Text on screen reads:
This webinar is part of a series that brings experts with lived experience together in dialogue with those from research, healthcare and other professional backgrounds.
By sharing stories and insights, we aim to increase awareness and understanding of FASD and improve outcome for people living with FASD and their families.
To find out more, visit: www.FASDhub.org.au
Elizabeth Elliott:
Good morning all and welcome to the FASD Hub Australia's webinar on alcohol and breastfeeding. Before I start, I'd like to acknowledge that we join from many different traditional lands of Aboriginal and Torres Strait islander people from all over Australia and I pay my respects to their elders past present and future. We note that teaching and learning has occurred in Aboriginal communities for many thousands of years.
My name is Elizabeth Elliott, and I am chair the FASD Hub Australia advisory board. I’m a professor of paediatrics and child health at the University of Sydney and a paediatrician at the children's hospital of Westmead where I head the New South Wales FASD assessment service.
The FASD Hub was funded by the Australian government Department of Health in 2016. We aim to raise awareness of fetal alcohol spectrum disorder and alcohol use in pregnancy and breastfeeding and to be a one-stop shop for evidence-based resources. The Hub connects clinicians with researchers and policy makers and with individuals and families who are living with fetal alcohol spectrum disorder. We run educational webinars such as this and we provide a repository for Australian research and policy
Our most popular pages are the guide to the diagnosis of fetal alcohol spectrum disorder, the service directory and our fact FASD fact sheets. So please visit us on fasdhub.org.au, and we welcome your feedback.
Now the purpose of this event today is to highlight the issue of alcohol use in breastfeeding and its potential harms on the infant. We'll discuss the physiology relating to alcohol and breastfeeding the Australian guidelines to minimise harm from alcohol and the national awareness campaign on alcohol and breastfeeding.
The format will be as follows: shortly I will introduce the panellists, then Elisa will facilitate a discussion, finally we'll address questions from the audience. So please type any questions or comments that you have into the Q and A box during the webinar, and we’ll collate those. Just to let you all know this webinar is being recorded so you will be able to watch it again later.
Now I welcome our experts. Our facilitator today is Elisa Strumpher. Elissa is one of the community representatives on the FASD Hub advisory group and she's the mum of two boys who she breastfed until they were toddlers. Welcome Elissa. Naomi hull is the senior manager for breastfeeding information and research at the Australian Breastfeeding Association. She's a registered nurse an international board-certified lactation consultant and has a Master of Public Health. Welcome Naomi. Dr Marnie Rowan is a general practitioner and lactation consultant with a special interest in the management of breastfeeding who mums are experienced in mums who are experiencing mental health problems. Welcome Marnie. Nicole Hewlett is a board member of the National Organisation for FASD (NOFASD) and project manager in the first nations well-being team at the University of Queensland. Nicole was a committee member of the NHMRC working group appointed to update the NHMRC alcohol guidelines to drinking including in pregnancy in 2020. Dr Roslyn Giglia is a dietitian and nutritionist with a strong interest in public health. Her research informed the first guidelines about alcohol use for lactating women and the development of an app which she'll talk about later which is called Feed Safe. Catarina Giorgi is a is the chief executive officer of the Foundation for Alcohol Research and Education or FARE. This is a leading not-for-profit organisation working towards an Australia free from alcohol harms, and she's going to tell us a bit about the national awareness campaign.
And now I'd like to hand over to you Elissa.
Elissa Strumpher
Well thanks, Liz. We're going to get started by looking at the benefits and value of breastfeeding. So, Naomi can we start with what the recommendations for breastfeeding?
Naomi Hull
Thanks Elissa, and happy well breastfeeding week everyone. The World Health Organization and the National Health and Medical Research Council both recommend exclusive breastfeeding to around six months of age, and then the World Health Organization goes on to recommend that breastfeeding continues until two years and beyond. The last national infant feeding survey that was done in Australia was back in 2010, 2011, and that revealed that around 96 of mothers and babies initiate breastfeeding. But by that six-month mark only around 15 percent is still exclusively breastfeeding. But we do know that there are many structural barriers that are in the way and can make these recommendations quite lofty to achieve, and those barriers are things like lack of accurate information, lack of timely support, the feeling sometimes that breastfeeding isn't welcome in public spaces, the pressure to return to work earlier, low rates of baby-friendly health initiative accredited hospitals, and in Australia at the moment we have only about 22 of our maternity services are accredited as baby friendly, and then of course there's the aggressive exploitative marketing of formula and toddler drinks along with bottles and teats so there's quite a few things that get in the way. And like other determinants of health these barriers to breastfeeding and associated health outcomes are not distributed evenly across the society, so in other words those mothers and children that have more barriers to overall health also experience significant barriers to breastfeeding.
Elissa Strumpher:
And so… you talked about the advantages of breastfeeding, for those babies can you tell us a bit more about that?
Naomi Hull
Yes, well there's quite convincing scientific evidence that shows that for children not being breastfeed, or being breastfed for shorter periods of time, there are increased risks for various illnesses and condition. And that's things like gastrointestinal illnesses, and infections respiratory infections, and viruses, sudden infant death syndrome, ear infections, dental malocclusions, being overweight and obesity, a lowered IQ, leukemia and, for our most vulnerable babies the premature babies, those who aren't fed with breast milk will have an increased risk of necrotizing enterocolitis and sepsis.
Elissa Strumpher
And are there any benefits of breastfeeding for mothers?
Naomi Hull
There absolutely are. We know that breastfeeding is actually the final part of the reproductive cycle and a woman's body expects to breastfeed when they don't breastfeed, or when breastfeeding duration is reduced, their risk of reproductive cancers and breast cancer are increased along with increased risk of type 2 diabetes, high blood pressure, and other cardiovascular diseases. And in addition to those health outcomes, we know that mothers report satisfaction and empowerment from breastfeeding. So breastfeeding is valuable to mothers in part from less from disturbed sleep, and avoidance of expense, and time involved in preparing breast milk substitutes, but also due to the physiological effects of lactation hormones that enhance sleep and mood and down regulates stress reactions as well.
And we’ve seen the challenges of food insecurity with local formula shortages due to global events and other impacts along with the difficulties presented by infant-feeding during severe climate events here in Australia. This is happening more and more, and they can result in lack of power clean water and logistical issues which shows the safety and security that breastfeeding offers during those kinds of events.
And so, when we consider that many mothers do go on to breastfeed for numerous years and we consider the value of breastfeeding for mothers, baby’s families and pretty much the entire community really. When or if a mother chooses to consume alcohol during her time breastfeeding, ABA is here to provide them with the information that they need to make an informed decision, and to plan and strategize around the safest way to do this while keeping the baby safe.
