Alcohol

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Alcohol and pregnancy

Basically alcohol and pregnancy don’t mix!

Avoid all alcohol while pregnant but if you have had one or two drinks don’t panic – it is heavier use that is of concern.

As no safe level of drinking in pregnancy has been established the safest option is abstinence even if the woman is not pregnant yet but planning to conceive.

After the embryo is implanted in the womb it is exposed to all the substances in the mother’s blood stream. Implantation usually occurs about four to six weeks after the start of the last period.

Regular alcohol use or binge drinking after implantation has been shown to be harmful and associated with foetal alcohol syndrome and a range of abnormalities of brain and physical development.

Avoid Intoxication as it is a high blood level of alcohol that is the most damaging.

There is no evidence of damage from having one or two drinks at different times during pregnancy. Often this will have occurred before someone knows they are pregnant. However, there is evidence that continued moderate drinking can be harmful.

Generally the heavier the bouts of drinking and the longer the period of use then the more severe the problems are. Other factors such as the mother’s age, general health and nutritional state also make a difference to the effect of alcohol on the developing foetus.

Alcohol and breastfeeding

Again the safest and easiest message is “don’t drink alcohol when breastfeeding”.

Alcohol goes into the breastmilk and continues to have effects on the baby’s development after birth.

If abstinence is difficult to achieve, breastfeeding before drinking alcohol and then waiting for three hours after the last drink before breastfeeding again is a good

Figure 1. Characteristic facial features in a child with fetal alcohol spectrum disorders. Findings may include a smooth philtrum, thin upper lip, upturned nose, flat nasal bridge and midface, epicanthal folds, small palpebral fissures, and small head circumference.

rule to follow. (You can express during that time and throw away the milk. If baby needs milk then use formula or milk you have expressed earlier and stored safely).

Alcohol in the milk will have a bigger effect on a newborn than an older baby as it is smaller and its bodily systems are less mature. As well as concerns about the effect on the baby’s development, alcohol in breastmilk may contribute to the baby having feeding or sleeping problems or being irritable.

Alcohol, mental health and relationships

Pregnancy and having a new baby in the house are stressful times. Sometimes people use alcohol as a coping mechanism. Although alcohol may help you forget your troubles for a brief time it usually makes things worse in the long term especially if intoxication is occurring regularly.

Alcohol is a depressant so it lowers mood and it can increase anxiety. It often adds to stress in relationships (e.g. with a partner) and it may interfere with the mother’s bonding with the baby and her ability to cope.

If you drink alcohol it may be dangerous for your baby because alcohol results in:

Impaired judgement.
Sleepiness.
Disinhibition, sometimes aggression.

It is not safe to look after children in an intoxicated state.

It is not safe to share a bed with a baby if you have been drinking.

Do I drink too much?

If you are pregnant and are drinking small amounts of alcohol occasionally then you are drinking too much for your baby.

Guidelines for ‘safe’ drinking (when not pregnant) are that a woman should drink no more than 10 units of alcohol per week with at least two alcohol free days per week and to avoid binges of more than four drinks in one session.

A unit is the equivalent of one small (100ml) glass of wine, one (330ml) can of beer or one shot (30 ml) of spirits. All alcohol containers have the standard drinks content on the label.

Am I developing a problem with alcohol?

People develop problems with drinking in different ways. This can include binge drinking often, in a social context, which may lead to alcohol abuse or regular drinking (e.g. in the pub after work) which starts to get out of hand or one or two drinks a night at home to cope, relax and forget problems but gradually creeps up to the level of dependence.

People with a dependence on alcohol have usually become tolerant to the intoxicating effects so that they need to drink more and more to get an effect.

They often find that they cannot control the amount they drink and find themselves drinking more than they intended.

They will try to stop or cut down but find they can’t because of cravings for alcohol or withdrawal effects. This may occur despite knowing about very important reasons to stop such as health, psychological or relationship problems which are being caused by, or made worse, by the alcohol.

They can also find that they are neglecting responsibilities and giving up other activities because their main focus is on getting alcohol and drinking. This is known as salience.

When dependence is severe people may be drinking large amounts each day e.g. two to three litres of wine or a bottle of spirits and experiencing blackouts, severe withdrawal symptoms such as anxiety, sleeplessness, sweating and shaking or nausea and vomiting, if they try to cut down their intake.

