The ugly side of breastfeeding: D-MER

So, I first noticed that something was different when I was about ten days postpartum. I was changing Maeve's diaper (which she screamed and cried throughout) late in the evening and had a wave of anxiety. It went as quickly as it came, but it was a bit jarring. I kept asking myself what I was worried about, why changing my newborn's diaper would make me feel anxious (and so out of the blue), but since the feeling passed quickly, my tired brain moved on to feeding her, or falling asleep sitting up, or maybe online shopping for another oh so important hair bow while late night nursing.

Oh hi BTW! I'm so happy to be back sharing my breastfeeding journey here with the F&G community. If you're following us on Instagram, you probably saw my recent post about this topic and I want to open up about my experience with D-MER, or dysphoric milk ejection reflex.

First, I want to be very clear-I am only sharing what MY experience with Dysphoric Milk Ejection Reflex (or D-MER for short), has been like. D-MER is different for every woman who experiences it, and my symptoms are quite mild in the grand scheme of things. I hope to normalize this diagnosis, help others understand what it feels like, and maybe help someone else who is struggling with similar symptoms.

Ok back to the story! After that somewhat random and overall forgettable experience, the waves of anxiety started to come more frequently... and they were all associated with Maeve crying, me pumping or nursing, or my breasts leaking. (Looking back now, I realize that it wasn't the crying that was the problem, it was the let-down I was having when she cried). The anxiety remained quite mild, mostly just an internal feeling of worry that passed within a minute or two, but it was consistent. And I remembered a story one of my favorite heart moms (mama of a baby with a cardiac detect) told me when I was working with her and her babe in the NICU. She had described a similar experience with nursing--but she felt waves of depression with her let-down and her diagnosis of D-MER. As a lactation consultant and infant feeding specialist, I know I’m in a unique position. Most women have never heard of D-MER and will have these experiences for months before knowing what’s going on or will never know and will likely stop breastfeeding without ever figuring out why they don’t “love it” the way they thought they would.

After talking with my lactation consultant and the midwife at my OB's office, it was clear that the symptoms I was experiencing were consistent with D-MER. I am very lucky that my symptoms are mild--some women experience anxiety so severe it leads to panic attacks, or depression and anger so intense they need to wean their infants from breastfeeding. This condition is not well researched or understood, but the lactation community is beginning to explore the hormonal causes of D-MER and potential treatment options. Research has found that it affects at least 8-9% of lactatating women.

It is postulated that D-MER is due to the hormonal interaction of prolactin and oxytocin or dopamine. When prolactin is secreted in the brain to initiate milk ejection (aka “letdown“), oxytocin and dopamine both drop systemically. Oxytocin is the one known commonly as the love hormone and dopamine is also associated with joy. It is postulated that in some women this drop in these two “happy” hormones causes the symptoms of anxiety, depression, and/or anger.

For me, identifying that it was a chemical response and that I knew it would pass quickly was key to reducing the impact. But again, I am lucky that my symptoms are mild. I can't imagine how anyone continues breastfeeding with severe symptoms... especially if you don't know why you are feeling it. Just think... you sit down to start breastfeeding your baby and you are immediately panicked, or furiously angry, or severely depressed... and you have no idea why. I have to assume that un-diagnosed D-MER (and probably diagnosed D-MER) is a contributing factor to PPD and PPA. Breastfeeding is stressful and challenging at first for most even without D-MER.

Unfortunately there isn’t a cure for D-MER. Some women report the severity lessens over time. And again just knowing what’s going on can help increase a woman’s feelings of control. For me, I noticed it's less intense in the morning when I'm better rested. Some research has explored the role of sleep and exercise (two things us new moms have little time for!) in decreasing symptoms. I

We want to spread the word about the fact that breastfeeding can be hard, D-MER is a thing and it can make breastfeeding even harder and bottom line is if you are having feelings of anxiety, depression, or anger with or without breastfeeding PLEASE know there are supports out there for you. Talk to your OB or midwife about your experience, and reach out to people who you love and love you. Motherhood is a journey and it takes a village to take care of us mommas.

xo

Kim (and baby Maeve)

If you're interested in reading more, here are some resources!

https://d-mer.org

Cox, S. (2010). A case of dysphoric milk ejection reflex (D-MER). Breastfeeding Review: Professional Publication of the Nursing Mothers' Association of Australia, 18(1), 16–18

Heise, A. M., & Wiessinger, D. (2011). Dysphoric milk ejection reflex: A case report. International Breastfeeding Journal, 6(1), 6. http://dx.doi.org/10.1186/1746-4358-6-6

Stacey, AJ (2020). Dysphoric milk ejection reflex. Breastfeeding Review, 28 (1): 29-32.

Tamara L. Ureño, Cristóbal S. Berry-Cabán, Ashley Adams, Toni L. Buchheit, and Susan G. Hopkinson.Breastfeeding Medicine.Nov 2019.666-673.http://doi.org/10.1089/bfm.2019.0091

Uvnas-Moberg, K., & Kendall-Tackett, K. (2018). The Mystery of D-MER: What Can Hormonal Research Tell Us About Dysphoric Milk-Ejection Reflex? Journal of Clinical Lactation, 9(1). DOI: 10.1891/2158-0782.9.1.23