Elissa Strumpher
Great, thanks Naomi. So now we'll just go into some of the basic physiology of breastfeeding and alcohol and explain how it works. This is the sort of information that the ABA would be providing to mothers. So, Marnie, can you explain to us how alcohol in breastfeeding is different to alcohol in pregnancy.
Dr Marnie Rowan
Thanks Elisa. I think it's a really important thing to start with. So, if a pregnant woman drinks alcohol the alcohol is absorbed by the mother, and it goes into her bloodstream the alcohol then crosses the placenta and the baby is exposed to the same blood level of alcohol as the mother there's no way that we can time or avoid this transfer of alcohol to the baby's bloodstream.
After a baby is born there's a there's a more complicated process for alcohol to reach the baby's bloodstream the alcohol is absorbed by the mum across her gut into
her bloodstream the alcohol then moves across into the breast milk and then out again over several hours. And for the baby to be exposed to alcohol the breast milk containing, alcohol has to be consumed by the baby out of feed and then absorbed.
Elissa Strumpher
You work with lots of breastfeeding mothers. Can you talk us through the physiology of alcohol and breast milk and how you explain it to mums?
Dr Marnie Rowan
Sure. So, we talk about that as being the pharmacokinetics of alcohol, and what happens in is alcohol moves into breast milk via a mechanism called passive diffusion. But what that basically means is that a chemical can move from an area of high concentration to one of low concentrations. It's basically a force to try and always kind of equalize. Initially when a mum has a drink of alcohol it’s higher in her bloodstream and so some of the milk will move across into some of the alcohol will move across into the milk, so it'll come down in the bloodstream and come up in the milk. What the interesting part is as the mother's body her liver primarily metabolizes the alcohol it will come down and the milk will move out of the breast milk and back into the maternal bloodstream. So, it doesn't just come across into the milk and stay there. Alcohol enters the breast milk approximately 30 to 60 minutes after a woman starts drinking and it remains there for several hours. The time until there's no alcohol in a mother's breast milk varies a bit according to her height and weight and whether she's eaten at the same time as drinking because food slows the absorption. But the general rule is that for everyone standard drink a woman drinks she needs to wait at least two hours for the alcohol to leave her milk.
Elissa Strumpher
Other than alcohol going into and out of the milk does it have any other effects on lactation?
Dr Marnie Rowan
So interestingly we do know that there seems to be an effect of alcohol on the maternal milk ejection reflex, or what we often call the letdown reflex. So, we think this is via mum drinking the alcohol with causing a in oxytocin levels. So, oxytocin is a hormone that causes the letdown reflex and a delay in that let down. So, we know from the research that after approximately one or two drinks, we could see a reduction in the infant’s milk intake by 20 to 30 - I'm sorry - 20 to 23 in the three to four hours after the mum drinks. When she feeds her baby in that time, we also know that it can cause infant agitation and poor sleep patterns in the baby. We think that nursing or pumping within an hour before ingesting alcohol might slightly reduce the subsequent amounts of alcohol in the breast milk but obviously that problem with reduced transfer to baby could be really quite problematic if large amounts of alcohol were consumed or consumed continuously.
Elissa Strumpher
If there is alcohol in the milk when the baby feeds how much is the baby exposed to and what are the effects on the baby?
Dr Marnie Rowan
Okay. So, I'll try and explain this. There was a study perhaps that I could use where women had just under two standard drinks. And if we remember that our driving limit is about, we often talk about 0.05 percent as a reference point as a cut off for safe driving. After that the mothers had just under two standard drinks after one hour the mom's blood level was about 0.032 at two hours after that the level in her milk was at 0.02 percent at two hours and that even lower at three hours. It was about 0.00 percent so quite low so if the baby drank some of that milk at the 2 hour mark the baby's drink would be a 0.2 0 2 alcohol drink so when we have a drink we might drink a four percent beer or a twelve percent wine and this is thought to result in very low levels in the baby. So, I am talking here about one to two standard drinks.
So, we also need to remember that older babies often feed less often and take lower volumes, so it can vary a little bit between mums and babies.
Elissa Strumpher
And can you speak just a little bit to the effect of alcohol on the baby once it's absorbed?
Dr Marnie Rowan
Absolutely. So, when we're thinking about this, we need to differentiate between chronic heavy alcohol use, regular alcohol use, and occasional timed alcohol use. And we also need to consider the effect a direct effect of alcohol on the baby but also the secondary stuff. So obviously a baby is at great risk of not being safely cared for if mum's intoxicated. And also, there's issues with safe sleeping and the risks of co-sleeping are obviously very much higher if mum's intoxicated. So, there's a couple of aspects there’s certainly no doubt that regular heavy drinking can cause serious adverse effects in newborns and infants. We know that heavy maternal use can cause excessive sedation fluid retention and hormone imbalances in breastfed infants. Long-term studies have been quite difficult, lots of them aren't able to adequately control for the timing of alcohol and breastfeeding and the frequency and volume of milk that's been consumed by babies at the breast feeds. So, it is a really difficult area to study the casual use of alcohol appears unlikely to cause either short- or long-term problems in the nursing infant particularly if mum waits two to two and a half hours per drink before nursing because we know that the amount of alcohol in the breast milk is basically zero at somewhere between two and two and a half hours after one standard drink. But what we don't know about is the effect of daily heavy use of alcohol. It does seem to decrease at least the time that mums breastfeed their infants the long-term effects on the babies are still unclear.
There's some evidence that that indicates that infant growth and motor function can be affected by one drink or more daily, but then there's other studies that haven't been able to confirm that certainly greater or riskier alcohol consumption by nursing mothers can affect children's academic performance negatively. So, it's a really important issue that we need to keep looking at.
Elissa Strumpher
Thanks so much Marnie. Nicole, you were part of the review committee for the recent the current NHMRC guidelines which were recently updated in 2020. As a reminder for those who might not be from a health background, what's the purpose of the NHMRC guidelines and what they contain with regard to alcohol and pregnancy and breastfeeding?
Dr Nicole Hewlett
Yeah, so the main aim of the HMRC guidelines is to promote health, prevent harm, and encourage best practice. And when it comes to the alcohol guidelines specifically, it aims to provide evidence-based advice on the health effects of drinking alcohol. They're really designed to help individual Australians make informed choices about how much they drink, but they're also designed to underpin policy decisions and public health messages as well as build the capacity and the confidence of health professionals on, you know, how to best support their clients in in any given area. But it's important to emphasize that they are guidelines, they're not prescriptive rules telling people how much they should drink or when they should drink. They're really there just to provide the best advice based on all the available evidence we have at this point in time, so that all Australians can make informed decisions. And when it comes to guideline three, which is what we're having a yarn about today, the best advice that we have is firstly to prevent harm from alcohol to their unborn child women who are pregnant or planning a pregnancy should not drink alcohol, and secondly for women who are breastfeeding not drinking alcohol is safest for their baby.
