Background
Stopping alcohol consumption is one of the key health recommendations for expectant and breastfeeding mothers in many western countries and most women cease alcohol consumption when they become pregnant [
1]. Nevertheless, it is reported that about 10% of women worldwide consume alcohol during pregnancy and 16–25% of women in the European region, including Switzerland [
2,
3]. During breastfeeding, results from international studies suggest that consumption is relatively common [
4,
5]. Consequences of maternal alcoholism during pregnancy on the foetus’s development have been well-documented since the late 1950s and recognised in research and clinical practice since the 1970s [
6]. Depending on the foetus’s degree of maturity, the amount of alcohol consumed and individual disposition, high quantities of alcohol consumed during pregnancy can lead to a severe physical and cognitive developmental disorder named Foetal Alcohol Syndrome (FAS), the most severe form of Foetal Alcohol Spectrum Disorders (FASD). Although the evidence is clear regarding high alcohol consumption and binge drinking and the severe consequences for child health [
7,
8], the evidence regarding low to moderate alcohol consumption in pregnant women is heterogeneous and leads to different conclusions. Flak et al. [
9], conducting a meta-analysis based on literature about the association between mild, moderate, and binge prenatal alcohol exposure and child neurodevelopment, conclude that there is no known safe amount of alcohol consumption during pregnancy. Another systematic review conducted by Mamluk et al. [
10] focuses on studies of pregnant women estimating effects of low-to-moderate levels of alcohol consumption on pregnancy and longer term offspring outcomes. The authors highlight the paucity and poor quality of evidence and the limited evidence for a causal role of light drinking in pregnancy, compared with abstaining, on most of the outcomes examined. There is also limited evidence regarding the effects of low to moderate alcohol consumption by breastfeeding mothers on infant development. Some studies show that alcohol consumption may reduce lactation or disrupt infants’ sleeping patterns [
11], but there is no clear impact on developmental outcomes [
5,
12]. As there is no definitive boundary between harmful and harmless alcohol consumption during pregnancy and breastfeeding, and FASD is still a prevalent alcohol development disability for many children [
13], public health recommendations in Western countries are based on the precautionary principle [
14]. Pregnant and breastfeeding women are therefore advised to stop alcohol consumption no later than the onset of pregnancy to avoid any risk to the child. Generally speaking, pregnancy is perceived as an “at risk condition” [
15‐
17] where medical risks need to be monitored by health professionals all through the pregnancy [
18]. Health professionals offering antenatal and postnatal care are in a key position to ask women about their alcohol consumption and advise them that it is safest not to consume alcohol. In this rationale, it is the task of health professionals to increase women’s compliance to be abstinent, because alcohol is teratogenic [
19], and the subject is too complex to be able to predict any safe threshold of alcohol consumption during pregnancy [
20]. Other scholars question the general recommendation for zero tolerance in official guidelines, especially due to the lack of evidence regarding the effects of light alcohol consumption [
10,
21]. Mamluk et al. [
10] conclude that the unclear distinction between light drinking and abstinence is the biggest challenge for health professionals and pregnant women, leading to inconsistent recommendations and advice. Indeed, several studies indicate that health professionals give discordant advice to pregnant and breastfeeding women, from strict abstinence to tolerating low occasional consumption [
22,
23]. Many authors therefore recommend consistent information about the effects of alcohol consumption on the developing baby as well as education for health care professionals to improve their counselling skills [
14,
24‐
27]. Information and counselling about alcohol consumption seems to be widely accepted by pregnant and non-pregnant women [
28] and there is a clear need to address this topic in routine antenatal and postnatal care [
24]. Additionally, a high amount of responsibility is attributed to the women themselves, who in public discourse are seen as mainly responsible for the foetus’s wellbeing and thus for risk minimisation [
29]. As alcohol consumption during pregnancy and breastfeeding is associated with taboos and fear of stigmatisation, a conversational approach based on a trusting relationship seems promising to increase women’s readiness to talk about their habits [
30]. Furthermore, understanding the individual perspective of women and their social context is necessary for the design and successful implementation of women-centred health interventions [
26].
