Alcohol while pregnant

Both my pregnancies have been somewhere in the grey area between planned and unplanned. The little dude was conceived the first time we ever decided to risk it; the current pregnancy resulted from the second time. With the little dude, I misjudged my cycle after it was disrupted by overseas travel, and we didn’t use a condom, and I was kinda taken aback that I got pregnant, though not displeased. We were at a stage in our life where we were discussing the next step, whether we should stay put or go overseas for a few years and if so where and for what purpose – general travel, work, study. The question of “when do we have a kid” was a big part of the conversation. We hadn’t reached any conclusions, and then one night we rolled the dice on life. It wasn’t 100% unplanned, like a random contraception failure; but you couldn’t entirely say it was planned either. I don’t mention it often – not so much because of the stigma (the stigma is much less when you’re married with a job and were thinking about having a baby in the next few years anyway), but because it seems insensitive to people who don’t conceive easily. Also because it means mentioning our sex life. 

Each time I’ve followed the super zealous approach of having no alcohol in the two weeks between having unprotected sex and taking a pregnancy test. 

I have mixed feelings over recommendations about alcohol consumption during pregnancy. The advice to not drink at all is probably excessively cautious, as there have been no robust studies which show the occasional drink causes damage; yet still I find myself not drinking at all, because… well… I dunno. It doesn’t feel like much to give up. 

If I follow this advice myself, why does it grate so much to hear it given officially? Even when it’s overseas official advice that I could totally ignore! Why, having myself refused drinks in the first few weeks of unconfirmed pregnancy, do I feel like it’s not reasonable for public health officials to tell people to either take all steps possible to avoid pregnancy, or take all steps possible to avoid alcohol?

The condescending tone gets me. That’s not all though. 

Maybe because I feel like it’s my body and if I want to err on the side of extreme caution I’m allowed to, but that doesn’t mean everyone should be forced to?

In both my pregnancies, it was easy to avoid alcohol before I found out I was pregnant. I wasn’t having unprotected sex on the regular, so I knew there was a specific risk of pregnancy that month, so I didn’t drink. If you were spending months or years trying to conceive, or if you were using contraception and thought there was negligible chance of pregnancy, I imagine it’d be different. 

Meanwhile, unplanned pregnancies are suggested as the big problem, those irresponsible people having sex for fun and also drinking for fun, etc etc. As with abortion, the stigma of unplanned pregnancy is strangely dissonant from reality – around half of pregnancies are unplanned! The Growing Up in New Zealand study found that 40% of the cohort births resulted from an unplanned pregnancy. That study found unplanned pregnancies were at no greater risk of alcohol consumption before pregnancy, but they were at greater risk during the first three months. In particular, in the first three months of pregnancy, mothers whose pregnancies were unplanned were much more likely to drink 4 – 20 drinks per week (10.5% vs 2.8%). Beyond the first three months, only 1.4% of mothers with unplanned pregnancies were drinking 4 -20 drinks per week. This suggests that the issue is both the quantity of alcohol consumed and the timing of pregnancy discovery. 

I don’t know if much can be done to enable earlier discovery of unplanned pregnancy. So I kinda get why some public health officials might think it’s reasonable to advise anyone who might possibly be pregnant to avoid alcohol. But it misses the point, which is that our bodies have evolved over millions of years to try and get us pregnant, and yet we still have to live in them. Pregnancy isn’t an aberrant human experience. Planned pregnancy has only been a comprehensible notion for the past few generations. I suppose pregnancy is an occupational hazard of possessing a womb and engaging in penetrative sex, which is why most partnered heterosexual women I know spend a lot of time and effort thinking about contraception. Just the other day I found myself googling tubal ligation vs IUDs and clearly preventing a pregnancy is not currently an issue for me. But when public health officials suggest that all women who could be pregnant should avoid all behaviours that are associated with any risk to developing embryos, it elevates the womb above the person. It also misses the point that foetal exposure to environmental risks is directly related to the presence of those risks in the environment! Zika is of course a very current example – advising women not to get pregnant seems like a cop-out. I’ve seen heavy-handed recommendations in relation to endocrine disrupting plastics too, advising pregnant women not to buy food packaged in plastic. And I’m like, what the fuck, if this is a risk to a developing tiny human maybe the fact that it’s on every shelf in the supermarket is the problem?

Relating this back to alcohol in pregnancy: the elephant in the room is the level of alcohol consumption across the population generally. That Growing Up in New Zealand study found that of women whose pregnancies were planned, 25% drank 4 – 20 drinks per week in the three months prior to pregnancy. The Ministry of Health defines binge drinking as more than four drinks on an occasion for women and more than six for men. A 2015 study found that 8.4% of people who’d had a drink in the past year were weekly binge drinkers. That’s one in twelve people* who, at least once a week, drink enough that they are too drunk to drive. Every week! Not every month, not most weeks, not just on special occasions – every bloody week, at least once. That’s, wow, that’s a lot of drinking. I’ve never been a big drinker so maybe I’m not the best judge of the normal range of drinking, but surely that much that often can’t be a good idea? That’s gotta do horrible things to the liver. 

A few weeks ago I had a rare night out with friends. It was at an old school kinda pub without much in the way of non-alcoholic offerings. The counter-top of the bar was high enough that my bump was hidden, and when I ordered a lemon, lime and bitters the bartender said “sober driver?”. I replied “No, pregnant”. “On the house!” said the bartender cheerily. 

Last year, when I was six weeks pregnant, I went out after work with colleagues – also a rare occurrence because of childcare arrangements. We went to a tapas place with a great non-alcoholic menu and I ordered something from that list while everyone else had beer or wine. A couple of months later when I told people at work I was pregnant, one of my colleagues said “oh I thought you might be pregnant ‘cause of that time we went out and you got a mocktail!”

Says a lot about our drinking culture, huh? These examples are just two among many. Similar stuff has happened in both pregnancies whenever I’ve been at a social event and not yet demonstratively full bellied. Every time, the refusal to have a drink has been cause for comment. Apparently there has to be a reason for not drinking and it’s valid to ask, whether you know me or not. It’s pretty uncool. Ironically, consumption of alcohol in the first trimester is the most dangerous – precisely when you aren’t showing as pregnant and other people are therefore most likely to pressure you to drink, including the implicit social pressure that inevitably exists when everyone else is drinking. Especially when everyone else is having several drinks. 

Upshot: maybe if our socialising culture was less alcohol dependent, excessive drinking in pregnancy would be less likely to occur. Maybe public health messages should focus on that. 

* (well, it’s between one in twelve and one in fifteen – 20% of the sample hadn’t had a drink in the past year, so excluding them it’s one in fifteen, but that group is mostly 15 and 16 year olds).