Upside: Anyone can put their ideas out there.
Downside: Anyone can put their ideas out there.
Debate and discussion mean we have a light side where we praise the scientific, the logical, and the rational; and a dark side where we critique the unscientific, the illogical, and the irrational. Well it is a dark side, unless you are a misanthropic, board certified snarkitecht like the rugbyologist.
Which brings me 'round to Cher "I Got You Babe" Stewart's article "Ethyl Alcohol, Breastmilk and The Drinking Breastfeeding Mother", which in dulcet tones essentially says that, if you have a glass of wine while breastfeeding, you are bad mother, potentially an alcoholic, and care not for the health of your baby, all while providing non-professional medical advice[1]:
Is it possible your infant will be fine? Absolutely. However, if you cannot help yourself but to have a drink or two, instead of considering the affects [sic] of ethyl alcohol on an infant, you probably should seek some alcohol dependency counseling. Furthermore, if you know you will want to drink, even lightly, while breastfeeding, pump ahead of time and bottle-feed your milk while you are enjoying the affects [sic] of that alcoholic beverage.
This is not just the batty advice of Great Aunt Mildred, Cher indicates that her pontifications are backed up by SCIENCE!
I am consistently shocked, on a daily basis, of the information that is
spread through our society. . .Most especially, it would seem, when they know little to nothing on the topic, scientifically.
Does the science agree with Cher? You see, over the past two years dealing with the advent of The Frogger upon this earth, the rugbyologist has frequently waded through the pediatric literature in order to be able to reduce negative environmental impacts on the >50% awesome genetics she inherited from mrs. rugbyologist. Yet, I had encountered no scientific or medical opinions, but plenty of lay opinions[4] that matched the strident conclusions of Cher's article. So, let's take a closer look at the evidence.
First, the math. To check the blood alcohol content (BAC) calculations, I used the US Department of Transportation update of the Widmark formula[5] (see the notes for the equation and values used).
To get the worst case scenario, we'll assume BAC is at maximum (i.e., no ethanol has been metabolized or excreted). A 12% alcohol by volume average glass of wine would give average American woman [6] a BAC of 0.032%[7], in agreement with Cher's calculation. How much alcohol would this mean for a breastfeeding 6-week old infant girl? At equiliibrium with the blood, this average woman's breast milk would be a 0.032% ABV beverage, which is comparable to ethanol concentrations in the juice of oranges (0.025% ABV). Based on this study, we can assume that an infant consumes an average of 74mL of breast milk per feeding[8]. The infant would consume 0.024g of ethanol[9] for a BAC of 0.0009%.
A breastfeeding infant is ingesting vanishing small amounts of alcohol, but is it dangerous? Does moderate alcohol consumption make for toxic breast milk? For that matter, should we be afraid of orange juice? Cher thinks so:
It may be negligible for an adult, but it's higher than zero, and therefore, can cause detrimental affects in a developing infant.
As a primary source of evidence for her position, Cher cites (the reference is vague, but I believe I have tracked it down correctly) a 1987 study by Vilaro et al. published in Pharmacology, Biochemistry, and Behavior (27:2). Cher's summary:
That study highlights the considerable growth and developmental problems occurring in pups as a result of alcohol intake in the lactating dams and the potential similar harm that could take place in humans with continued alcohol intake during lactation.
The actual study addresses chronic alcohol consumption, not moderate and occassional consumption. What the study authors say (from the abstract):
The effects of chronic ethanol consumption on lactational performance were studied in the rat. . .We may therefore draw the conclusion that chronic ethanol treatment impairs lactational performance affecting mammary gland function as shown by the decline in milk production and altered milk composition. All these changes result in evident notable malnutrition in suckling young. . .
There is nothing here about alcohol content in the breast milk negatively affecting the pups. Rather, chronic alcohol consumption leads to poor lactation by the mothers and malnutrition in the pups. Construing this study, or any of the related studies, as support for Cher's position requires either a grave misrepresenation or misunderstanding of the results.