This is the reason why women’s perception of risk is at the centre of our research. Our approach to the concept of risk is sociocultural, which means that variations in individuals’ conceptualisations of and responses to risks are not only prompted by intrinsic characteristics of the danger itself but are shaped by the particular sociocultural settings in which individuals live [
31,
32]. Within this theoretical paradigm, we adopt a weak-constructionist approach, which does not deny the existence of objective risk, but posits that risks are culturally biased based on societal framing and personal experience. Risks are also viewed as mobile and not static, but as changing over time in response to new experiences and new information [
33]. In connection with alcohol risk, previous research from French-speaking Switzerland has shown that alcohol consumption guidelines are contextualised and interpreted by pregnant women, and that occasional alcohol consumption during pregnancy can sometimes be deemed acceptable and be perceived as comparatively less risky than smoking [
34,
35]. Despite this, abstinence or strong alcohol reduction are largely envisioned by women as ideal strategies of dealing with alcohol risk during pregnancy, with feelings of guilt and anxiety over alcohol consumption during pregnancy often being concomitant to these exceptions [
36]. While other longitudinal qualitative studies analysing the development of health risk perception over time exist [
37,
38], to our knowledge, there are no studies that have examined women’s perceptions of the risk of alcohol consumption during the transition from pregnancy to breastfeeding. To frame this approach, we refer to Levy [
39], who defines the concept of “transition” as a period of change in the individual life course perspective. If in this paradigm life stages are considered as relatively stable states in the life course of an individual, then transitions mark the periods of change between stages, periods in which development takes place [
40]. Taking the theoretical perspectives of sociocultural risk and life course transition into account, the present study aims to explore the subjective transition in its entirety from the woman’s perspective, focusing on perceptions of alcohol as a risk, changes in alcohol consumption in daily life and experienced support from health professionals in this life span.
Results
No participants withdrew from the study. In our sample most women were expecting their first child (n = 27), 13 had one child and 6 had two children or more. Most women breastfed exclusively or partially for a minimum of three months, except four women who stopped breastfeeding early in the postpartum phase. The women were aged between 27 and 43. Most participants spoke Swiss German or French as a native language, some spoke German (n = 12) or a different native language (n = 11). The participants overwhelmingly had a tertiary level of education (39 out of 46), and a certain number of women working in health care (nurses, midwives, healthcare technicians and doctors) were present in our sample (16 out of 46). Among our participants the majority were cared for by ob-gyns during pregnancy. In the following description of our results, we will refer to pregnancy interviews as “P” and breastfeeding interviews as “BF”.
In our interviews, alcohol consumption and the way it is perceived as risk by the women changes during the transition to motherhood. We identified five significant stages in the subjective transition regarding the perception of low and moderate alcohol consumption as risk: (1) Around conception and getting pregnant: the intangible risk of alcohol consumption, (2) Manifestation of pregnancy: weighing the “psychosocial” and “medical risk” of alcohol consumption, (3) Being pregnant: dealing with the concept of abstinence, (4) The first weeks after birth: alcohol consumption is incompatible with childcare and (5) The public mother: the risk of being criticised for consuming alcohol.
