Should Women Drink Alcohol While Pregnant?
Striking numbers of expectant mothers are deciding that there’s nothing wrong with the occasional drink of alcohol. New studies suggest that they may be right, but the medical establishment is hardly convinced.
Striking numbers of expectant mothers—professional, educated, and informed—are deciding that there’s nothing wrong with the occasional drink of alcohol. New studies suggest that they may be right, but the medical establishment is hardly convinced. So are these moms-to-be valiantly pushing back against political correctness gone awry, or are they simply part of a new generation of entitled narcissists, unwilling to sacrifice even for the health of their babies?
For most of my life, I believed that my mother, who smoked until I was in my teens, had at least quit during the months she was pregnant with me, her only child. It wasn’t until recently that I found out this wasn’t the case. She’d never actually stopped, so maybe I could’ve been taller, after all. Back then, though, it was fairly standard to drink and smoke and eat cold cuts while carrying a baby: A good friend born the same year I was reports that her mom got stoned the night before giving birth. My aunt, meanwhile, remembers being pregnant with my cousin in the early ’80s and having her Boston obstetrician advise that she cut back on cigarettes—to half a pack a day.
My mom had issued the lie in part, I assume, because by the time I was old enough to ask, smoking was no longer a recommended practice among the gestational, and because I was a kid who tended to like to assign blame. By 1984 the surgeon general had mandated labels on all cigarette packages warning women that smoking could cause fetal injury, low birth weight, and premature birth. This was not long after the surgeon general’s official position for pregnant women became to abstain from drinking and smoking completely, following a study that identified a group of physical and mental birth defects now known as fetal alcohol syndrome. As it was, I had been crediting my poor showing on the Presidential Fitness one-mile run to a childhood spent in the confines of my mom’s Nissan Maxima, hotboxing our way through afternoon errands. Armed with the information that she’d also smoked throughout what were literally my most formative months, I’m sure I would have been a sanctimonious nightmare. Eventually, I badgered her into quitting when I was 15. I told myself, and her, that if I was to become a mom one day, I would neither smoke nor drink.
Many people were soon taking an equally rigid position. After the surgeon general issued the new guidelines, the United States experienced a massive societal shift away from smoking and drinking by pregnant women. So complete was the transformation that by 2005, the surgeon general was advising women who were simply trying to get pregnant to also quit drinking entirely, just to be safe. But in more recent years, the mood, and the rhetoric, around drinking during pregnancy have begun to shift yet again. Lately, we’ve seen the publication of study after study showing that, rather than dooming the unborn to a lifetime of birth defects and personality problems, the occasional drink or three may actually be free of negative consequences. One recent finding even suggested that as many as eight drinks in one week, and up to five in one sitting, may have no significant effects.
And so lots of educated, informed, and professional women are giving themselves license to drink. According to the Centers for Disease Control and Prevention, 7.6 percent of pregnant women drink at least occasionally. Among college-educated women, however, that number jumps to 10 percent, and of those between the ages of 35 and 44, 14 percent consume alcohol. These days, spotting your pregnant-with-twins lawyer neighbor having a glass of wine with dinner isn’t quite as shocking as it once was.
The moms-to-be who are choosing to drink aren’t thoughtless or careless women given to making blind decisions. They’re part of one of the most informed generations of mothers in history, middle- and upper-class professionals in their late twenties, thirties, and forties. They read all the books about having healthy babies. They eat organic food and work out in fancy gyms. They travel the world, always seeming to bump into pregnant women around Europe who smoke and drink and pop out beautiful, brilliant children.
And yet, their decision to drink while expecting puts them in the middle of what may be the greatest divide among the pregnant and those who come in contact with them—which, of course, is all of us. That’s because pregnant or not, woman or man, everyone, it seems, has an opinion about everyone else’s drinking habits, especially if the everyone else in question is carrying a child. I’ve seen friends at both ends of the spectrum—from the one who sat at home for the first six months of her pregnancy for fear of doing anything that could possibly harm her baby to the one who took a far more “European” approach. (If pregnant ladies in Europe are, in fact, doing Jäger shots.) I’m also hearing them judge one another and the comparative health of their babies—out of earshot, of course. And I have to wonder: Is there such a thing as “drinking safely” while pregnant? And who has the right to say? Are we basing decisions about drinking while pregnant on science? Or something else?
