My Experience with Breastfeeding and Dysphoric Milk Ejection Reflex (D-MER)...
Dysphoric milk ejection reflex (otherwise known as D-MER) is something I only just recently learned about, but I really wish I’d known about it sooner. The beginning stages of my breastfeeding journey with Maya were rough. Based on all the reading I did on the leadup, I thought breastfeeding could be and would be easy, or at least manageable. It was not (manage it, I did, but it was decidedly not easy). While my milk supply was ultimately fine, I found myself constantly stressing about it, and besides that, it was f***ing painful. At first, latching, whether it be correctly or incorrectly, often felt like someone was violently biting down on my nipple. At its most graphic, one of my nipples actually bled and I had to give that breast a full 24 hour hiatus from actual breastfeeding (I pumped instead to avoid engorgement, but even that hurt my poor, sore nipple).
I grimaced and curled my toes each and every time I sat down to nurse my daughter, and often, it took us 10-15 minutes of trying to actually get things finally right. Then it took another 45 minutes for my daughter to actually finish her meal. By that time, as a newborn, she was almost ready to eat again before she’d even finished eating her last meal. I required complete silence and total focus while latching Maya at first or else we wouldn’t succeed. I read hundreds of pages on how to breastfeed correctly and tried and tried again to get things right, both to minimize my own pain and also to ensure that Maya was actually getting enough milk.
Things were bad enough that at around 3 weeks postpartum, I seriously considered giving her a bottle instead, especially in the nighttime hours, because the whole experience was so incredibly stressful. I had a box of carefully chosen goat’s milk formula sitting on my kitchen counter, along with a bottle warmer and a clean bottle, just in case I cracked and decided to throw in the towel. In the end, at around 5 weeks postpartum, I figured out how to nurse Maya while lying on my side, and from there on we just co-slept in the same bed. Side-lying was a more comfortable breastfeeding position for some reason, and we both slept better since neither of us had to wake up fully to do breastfeeding. Thus, my stress levels were thus significantly lower, which was good for both of us. Moving on…
Things got better at 6 weeks (as they do for a lot of women, apparently, according to one life-saving book I found around 3-4 weeks postpartum), but even besides the latching pain and my chronic stress about my milk supply, I now know that I had/have D-MER, which has added an extra layer of “fun” to the breastfeeding experience. This is something I literally just learned about in the past week, 5-and-a-half months into breastfeeding, and now that I’m getting ready to wean Maya and stop breastfeeding entirely.
(I really hate to label myself as “having” anything as if it's a part of my identity somehow, but for the sake of clarity, that’s what I’m going to do here…)
Early on, I noticed that every time I breastfed Maya, I’d get a massive surge of anxiety. I felt like I was going to rocketship to the moon, or maybe just start screaming or hyperventilating. The anxiety sometimes literally took my breath away, and the sensation lasted anywhere from mere seconds to a few minutes. Pumping also gave me anxiety, but to a lesser extent. I felt vaguely panick-y sometimes, and breastfeeding stressed me out SO MUCH, especially in the first month or two of Maya’s life. I had to be completely focused and zen in order to accomplish what needed to be done. Each breastfeeding session felt like some kind of marathon or grand performance until Maya was latched well and my milk had officially let down.
Breastfeeding in public especially (even in semi-private locations) was enough to make an okay day go completely bad. My husband had left me shortly before I gave birth, so I was already working through a heavy trauma load after Maya was born, and often, a particularly difficult session of breastfeeding (especially in public, though sometimes at home too) was enough to trigger me and send me over the edge into some kind of trauma spiral.
I ended up in tears many, many times (even if the breastfeeding session wasn’t all that painful, the anxiety or stress it brought out in me frequently pushed me to tears on bad days… of which there were many). For a while, my mom and I went for walks downtown every day with Maya, and when she was really little, this wasn’t a big deal. Maya pretty much just slept happily in her little wrap for the whole trip, including during a lunch meal. The walks were therefore balancing and relaxing for both of us. I got some exercise and my mom and I talked, and Maya got a nap and some closeness time.
But, when Maya started waking up and wanting to hang out and nurse during Downtown Restaurant Time, these outings became stressful. I started trying to plan ahead to avoid having to nurse in public. I didn’t want to go to most restaurants because being around other people while nursing stressed me out, and at some restaurants, there was little I could do to avoid being in plain view of other people. At that time, I didn’t know why I felt this way and I couldn’t explain it, so it just felt silly, and I thought that perhaps I was just being reclusive. I afforded myself the “luxury”, though, and I chose locations to sit in restaurants where I was as far away from others as possible. Eventually, I opted to set up in front of the downtown church to nurse Maya, because it felt more private and “safe” to me, even despite being outside.