Around conception and getting pregnant: the intangible risk of alcohol consumption
In our interviews, women describe the stage of the expected but not yet confirmed pregnancy as a challenging one in terms of assessing the risk of alcohol consumption. As the pregnancy is not yet ascertainable, the risk for the embryo also remains intangible. Rahel, who is expecting her first child, qualifies this early phase of uncertainty as a difficult one, when around “day 25 of the cycle” you might be pregnant, but you don’t actually know, if you are. During this time Rahel did not stop alcohol consumption and was unsure if she should. Stefanie, who suffered several miscarriages before her current pregnancy, also did not stop drinking before her positive test, explaining that she “didn’t want to punish herself”, by being abstinent in view of the insecure nature of the pregnancy at this early stage. Women, like Anna, who stopped drinking altogether before pregnancy to prepare the body for pregnancy, were in the minority in our sample. However, many women had already begun to adapt their alcohol consumption to varying degrees, for example by avoiding binge-drinking or reducing the frequency of their consumption. Other women, like Mia, who was now expecting her first child, drank only beverages with a low percentage of alcohol, perceiving them as being less dangerous for the embryo:
“Yes, I mean, I’m already someone who doesn’t drink too much alcohol. I won’t have a glass of wine with each meal. But sure, I also liked going to an apéro or something. I did reduce my alcohol consumption, because I felt like, if it does happen, I don’t want to have a guilty conscience, because I had alcohol. So, I was careful with what I drank, I didn’t drink any hard liquor, but a glass of wine or things that don’t have a high percentage (of alcohol).“(Mia, P).
Most women in our sample were in long-term partnerships and recounted that the pregnancies were planned or at least desired. Therefore, most women suspected early on that they might be pregnant, except for one woman who reported the pregnancy later and consumed alcohol during that time. The confirmation through the pregnancy test was usually an important step, as it was the moment when most women stopped drinking alcohol, some describing a sudden lack of interest in it. Almost as an instantaneous effect Stefanie and Paulina described being “done” with drinking alcohol, the moment they got the confirmation that they were pregnant.
As women perceived the confirmation of the pregnancy through a positive pregnancy test as an important moment, one where they were expected to immediately start changing their dietary and alcohol consumption habits, some women purposefully delayed taking the test. Marie for instance describes delaying her test to one week after a particular weekend, when she knew she would be “drinking, smoking, eating tartars and salads”, habits which she perceived as being incompatible with pregnancy, although she did not really consider them dangerous for the embryo at the beginning of the pregnancy. Thus, delaying the pregnancy test meant delaying the official beginning of the pregnancy and the responsibility and social expectations that come with this state.
How much women had to reduce their alcohol consumption at the beginning of their pregnancies depended a lot on their age, professional context and family situation. Some women, like many of the ones who were already mothers, had a very low alcohol consumption, because of long-term breastfeeding, or their overall demanding family life. For these women, alterations of their alcohol consumption were hardly necessary. For many of the first-time mothers, however, as well as for women whose work or private life involved regular socialising accompanied by alcoholic beverages, the adaptation was more constraining. Isalyn, expecting her third child, explains the difference between her first and second pregnancy in terms of changing her habits of alcohol consumption:
“The first time, what was striking was the fact that I didn’t drink alcohol anymore, that I didn’t go to aperitifs with our friends, in fact one felt completely out of step (…). So, the second time I experienced it differently because I had already mourned what I couldn’t do and then there is the rhythm of parenting, which is already in place.” (Isalyn, P).
For Marie, just as for Mia, the early stage of the transition to motherhood is accompanied by an emerging feeling of responsibility for the child’s wellbeing and guilt, which are dealt with in different ways. For some women this responsibility can be stressful, especially for those who consumed alcohol when they did not yet know they were pregnant and who deem the consumption potentially dangerous for the child. Patricia for example recalls how, during her first pregnancy, she considered an abortion because she feared that her alcohol consumption early in the pregnancy, might have harmed the foetus. She describes contacting a local association against alcoholism, in order to discuss her insecurities, which then tells her to “relax” and not be too troubled by this early consumption, as at this point in the pregnancy, according to the association, it’s the “all or nothing principle”. Aside from this example, in this very early stage of pregnancy, most women report that discussions with health professionals are largely absent, or only occur once the pregnancy is confirmed by a doctor.
Manifestation of pregnancy: weighing the “psychosocial” and “medical risk” of alcohol consumption
After the pregnancy is confirmed, there is a stage when several of the women we interviewed did not want to disclose the pregnancy to their wider social circle because they feared complications such as a miscarriage in the first three months. During this phase women often described the pregnancy as externally invisible, as they often did not yet physically appear pregnant. Abstinence, in this context, was perceived by women as an outwardly recognisable manifestation of pregnancy, which risked breaking the confidentiality of the pregnancy, as Jana recounts.