From the end of Prohibition, in the 1930s, until the early 1970s, moderate drinking while pregnant was both common and unquestioned. In 1973, however, a University of Washington study attributed physical, mental, and developmental birth defects—things like heart murmurs, small heads, and narrow eyes at birth, as well as delayed speech and poor hand-eye coordination later on—to fetal alcohol syndrome, or FAS. It wasn’t long before follow-up studies showed that FAS was actually a very rare outcome related to severe alcoholism, with an estimate of 0.5 to 2 cases per 1,000. But FAS as a notion was transformative, mostly because birth defects as a result of alcohol were viewed as completely preventable, which made continuing to drink not just thoughtless but also reckless and cruel. According to a 1999 report published in the journal Alcohol and Alcoholism, FAS was instrumental in turning excessive drinking in the public’s mind from a moral (and largely private) concern to a public-health concern on par with child neglect and abuse. In our collective consciousness, drinking while pregnant became widely associated with poverty, crime, and mental illness.
Around the time of the surgeon general’s 1981 call to abstinence, state and local governments began implementing point-of-purchase warnings about drinking during pregnancy, and in 1988, the United States became the first country to adopt legislation requiring similar warnings on the labels of beer and alcohol containers. A string of overwrought articles and movies—such as The Broken Cord, based on Michael Dorris’s bestselling 1989 book about the challenges and heartbreak of raising an adopted son who’d been born with FAS—helped fuel the idea that drinking while pregnant wasn’t just potentially dangerous but also immoral. In 1990 Wyoming became the first state to charge a drunk pregnant woman with felony child abuse.
So it’s not surprising that, according to the CDC, alcohol consumption among pregnant women declined throughout the ’80s. After that, though, the numbers began to rise. Some of the shift is doubtless attributable to the fact that researchers to this day cannot definitively say just how much alcohol, at what stage of pregnancy, causes FAS. And some of it probably owes to the fact that studies keep coming out indicating that a drink from time to time while pregnant is safe. Like the one published in June in the International Journal of Obstetrics and Gynaecology that found that up to eight drinks in a week—and as many as five at one time, which seems like an awful lot—did not have significant negative cognitive effect on kids five years later. This study followed an earlier one published in the International Journal of Epidemiology that indicated that not only could pregnant women safely drink a glass of wine or two per week, but that their children would actually perform better three years after birth than those of women who chose not to drink at all. And in Europe (of course), where the perception, at least, is that pregnant women regularly drink and smoke—though, in fact, the official position on drinking in France is abstinence throughout pregnancy—birth-defect rates are lower than those in the U.S.
The truth is, there’s no real proof that low levels of drinking are harmful to a fetus. “The quality of information is not so definitive that it is absolutely clear that drinking in small quantities is going to significantly affect pregnancy outcome,” says Robert Barbieri, the chairman of Obstetrics and Gynecology and Reproductive Biology at Brigham and Women’s Hospital. And, as we know, people like definites. It’s this very absence of actual scientific evidence that drinking is absolutely and without question bad for a baby that has led a lot of very smart, very informed pregnant women to decide that there’s nothing wrong with the occasional drink. Not that the rest of society necessarily agrees.
You don’t have to be a parent yourself to know that modern parenting can seem like a series of unending judgments, from how we conceive to what we eat and do while pregnant, with stops along the way including, but not limited to, birthing, breastfeeding, vaccinating, what our kids eat, where they sleep, how they learn, how much TV they watch, if we marry, or stay married to, the people who helped us conceive them, and if we have them at all.
At 36, and many years after declaring my mother unfit to drive me around in her exaggeratedly smoky car, I’m undecided about having children of my own. My uncertainty has nothing to do with other people’s decisions, and yet I sense that strangers and sometimes friends can feel a bit slighted when I can’t explain what it is about parenthood that doesn’t interest me. I do know my ambivalence is less about my opinion of children and more about knowing myself. I’m not sure I’m particularly well suited to sacrifice. Or to the pressures of parenting-by-comparison, which these days seems impossible to avoid. Having married a man with a child of his own, I believe I have a responsibility to be a thoughtful, caring parental figure and friend to my stepson, and supporter to my husband in his parenting choices. But I also know what it’s like to feel judged, and I’m not sure I want to sign up for more.
