Mulled wine? But you’re breastfeeding…

A woman sits down in a pub with a large glass of wine and a newborn baby, then pulls up her top and starts breastfeeding. Would you do a double-take? A few years ago, I was out celebrating a friend’s birthday (with baby in tow), when a hairy man in his fifties wearing a grubby t-shirt strode up to me and told me that I was disgusting. I’m not sure if he was referring to my swollen breasts, the fact that I was drinking, or that I’d deigned to take a baby into his local pub, but with the current onslaught of Christmas parties, friends have been bombarding me with questions about how much alcohol it’s safe to drink when pregnant or breastfeeding.

I’ll refer any pregnant readers to a column I wrote for New Scientist about alcohol during pregnancy when I was expecting my first baby, but to summarize: it’s a massive grey area, though you’d be hard-pushed to argue that the odd glass of wine is going to cause any harm to your developing baby.

As for anyone who, like me, has just completed nine months of near-abstinence and is relishing the taste of mulled wine (but worries that alcoholic wineshakes might not be so good for their breastfed baby) I have both good news and bad.

The bad news is that alcohol does get into breast milk in roughly the same quantities as it gets into your blood. So if you’re drunk, then yes, that breast milk is boozy too.

The good news is that:

  1. It isn’t stored there, meaning that as your blood alcohol levels fall, so too does the amount of alcohol in your breast milk. There’s no point in pumping and dumping your milk the morning after a night out because you’re worried about its alcohol content (unless it was a REALLY big night out). As a rough guide, it takes about an hour to process and eliminate one unit of alcohol from your body – although it also takes a little while for alcohol to get into your bloodstream after having a drink. This means that drinking your wine while breastfeeding is probably slightly better than drinking it afterwards as there’s more time to eliminate it before the next feed. It also means that if you have three glasses of wine (approximately 6 units) it will take 6-7 hours before your milk will be alcohol-free again.
  2. If you do decide to breastfeed after a few drinks, the amount of alcohol that gets into your baby’s bloodstream will be significantly less than the amount in your blood, because it has to pass through their digestive system first.

So is it wrong to breastfeed if your milk is ever so slightly boozy? In the short-term, drinking alcohol dampens your “let-down” response, meaning your baby gets less milk to drink and will try and compensate by feeding more frequently until it catches up (not great if you have a hangover). Alcoholic milk also seems to affect the quality of babies’ sleep: they fall asleep faster, but sleep for less time overall.

However, there is no strong evidence that drinking while breastfeeding has any long-term health impact on babies’ development – though there is a surprising paucity of research in this area, so no-one really knows for sure. Personally, I don’t worry about breastfeeding if I’ve had a glass of wine or two with dinner, but I would feel uncomfortable about feeding my baby if I’d had a lot to drink, as it stands to reason that very boozy milk probably doesn’t do little babies any good. If I’m planning a big night out, I’ll either express some milk the morning before, or turn to my “emergency formula” supply.

My current dilemma is that I have a friend’s birthday to go to tomorrow night, and a 12-week-old who is going through a growth spurt — there’s literally no excess milk to express. So if you see me in the pub with a glass in one hand and a baby in the other, please raise your glass in solidarity.

Does Kate Middleton’s morning sickness suggest she’s growing a future queen (or queens)?

Poor Kate Middleton has been hospitalised with hyperemesis gravidarum, an extreme form of morning sickness that afflicts around one in 50 pregnant women. The jury is still out on the precise cause of morning sickness, but the most convincing explanation I’ve found is that it’s down to an unfortunate side effect of the same hormone that confirms you’re pregnant in the first place: human chorionic gonadotrophin (HCG) (which is the hormone pregnancy tests detect).

As well as enabling pregnancy to continue by keeping the production of other pregnancy hormones going, HCG has other effects on the body, such as stimulating the thyroid gland, which regulates metabolism. Previous studies have found particularly high levels of thyroid hormones in women with hyperemesis gravidarum, like Kate Middleton. Two other pregnancy hormones, progesterone and oestrogen, also slow down the digestive system, which might also contribute to the queasiness, bloating and heartburn that so often plagues pregnant women.

A common myth is that bad morning sickness suggests you’re carrying a boy, when in fact the opposite is true. In 1999, researchers analysed the records of 8,186 Swedish women suffering from hyperemesis gravidarum and found that just 44.3 per cent of them gave birth to boys, compared to 51.4 per cent of the general population. Researchers have also found higher levels of HCG in women carrying female foetuses and (cue rampant excited royal speculation) twins!

Birth freedom or setting pregnant women up to fail?

I recently heard about a campaign called “the birth I want”, by an inspiring woman called Vicky Garner who believes there should be greater continuity of care during pregnancy and childbirth so that women are better supported in achieving the type of birth they want. While I wholeheartedly agree, I think there’s also something missing from this argument that could improve women’s birth experience – even in the absence of a personal birth attendant: a greater honesty about just what birth entails.