“I was at the Christmas party and usually I like to drink some alcohol and it became really apparent, that I didn’t drink alcohol, and it really annoyed me; I can understand why someone might make a quick remark: aha you’re not drinking alcohol, are you pregnant? But it’s so intrusive.” (Jana, P).
At this stage, disclosing the pregnancy too early may be perceived as a psychosocial risk, which from the women’s point of view must be weighed against the medical risk of alcohol consumption. Indeed, some women weighed the potential consequences of a small consumption of alcohol at this early stage of pregnancy against the possible consequences of disclosing the pregnancy too early and found the secrecy of the pregnancy to be more important. Amanda describes having to “pretend she drank” and also drinking “one or two glasses” until she was twelve weeks pregnant, even in front of her parents, who did not know she was pregnant. In retrospect, she describes how this prioritisation changes during the course of pregnancy.
“At the beginning of the pregnancy, the priority is that it’s a secret and then later on in the pregnancy, the priority is the baby. (…). It’s a bit strange that we sacrifice the safety of the baby at that moment, even if the sacrifice is probably minimal, but it’s strange that we sacrifice the safety of the baby at the beginning of the pregnancy, just during embryogenesis, when it’s most crucial, because it’s so important that it’s not known.” (Amanda, P).
Amanda’s passage reveals the dilemma in which many women find themselves. On the one hand, there is the expectation of being a good mother who protects her foetus from possible harm and is therefore abstinent. On the other hand, the interviews reflect the social expectation that a woman should keep her early pregnancy private, until the risk of miscarriage is reduced.
This stage of transition coincides with the period when women report having attended at least one antenatal check-up. While most women report having received dietary advice at this check-up, only a minority talk about alcohol consumption with their doctors. Lena, who is expecting her second child, explained that she does not dare to address the issue directly:
“Have you ever discussed this with the gynaecologist?“
“She didn’t bring it up?“
“And you didn’t ask it either?“
“No. Because it just makes me feel bad about asking how much alcohol I can drink. I think it already has a stigma.“ (Lena, P).
Only a minority of the women in our sample recalled that the issue of alcohol consumption had been addressed by health care professionals during these initial check-ups. Most reported that they were not advised in detail, but that a recommendation was given, which sometimes was not compatible with their personal views. Barbara, for example, who continued drinking some wine occasionally during the first few months, as it made keeping the pregnancy private easier, discussed this early consumption with her gynaecologist and received the answer that “pregnancy means zero alcohol”. This left her feeling unsure about whether she had put her child at risk. Other women, however, like Cornelia, received an entirely different advice, being told that a small occasional consumption of alcohol is not perilous for the foetus. She describes how she knew that she does not want to drink any alcohol during her pregnancy, despite different advice from her doctor:
“I’ve heard from different sides, even from my doctor who told me that I could have a glass of Prosecco (sparkling wine) on Valentine’s Day. But I would have had a much too guilty conscience and even one sip wouldn’t have given me any pleasure.” (Cornelia, P).
Although the tension between the perceived risk of alcohol consumption and the advice of health professionals was perceived as stressful, this issue was not addressed further, neither from the women’s nor from the health care professionals’ side. As a result, the women in our sample were largely left to their own devices with the challenges of assessing and weighing the risks.
Being pregnant: dealing with the concept of abstinence
As soon as the pregnancy was announced or visible, women described that abstinence was more easily accepted, endorsed, or sometimes even demanded by their social circles. However, some women explained that the opposite could also be true: people in their families, circle of friends and occasionally even health professionals, encouraged occasional low consumption at special events. These women were often confronted with the expectation that they should be more relaxed and not enforce health recommendations too drastically. Some women, like Anna, were faced with both expectations.
“It’s funny, you can see the way people look at you. You have the ones who say, “go on, one glass isn’t going to harm you”. That’s especially the older generation, it’s quite funny (…) and then younger people say “oh, you’re drinking?” (Anna, P).