Elissa Strumpher
Great! Thanks Nicole. Roslyn, your research contributed to the first breastfeeding and alcohol guideline which was published in 2009 as well as the current 2020 guidelines. Can you tell us a bit about your involvement and the changes to the guidelines between 2009 and 2020?
Dr Roslyn Giglia
Yeah sure. The 2009 guidelines were the first time where there was the inclusion of the alcohol and breastfeeding guideline, was when I was just finishing up my PhD, so it was very exciting. I was on an NHMRC scholarship, so it made complete sense for my research to be included when I was being funded by the organization that were, you know, collecting the evidence on breastfeeding and alcohol. So, it was very exciting because it was not only the first guideline nationally for breastfeeding and alcohol but actually internationally there'd never been a guideline that gave direction for breastfeeding women about alcohol, and there was a there was very little evidence around what women should be doing around alcohol and drinking alcohol and breastfeeding. And as Marnie has said there was a lot of information around alcohol entering the breast milk, albeit at small amounts, but no guidance for women around what they should be doing at that time. So when I was invited to contribute to the 2009 guidelines I was aware very much around the research that had demonstrated alcohol going into the breast milk and it was really important that we look at - um - we- I mean the re my research supervisor and myself, around what would be the best recommendations for women at that time with breastfeeding. So, the 2009 guidelines looked at alcohol and the effect on lactation and that's where my research was focused.
And the difference with the 2020 guidelines is that the evidence base that has informed these guidelines is really around the effect of alcohol on the infant and not lactation as a whole, and so regardless of where the evidence has come from the recommendation is the same is that breastfeeding woman not drinking alcohol is the safest option. And to add on to that is the harm minimisation message around timing and I guess that's what we’re really exploring today as well.
Elissa Strumpher
Cool. Thanks Roslyn. Nicole could you tell us a bit more about some of the emerging research into the harms of alcohol to the baby that was considered in the current guidelines?
Dr Nicole Hewlett
Yeah, so the emerging evidence is it’s in line with what Marley and Roslyn have already said. It's still limited and as we've already heard what we do know is so that alcohol crosses into the breast milk, so if a mother breast feeds her baby while there's still alcohol in her breast milk, the baby drinks alcohol. Also, we also know that a baby’s brain keeps developing after they’re born, so this means that an infant's brain is more sensitive to damage from alcohol than an adult brain but what that damage is remains to be discovered. So, in terms of emerging research into the harms on babies, the limited evidence that we have more speaks to short-term effects on babies exposed to alcohol via breastmilk which is really around what Dr Marnie’s already said around feeding and sleeping. So, we know that alcohol in the bloodstream, as Dr Marnie said suppresses the action of oxytocin which is linked to that let down reflex and that suppression of oxytocin results in a delay in that milk down. The milk let down and also the amount of breast milk available to bub this then affects how much breast milk the baby is getting, which is often inadequate, so we see issues around feeding which then of course affects sleeping. That sleeping issue is compounded by the evidence that suggests that even infants exposed to alcohol they may fall asleep immediately, but the sleep is disturbed and restless, so they tend not to be able to self-settle between sleep cycles and it's a much it's much harder for them to settle when they do wake. And when it comes to the research that underpins the guidelines, we should acknowledge there are some limitations.
Elissa Strumpher
Could you tell us more about why they made the recommendation that they did?
Dr Nicole Hewlett
Yeah, so a lot of those limitations sits around what good quality evidence is available, and because the HMRC guidelines are based on like the crème de la crème of studies. But what do we do when there isn’t that level of quality in the research, the little research that we do have suggests that if women want to resume drinking after pregnancy, they tend to give up breastfeeding to do so. Women that do continue to breastfeed tend to employ strategies to minimise the exposure of alcohol, or they don't disclose the amount of alcohol they have, or they do not participate in these sorts of studies, or there is incredible inaccuracies or bias in that self-report. So it's really, as we’ve already said, it's a really difficult area to have, you know, robust evidence around. And of course, ethically we can't make one group of breastfeeding women drink alcohol while another group doesn't and just see what happens.
There also hasn't been you know any robust longitudinal data collected, and by that I mean we haven't got studies that follow up babies that have been exposed to alcohol by breast milk at like 10, 20 years to later understand what the implications of that exposure may or may not be.
Elissa Strumpher
So what the evidence base can NHMRC give when there when there really is limited evidence?
Dr Nicole Hewlett
Now this is where the demigods of their fields sat around this table at the committee and had to really reflect and respectfully debate and play devil's advocate on every point. And the result of that insightful yarn was that because alcohol is the most widely used drug in Australia, it's been it's been separated from that term 'drug'. And you see this everywhere right, like 'alcohol and other drugs', and because of that it is not held to the same account as pharmaceuticals or even your Vick’s vapor rub. So if it were, we wouldn't be having to prove its level of harm, we would have to be responsible for proving its level of safety. And the same goes for pregnancy. We know alcohol is a teratogen, we know it causes birth defects and yet we still have this narrative in our society of 'how much can I drink before it's harmful or risky?' Whereas you take a drug like Valium for example. We know it has the potential or the risk to cause birth defects, but we don’t spend countless dollars and time investigating dose, body weight, nutrition. At the time everyone agrees it’s a hard and indisputable 'no’ because it's not been proven safe to use during pregnancy. So, the NHMRC working group, we decided to hold alcohol to the same account. Is there any evidence to say that alcohol passing to bub during breastfeeding is safe? no there’s not. So, if alcohol passes through breast milk, you are taking a risk with a brain that is incredibly sensitive to damage, and no one in the world to date knows fully what the consequence of that risk is. And that's what women should know and be informed about. But what women should also be informed about is that there are ways in which you can ensure that babies are not exposed to alcohol in their breast milk.
Elissa Strumpher
Well thanks, Nicole. That leads us quite nicely to Caterina. You at FARE, which is the Foundation for Alcohol Research and Education, have got an upcoming campaign on breastfeeding and alcohol. What are the key messages that you'll be sharing with breastfeeding mothers to provide them with information on this topic?
Catarina Giorgi
Thanks Elissa. Can I just start by saying what a stellar panel. I feel so lucky to be part of this panel of incredible women, and it's so great to hear all of the amazing work that everyone's doing and all of the knowledge here. Our role as health communicators here at FARE is distilling this information, this amazing research, into a message that's clear for people because what we know is that women want clear information, and they want their health professionals to provide them with advice. And so, we've been working on Every Moment Matters campaign, and Every Moment Matters talks about alcohol use during pregnancy and while breastfeeding. Our role here is to understand what messages work and to try and communicate those messages to the general public and to health professionals, because we know that the vast majority of women go to their health professional to get really clear information on alcohol and pregnancy and breastfeeding.
