Last month, I started talking a little bit about alcohol, pregnancy, and abstinence-only messages, in a takedown of one particular study which failed to link alcohol and preterm birth, but said it did. “Bad science on booze in pregnancy: Women infantilised with absolutist messages”
Crikey took on the new abstinence-only NHMRC guidelines today, in “Questions for the NHMRC on behalf of pregnant tipplers”. Excerpted (read the rest):
The guidelines issue a “last drinks” call for women who are either pregnant, planning a pregnancy or breastfeeding, advising them that the safest option is to consume no alcohol at all.
This updates the NHMRC’s 2001 guidelines which told pregnant women: “…if you average less than one drink per day, there will be no measurable impact on the physical and mental development of your child.”
So what new evidence has come to light to cause the NHMRC to change their recommendation?
It may come as a surprise to women wishing to make an informed decision about their alcohol intake, that the NHMRC decision was (in its own words), “not based on the fact that substantial new evidence had emerged since the previous guidelines were published, but on limitations of the existing evidence.”
In other words, the NHMRC found no evidence that low levels of alcohol consumption cause any harms at all during pregnancy. In fact, the research it cites to support its recommendation includes several studies which fail to show any link between low levels of alcohol exposure and birth-related problems.
Don’t get me started on the “pre-pregnant” thing; not today. Moving on to breastfeeding:
The NHMRC guidelines betray their lack of rigorous summarising up front. Not only on the alcohol side of things – in the same breath they say that “Australian and international guidelines recommend breastfeeding for the first six months”! Later in the fine print they mention the “two years” WHO recommendation – but not many people read that deep in a report.
And, here’s the thing – according to my anecdata, the more we say that women are Bad Bad Nasty Evil Mothers for having a glass of wine while breastfeeding, the more women will wean early “because I want to have a drink now and then”. The NHMRC explicitly acknowledges this discouragement effect, on pages 68 and 79 – but they fail to modify their headline guidelines because of it.
The detailed guidelines on how to drink for mothers who do choose to drink while lactating are buried on pages 80 and 81:
Advice for Breastfeeding Mothers
* Not drinking alcohol is the safest option.
* Women should avoid alcohol in the first month after delivery until breastfeeding is well established.
* After that:
– alcohol intake should be limited to no more than two standard drinks a day
– women should avoid drinking immediately before breastfeeding
– women who wish to drink alcohol could consider expressing milk in advance.
There is still a glaring lack of evidence here. Despite numerous studies, we have no evidence that abstinence is any safer than light drinking, nor that having half a glass with a young baby (or more, for an older child) latched on is harmful, though I’d not suggest doing it for every feed. And it’s probably quite a lot safer than juggling an open mug of hot coffee, which I rarely see women copping the stink-eye for.
“Not drinking alcohol is the safest option” is unsupported.
The other problem is that not many people read the fine print. The vast majority will only ever access or read the Summary guidelines, which state, on page 5:
Guideline 4: Pregnancy and breastfeeding
Maternal alcohol consumption can harm the developing fetus or breastfeeding baby.
A For women who are pregnant or planning a pregnancy, not drinking is the safest option.
B For women who are breastfeeding, not drinking is the safest option.
Are you looking for proof that most people won’t access the more nuanced guidelines? Here it is: I can’t find a single reference to any of them in the mainstream media, nor in any of the blogs mentioning these guidelines. Crikey is the sole exception.
It is now considered unsafe for a pregnant woman to have any alcohol in pregnancy or while breastfeeding.
The nation’s top health advice body today released long-awaited new guidelines on alcohol intake, which also recommended no alcohol at all for children, people under 18, pregnant women and breastfeeding mothers.
And teetotalling is the safest option for young people and women who are pregnant, breastfeeding or trying to have a baby, according to new guidelines that ”usher in a new era of caution” about alcohol.
Young people are now advised not to drink at all — as are women who are pregnant, planning to be pregnant or breast feeding.
The guidelines also advise people under 18 not to drink and for pregnant and breast feeding women to stay away from alcohol.
The Council advises people under 18, and pregnant and breastfeeding women, not to drink at all.
In a departure from previous advice, the guidelines also recommend that pregnant and breastfeeding women and people under the age of 18 should drink no alcohol at all.
You know, our mummy-brains really can process complex information in the first instance. Even if journalists choose not to. (Yes, I crossed out “can’t”.)
If you’d like to play along at home, ask your midwife, child health nurse, GP or obstetrician whether she’s read the guidelines, and what they say about breastfeeding and alcohol. Report back here!
In the meantime, I can’t help but recommend to breastfeeding women, particularly women in already marginalised groups: educate yourself, and think hard before disclosing informed light alcohol intake to healthcare staff. Unless you want this to go on your medical record, and risk being treated as an abusive mother.
[image is of Ramona and Maggie Gyllenhaal breastfeeding. I particularly like this shot because it isn’t the usual breastfeeding image: a soft-focus shot of the mother of a tiny baby nursing in private, eyes locked on each other, no other people around, often in a nightgown. Maggie’s just going about her life.]