“As soon as you’re pregnant, or have a baby, it’s like all bets are off,” says Kara Baskin, a 33-year-old mother of a two-year-old boy. “People can say whatever they want, touch whatever they want, make whatever comments they want.” A few years back, she was at a Starbucks when the barista asked her, “Are you supposed to be having any caffeine when you’re pregnant?” She wasn’t pregnant—it was just the shirt—but of course that didn’t matter. She ran out crying.
Baskin, an Arlington-based writer, eventually did become pregnant. She recalls the time she was eight months in and “enormous,” and was meeting a friend for dinner at Lucky’s Lounge, in Fort Point. While she waited, she ordered a bottle of O’Doul’s, the nonalcoholic beer. Barely two sips in, she noticed the table full of twentysomething women whispering and sending dirty looks her way. Finally, the women signaled for a waitress, who then marched over “as if she were going to arrest me or something,” Baskin says. At the table, however, the waitress got close enough to see that it was a nonalcoholic beverage. “Oh, never mind,” she said to Baskin. “It’s okay. It’s O’Doul’s!” But what if it hadn’t been?
Women’s bodies—and not just the pregnant ones—are still somehow seen as public property. This summer, all 49 Massachusetts birth facilities banned free baby-formula gift bags in order to encourage new moms to breastfeed. We’re the second state to do so (Rhode Island was the first). Okay, so we want to encourage breastfeeding, right? Then what to make of the uproar over the recent Time magazine cover featuring the breastfeeding mom who, in the court of public opinion, had “gone too far”? No matter what she does, there will always be someone telling a mother she’s doing it wrong.
“We reason that it’s because the state has a vested interested in producing healthy babies, but it’s really about the sexist idea that women don’t know what’s best for them,” says Jessica Valenti, the founder of the blog Feministing, author of Why Have Kids?, and a Jamaica Plain mom. “Motherhood is a lifetime of judgment, unless you’re willing to do anything by someone else’s standards. And there’s always going to be someone else.”
Confident that what the data actually show is that there’s nothing wrong with a drink from time to time, this new generation of mothers is determined to make its own choices about drinking while pregnant. “I had a sip of my partner’s scotch here and there because I really like it,” says Jess Meyer, 35, a yoga instructor with two kids younger than three who drank a glass or two of wine four times a week while pregnant. “My doctor was a mother of three herself and she was like, ‘Honestly, a little wine here or there is not bad.’ Especially with the second one, when you’re dealing with a crazy toddler, too. The way I see it, if you’re sitting there with a bottle of vodka sucking it down: That’s a problem. But a few glasses of wine—there’s nothing wrong with that.” She mentions the International Journal of Epidemiology study that found that prenatal drinking actually led to better-behaved kids, saying, “People are always complimenting me on my relaxed, chill children.”
Maybe so, but they weren’t exactly kind about her drinking. Five or six months into her first pregnancy, Meyer was in Beacon Hill buying liquor for a party she was throwing when the clerk questioned whether he was legally allowed to sell to her. “I told him it’s illegal not to,” she says, but she still felt compelled to explain that she was shopping for a party, not herself. He needed to call his manager anyway. At various times throughout her two pregnancies, Meyer was also refused wine at restaurants. At least one waiter wouldn’t even show her the wine list.
For every smart and informed woman who’s chosen to have the occasional drink while carrying a baby, however, there are others who’ve made the opposite decision. One female friend of mine who regularly, and loudly, shares her point of view with pregnant women in restaurants around Boston, calls drinking while pregnant the “most selfish act imaginable. I think those women should be put in jail!” And Baskin, whose drinking never progressed beyond that O’Doul’s, says, “I’d think of my baby swimming in a pool of chardonnay and being like, ‘Mommy.’”
Eliana Stern, a mother of two who lives in Exeter, New Hampshire, believes that “part of being a good mother is loving your child more than you love yourself, and that means not drinking while you’re pregnant. Drinking can cause irreparable damage to the baby. Mothers who cause fetal alcohol syndrome in their babies have to live with that fact their entire lives. By not drinking during pregnancy, I gave my children the best chance to reach their full potential in life.”