Being abstinent at this stage of pregnancy seemed to most of the women interviewed to be a benchmark for the role of a good, caring mother who takes her responsibility towards the child seriously. A few of the women even saw this as an element of control that they had over their pregnancy and their baby’s health. Denise for instance, who was expecting her first child, explains that “It (abstinence) wasn’t that hard because I know exactly why I’m doing it and it’s not forever”, while Stefanie says that “it’s (abstinence) something I can control, so I do”.
The experience of changing from non-abstinence to abstinence is sometimes seen in relation to pre-conceptual alcohol consumption. For Patricia, who talks about practices of alcohol consumption in her family and thinks that she and her partner drank too much in the last two years, “giving up alcohol still changes a lot”. For her and her partner, pregnancy was also an opportunity to rethink and change their consumption habits: “He drinks less since we stopped drinking together”. Hélène, on the other hand, explains that her pre-conceptual alcohol consumption was minimal because she does not like wine. For her, the transition to abstinence was “not a big sacrifice”.
However, many women were conflicted about the actual definition of abstinence simultaneously referring to themselves as being abstinent, while ruefully admitting that there had been small, occasional exceptions, which they didn’t know how to classify. Thus, there was uncertainty among the women who wanted to be completely abstinent about how to interpret this term; does abstinence also mean not cooking with alcohol, is non-alcoholic beer allowed, is it okay to take a sip from your partner’s glass at a social gathering? Women’s practices around these uncertainties varied. Some, like Stefanie, decided to cook without alcohol and send back dishes in restaurants that seemed to contain alcohol. Unfortunately, there were limits to what they could influence, as Lena found out when she thought she was being safe by drinking non-alcoholic beer during her second pregnancy, only to later realise that it also contained a small percentage of alcohol, a realisation that “scared” her. Similarly, Stefanie, took medication which contained alcohol and was similarly worried once she realised it afterwards.
Conversely, what was an exception from the no alcohol rule they had imposed on themselves, was also a question. For some women, having “a glass of wine at Christmas with my meal” (Isalyn, P), or “having a glass with a meal every two weeks” (Anja, P) might be acceptable, in terms of risk for the child’s health. At the same time for many of them, exceptions, however small, are also linked to a lot of guilt and doubt:
“I may have had one every 2–3 months, when there’s a bottle of champagne and I’ll have a quarter glass, but I feel guilty about it. As soon as I have two sips of alcohol, I tell myself that it’s terrible for the baby, and that I shouldn’t.“ (Lou, P).
Many of our interviewees explained that as time went by and the pregnancy progressed, they started feeling left out during social gatherings, feeling an increased sense of separateness and distance from their social circle. Some reported a more direct exclusion, such as friends meeting without them and referring to them as “no longer fun” now that they are pregnant and cannot drink (Aurelia, P). For most women, this was a more implicit gradual process, in which they started feeling more and more “different” from their circles. Some felt like their habits as pregnant women, who need to leave out certain dietary ingredients and not drink alcohol, is somehow being “complicated” or “difficult”, which makes them feel “annoying” (Stefanie, P).
Similarly, some of the women reported feeling that a quality of comfort and relaxation was missing from their social interactions in the absence of alcohol consumption. For some, this was seen as a temporary inconvenience that was readily accepted because of the time limit. For other women, however, this same feeling plays a part in consciously allowing themselves a low consumption of alcohol during pregnancy. Dalila, for example, is well informed about the studies on alcohol consumption during pregnancy, and she believes low consumption to be tolerable during pregnancy. She appreciates the feeling of relaxation this low consumption allows her in social situations:
“I was relatively far along (in the pregnancy) over Christmas. I think eating well and drinking wine are valuable things. And then just doing without or just taking two or three sips is just not the same (…). Now it’s spring and if you go out and have a sip of beer, I don’t think that’s so bad.” (Dalila, P).