What we've found is that lots of people are seeking out information on breastfeeding, which shows that there's lots of misinformation out there and so we've prepared some resources, both a pamphlet and also some information on our website, that provides some clear messages. Those messages are not just similar to what we've heard today. So, the first thing is that you know the guidelines say that it's safest not to drink alcohol while breastfeeding, and the second message that's really important is that for a standard drink of alcohol it takes about two hours for your body to process that, and importantly a standard drink of alcohol is a lot less than you probably think. o a glass of alcohol might have two standard drinks. So, it's really important to understand that you know as someone who's five foot nothing, it takes my body quite a while to process a standard drink of alcohol, so it's really thinking about that so that your milk is alcohol-free and so that you're doing all you can to keep yourself and baby healthy.
Elissa Strumpher
And how will this program be rolled out and evaluated?
Catarina Giorgi
Evaluation is absolutely key because we often put out lots of messages but we're not really understanding how people are receiving those messages. So, we're doing an evaluation with the university of Adelaide over the course of the campaign. We're really lucky that Every Moment Matters will run from now until mid-2024 which is excellent. So, as we get data as we go, we're adjusting and we're developing further resources to help to support people. That's how we found out for example that breastfeeding was an area that people wanted a lot more information. People can jump on everymomentmatters.org to find out more information about the campaign or just google 'Every Moment Matters' and it'll come up. In addition to those resources that I mentioned, the website, and the pamphlet, there will be some e-learning tools for health professionals to talk about how you talk through these different things with women so that they have a good understanding of what they can do to help to keep themselves and their bubs healthy and safe.
Elissa Strumpher
Great, that sounds like some very useful resources for our audience to look into. So having talked about the recommendations and the research, now it's time for us to get into the practical details of how mums can manage this on the ground in their day-to-day lives. To avoid harm to babies it’s important they're not exposed to alcohol, so it's safest not to drink during breastfeeding.
Catarina can you maybe give us some strategies that women can use to avoid alcohol?
Catarina Giorgi
I absolutely can and I actually also just want to provide some messages for health professionals who are on the line today because they are a key source of information which is excellent. I think the key thing is that language matters and messaging matters and so often what happens when we're talking about breastfeeding generally is we don't use language like choice etc. We go this is this is what happens, this is the best available evidence. But as soon as we start talking about alcohol we start going 'if you choose', 'if this happens', 'if that happens', and it's presented in a very different way. So, there’s something to really think about in the way that we message this. So, the assumption I think health professionals are making in the first instance is that every woman drinks, and I think that that's a flawed assumption and it's a problematic assumption particularly as younger people we're seeing are drinking less alcohol. So, it's important to get an understanding of the person’s situation and to provide messaging that really does reflect the evidence that's also really important to provide a harm minimization message. And that's what we found through our research - that people want to also know, okay, and what does happen in terms of metabolizing alcohol.
The other thing is a really important message around mum is that alcohol contributes to anxiety, and it worsens mental health. So, there's often this 'I have a drink at the end of the day to wind down' and 'it's okay to have a drink at the end of the day' - it's just complete crap, and we're selling people the wrong message there. We really need to point out that alcohol does increase anxiety, and it does worsen mental health, and if you’re a new mum, or if you're a mum with a small bub, there's already a lot going on and it's already a really tricky time, so avoiding alcohol can help with that as well and that's a really important message and for women who are breastfeeding. What you can do firstly is to plan ahead so plan ahead and have a think about the scenario that you might be in where there might be alcohol or food and think about what you might drink instead in terms of non-alcoholic drinks. I should say I completely know that that planning is tricky. I'm actually just looking here at I'm trying to work out when I'm about to express milk today in between my meetings because I have a five-month-old at home, but it's really important to think those things through to try and have a plan. And babies can be unpredictable as well, as much as we like them to stick to our routines and our structures sometimes, they don’t, so thinking about that when you’re thinking about alcohol use as well.
Elissa Strumpher
Yeah, mothers will all have these strategies um from their pregnancy about how they avoided alcohol in their pregnancy and so you can just continue those while you're breastfeeding as well.
So apart from avoiding alcohol all together, the important thing is avoiding alcohol in the milk going to the baby and so this issue of timing. We've talked about before for one standard drink it's about two hours, but it differs from person to person. Rosalyn, could you tell us more about your work in this area particularly developing the Feed Safe app for mothers?
Dr Roslyn Giglia
You might not be able to stop me now Elissa! So, I first developed a brochure actually when the 2009 guidelines were released because I knew that women weren't going to read the guidelines, and I knew that health professionals would really want to communicate the messages in the guidelines well to breastfeeding women. So, I developed a pamphlet and that was supported by fair, and ABA and it had really clear messages around timing. There was a chart that showed if you were this tall and weighed this much, it took this long just to metabolize however many standard drinks that was really well-used. Then I was approached by an app developer who was also a health promotion graduate who said I keep losing my pamphlet and you need to develop an app. And I said, well, actually I don't even - this was in about 2012- and I said I don't even have a mobile phone, so um I'm not really sure how you do that. And she said, well you don't need to worry about the app, you just need to help me develop the content. And so, we went about developing the Feed Safe app which is still available. It's fantastic we now have the android version as well which I think came about in 2014.
The app basically takes that algorithm of height and weight and looks at the metabolism of alcohol for that woman. So as Caterina said there are other things and that affect the metabolize of alcohol such as what you've eaten if you're menstruating, but it is a standard of about two hours for every standard drink. The app has been incredibly successful in that respect. It's a research translation tool. I'm from a health promotion background as well as a dietitian and I really wanted women to keep breastfeeding if they were going to drink alcohol, and my research had shown that some women actually stopped breastfeeding so they could resume alcohol intake, and i wanted to minimize the harm to the infant. The app has been incredibly popular, more so around Melbourne Cup day and New Year's eve we see a spike in use. it's free, I never wanted it as a public health measure to be charged for because I want it to be available to everyone. It's incredibly useful for everyone the most important thing to remember though is that if you are going to drink alcohol you need to time, as Caterina also said and the app helps you do that women really want to know exactly how long it's going to take and there's a timer in the app so it actually pings off or you can have it silent so you can just see when your alcohol is clear of breast milk.