Charlestown Yoga Studio owner Kristin Quinn, 33, used to feel that way, too. She recalls the time she was having a drink at the Liberty Hotel a few years back when she saw a very pregnant woman sipping a glass of red wine. “And I just couldn’t stop staring—‘Oh my God, that is the worst thing I’ve ever seen,’” Quinn says. A year and a half later she was pregnant with her first child and very sorry she’d been so judgmental. “I literally remember my first sip of wine,” says Quinn, who now writes a blog called Misadventures in Mommyhood. “It was so delicious.” From then on, she enjoyed what she calls a ceremonial half glass every Friday. “It was just something to look forward to and nothing dangerous,” she says. “Sometimes, I didn’t even finish it. It’s actually better than to be stressed out.” But she wouldn’t drink in public. “I knew people were out there judging,” she says, because, of course, she had been one of them. “You just feel like you have a big target on your face.”
Quinn says her drinking was ob-gyn-sanctioned in what she calls a “wink-wink” sort of way. “There are so many things you can’t do when you’re pregnant,” she says. “You stress yourself out about everything. Did I get enough water? Did I eat enough vegetables? The wine was just a nice way to put your feet up and not have to worry about that.”
Leah Callahan, who is 27 and lives in Worcester, gave birth to her first child, a boy, in October. She started having an occasional glass of wine (never more than four ounces, she says) at about six months. Though she didn’t discuss drinking with her doctor, she aimed to be healthy throughout. She ate right, exercised, and gained fewer than 20 pounds. Her blood work was normal. “I don’t feel like having a glass of wine made me a bad person, or a bad soon-to-be mom,” she says. “It helps me relax, and we all know pregnancy can be stressful.”
That’s something Laura Riley, the director of labor and delivery at Mass General, hears from a lot of patients. Being pregnant certainly is stressful, says Riley, the author of You & Your Baby: Pregnancy, but “I’m not too sure relying on alcohol to relax you is a reasonable way to live. The question is, Why don’t you have different coping skills? Because you’re going to need them once you have a baby.”
Riley is unwavering in her position of zero tolerance. “While I recognize that there are random studies suggesting that small amounts of alcohol in some women are probably safe, I feel that nine months is a relatively short period of time” to give up drinking, she says. “It’s clear that alcohol in some levels can cause babies to have fetal alcohol syndrome, which is characterized by gross restriction and facial abnormalities and mental retardation. The fact that you’re not buzzed doesn’t mean that your baby’s not getting the end result.” To the women she sees who point to themselves or their friends as products of mothers who drank their way through their 1970s pregnancies, Riley’s response is, “I say you were lucky.”
It’s true that there are no studies that prove a glass of wine “here and there” is harmful, but it’s also true that there’s no real way to define “moderate” drinking. Anyone who has that friend who gets embarrassing after a single glass of pinot noir, or who is that friend, knows that alcohol affects everyone differently. “What level is safe for Mrs. Jones and what level is safe for you may be entirely different,” Riley says.
Whatever the research may be telling us, not a single Boston-area doctor I spoke with would go on record saying that drinking any amount of alcohol during pregnancy is acceptable. And yet there is the sense that many of them are quietly telling their patients that an occasional beer or glass of wine is fine. Nearly all the women interviewed for this story said they got at least a tacit okay from their doctor before starting to drink. One factor that might give doctors pause about publicly endorsing drinking while pregnant is that women—pregnant or not—traditionally underreport how much they drink by four times the amount men do. That can make it far more difficult for doctors, or patients, to identify the kind of problem drinking that everyone seems to agree can lead to trouble for babies. Put another way, what good is it to tell a pregnant patient that it’s okay to drink in moderation if that patient has no real conception of what moderation looks like? Even “women who are not diagnosed with any substance abuse disorder may not recognize how much is too much,” says Kelley Saia, assistant professor of Obstetrics and Gynecology at BU’s School of Medicine. “And because alcohol is so widely available, we have to be careful what we say.” Even one glass a few times a week, she says, counts as chronic exposure.
“Parents are constantly in an uproar about the fact that there’s more ADD, there’s more this, there’s more that,” Riley says. “I just don’t understand, if you’re concerned with all these different things that are all neurodevelopmental, why on earth would you take a chance with something that you know is a neurotoxin? People worry about eating fish, for God’s sake. They’re worried about mercury poisoning when, really, what’s the likelihood of that compared to all the beneficial things you can get from fish? I just find drinking a very odd thing for people to latch on to.”
