The pathetic reality in the U.S. is that the time during pregnancy when drinking alcohol is most likely to do serious damage tends to be before most women even realize they are pregnant, both directly (alcohol does have some bad effects of its own) and indirectly (through interfering with the metabolism of things like folic acid, which in turn interferes with early development). If you are trying to get pregnant, drinking no more than two servings of alcohol at a time would probably be prudent and might well save you some worrying down the line. If you are pregnant, abstaining to the degree possible during the first trimester is prudent, and limiting consumption to no more than one serving of alcohol at a time thereafter. Bizarrely enough, however, many women in the U.S. will happily consume during that first trimester that wouldn’t be caught (at least in public) drinking when obviously pregnant during her third trimester – when an occasional drink is unlikely to have any impact.
This advice differs starkly from the standard line in the U.S. (which is do not drink at all while pregnant). Consider this from the U.K. Be compassionate about other women's decisions in this area. Not so long ago, it was believed that the fetus was completely protected from smoking, drinking and drugs that were given to a pregnant woman. We do not have full understanding. In the past, our response was to assume safety. Our current presumption is hazard. Remember that we do not know, and pregnant women are (generally) adults who have the right to make their own decisions.
Smoking is worse, but smoking is a hard habit to kick. Even highly motivated mothers have a lot of trouble. If you are trying to get pregnant, now would be a great time to talk to your health care provider about enrolling in a smoking cessation program or other strategies that might help you quit.
A lot of people worry about a nursing mother drinking. A lot of other people say nursing mothers should have a drink, possibly of stout or some other very dark beer, to help the milk come in, or let down. Alcohol, unlike most drugs, enters milk at exactly the same concentration it is present in the mother's bloodstream. So if mama is flat drunk, her blood and her milk have about the same amount of alcohol as is present in non-alcoholic beer. If you drink, your baby is highly unlikely to be affected. When the alcohol is processed out of your bloodstream, it is also removed from the milk, so "pumping and dumping" is definitely unnecessary.
All that said, some studies suggest that alcohol consumption, particularly in large quantities, may inhibit milk production. I have not found that to be the case, but if you already have a low supply, perhaps you could factor that into your decision about drinking. A baby has limited ability to process and pee out alcohol, so if you drink steadily, you might cause some problems there.
In our culture, drinking alcohol is regarded as either a problem, and therefore alcoholism, a disease for which the only cure is complete abstinence, or not a problem, and therefore nothing need be done. Because the only obvious solution for a problem with drinking is Alcoholics Anonymous, many people who understand they drink more than they would prefer do not attempt to get help because they do not want to stop entirely. While I would not go so far as to advocate alcohol use during pregnancy as a good thing, I do think that this either/or strategy hampers women who might become pregnant from seeking help to reduce their drinking before getting pregnant. It also hampers everyone who drinks more than they wish they did from getting help.
Moderation Management's book Responsible Drinking is a source of information and ideas and exercises to help identify why we drink, and successfully modify that pattern. There are other approaches as well, including Rational Recovery.
Copyright 2005 by Rebecca Allen
Created May 20, 2005 Updated February 1, 2006