It's not infallible and it is only a resource to support a harm minimisation, but I still advocate that breastfeeding if you don't have the app and you haven't timed if you've been caught unawares. And as Caterina said babies, particularly in those first six weeks when you're establishing breastfeeding, I wouldn't even think about drinking alcohol because you're trying to get your feeding established and alcohol interferes with the letdown so any alcohol during that time is not recommended. And again, the app has all these really great recommendations and information about that it's a library of information that is evidence-based, but if you are caught unawares, you have time but all day your baby wakes up and wants a feed and I've just drunk alcohol it is still better to breastfeed with a small amount of alcohol in your bloodstream than to introduce formula.
Elissa Strumpher
Well thanks Roslyn. Nicole, you used the Feed Safe app when your first was born. Can you briefly tell us a little bit about how that was for you?
Dr Nicole Hewlett
Yeah, so I mean I have got nothing but like Roslyn is royalty to me after that Feed Safe. So for myself, you know you spend such a long time you know when you're pregnant, and you know trying to get pregnant, and then breastfeeding feeling like a you know multi-purpose factory, and that has to be constantly conscious about every choice they make because it affects someone else, someone that is so precious and sacred to you, you're doing this for no less than 18 months from trying to conceive to pregnancy to breastfeeding. I found that particularly exhausting and this is all on top of that shifting identity and becoming a mother and all the responsibilities and emotions that couple that. So, for me psychologically I needed goal posts I supposed to look forward to, like a platter of sashimi when you know bub was born. And when it came to alcohol, I was really looking forward to feeling like myself a bit, before you know the two years that who say that you've got to breastfeed till, but feeling like an adult, having something for myself. But also knew how incredibly important breastfeeding is for the health of bub, so knowing and being informed that there was a way once bub had an established predictable routine with breastfeeding where I could have the best of both worlds was it was really huge for me. And that kind of independence and sense of control, I suppose, during a time when I seriously lacked both of those qualities was important for my social emotional well-being. And I should add that my mental health was great at the time. Like I enjoyed breastfeeding, and I absolutely delighted in my bub, and I was fortunate not to experience you know mental health issues like postnatal depression. But I still felt like that I still recognize it was important to me at the time of my first bub and Feed Safe for me provided me with that sense of control and that information that we can have that for my own social emotional well-being as well as keep bub safe. So, you know big love for Ros and that Feedsafe!
Elissa Strumpher
Cool, thanks so much. There's still some misconceptions and misunderstandings about breastfeeding and alcohol. For example, you might have heard about the need to pump and dump to get rid of the milk with alcohol in it or the idea that alcohol can help with letdown.
Marnie, can you tell us if there's any truth in these ideas? You're on mute again.
Dr Marnie Rowan
Clearly not very quick to learn. Thanks Elissa, as I said earlier there really is no evidence that alcohol helps with the milk ejection reflex. In fact, it's actually the opposite so that is one of those breastfeeding myths that's been around for a little while and we probably need to keep talking about the fact that it's not the case. There's no specific need to pump and dump just to remove milk that contains alcohol because we know that alcohol diffuses out of the milk over time. It's often really helpful to breastfeed your baby or pump just prior to having a drink if you're planning to have a drink to minimise that alcohol transfer to the baby and minimise the disruption to feeding. If you're going to only have one drink, you'll use your Feed Safe app and likely the alcohol will be out of your milk by the time your baby next asks for a feed. If women plan to drink some women will plan to drink more than just one drink at a time and they then obviously can't breastfeed their baby for a bit longer they might need to pump for comfort during that time where it's not safe to breastfeed their baby, so those women may need to take the milk off to maintain their milk production, because we know that we need to continuously remove milk to maintain a good production, but also to stop themselves from becoming uncomfortable. So they need to plan ahead for that and they also may need to pump in the days coming up to that particular time so that they've got some expressed breast milk to give to their baby, if their baby needs to have a feed and they've still got alcohol in their breast milk.
Elissa Strumpher
Thank you. So when it comes to managing alcohol while breastfeeding it's tricky in the early days but it can become easier to plan and manage later on as the baby is bigger not feeding as frequently. Naomi, what other tips and resources does the ABA have to support breastfeeding mothers particularly as they continue to breastfeed with older babies?
Naomi Hull
Thanks Elissa, and I will echo what Nicole said: ABA is forever grateful to Ros for the creation of the app and the work that she did around breastfeeding and alcohol um the Feed Safe app is extremely popular and incidentally it's not just used by breastfeeding women it's used by many people who sometimes rely on it to know if they're okay to drive et cetera. So, it has many uses and we love having it as a resource. The other thing I wanted to say is that the messaging around alcohol and breastfeeding is extremely nuanced, and as we've already heard there's so many differences around a brand-new baby in the first few weeks and then an older baby and we know that women do go on to breastfeed babies until they're two or three four or five, so you know they might only be breastfeeding once a day. And that's where ABA comes in with our breastfeeding helpline which is 24 hours, seven days a week, and we also have an online live chat service via our website breastfeeding.asn.edu. And we have trained breastfeeding counsellors on the helpline and on the live chat service, we have breastfeeding counsellors and breastfeeding educators, and they are there ready to chat to any mother who has any questions around this. We can help in the heat of the moment if they have had too many drinks unplanned, but we can also help them plan and strategize ahead of time and help them work out what's going to be the right strategy for them given the age of their baby, frequency of feeding, whether they've started solids or not, is there going to be another carer available to help look after their baby or young child. So, I guess that's my message really is to all the health professionals out there is knowing that that resource is available in the community for, you know, when it's the weekend, or when they can't get an appointment, ABA is there with our app Mum to Mum, and with our helpline which is 1800-686-268, and the live chat service on our website. Our trained counsellors are there, and I can tell you we do get frequent calls asking for support in making those decisions. What do I do now I actually stayed out longer than what I had planned? I only finished drinking two hours ago, what do I do now to make sure that my baby is fed and safe? so yeah, I guess that's my main message. The other thing yeah is thinking about the age of the baby, so as babies get older, they feed less frequently, and they also start solids at around six months and that's when sometimes some other um some other food or liquid can be utilized instead of breast milk if um something has happened in an unplanned situation. But really, I think um we have already discussed a lot of strategies today so I won't go over all of them again, but just remind you of those resources, that the Feed Safe app and ABA's helpline and live chat.