Even now, with Maya nearing 6 months old, I have a little bit of anxiety every time I nurse. And I still don’t like nursing in public at all (though it’s less of a Big Thing now than it was when she was first born, mostly because it takes Maya no time at all to nurse now). Sometimes, I’ll have a burst of anxiety just when my milk lets down when I hear Maya cry, or when I’m particularly relaxed (such as in the shower, for example). Or in fact, sometimes my milk will let down at apparently random times. When this happens, I get a burst of anxiety about 30 seconds to 1 minute before I feel my milk let down. Needless to say, it’s super confusing. And it’s taken me 6 months to finally zero in on the problem and look it up on the internet (I spend my entire day researching health problems most of the time, why has it taken me this long to start working out my own situation?).
This is D-MER, or Dysphoric Milk Ejection Reflex.
Different women experience somewhat different symptoms, but the general theme is the same: a woman has a baby, breastfeeds the baby, experiences feelings of anxiety/depression/agitation when her milk lets down while nursing, pumping, or both. These feelings can be extremely intense, or they may be relatively mild. They may last for a couple of seconds, a few minutes, or even for entire nursing/pumping sessions. The woman may or may not also have postpartum depression/anxiety or other mental health complaints.
In fact, many women don’t have postpartum depression or any other kind of mental health issue, and may have an otherwise very happy and healthy relationship with their baby (and with Motherhood in general), but still experience D-MER symptoms.
I was depressed before and after Maya was born, but I can’t really classify it as postpartum depression. While it’s true that I was postpartum and depressed, I had good reasons to feel depressed (for example, my husband had left me at 8 months pregnant, I still had a ways to go on finishing my new house and little to no ability to do any of it myself due to pregnancy/having a tiny infant, which frustrated me because I really like my independence on these kinds of things, and last but not least, my birth experience hadn’t gone anything like I’d expected it to), so I don’t classify my “postpartum depression” as… well, postpartum depression. The depression was pretty valid. The postpartum hormonal changes didn’t help things, I’m sure, but they certainly weren’t the main players in my depression symptoms.
That being said, I also had/have D-MER. But… none of this had anything to do with how I felt about my baby. I adore Maya, and I felt an instant connection with her from the moment she was born. I’ve loved spending every day with her and I love being a mom. I have no complaints whatsoever in that department. Ultimately, though, I pushed through the rough parts of breastfeeding because it was really important to me that I was able to breastfeed, for the sake of Maya’s health. I can’t say I enjoyed breastfeeding at first. Now, Maya and I thankfully have a pretty good breastfeeding relationship, but even still, I get anxiety each and every time I feed her.
D-MER is sometimes associated with a mother having experienced birth trauma (this isn’t always true, but it’s worth noting). Therefore, I just want to note that I did have a traumatic birth experience. In the end, it was positive in a lot of ways, and I’m very grateful for the people who were there for Maya and I when she was finally born, but still, it was traumatic and not what I expected to have happened. I also had a lot of other types of trauma that happened before Maya was born, and therefore, I acknowledge the very likely possibility that my own D-MER symptoms were/are rooted in this trauma.
I tell this story so that other moms in a similar position don’t feel so lost and alone. I wish someone had told me about this, since literally every book and website that I found before Maya came along told me that the release of oxytocin was just automatically supposed to make me feel all chill and happy and relaxed while breastfeeding. Not anxious. Once the initial pain of latching was under control, I actually did come to enjoy nursing, but… I can’t say it’s always relaxing for me. It actually does relax me sometimes, but only after the initial anxiety surge. Occasionally, breastfeeding still makes me feel unusually flustered, especially if I have a lot of other things on my mind and I’m holding a conversation while trying to start a breastfeeding session. I’ve gotten much more used to the D-MER symptoms at this point, and they’ve gotten less severe over time, but for a lot of women, the D-MER symptoms alone are bad enough to cause a complete end to breastfeeding (which is unfortunate, though definitely understandable).
Click here to read about other women’s experiences with D-MER.
Types of D-MER
According to the conventional model, there are 3 main categories or “types” of dysphoric milk ejection reflex. Some women may experience symptoms of all of these categories, or they may tend toward only one or two types. The different D-MER categories are:- Despondency / Depression D-MER
- Anxiety D-MER
- Agitation / Anger D-MER
Dysphoric milk ejection reflex may further be categorized as being mild, moderate, or severe.
Understanding that there are a few different categories and ratings of D-MER can be helpful if you’re trying to understand your own symptoms. This can be a valuable communication aid if you’re wanting to express yourself clearly to a partner or loved ones. That being said, if you see yourself in all three of these categories, or in two of the categories, that’s fine. Again, this is intended to help you to communicate, both with yourself and others.
