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 When Megan Paynter * discovered she was six weeks pregnant she immediately thought back to what she had drank at her 30th birthday party a fortnight earlier. While she hadn’t had a ‘huge’ night like she used to have in her university days, she had definitely felt tipsy after enjoying some good wine with dinner that night. “We had been trying for a while and I had tried to be really healthy. Nothing had happened so I decided to let my hair down a little on my birthday. I felt so ashamed when I had to ask my doctor whether I could have damaged the baby by drinking that night.” Her GP reassured her that the risk that any harm had been done was low. “I stopped drinking for the rest of the pregnancy but I still worried about whether I had already done some damage,” she said. Her daughter was born healthy and there have been no signs of any delays in her development.
According to the National Health and Medical Research Council (NHMRC), Megan is among the 47% of Australian women whose pregnancies are unplanned. Added to this is the fact that the majority of women in this country drink at least once a month or more. This means that many women have inadvertently consumed alcohol while not knowing they are pregnant. The NHMRC’s new 2009 Australian Guidelines to Reduce Health Risks from Drinking Alcohol were released earlier this year in Melbourne following three years of extensive research and consultation by a committee of high level experts, chaired by Professor Jon Currie, Department of Addiction Medicine, St Vincent’s Hospital Melbourne, and Melbourne University.
For the first time, the guidelines have a specific recommendation for pregnant and breastfeeding women: that there is no safe level of drinking. The council’s previous guidelines released in 2001 recommended women consumed no more than two standard drinks on any one day and no more than seven standard drinks per week, whether they were pregnant or not.
Just how will Australian women respond to the idea that they should abstain from drinking when pregnant and breastfeeding? Preliminary research by the NMHRC suggests that most women will be receptive to the notion of not drinking at all while pregnant or breastfeeding, with 80% agreeing that this is good advice. This response is interesting, however, given that recent studies also show about half of all pregnant and breastfeeding women currently consume alcohol. It seems that while women agree with the idea, it may be difficult to actually live by.
As Professor Currie explained in a recent NHMRC podcast (6 March 2009), "The guidelines aren't telling you what you can or can't do. They aim to help Australians make their own informed choices about alcohol and how much risk they want to take with their health.”
When asked about the recommendation of no drinking for women who are breastfeeding or pregnant, professor Currie responded, “What we are trying to do is give advice on how to reduce risks so the question was asked: well, what is a safe level for pregnant women? And the answer is, we cannot define any level of drinking which can be guaranteed to be safe. In other words even low levels of drinking of several drinks a week may have some affect on the unborn child and so the safest option is actually to recommend not drinking during pregnancy and not drinking during breast feeding. Now this doesn't mean that if someone's had a few drinks and then find they're pregnant there is an obvious risk to the baby in fact there is probably a very low risk. But what we are saying is that if you are planning a pregnancy or wanting to become pregnant it is worth considering taking measures to actually stop drinking throughout the pregnancy.”
In reviewing the research the NCMRC found clear evidence that high-level and/or frequent intake of alcohol in pregnancy increases the risk of miscarriage, stillbirth and premature birth. It is also known that if a mother drinks, her concentration of alcohol will be nearly the same as for her foetus. Exposure of the foetus to alcohol may result in a spectrum of adverse effects, referred to collectively as foetal alcohol spectrum disorders (FASD). FASD is not normally diagnosed at birth but these children have characteristic facial abnormalities (and often a range of other birth defects), impaired growth and abnormal function or structure of the central nervous system. People with FASD experience lifelong problems, including learning difficulties and disrupted education, increased rates of mental illness, drug and alcohol problems and trouble with the law (NHMRC 2009). Serious stuff.
Yet remarkably other children exposed to alcohol in the womb do not appear to be adversely affected at all. It is thought that the timing, frequency and degree of drinking all determine the degree of harm to the unborn baby. Obviously high levels and repeated exposure to alcohol will cause more harm than the occasional celebratory drink. It is largely because there are so many unknown factors that the NHMRC has recommended a “no safe limit” guideline.
In regards to alcohol and breastfeeding, the NHMRC reviewed research showing that alcohol enters the breast milk and may persist in the milk for several hours after alcohol consumption. Alcohol adversely affects lactation, infant behaviour (e.g. feeding, arousal) and psychomotor development of the breastfed baby.
It will be interesting to see how Australian women of childrearing age take up these new messages. Will it be just another thing for women to feel guilty about in relation to their children? Will it deter some women from breastfeeding for as long as they would have otherwise? For how long will women who are trying to become pregnant avoid all alcohol? What if it takes a few years for them to fall pregnant?
Like not smoking during pregnancy, will not drinking become a serious social and medical taboo? Or will the new recommendations be no big deal given that half of the pregnant and breastfeeding women in Australia chose not to drink even before these guidelines were released? After all, it’s fair to say that all pregnant women want what is best for their baby.
In reality, women will have a range of different responses to the new guidelines. There are those who choose not to drink at all and who do not feel this is a significant sacrifice if the outcome means a healthy baby. Lucinda Brundell*, pregnant with her first child, is one such woman. “Even before I was pregnant I knew I would not drink. I want to do everything I can to make sure I have a healthy baby” she said.
In contrast, Stacey Blackman* drank the occasional glass or two of wine during her first pregnancy. Now planning a second pregnancy, she has decided not to drink at all. “With the new advice coming out, I don’t think I would be able to enjoy my wine without feeling guilty. I’m ashamed to admit it but I will find it really hard to not drink at all for that long - red wine is one of my favourite pleasures and I definitely use it to relax. When I’m breastfeeding I’ll probably have a glass or two. I don’t know if it’s true or not but I figure if I do it straight after a feed my body will have time to process it before the next feed”.
Other mothers feel that the guidelines are too strict. Samantha, mother of a toddler says, “I definitely don’t think it’s a good idea to get completely drunk when you are pregnant or breastfeeding but I think it’s ridiculous that women cannot enjoy a drink now and then. If you deny yourself everything when you are pregnant you will be miserable. I don’t know of anyone who has damaged their baby by drinking now and then while they were pregnant or breastfeeding. I’m sure French women don’t give up their champagne and soft cheeses when they are expecting and breastfeeding!”
• *names have been changed
• National Health and Medical Research Council’s 2009 Australian Guidelines to Reduce Health Risks from Drinking Alcohol. NHMRC Publication Reference DS10. For a copy of the full report click here.
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