Elissa Strumpher
So yeah, thank you very much. So just to sort of summarize the strategies that we've talked about. we've looked at sort of um you know that you can avoid alcohol use entirely and that's the safest option. If you do want to have something you can use timing use resources such as the Feed Safe app to ensure that your milk is free of alcohol before you feed the baby again. You might need to express some milk um beforehand if you think you're going to need it. And so you've got an option there or for older babies you can sort of you know flop them off with a strawberry and a sandwich until you're ready to feed. And that the other thing to think about is care for the baby about safe sleep and things like that. And about you still have to be a parent after your after you've had a few drinks. And for me personally that's one reason why I don't drink because it's really hard to drag yourself through bedtime when all you want to do is sit on the couch and rest because you're tired. You know so that's the other things that people could think about is you know waking up early um the next day and kids are rampaging. I'm sure a bunch of you have seen the whale watching episode of Bluey, you don't want to be there. So, like yeah there's a lot of the non-alcohol specific things as well about looking after your baby safely and looking after yourself. I think we've that's all we've got planned to cover here, so I might hand over to you and then we'll have some time for questions.
Elizabeth Elliot
Thanks very much um and thank you all for your insights, it's been a really interesting session.
So perhaps if I could just summarize we know that exclusive breastfeeding feeding is recommended for six months and breastfeeding when possible is recommended beyond that up to two years, and that there are clear benefits both for the mother and baby not only physical but emotional benefits. We know that alcohol goes into the breast milk, and we've heard from you that that can affect a lot of issues. It can affect the actual breastfeeding process let down etc, and supply, and it can also potentially interfere with the baby's behaviour. More worrying for heavy drinkers it can potentially damage the rapidly developing brain, and cause problems with brain function. And really new in research is that alcohol in breast meat potentially can also switch genes on and off which might confer risk for later health problems. Nicole mentioned we're not going to do a randomized trial where we ask half the women to drink alcohol and half not, so we’re actually never going to know if there is a safe level for alcohol consumption and if so what that is. And that's really why, as Nicole explained, the NHMRC has taken a precautionary approach to this, and there's a clear recommendation that the safest option to prevent harm to your baby and all sorts of other harms we've heard about to the mother to avoid alcohol where you can during pregnancy. But as we've heard again from Ros and Naomi and others, it's to be pragmatic about this. Two years is a long time not to have a drink, and so it's very good for women to have some strategies that they can employ to minimize the harm to their baby particularly beyond that period of exclusive breastfeeding.
So, what I'd like to do now is we have had some questions in the chat and I'd like to just go to some of those questions. Now there's a question from Julianne Woods here asking what target group with the within the community - and I think this is for you Caterina - is the majority of information you're putting out, who are you targeting with that information?
Caterina Giorgi
Sure, that's an excellent question. So with the Every Moment Matters campaign, there are four different streams and so for the general awareness raising stream we're targeting women who are aged 18 to 44. And we found that the messages particularly around pregnancy are more likely to resonate or connect with people that's more likely to result in behaviour change.
If the person is thinking about pregnancy and if they're thinking about drinking small amounts of alcohol during their pregnancy so that's our predominant target in terms of the behaviour change. But you will have seen the resources and the ads on telly or around the place, so you'll see that we're also trying to get this message out to the broader community because that supportive community is really important to the woman as well really important to mention that there are other streams of the campaign. So, a stream that's targeting health professionals to engage them to talk about how you talk about this in a consultation environment, a stream working with NACCHO around working with Aboriginal controlled health organizations to reach Aboriginal and Torres Strait Islander people in rural and remote communities, and another stream that's working with AOD or alcohol and other drug services and other services to target women who may have an alcohol dependency and need further support. So that just acknowledges that for some people there are additional and different messages, and it's really important that we get that support out there as well.
Elizabeth Elliott
Thanks very much Catarina Now there's a question for you, Roslyn, here regarding the Feed Safe app. We've heard that alcohol levels in any woman is difficult to predict because of a number of different factors: how much you drink, how quickly you drink, body composition etc. Her question is how does the app cope with the differences between
metabolism of alcohol in different people and does the speed at which you drink affect that. For example, I tend to slip sip slowly after a long time, do I have to wait longer than usual.
Dr Roslyn Giglia
Thanks. And so, the app does have the ability to for you to put in your height and weight, and that will be as accurate as we can get it without knowing if you're menstruating, or what you’ve eaten, and your fat levels. So, without we can't do an alcohol metabolizing study for everyone, so we just go on the algorithm that's in there. Now with the sipping the drink question, I did see that come up and I must have been asked that question maybe three years ago because I still am the moderator for the questions for the app. And if I remember correctly it - and I would probably need to follow this up for the person - I think it's Tim - it will just mean it's longer that you're metabolizing so it's longer until you can breastfeed.
Elizabeth Elliott
So perhaps some if anyone's listening and has a question that they feel has not quite been answered, they could email us at the FASD Hub and we'll get back to you on that answer. And remember this webinar will be posted on the Hub so you can watch it again, and if there are particular questions that we want to highlight we can put some text into the end of that recording.
Now there's another question here from a child health nurse regarding mental health and mums: I'm often seeing mums who tell me they've been advised by their obstetrician that it's better to have a glass of wine with dinner to deal with their anxiety.
How can we help dismiss this myth? Perhaps that should go to Marnie, would that be your area?
Dr Marnie Rowan
I'm a general practitioner so I suppose everything ends up being my area. Who wants to answer that question? Marnie you've gone on to mute. I’m sorry. I think it's tricky, isn't it? I think everywhere we sometimes come across advice that's sometimes not evidence-based, and I think that as a childhood nurse sometimes that's a little bit tricky. But probably the best advice to give you is to refer your mums to these sites where they can access accurate information. So, you know showing them the Feed Safe app if they're breastfeeding, directing them to the guidelines. It is tricky. We all know that sometimes colleagues don't give the most evidence-based advice and we get caught in the middle of those sort of discussions. Yes, and we've done a bit of work with obstetricians and other health professionals and we're often very reluctant to provide evidence-based information particularly about alcohol and that's because alcohol is such a pervasive part of our society. And yet women tell us they really want the information so that they can make an informed decision.
Elizabeth Elliott
Did anyone else want to respond to that question before we move on?
Catarina Giorgi
Liz, I might just add that this is a massive misconception and I like to point my finger squarely at alcohol companies who push in their marketing that the way to wind down the way to deal with a good day, the way to deal with a bad day, is to have a drink of alcohol. And then those messages just become a bit like gospel and people don't question them, but actually a key message that we should be providing is that alcohol does exacerbate anxiety and worsen mental health particularly over time. So even though people might have a drink and initially feel like there's relief, they'll identify then that I found it hard to sleep that it worsened my anxiety over the next week, that it made me feel all of these different emotions. And so we should be communicating that with people that actually you might think that there’s this initial reaction, but it actually makes it worse for your mental health in the longer term.
Elizabeth Elliott
Thanks Caterina. Okay there's a question here from Susan thanking us very much for the webinar, very helpful and relevant. Now she's worked for the last 20 years and has found that often mums who are really struggling with their alcohol and breastfeeding have a problematic drinking problem prior to pregnancy. Naomi pointed out that women are just wanting to feel normal again, is there more information that we can provide to support mums who have problematic drinking at this time, and should we include fathers in that? So that's of course a really broad reaching but important question.
