What To Avoid While Breastfeeding, From Botox To Wine To Weed

Motherhood has a lot of rules — and moms aren’t just making them, they’re following them. Particularly when it comes to breastfeeding, we hear more about the “don’ts” than the “dos.” Don’t take allergy medicine! Don’t touch that sushi! But how much science is backing these rules? What should you avoid, what’s okay to have in moderation, and what rules are flat-out myths? Sharman L. Reed, MD, an OB/GYN at Kaiser Permanente, says that there are fewer things to avoid when breastfeeding than when pregnant. “While you’re pregnant, you’re sharing a blood supply with your baby,” Reed says. But in breastfeeding, you’re effectively just making a smoothie for your baby. Less is being converted over that goes in the baby’s gut.” The World Health Organization recommends new moms breastfeed for up to six months, but when to stop (and whether you do it at all) is ultimately a personal choice.

Pediatrician Natasha Burgert, MD, FAAP, National Spokesperson for the American Academy of Pediatrics and an expert for Philips Avent, explains that when doctors advise mothers to avoid certain foods, medicines, or activities during breastfeeding, there are two reasons: They either make milk production hard or they affect the quality of the milk. When it comes to quality, she says most moms think that if they indulge in something on the “avoid when breastfeeding” list, such as a glass of wine or roll of sushi, they’ll need to “dump and pump” to get any toxins from the mercury or alcohol out of the milk. But that’s not exactly true.

“There’s a common misconception there,” she says. “When they think about breast milk production, people assume that the milk is made and it just stays there until it comes out, and then more is made. But it’s not like a Coke machine. Breast milk is a living dynamic organ in itself when it’s still in the breast, and it’s impacted by hormone fluctuations.”

Basically, just because you eat or do something on the “avoid” list, it generally doesn’t mean you need to totally drain your breasts and start anew with your breast milk making. Ultimately, breastfeeding is complicated. There are rules, yes, but there’s more gray area than you might think.

That’s why we asked experts to help us create the ultimate guide to answer your “can I have…” questions about breastfeeding.

"Prohibiting alcohol is another way we make life unnecessarily restrictive for breastfeeding mothers," states the guidelines from the Canadian Breastfeeding Foundation. You can have alcohol in moderation, but realize that if you feel drunk, your milk might have alcohol in it.

“When you have a glass of wine, your blood alcohol level goes up, and then it goes back down after an hour or so,” Burgert says. “The same happens in the content in the breast milk.” The milk isn’t stationary. “It’s not like: You have a beer, and the alcohol is going to stay in the milk until you pump and dump it,” Burgert says. “It’s a dynamic process.” So, it’s okay to drink alcohol, but if you feel drunk, you shouldn’t feed your baby. Try feeding your baby before you drink, and having a supply of already pumped milk on hand so you won’t have to feed your baby after a glass or two of wine.

When it comes to medicine, Burgert says most moms have issues with antihistamines. “What dries up your nose is going to dry up your boobs,” she says. As such, allergy season can be rough on moms. She says you can still do nasal sprays.

Reed says it’s true that some oral contraceptives, especially ones with progesterone and estrogen, can decrease milk production. “But looking at studies for moms on oral contraception, those babies gain the same amount of weight in the same amount of time,” Reed says. “They think those babies maybe drink more deeply during nursing sessions. So, while production may decrease, the babies growing just as well.” If you struggle with milk supply, you may want to talk to your doctor about alternative kinds of contraception.

There isn’t a lot of research on Botox and breastfeeding, Reed says. “The amounts they use are probably small, but Botox hangs out for three to four months in your tissues, and could potentially go to the breast milk,” she says. “If you have a choice to delay using it and can look for topical alternatives, it’s something we’d likely recommend waiting on.”

Burgert says this one is up to the mom. Caffeine won’t hurt your child, but it may have effects on them. “I have moms who will have a latte, and they swear their baby will get jittery,” Burgert says. “But then there are moms who drink five Starbucks a day and they say their kids is fine. It all depends on how the baby metabolizes it. Babies can metabolize caffeine.” You basically just need to watch and see if it makes your baby uncomfortable.

“I have mothers who say they’re not going to nurse because they smoke cigarettes,” Reed says. However, she says that she encourages mothers who smoke to still nurse, while trying to quit. There’s no contraindication, and breastfeeding has been shown to protect your baby from other issues along they way. And, according to the Canadian Breastfeeding Foundation, "Breastfeeding has been shown to decrease the negative effects of cigarette smoke on the baby’s lungs, for example."