I’m certainly not against natural childbirth. My first daughter was delivered naturally, although I did request an epidural after 31 hours of contractions had failed to make my cervix dilate more than the width of a milk-bottle top (which was dispiriting, to say the least). I think every woman should have the right to choose the type of birth she has, but I also think that it should be an informed choice guided by facts and not the opinions of those around her.

What bothers me is the suggestion by some in the natural childbirth movement that all medical intervention is to be frowned upon, and that labour can be pain-free if you just relax, banish fear, and think positive thoughts. Suggesting that you can choose whether or not to experience pain (unless it’s through the use of drugs), or that you can control whether or not you’ll need a medical procedure like a c-section is in my opinion, simply setting women up to fail.

Before my daughter was born, I attended classes run by the National Childbirth Trust (NCT), which aims to empower women about their birth choices by giving them access to evidence not opinion. The trouble is that my NCT teacher at least, seemed to hold pretty strong opinions about the superiority of natural childbirth, and frightened us with tales of “spirals of medical intervention”. To give an example, we were told that if we requested an epidural, we’d likely end up flat on our backs with heaps of straps and cables hanging off us, and would be more likely to end up having our babies ripped out of us with a pair of forceps, or on the operating table undergoing an emergency caesarean section. Combined with the hypnobirthing course I had attended, I came away with the message that doctors couldn’t be trusted and that since pain is in the eye of the beholder, I could choose not to experience it. My birth plan strongly stated: no epidural!

Unfortunately, for the majority of women, childbirth hurts — a lot. I for one, was unprepared for the level of pain I was going to come up against, and (despite the hypnobirthing training) I panicked, which undoubtably made it worse. A recent study found that while 36% of women anticipated suffering extreme pain during labour, 65% reported experiencing it. Of course there are a lucky few who sail through labour with only mild discomfort, but they are in the minority. When I eventually requested an epidural, I felt guilty, but when my baby then took another eleven hours to make her appearance (42 hours in total), ultimately vindicated.

This isn’t the case for every woman who sets out wanting a natural birth, but ends up needing medical assistance. I recently came across this small study which found that women who went into childbirth with a relaxed and flexible attitude towards what they could expect were more likely to be satisfied with the experience than those who went in with fixed expectations of a certain type of birth, or who focused on specific results like having no medical interventions.

I don’t want to frighten women who are expecting their first child, but I do think there’s a case for greater honesty about what to expect during birth so women are more open-minded to the possibility of drugs, or to the idea that they may need medical assistance at some point. I say this because there’s also evidence that those women who go into birth with their eyes open to the fact that it’s likely to be tough are the ones who are more likely to achieve their goal of a natural birth.

One study of women who planned to have a natural birth found that those who anticipated more pain, who already had children and knew what to expect, and who had higher pain thresholds were more likely to succeed without drugs than first-time mums who had no idea of what to expect. What saddens me about this study is that of those women who had an epidural, 88% said that they thought it made their childbirth unsatisfying, even though it relieved their pain and they gave birth to a healthy baby. Why? Among the reasons given were a sense of failure, and a misplaced concern that an epidural might have harmed their baby somehow. I’ve heard similar anecdotes, including one friend who said she’d feel unable to look her NCT friends in the face if she asked for an epidural.

And epidurals really aren’t as bad as some would have us believe. During the research for my book, Bumpology, I fell pregnant with my second child, and I was forced to revisit much of what I had been told the first time around. This is when I realised that much of what I’d been told wasn’t necessarily true. Take the risk of needing an instrumental delivery (one involving forceps or a ventouse) following an epidural. There is an increased risk, but if you look at the numbers you realise that it’s a small one, and one which has to be weighed against the great relief an epidural can bring. In fact, twenty women would have to undergo an epidural for just one of them to end up with an extra instrumental delivery – and not necessarily because of the epidural drugs, but perhaps because doctors are more ready and willing to get the forceps out if a woman already has an epidural in place. There is no increased risk of a c-section, despite popular belief.

Another midwife friend of mine has just left the labour ward to become a community midwife specialising in home births. I asked her what the majority of pregnant women she sees expect from birth, and she confirmed that many of them come to her with very fixed ideas — be it of a water birth, one completely free from drugs, or one involving alternative ways of managing pain, like hypnotherapy. She tells them: “how can you possibly plan how you’ll react to birth, if you’ve never been through it before.? Let’s just take it as it comes.”

And this is a key reason why we need more midwives to accompany women throughout that bumpy journey into motherhood. For just like a good friend will support your decisions, but let you know if you’re being unreasonable or kidding yourself about sensitive issues (even if you don’t want to hear their advice), a good midwife who has the time to get to know you and your wishes, but who can also counsel you on the true nature of what you’re up against, has got to be a better advocate than a stranger who only meets you once you’re in the throes of labour and has to leave at the end of their 12 hour shift.