Who'd like to have a go at that one? Naomi, would you like to have a go or Marnie?
Naomi Hull
I think it's probably not my area of expertise given it's around alcohol use prior to pregnancy, but I'm sure that this all falls in part of the campaign that FARE is working on in educating all those streams in the community. And I'm sure others will have something to add, but I think that we are working towards getting stronger as a society in being clearer about the impacts of alcohol and how to tackle those. So yeah, but I will hand over to someone else.
Elizabeth Elliott
Well I might just comment that Denise Hutchinson's done sort of quite a lot of work looking at the longitudinal prediction of drinking alcohol in pregnancy, and it's very clear that the earlier you start drinking as a teenager and the more you drink during those teenage years, the more likely you are to drink during pregnancy. So that's where Marnie that you might like to comment the role of the GP is so important in identifying those people with problematic alcohol use before they even get pregnant, Marnie?
Dr Marnie Rowan
Absolutely Liz. I think it is it's in all in you know ideally, we get to talk to women before they are pregnant and have those all of those pregnancy planning discussions. I think the other thing to be aware of is certainly in Western Australia, I can only speak from my work at King Edward, is that our tertiary hospital has a clinic for women who have alcohol and other drugs that they're using at problematic levels, so they can actually engage in antenatal and postnatal care through that clinic and have a lot of support around making harm minimisation in in that, and for many women they actually are assisted to cut down and abstain during their pregnancy and afterwards. So, I think the more that we're aware of that in the community, we can then refer women with problematic drinking into our clinics in our tertiary women's hospitals and they do amazing work right now.
Elizabeth Elliott
Caterina a few years ago FARE ran a program called the Pregnant Pause where they were trying to engage with partners including fathers to support their partners to stop drinking during pregnancy. That relates to this question, what should we be doing should we be including fathers? I think the answer is yes, and perhaps you could tell us how you're going to target fathers in the awareness campaign?
Catarina Giorgi
Sure. I think it's uh really important to always point out when it comes to these different health issues or conversations that people don't exist in a vacuum, so they exist in a broader community and a broader environment, and one where alcohol is ever present, and it seems like it's everywhere. So, we've absolutely identified this with Every Moment Matters, and it was really important in the materials that we've prepared that it shows not just the woman refusing alcohol but the people around her providing that support as well. And the next phase of the campaign we're really looking at the influences. So, the people around the woman, and seeing messages and ways that we can target and reach those people as well, because it's we can all play a role in providing that supportive community and no one should have to go through these things alone. So, it's definitely a key part of our next phase and on our Every Moment Matters website, you can jump on and there's a section for people who might be the partner of a woman or a family member to find out how they can provide support as well. So, it's an excellent question, and it's great that we're all thinking in that space.
Elizabeth Elliott
Great, thanks. Now the next question comes from a child health nurse, and she wants to talk about women's mental health. She said she feels that so many talks address the physical aspects of breastfeeding and highlights the importance of emotional and mental effects on mothers who initiate and continue to breastfeed. She said she's encountered many women who cease breastfeeding because of drug and alcohol problems also mums who become very agitated and anxious she asks about a phone line support. And we've already heard about that from Naomi you might like to elaborate on that Naomi, that can provide ongoing counselling.
So, I'll start with you Naomi and then I'd like to get opinions from Nicole and Elisa and others about these mental health aspects, the bonding aspects that are so important with breastfeeding. So, Naomi, first of all just the helpline again.
Naomi Hull
Yeah, so we have the national breastfeeding helpline which is a government-funded helpline, 24 hours, seven days a week, and it is staffed by trained volunteer breastfeeding counsellors. They can specifically help with talking through any issues around breastfeeding specifically and some other mothering and parenting issues. Probably when it comes to anxiety or drug and alcohol problems, we would probably refer on to other services such as PANDA or COPE (the Centre of Perinatal Excellence), and there may be some others but they're the first two that come to mind as the main ones that we would refer on to.
Elizabeth Elliott
Great. Marnie, would you like to talk a bit about the sort of the mental health aspects as well as the physical aspects the benefits of breastfeeding?
Dr Marnie Rowan
Sure. There's a number of questions in here I've been scribbling away at myself. One of the one of the issues that I'm frequently asked to talk about is grief and trauma around breastfeeding and when breastfeeding doesn't go well. It's a very real issue and it's something that we need to talk about and I think sometimes um women take the view that when they've needed to stop breastfeeding earlier than they'd planned for whatever reason, that it's an entirely something that's their fault and they carry a lot of grief rather than viewing it as a - sorry - take hold a lot of guilt rather than viewing it as a grief and a loss. And there are women who have to stop breastfeeding for very, very good reasons, and their use of alcohol or other medications that might not be safe to use in breastfeeding, is one of those areas and I think we need to be really aware of that. I think on the subject of mental health and the safety of medication in breastfeeding, I think this is a subject that's really close to my heart because I work half my week in a consult liaison service in a tertiary women's hospital in mental health in the perinatal period, and I think it's really important that people are aware that each of our tertiary hospitals has a drug information service specifically about medication safety in pregnancy and breastfeeding. There are a lot of drugs that are in fact safe to use while you breastfeed and it's really important that people get accurate information about that rather than assuming that they need to stop breastfeeding in order to be treated for their mental health problems.
Has that answered the question?
Elizabeth Elliott
It has, thanks Marnie. And Tina's also put onto the chat a number of other sources of information and support for people. I might just ask Elisa and then Nicole as mums who've breastfed, what benefits did you feel also stemmed from for your mental health and well-being?
Elissa Strumpher
I think for me the one big benefit of breastfeeding is just that it was always there and always ready. Every time I forgot to take snacks to swimming lessons, it was, you like there was a lot that I didn't have to worry about and manage because I was breastfeeding in terms of sort of the extra work, i guess that would be produced. And I found it was just a really great way to, you know, particularly as the kids got older into those toddler years, to get sort of, you know, that snuggles and closeness when they're sort of more inclined to sort of run away and explore and do things. It's a great opportunity I guess to reconnect when they come back. And you can do that without breastfeeding, but the breastfeeding was sort of a nice little way of making sure that happened in the day.
Elizabeth Elliott
And you breastfed both your boys for quite a long time?