Symptoms of Dysphoric Milk Ejection Reflex
Let’s explore the symptoms of D-MER in more depth. Please keep in mind that different women with D-MER have different symptoms and different levels of intensity of these symptoms. If any of the symptoms below describe you, read on. If you’re not sure, it may be helpful to keep a journal to see if you notice any patterns (I recommend carrying around a little notebook and pen in your pocket or in a fannypack so that you can write down your impressions any time you’re feeding your baby, pumping, or when you feel a spontaneous milk letdown; you’re not going to be able to note down impressions for every letdown, and that’s fine, even a few notes here and there will help you notice patterns).For many women, these symptoms disappear after 3 months of breastfeeding, but for others (like myself) the symptoms can persist up to 6 months, 1 year, or even longer, potentially for the entire duration of a woman’s breastfeeding journey. The severity of the symptoms may be persistent, or the severity may decrease over time.
It’s important to remember that these symptoms are reflexive. Dysphoric milk ejection reflex is, for the women who experience it, a physiological response that happens automatically in the same way that other women automatically experience relaxation or feelings of peace while breastfeeding. While there are medicinal agents that can help manage the D-MER reflex, it’s not realistic to try and control it only with your mind, just like with any other reflex (try to stop your knee from jerking reflexively when the doctor taps it, it’s not even possible, no matter how strong your willpower is or how much you believe that you can). You can however observe the reflex in action and learn to understand it. A solid understanding of your own reflexive response to a milk letdown can do wonders in helping you feel like you handle yourself and whatever emotions might come up while breastfeeding.
Here are some D-MER symptoms that a woman may experience during a milk letdown (regardless of the exact “type” of D-MER she experiences):
- Sadness
- Hopelessness
- Feelings of self-hate
- Low self-esteem
- A sinking or hollow feeling in the stomach
- Heaviness in the chest
- Feelings of dread / impending doom
- Anger
- Agitation
- Anxiety
- Panic
- Irritability
- Shame and/or embarrassment
- Guilt
- Food aversions or lack of desire to eat or drink while breastfeeding (feeling temporarily “disgusted” by foods/drinks)
- Thoughts of self-harm or suicide (these feelings are transient and it’s extremely rare for a woman to act on them, but they can still be extremely distressing)
- Introspectiveness
- Apprehension
- Paranoia
- Dread
- Tension
Many women characterize the symptoms of D-MER as being a feeling of “homesickness”, or in other words, a feeling of longing or wistfulness. Another way to describe the feeling of homesickness that’s worth considering is that it feels like the “unhappy remembering of a happy time”, according to one scientific article.
Factors Influencing Symptom Severity
It’s also helpful to know about some factors that can potentially make the symptoms of D-MER worse. While you’ll likely be unable to avoid all of these factors, it can be good to know what they are since this can help you understand what you might experience emotionally on different days and in different circumstances. Factors that can exasperate D-MER include:- Physical touch
- Caffeine
- Stress
- Birth control medications
- A negative or cluttered environment
- Being around other people
- Changes to the menstrual cycle
- Lack of self-care
- Galactagogues
- Low carb diets
- Going too long between feedings
Again, keeping track of your impressions of your symptoms in as much detail as realistically possible can also help you identify which factors might worsen your D-MER symptoms.
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Resources:
• Cleveland Clinic (n.d). Dysphoric Milk Ejection Reflex (D-MER). Retrieved January 13, 2023 from: https://my.clevelandclinic.org/health/diseases/24879-dysphoric-milk-ejection-reflex
• Heise, Alia M. and Wiessinger, Diane (2011). Dysphoric milk ejection reflex: A case report. Retrieved January 13, 2023 from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3126760/
• Deif, Reem, et. al. (2021). Dysphoric Milk Ejection Reflex: The Psychoneurobiology of the Breastfeeding Experience. Retrieved January 14, 2023 from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8594038/
• Uvnas-Moberg, Kerstin, et. al. (2018). The Mystery of D-MER. Retrieved January 14, 2023 from: https://connect.springerpub.com/content/sgrcl/9/1/23.full.pdf
• Revelant, Julie (2017). The Anxiety I Had While Breastfeeding Is a Real Condition. Retrieved January 14, 2023 from: https://www.thebump.com/a/dmer-breastfeeding-anxiety-condition
• Upledger Institute (n.d). Emotional Difficulties, Depression, and CranioSacral Therapy. Retrieved January 16, 2023 from: https://www.upledger.com/conditions/emotionaldifficulties.php
• Bhattacharjee, Monojit, et. al. (2023). MAO inhibiting phytochemicals from the roots of Glycyrrhiza glabra. Retrieved January 16, 2023 from: https://pubmed.ncbi.nlm.nih.gov/37243713/
• Van Diermen, Daphne, et. al. (2009). Monoamine oxidase inhibition by Rhodiola rosea L. roots. Retrieved January 16, 2023 from: https://pubmed.ncbi.nlm.nih.gov/19168123/
• Janda-Milczarek, Katarzyna, et. al. (2020). Passiflora incarnata in Neuropsychiatric Disorders - A Systematic Review. Retrieved January 25, 2023 from: https://www.researchgate.net/publication/347495207_Passiflora_incarnata_in_Neuropsychiatric_Disorders-_A_Systematic_Review
