible tale of a 27-year-old Wisconsin mother with an estimated blood alcohol level of between .15 and .27 percent; she is accused of falling asleep on top of, and suffocating, her four-month-old daughter.

    What’s my problem? Just this: Only four headlines include information on the mother’s highly intoxicated state; 104 headlines focus tendentiously on the fact that she was breastfeeding; and though 105 headlines do not mention breastfeeding, it is amply described in the body of each story.

    Here are some examples of the 104 headlines. “Mother crushes infant while breastfeeding in Wisconsin”, “Woman accused of killing baby by falling asleep while breast-feeding”, “Wisconsin mom accused in breast-feeding death”, “Woman accused in baby’s breast-feeding death”, “Baby dies while breast feeding”, “Breast-feeding death”, “Breast-feed death horror”, “Breastfeeding baby’s death lands sleepy mother in prison”, “Baby dies while breastfeeding. Mother falls asleep on child”, “Infant dies, mom accused of falling asleep while breastfeeding” “Breastfeeding mom kills baby”, and “Mother accused in breast-feeding death”.

    Of the only four headlines to mention inebriation, two are from outside the USA: Canada (“Drunk mom crushes tot”) and Germany (“Drunk mother accidentally kills child while breastfeeding”). Ironically, the latter article is a ten-line summary of a considerably more detailed account from MSNBC under the more provocative – and less informative – title “Mother allegedly kills baby while breastfeeding”.

    What’s my point? Just this: The drunk-as-a-skunk mother was acting irresponsibly in every sense, and this quite irrespective of her feeding mode (indeed, she was already on probation for neglect of the same child at the time of the baby’s death). Drinking six double shots while out bowling rendered her physically incapable of caring for her baby daughter, let alone of feeding her in a conscientious manner, whether in or out of bed.

    Unless justifiably germane, we expect the mainline media to forgo partisan qualifiers, for example extraneous references to class, ethnicity and national origin, when reporting on most any topic. How, then, can 209 out of 213 headline-writers ignore the obvious proximate cause of this tragedy? How can 104 out of these same 213 headline-writers fix their lurid journalistic gaze, instead, on breastfeeding? Indeed, in the context, of what possible relevance is breastfeeding to the tragic death of this four-month-old innocent?

  2. I so appreciate your voice of reason! Your blog is wonderful. Thank you especially for not making this a "bed-sharing is the REAL villian" post. We bed-share in our family, but I always feel like we are walking between people who say that bed-sharing is *always* perfectly fine and safe and people who say that it is *never ever* safe, in any circumstances. Because of this, it took quite a bit of digging for us to come up with guidelines for bed-sharing safely. You should write a post on it! I meet an awful lot of people who tell me that they don't think bed-sharing is safe, but tell me that they sometimes sleep on a couch or recliner with their baby. Or worse, driving around at 2 a.m. while exhausted to lull the baby to sleep. It's troubling when common sense is overridden by "the rules."

  3. Glad you both found the post interesting. The confusion over BF and alcohol was something that had been really bugging me whenever these kinds of stories come up. Disappointing to see that this has apparently been a trend in the media for a while now. I was not adverse to sipping a little of my husband's beer with a meal during pregnancy (and even had the odd full drink in my 3rd trimester) so no way was I going to abstain while breastfeeding! I would not, however, drink heavily (and if I did I would definitely not share a bed with my baby).

    Sadie--I haven't been planning to write a bedsharing post, but there is a really good post here which you might find interesting. The blog itself hasn't been updated for a while, but has some excellent posts.

    I think bedsharing is always going to slightly riskier than a cot in the parents' room, but it has to be weighed up against the risks of parents falling asleep at the wheel of a car, or dozing off and leaving the cooker on etc. There are parents who are absolutely adamant that they really did try everything and nothing but bedsharing worked--I believe them.

  4. I don't know if Crowe included this reference as some sort of unpleasant joke or because he thinks that his readers don't know how to Google stuff, mommystap

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