Like Dalila, Rahel is a woman who cultivated an alcohol consumption during pregnancy, which she describes as “half a glass of wine” at social events. She qualifies this consumption consciously as “more than an exception” and as “chosen moments”. She explains that while the component of relaxation also plays a part, another part of her motivation is the conviction that the dietary and alcohol consumption guidelines for pregnant women are exaggerated:
“I’ve already been interested in the guidelines and the criticism of the guidelines for my academic work. And then what I say to myself is, that first of all, we don’t know. If they really knew that half a glass of wine every fortnight is very, very serious for the baby, we would know that. (…). So, I’m maybe a little bit in reaction against the kind of posture that is a little bit too bossy, especially coming from North America where the philosophy is completely different and the list of things you shouldn’t eat is quite long.” (Rahel, P).
All women in our sample reduced their alcohol consumption significantly in comparison to their previous alcohol consumption habits. In general, alcohol consumption during this stage of transition was partly discussed with the social environment, especially with friends and family, as well as the partners, who were sometimes consulted when the women were unsure what to do. According to the women’s accounts, these doubts about instances of small consumptions and exceptions from abstinence were rarely discussed with health care professionals. Some women who had the necessary health literacy specifically researched study results on alcohol consumption during pregnancy.
The first weeks after birth: alcohol consumption is incompatible with childcare
Most of the women in our sample reported that they had read or heard that some alcohol consumption during breastfeeding can be safe if the interval between consumption and breastfeeding is long enough. According to the women, this interval could only be maintained after a breastfeeding rhythm had established or, for some, when solid food was introduced. Drinking alcohol before this moment when feedings are sufficiently far apart is described by many women in our sample as logistically difficult and stressful:
“So still no alcohol. I mean, sure, you can drink alcohol, pump it out. It’s just too stressful for me, I have to be honest.” (Mia, BF).
Other women, like Ronja, describe having to count the hours between consumption and feedings as simply “not worth it”. On a broader scale, describing the context during the first weeks after the birth, many women explain that their birth experience, for some including caesarean sections, long labour and other unexpected complications, left them especially tired. Some women like Jana, who suffered from post-partum insomnia, feared consuming alcohol would make her even more tired. Others, like Lena, who had an unplanned caesarean section that left her feeling guilty and worried for her baby’s wellbeing, was simply too preoccupied during this early period to contemplate drinking. Most women, however, simply described being too overwhelmed with the responsibilities of childcare and managing breastfeeding. Manuela, who has a young child and now the baby, said that “drinking alcohol is out of the question” in a context where she barely has time to shower during the first months after the baby’s birth. Aside from the issue of physical tiredness, women highlighted the issue of responsibility. As Ramona explains, the desire to drink alcohol vanished for her during this period, with her focus being on her maternal responsibility:
“Yes, but you don’t feel the desire. Because you have the feeling that you have to be there for your child. And somehow the care doesn’t stop (laughs).” (Ramona, BF).
Other women, like Yvana, explained that, in the context of the great tiredness she experienced from breastfeeding, alcohol consumption was perceived as more of a stress, than a relaxation, and an impediment to being able to fully manage the responsibilities of breastfeeding and childcare:
“It’s also something, between the tiredness, the tiredness of breastfeeding as well, I don’t react the same way to alcohol. And I feel that I won’t be able to drink again (…) if I drank in the evening, if we celebrated something, I wouldn’t be able to manage the night of breastfeeding afterwards, if she woke up, that would be sure.” (Yvana, BF).
Although all these women have male partners who are involved in childcare to different degrees, the responsibility for the baby’s wellbeing during this early stage of motherhood is experienced by most women as being primarily in their hands. As the main caregiver during the first months of the baby’s life, the pressure to perform this task as well as possible is thus very high. Another factor influencing non-alcohol consumption during this stage of the transition to motherhood is the relative isolation that some new mothers find themselves in. Jana, for instance, describes how she would have barely had any occasion to drink, had she wanted to, as she was mostly at home alone with the baby:
“Yes, I never went out because it’s so hard to sleep, so I never went out to eat in the evening or anything like that. There were also no social situations where I could have had a drink.” (Jana, BF).