Go forth and enjoy your yogurt. Burgert says this is fine to have, and it’s even good for the baby to eat foods that people can develop allergies to. “The more diverse that moms keep their diet, the more their babies will transition to eating their first foods without issues,” Burgert says. “They’re getting proteins and food particles from the milk. So, if you want to prevent peanut, dairy, or soy allergies, this is a good way. You want them to get exposed to all of those foods throughout the first six months of their life.”

You might have heard that celebrities such as Chrissy Teigen and Kim Kardashian ate their placentas. But just because someone famous does it, it doesn’t mean it’s a good idea. Earlier this year, the Society of Obstetricians and Gynaecologists of Canada released a report saying there's no evidence eating placenta in beneficial. It advised against the practice, citing a potential for harm. Health Canada also advises against consuming any products claiming to be made of human placenta. Meanwhile, the U.S. Centers for Disease Control and Prevention did a study that linked one baby’s bacterial infection with capsules the mother was taking that contained her dehydrated placenta.

When it comes to breastfeeding, Reed says hydration is a major factor. Being in the sun for too long can dehydrate you, so you just need to make sure that you’re rehydrating afterwards.

Fish and good-quality sushi are both safe to consume while breastfeeding. In fact, Health Canada recommends that pregnant and breastfeeding women consume fish that are high in omega-3s and low in mercury. However, it's important to avoid fish that are high in mercury, such as tuna and swordfish, since too much mercury can harm your baby's development. For a full list of fish Health Canada recommends consuming (and avoiding), visit here.

Although some outlets report that garlic makes your breast milk taste bad, Reed says that it’s not harmful to your baby, and they’ll usually adjust. “That’s just what your diet is,” she says “Newborns like to be fed. And if you’ve ever tasted commercial formula, that tastes fouler than any amount of garlic in milk could.”

Similarly to soy, this is okay for moms to have — unless they have Celiac disease, or a gluten allergy that causes gastrointestinal inflammation and issues. Then you can avoid for your own health reasons.

There isn’t tons of research out there, but the American Pregnancy Association says it’s okay to dye and highlight your hair while breastfeeding. Dyes aren’t highly toxic, so while some might be absorbed into your skin, it’s unlikely it will make its way to the milk.

Similarly to sun exposure, you should be okay to indulge in this relaxing and sweaty activity — as long as you rehydrate.

When it comes to this acne medication, the medical community says there’s a link between the high levels of vitamin A in the medicine and how babies form early on. “We don’t want you to get pregnant taking Accutane, which is why women need to be on effective contraceptives when taking it,” Reed says. There’s not much data regarding taking it during breastfeeding, Reed says, but topical treatments for acne are preferable.

“Having a baby is uncomfortable, no matter how you do it,” Reed says. Most moms need some kind of pain medication, and Ibuprofen or Tylenol sometimes do the trick. Reed says these are fine to take when breastfeeding.

She also notes that you can take narcotic while breastfeeding. It depends on your baby, and you should consult your doctor, but usually you can also take narcotics or opioids when breastfeeding. “Even moms who are on high levels of opioids or who are on monitor programs who are recovering from a problem, we want them to be breastfeeding, there’s no contraindication at all. Breastfeeding is for everybody, even with complicated things going on.”

Reed is based in Colorado, so a fair amount of her patients are serious athletes. She says that as long as you’re replacing you’re getting proper nutrition to make up for the energy you’re burning during training, and staying super hydrated, you should still be able to do intense workouts.

However, it’s important to listen to your body, and know when you need to switch something up if you’re having issues with milk production.

Usually topical treatments don’t get into your tissue, so Reed and Burgert say it’s usually okay to use those while breastfeeding. However, you may want to talk with your doctor before you use prescription Retinoid.

You can have it. Mayo Clinic says it’s a good way to get in protein via a plant source.

“There are some myths about spicy foods and peppers and breastfeeding,” Reed says. “The truth is most women in other parts of the world are living on a spicier, garlic-ier, more exciting and aromatic diet, and those women are still breastfeeding their babies, there are few types of foods not to eat, other than some fish.”

This is one of the few things on the list that Reed says you shouldn’t do. Because of the way marijuana is processed in the body, it stays in your system for a long time — and in the breast milk. Research is still limited, but some studies suggest that it can be passed along to the baby in the milk, and cause developmental or learning difficulties. Although there could be more research on the topic, it’s better to avoid toking up while you’re breastfeeding. “We don’t want you to do that,” Reed says. “Ever.”