Northborough mother Marile Borden, founder and editor of Momicillin Publishing, whose blogs include the wildly popular Moms Who Need Wine, sums it up this way: “I didn’t want to have a reason to blame myself should, God forbid, anything have gone wrong with my pregnancy or baby. Not that I thought a drink here or there would harm the baby. But I never wanted to have to say, Was it something I did?”
Many women told me that they drank during pregnancy not to relax or be social, but simply to remember their carefree days prior to deciding to become a mother. For pregnant women, danger is everywhere: mercury in canned tuna, salmonella in peanut butter, listeria in soft cheese, disfigurement and mental retardation in a glass of wine. Nothing, they’re told, is safe. Which apparently demands flawless behavior—being perfect pregnant people. It’s enough to drive a girl to drink.
In fact, some moms-to-be say the decision to drink was just one small step in pushing back against the overwhelming sense that they are very probably doing something wrong at any given moment of motherhood. “I feel like the ban on drinking promotes this idea that our job as mothers is to make sure that our babies are ‘pure,’” says Arlington mom Jennifer Feller, “that they never, ever have contact with a germ, a toxin, a speck of honey before the age of one. It’s not that I ignored all of this, but it’s an approach to pregnancy that prepares parents for the overbearing, helicopter style of parenting we’re realizing is actually hurting our kids.”
Before her first glass of wine while pregnant, Sarah Pike, a Newburyport resident, decided on a level of drinking she and her husband both felt comfortable with: one to three glasses of wine over a one-week period, and not more than one in a single evening. “If something happened and maybe was related to wine consumption, I had to go into that glass of wine knowing that I had made my decision based on the risks and non-risks,” Pike says. “My midwife actually told me I could have a bologna sandwich every once in a while. I’m pretty certain there are worse things in bologna than a glass of red wine.” Pike, now a mother of two boys, says that more than a desire to enjoy the alcohol itself, she found she simply missed the act of holding a glass of wine. “A little bit went so far for me in feeling I hadn’t lost myself completely,” she says.
Still, many parents argue that parenting is about sacrifice, that you never really are quite the same again—indeed, that’s one reason many people opt to have kids (and many, myself included, may opt not to). The current generation of moms may be the most educated and informed ever, but these women also embody the narcissism that’s pervasive in this ambitious, driven era. According to a study published in the journal Social Psychology and Personality Science, clinical narcissism among college students—defined by heightened feelings of entitlement, decreased morality, and a dog-eat-dog mentality—increased by 30 percent from 1982 to 2006, when two out of every three measured high for the disorder.
“Hearing women say, ‘I want to (fill-in-the-blank) to be my true self again’ is not language we heard a generation ago,” says Jean Twenge, author of the recent The Impatient Woman’s Guide to Getting Pregnant and coauthor of The Narcissism Epidemic, which argues that we live in a culture that not only tolerates, but also encourages, me-first behavior. Twenge points to the highly competitive nature of pregnancy and parenting as a manifestation of narcissism. “We have this new idea that we need to be true to ourselves and not waver from that—we use phrases like ‘Never compromise’ and ‘Believe in yourself,’” she says. “Everything is personalized, customized. There’s the idea that ‘We’re all unique,’ that ‘The rules don’t apply to me.’ And that is a problem for women when they’re pregnant and transitioning to parenthood. You are the same person, but there are some things you have to do differently than you used to. And one of those things is not drink.”
Upon returning home from Lucky’s after the O’Doul’s incident a few years ago, Kara Baskin started to wonder if the women at the other table had actually been right. “I realized that sitting there with my bottle of O’Doul’s, I had felt like a badass, like I was being rebellious,” she says. “Did I really want to be a badass? I ended up going home and berating myself.” Because it wasn’t just the taste of the beer that appealed to Baskin. At that point in her pregnancy, with only a few weeks to go, she’d found the freedom of that sip intoxicating. “It tasted like a memory, like a different part of my life that I might not ever get back to,” she says. She hadn’t missed alcohol. She had missed being Kara. Because, of course, she wasn’t anymore, and as far as she knew, might never be again.
Source URL: http://www.bostonmagazine.com/2012/11/drinking-alcohol-while-pregnant/