At this early stage, discussions with health professionals rarely touched upon the issue of alcohol consumption. Most of the women who sought advice were dealing with other issues, such as breastfeeding problems and rhythm, how to sleep through the night, and how to deal with other physical problems such as pain. Alcohol consumption would thus return to the women’s focus only in the next stage of the transition to motherhood, as breastfeeding frequency would decrease and a return to more sociability and activities that are independent from the baby would begin again.
The public mother: the risk of being criticised for consuming alcohol
After a first period with the baby and the establishment of a breastfeeding rhythm, life normalised again somewhat and some women started occasionally drinking alcohol and some women started going out a little more. However, many found that the judgment of their social circles on their alcohol consumption, was a frequent companion.
Ygritte, despite her efforts to breastfeed, had to stop around the third week after birth. She then fed her baby formula milk. She described how going into the restaurant with the baby, she often felt judged by people around her, when ordering a glass of wine. Other women, like Dalila, describe how she found herself being questioned by friends and family after her first pregnancy, when she wanted to consume alcohol while breastfeeding, despite being a health professional herself. She would then explain her standpoint, something which she stopped doing after her second pregnancy:
“With the first child I still discussed and explained my point of view, now I think, no. I no longer have to justify myself to everyone. It’s enough for me to say that I made this decision, and I can stand behind it.” (Dalila, BF).
Some breastfeeding women report that friends or relatives encouraged them to drink some alcohol. If the women regarded the people encouraging them as trustworthy, alcohol consumption may sometimes be perceived as safe. Lena, who did not discuss alcohol consumption during breastfeeding with her midwife, describes an interaction with her brother-in-law who is a physician and a father as well:
“And we were there on holiday, and he did a barbecue and he said do you take a little wine as well? Then I said no. And then he said it doesn’t matter in the case. Then I said, all right. And this gave me like a little bit of safety because he also has two children.” (Lena, BF).
As during the pregnancy, health professionals generally did not discuss the topic of alcohol consumption during breastfeeding and women themselves did not ask, this even though other dietary restrictions were discussed.
The motivation for breastfeeding for most of the women was deeply linked with the baby’s wellbeing. Women perceived breastmilk to be the best kind of nutrition they could offer the baby in terms of protection against allergies and overall immunity, as well as in terms of bonding. Therefore, most were motivated to breastfeed for as long as possible. For some, like Dalila or Paulina, the endpoint of breastfeeding needed to be adapted to the baby’s needs, while for others, like Lena, keeping up with the guidelines recommending six months of breastfeeding was particularly important. None of the women mentioned wanting to take up more regular alcohol consumption as a reason for shortening breastfeeding. While stopping breastfeeding was interpreted by the women as a moment that would free them of the obligation to curtail their alcohol consumption some women looked forward to, many described the transition to motherhood as a time that radically changed their habits and priorities.
Indeed, talking about how the women viewed their alcohol consumptions in the future, many mentioned that they were not sure that they would ever return to their pre-pregnancy alcohol consumption habits. Vanessa describes the difficulty of being able to go out, on the one hand, as a mother of three, which already limits the occasions where she would consume alcohol, as well as the sensation that something has changed in the way she metabolises alcohol after giving birth to three children. She explains that she ultimately does not want to return to her prior alcohol consumption habits:
“No, not really. I just realise that I don’t really metabolise it well anymore. Maybe everyone says that (laughs). If I have a glass of wine with dinner, by the time I drank half of it, I already feel tipsy. Before I could really have a few glasses. But it’s not that bad.” (Vanessa, BF).
Here we again notice a difference between first time mothers and women who already have children, with the former being more inclined to want to take-up a similar alcohol consumption as the one before the pregnancy. In retrospect, the women we interviewed regretted that they had received so little support from health professionals on how to integrate alcohol consumption in a responsible and safe way during pregnancy and breastfeeding.