Elissa Strumpher
Yes. Yeah, my first through to four and a half years, and my three-year-old is still feeding. So I found that really valuable for them and for me as well as sort of a parenting strategy in the toddling years. You know milk can solve all sorts of little toddler disasters, and you know it was great for both of us in that relationship to have that sort of source of comfort, particularly when I was quite tired and overwhelmed. You know, it's quite a low effort way to sort of rest and reconnect together. I don't have to think a bit you know about sort of whereas I think maybe if I’d had to be yeah when I was tired, because I was tired a lot, my kids were not good things. It was an easy way for us to have a nice comforting sort of reconnection and relationship together.
Elizabeth Elliott
Thanks Elisa. Nic, did you want to make any comments about yours? I don't know if you're still breastfeeding, but you’re breastfeeding and how you're managing alcohol etc.
Dr Nicole Hewlett
Yeah, I mean I wasn't drinking by the time I've had my second bub, but in addition to what has already been said, you know, like I had said before I had a healthy you know breastfeeding experience, I didn't experience issues with milk production or anything like that. And it's really important that people do raise their mental health and the social emotional well-being that many people have triggered, they come from very um complex trauma backgrounds, and I think you know sometimes it's really useful when we talk about these issues that we're talking to the general population with the assumptions that there is a healthy background there. And of course, we know that that's not the case for everyone. You know many people struggle, and then there's that's layered when women aren't able to breastfeed, and the feelings associated with that. I mean we already feel you know as soon as we conceive and then we feel like failures every moment that our kids are you know traveling forevermore. Because no one's an expert at parenting and there's no confidence that comes with parenting because our children remind us of every day of how we are not meeting their needs in various you know tantrums. So I think you know to be really to keep that salient in our minds and it did come up in NHMRC guidelines and there has been a push to advocate for in the next reiteration of the guidelines for a guideline for around mental health and for a suite of guidelines to be um set around how do we what's the best evidence say around alcohol and mental health, and what does this mean for breastfeeding, what does this mean for pregnancy, and having a really good robust evidence base in which we can make recommendations and give health professionals and Australians that are having various struggles. Because it’s all the spectrum. How can they make you know informed decisions given their circumstances and their background. Yeah, and I think as Caterina pointed out before, I mean alcohol can be used to self-medicate to deal with mental health problems, but in turn can also cause mental health problems.
Elizabeth Elliott
So, look we're nearing the end of time. There is one question about the role of alcohol in genetics, and I'll just briefly answer that by saying that there's a whole new science of epigenetics which suggests that exposures both prior to pregnancy during pregnancy and postnatally may actually switch on certain genes or other genes they may switch off which might then determine your risk for later health problems. So, it really is an emerging science and there's more to come on that and I suspect that that sort of evidence may be influential in the future in informing our public health messages.
So, we're near the end of time but I just want to ask go around the and see if anyone has any sort of final comments.
Caterina, do you have a final comment you'd like to make?
Caterina Giorgi
I think the final comment is that um you know health professionals play such a significant role in in answering questions that people have around alcohol around pregnancy around mental health around breastfeeding. It's really important that messages are consistent and that we're providing the support that people need. Messaging is really important and so it's about making sure that we're meeting people where they're at and giving them the right advice and then providing supports and referrals when people need that additional support as well.
Elizabeth Elliott
Thanks. Marnie?
Dr Marnie Rowan
Thanks, Liz. I think I've said all my things. I think the most important thing is that individualization of our messages when we're talking to families and I guess that we know that for some women it's not going to be safe for them to continue breastfeeding with their level of alcohol use. It's my wish that that we're able to help women to understand where the evidence sits and what they can do if they do want to drink small amounts infrequently so that we don't have a situation where women are stopping breastfeeding unnecessarily in order to have very infrequent drinks.
Elizabeth Elliott
Thanks Marnie. Ros?
Dr Roslyn Giglia
Yeah, I think everyone's really covered the information. But my advice or suggestion would be never missing an opportunity to upskill someone in your sphere of influence. So, when I started my PhD research journey, I became so aware of drinking at a first birthday party or a christening or in the park, and then it made me so aware that it's a whole community that really needs to change, that ubiquitous alcohol intake. I often feel like the pariah, and I'm not a teetotaller, I do like a drink but there is a time and place for alcohol consumption, and is it actually at the first birthday party? Well, that's not my party, so no it's not and I really encourage others in my family and my friendship group to also consider those relationships with alcohol and I find that's a very powerful way to help people in the in that environment and those as knowing. We talked about those real structural changes, and environmental changes, and social changes that also need to take place. So yeah, don't miss that opportunity and sometimes when we drink alcohol, I think Liz you might have said this already professor Carol Bower when you drink alcohol you view the world through rose-coloured grasses, so you don't quite see all that alcohol consumption around you or you normalize it and it's really important that it's not normal. And as a dietitian I often start a presentation saying that alcohol is a toxin. It's a toxin in our body, it's a non-nutrient and it stops every other metabolic process of digestion to ensure that alcohol is metabolized first and removed as fast as possible.
Elizabeth Elliott:
Thanks, Ros. Naomi?
Naomi Hull:
Thanks. Yeah, I think it really is a whole of society issue, but really uh the other thing is that becoming a new mother or a new parent has is overwhelming. There is so much information to take on board and to distil and to understand how it relates to you as an individual and to your child. I guess really, it's that's where when it comes to breastfeeding, ABA is here to support mothers and their families to reach their own breastfeeding goals and to help them feel as informed as possible to be able to make those decisions. So yes, just the national breastfeeding helpline so thank you.
Elizabeth Elliott:
Thanks Naomi. And very briefly Elisa?
Elissa Strumpher:
Just my main thing I guess for health care providers is it's I really value when my health providers see me as a person who has the ability to understand the information and make an informed choice, and so I guess that's the one thing I'd love people to take away is to see the person you're working with as a whole person who has knowledge and can apply it and I really valued understanding how alcohol works with breastfeeding and that helped me to make the choices.
Elizabeth Elliott
Thank you. And Nicole?
Dr Nicole Hewlett
I suppose you know I think that every person in this country should have equitable access to knowledge support advice and services with regards to anything and especially to alcohol when there is so much confusion out there. And I think we all have a duty to ensure that everyone has that access to clear consistent messaging.
Elizabeth Elliott
Thanks so much. Look I really want to thank you all, I think it's been a really interesting session and I've certainly learnt a lot and I hope that all the other health professionals, researchers and others. So, thank you all.
If anyone needs more information, we do have information available the NHMRC guidelines the Australian Breastfeeding Association, FARE's website and the Feed Safe app.
These are just some useful websites. We do encourage you to come to the FASD Hub, and do let us know what other information you'd like there and what we could do better.
Text displayed on screen:
NHMRC Guidelines on Alcohol
www.nhmrc.gov.au/health-advice/alcohol
Australian Breastfeeding Association
Foundation for Alcohol Research and Education
Feed safe app