Emily's Story

Emily is 24 year woman who works as a travel agent. She lives with her parents and is saving up with her boyfriend so they can buy a house together. Several times a week she goes out socialising with her workmates after work. Emily usually drinks three to four glasses of wine - but on weekend nights she drinks considerably more - wine and then premixed spirits (RTD's) before going to a club later in the night. Sometimes Emily's boyfriend joins them but he prefers to socialise with his own work friends.

On the nights when she goes clubbing Emily may drink 12-15 standard drinks and on several occasions has woken up at home and been unable to remember how she got there. Her friends say they looked after her and put her in a taxi. On one occasion Emily woke up with one of her male workmates at his flat, and both were unsure of what had happened. She didn’t tell her boyfriend. There have been a few times when Emily was due to work on a Saturday morning but couldn’t make it in because she had a bad hangover.

Emily says she drinks a lot on the nights she goes out clubbing because she is self-conscious as she feels people will be looking at her and judging her appearance. She enjoys talking to people, but finds it hard to talk to strangers unless she is intoxicated as she worries she won't know what to say or they may reject her. She isn’t concerned about her alcohol intake as she sees herself as a “social drinker” as she always drinks with her friends. Emily is the most regular attender at the after work drinks and the others are starting to get fed up of having to look after her when she becomes so intoxicated she can’t reliably get herself home safely.

One day Emily realises her period is late by two or three weeks but she doesn’t let herself worry. It’s a Friday and she goes out drinking as usual. There’s a nagging worry in the back of her mind but after she’s had a few drinks she feels better. However, the next day she feels terrible and can’t make it in to work as she’s vomiting. This is unusual for her as her hangovers usually consist of a bad headache. She confides in her best friend who makes her take a pregnancy test which is positive.

Emily is upset and surprised. She remembers about the time a few weeks ago when she woke up with her workmate and feels guilty. She doesn’t know what to tell her boyfriend. She tells her friend they need to go out for a drink that night so she can talk about it and decide what to do. Her friend tells her she shouldn’t be drinking if she’s pregnant. Emily says she’ll only have a couple but it’s her friend who has to remind her about that. Emily decides she’ll just tell her boyfriend she’s pregnant and leave it at that. After all it probably is his baby. After the surprise he’s excited about the baby and keen for them to move in together as soon as possible but its going to be hard as she’ll have to stop work. It looks like they’ll have to rent and not buy.

Emily goes to the doctor who reinforces how important it is not to drink during pregnancy. Emily tries unsuccessfully going out with her workmates and not drinking but finds the urge to drink is more than she can resist. She manages to stick to one or two drinks, except on one occasion, when she gets drunk again. Her boyfriend says she is being selfish and wasting the money they need to move in together. Emily thinks this is her last chance to have fun before the baby arrives.

Emily has her first meeting with her midwife who talks to her more about the effects of drinking in pregnancy rather than just telling her not to do it. Emily feels guilty about the drinking she’s already done and worries she might have harmed her baby. The midwife then discusses with her what changes she might make which could help her be abstinent while she’s pregnant. Emily decides she just won’t go out with her workmates any more and the midwife helps her to plan what she will do instead on those evenings so that she’s not left with a big gap in her life. The midwife encourages her to bring her boyfriend along to the next meeting.

At first, Emily finds she thinks about having a drink quite a lot. However, the midwife gave her some leaflets to read about alcohol in pregnancy and she is committed to maintaining her abstinence. She does miss socialising with her workmates but is quite busy with preparing for the baby and moving in with her boyfriend. She and her boyfriend are attending antenatal classes where she becomes friendly with another woman and they arrange to meet at the weekend to go walking and then to a cafe. Soon one of the others from the class joins them too. Emily finds that as time goes by she doesn’t think so much about alcohol as it doesn't seem to fit into her current lifestyle. Sometimes on a Friday night feels annoyed and jealous when her boyfriend goes out with his friends and she tells him he’ll be staying home with the baby sometimes after it’s born so she can go out again. Her Mum tells her she won’t want to leave her baby, and anyway, she’ll be too tired. Emily says she’ll wait and see.

Other useful information

More information is available from the Alcohol Advisory Council of New Zealand (ALAC), who have a website at mailto:www.alcohol.org.nz

Seeking help

It can be very difficult for someone to accept that they have a drinking or drug problem – it takes a lot of courage to admit it.

If you think your use of a substance is causing problems for you, there are lots of places to talk about the issues and get help. These include your GP, midwife, Plunket Nurse, and local Alcohol and Drug Service (which should be in the phone book under mental health services).