Why Do I Feel Upset While Breastfeeding: D-MER

by jordan berns

Mothers’ mental health is an important discussion that everyone should engage with. Caring for a newborn is a vulnerable time, and postpartum depression and anxiety can be a real concern. However, some mothers present with negative emotions only during the let-down of breast milk. These women feel fine during all other aspects of the day, but nursing brings up feelings of dysphoria, including anxiety and depression, just to name a couple.

What is D-MER:

Roughly over a decade ago, mothers and scientists partnered together to create a new diagnostic criteria for this phenomenon. It’s called D-MER, Dysphoric milk ejection reflex. It occurs during milk let-down, including pumping and spontaneous milk let-down not prompted by breastfeeding. Women with D-MER can feel a myriad of emotional responses such as irritability, homesickness, anxiety, hopelessness, a churning stomach, feel fidgety, emptiness, anger, dizziness, or feelings of restlessness. Having D-MER does not mean you hate breastfeeding, dislike your baby, or have “breastfeeding aversion;” it’s a specific and abnormal hormonal shift.

Do you experience negative emotions while breastfeeding?

Why Does D-MER Occur:

Your body releases the hormone oxytocin to encourage milk to leave the breast. Then dopamine levels drop to make room for the hormone prolactin, which signals your body to produce more milk. Normally when a woman breastfeeds, the oxytocin causes her blood pressure and pulse to lower, which generally should make both baby and mother feel relaxed and happy.

In women with D-MER, the drop in dopamine levels is too severe, causing a negative emotional reaction that starts 30 seconds to 1.5 minutes before release, and these uncomfortable sensations can last several minutes. Oxytocin is a natural trigger to prompt women to feel more protective of their babies. With D-MER, this increase in oxytocin goes beyond a protective response and instead activates the fight-or-flight response. This explains the rush of troublesome emotions.

Is your let-down a let-down?

How to Diagnose D-MER:

There is no blood or physical test for D-MER. D-MER is diagnosed through the analysis of symptoms that occur during let-downs. Let-downs don’t necessarily only occur when you’re breastfeeding or pumping; hearing your baby cry or even just thinking about your baby can cause a let-down. There may be times you can physically feel the sensation of a let-down and times where it occurs but doesn’t register with you. While women can also present with breast or nipple pain or injuries, that is not a prerequisite for having D-MER.

D-MER cases are rated on a scale of mild, moderate, or severe. Mild D-MER will dissipate before 3 months, moderate cases go away before 9 months postpartum, and severe D-MER can take a year to self-correct. On some occasions, D-MER is only solved by completely weaning.

The top 9 ways to treat D-MER.

D-MER can be very distressing and is an automatic reflex to a legitimate chemical issue; there is no willing yourself to feel better. However, here are few ideas for treating the emotional distress.

  1. Skin-to-skin contact between you and your baby can decrease cortisol levels and lower your heart rate, which can reduce feelings of anxiety.
  2. Mindfulness practices such as differentiating between facts and momentary feelings that will eventually go away can sometimes help.
  3. Watching your favorite show while you nurse can distract away from unpleasant sensations.
  4. Many mothers find solace in breastfeeding in a pleasant place, with a warm compress on their shoulders or soaking their feet in a warm bath.
  5. To maintain blood sugar levels, eat a healthy diet with adequate amounts of protein.
  6. Staying hydrated and minimizing caffeine intake may also be affective.
  7. Exercising and making sure to rest and relax is also a foundation of feeling better.
  8. Lower your vulnerability and anxiety by decreasing your exposure to toxic and stress-inducing individuals.
  9. CBT therapy or some medications, like the antidepressant Wellbutrin, may be helpful as it raises dopamine levels.

D-MER is a serious condition that is believed not to be rare, but instead is underdiagnosed. According to a 2011 case study, D-MER was suggested to be more common than galactosemia and Sheehan’s Syndrome. New mothers who experience dysphoria at the beginning of breastfeeding sessions should keep a journal of let-downs and emotional experiences to share with their doctor to aid in getting the right diagnosis. Those with previous trauma and high levels of stress are particularly at risk. Having undergone D-MER with one child predisposes you to having it with future children. D-MER can make breastfeeding a difficult and trying time. Considering all of the available treatment options, including weaning, is vital. There is nothing more important than your mental health!


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