Her Oyama reference was too vague to identify at a level of confidence with which I was satisfied; but most candidate articles by an Oyama (the one in question?) refer to studies using mice with defective or knocked out alcohol dehydrogenase enzyme. Studies on organisms lacking an enzyme critical for metabolizing alcohol are not a good model for normal humans. Let's hope none of these were the intended article.
Fast forward to the modern day. What does current research has to say on the matter?
We conclude that cerebellar dysfunction induced by maternal ethanol consumption in mice depends upon the drinking regimen during pregnancy and not during lactation.
-Cebolla et al. (2009) Neuroscience Letters 455(1)
How about medical professionals? Anecdotally, The Frogger's pediatrician endorsed a glass of wine to relax mom. I also bothered to check out the opinion of a trained ObGyn who spends a lot of time worrying about the science of parenting, Amy Tuteur:
There is no scientific evidence that breastfeeding during a single episode of intoxication is harmful to the baby in any way.
In this case, we are talking drunk, not just a social beer.
The dose makes the poison.
Sorry, Cher, the science supports having that glass of wine, not your position.
Cher's article seem to be in line with a certain cultural totalitarianism about parenting that has been building. The unscientific norms of certain groups have become codified in the public mind as not just the best way to parent, but the only responsible way to parent. This includes villifying anyone who does not conform to these unscientific norms-the BAD MOM that has a glass of wine, does not breastfeed to 6 months, went into a smoky room while pregnant, doesn't hug their kid enough, hugs their kid too much, let their kid have peanut butter before they were two, etc. Parenting has become a socially acceptable arena for the harshest and scientifically unjustified judgment of others.
Coincidentally, at almost the same time Cher published her article, a woman in North Dakota was being charged with child abuse and neglect. The crime was breastfeeding while intoxicated. Having an heavily intoxicated care giver is indeed a hazard to an infant, but apparently she was not so drunk that that was the issue. The police considered her breast milk to be a toxic substance, which, as we have seen, was an unmerited assumption.
Just look at the culture of judgment that Cher's article feeds in the comments about the intoxicated breastfeeder:
What an idiot. This maggot should rot in jail. -NicholsonK32
What an IDIOT! This dolt actually has a baby??! What a crying shame. LOSER!!! - Sperks
ironically, alcohol was obviously a main factor in this redheaded cow getting l a i d to have the poor child in the first place
yet another candidate for my controversial involuntarily sterilization program - jonnyess
compared to the comments about adults who let rats chew off the toes of an infant:
throw these filthy disguisting pigs in jail! FOREVER - nimby
POOR baby,,, parents are indengents.. - chrishamilton34
....Mobile Home.....? That's rather unenthusiastic considering the real
deal is 'TRAILER PARK TRASH' living across the street from Jerry
Springer himself. I'd strongly recommend her tubes be tied and sewn to
her mucilaginous v a g ! n a. And he gets an all expenses paid
vasectomy. This madness can only end by starting right here. - The~Editor
It seems to me that, in a rational, scientific society, there should be a lot more to distinguish these two sets. In the technical parlance, our outrage has a piss poor linear range.
NOTES
1: Of course, everyone and their dog offers non-professional (and unsolicited) child rearing advice[2] as if it is a Constitutional right.
2: My advice based on my experience, "DON'T PANIC." Oh yeah, and towels are really, really useful[3].
3: If you do not understand this reference in its entirety, you are probably on the wrong site and you are definitely reading the wrong blog.
4: In addition to all sorts of bizarre food-milk connections that seem to completely forget that lactating mothers still have a functioning digestive system.
5: Since the symbology used was unwieldy, I made up my own:
where E is the grams of ethanol consumed, H is the milliters of water per mL of blood, m is the person's mass in grams, W is the fraction of their body weight that is water (mL/g body mass), B is the rate of alcohol clearance from the system, and t is time. Values based on Centers for Disease Control statistics, when available.
6: E=14.2g H=0.806 m=74000g W=.49 B=0.015%/hr t=0
7: 0.00032g ethanol/mL
8: Cher's 4oz per feeding estimate suggests that she has limited experience feeding a 6-week old child.
9: E=74mL*0.00032g/mL=0.024g H=0.806 m=4540g W=0.49 B=0.015%/hr t=0
