Alcohol and Breastfeeding: Do the carers' care?

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Written by:  

Dr Roslyn Giglia PhD, MPH, Grad Dip Diet, BSc, Adv APD

Team Leader, Alcohol and Pregnancy and FASD Research


A recent article in The Australian and New Zealand Journal of Obstetrics and Gynaecology highlighted a lack of uptake by maternal health professionals of the 2009 National Health and Medical Research Council (NHMRC) Australian Guidelines to Reduce Health Risks from Drinking, specific to lactating women. Guideline 4B states that not drinking during breastfeeding is the safest option and provides practical advice, to ensure that an abstinence message does not result in early breastfeeding cessation. Alcohol has been shown to compromise lactation status with subsequent effects on the breastfed infant.

Advice included in Guideline 4B outlines avoiding alcohol in the first month after delivery until breastfeeding is well established, and after that limiting alcohol to no more than two standard drinks a day, and avoiding drinking immediately before breastfeeding. If a woman is wanting to socialise and drink alcohol she might consider expressing milk in advance.

ACM were involved in disseminating the survey which informed this research and it is pleasing to see that midwives were one group of maternal health practitioners that demonstrated ‘some’ adoption of Guideline 4B. Child health nurses and general practitioners (GP) were also identified as demonstrating some adoption by being aware of Guideline 4B, knowing and understanding Guideline 4B, believing it was important to discuss the guideline with their patients, and actually discussing Guideline 4B with their patients.

Unfortunately, however for midwives, child health nurses and GPs talking about Guideline 4B this adoption was only happening sometimes. The results for paediatricians and obstetricians was even more disappointing and these practitioners remained to be persuaded about the incorporating Guideline 4B into their everyday practice with their patients.

This article highlights that opportunities exist at all time points on the reproductive continuum to talk about alcohol and breastfeeding. Midwives, GPs and child health nurses had at least four-fold higher odds than obstetricians and paediatrician of using Guideline 4B in their everyday practice. Reasons for this increased adoption of the guideline may include that GPs are more often confronted with the question of drinking alcohol and breastfeeding, more likely to see lactating women in the routine care of their infant (i.e. immunisation), and potentially more likely to encounter women on a regular basis, and not just at predetermined scheduled appointments. Similarly, midwives also have a longer term relationship with women, both antenatally and postnatally, and child health nurses can have years of contact with a mother as their child is assessed at critical developmental growth stages.

Obstetricians have been identified as playing a pivotal role in advising women on the effects of alcohol during pregnancy, and potentially in the postpartum period as well when they return for a postnatal health check. It is possible that obstetricians consider their role primarily to be associated with pregnancy and delivery of the baby and not to extend into the postpartum period. Despite this their influence on a woman’s adherence to health advice they provide cannot be underestimated or undervalued and they could be a key intermediary in supporting breastfeeding. Similarly, the engagement of paediatricians was limited, and this group also remained to be ‘persuaded about the practice’ of discussing the consumption of alcohol during lactation. Paediatricians are intrinsically linked to the care of the infant, but have been shown not to actively engage in the promotion of breastfeeding or feel adequately equipped to support breastfeeding women. With many women attending a postnatal check and potentially having an ongoing relationship with both these maternal health practitioners in subsequent pregnancies, their interactions provide an ideal opportunity to raise the topic of alcohol and breastfeeding.

This research shows that despite the existence of a national guideline for breastfeeding women, maternal health professionals have not emphatically taken Guideline 4B on board and are not incorporating it into their everyday practice. Raising the awareness amongst all maternal health practitioners of the important role they can play in discussing alcohol and breastfeeding can help to promote breastfeeding while protecting the infant from potential alcohol related harm.

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