Alyssa Walker was starting to figure new motherhood out—her daughter was healthy and her milk had finally come in. But the act of breastfeeding was awful, and not because of the typical cracked nipples and cluster feeding. Whenever Walker nursed her daughter she felt an intense wave of emotions. “Suddenly I felt completely helpless and very stressed out and anxious about my future as a parent,” says Walker. And then, just as quickly, the feeling of hopelessness went away as if it had never happened.
At first, the 29-year-old Toronto mother had no idea what was happening—she was aware of postpartum depression, but didn’t think that’s what she was experiencing, because of how quickly the emotions came and went. Of course, she turned to google, and an internet search revealed she was suffering from a little-known condition called Dysphoric Milk Ejection Reflex, or D-MER.
During breastfeeding, your baby’s tongue pushes up on your nipple, which signals the release of oxytocin. This oxytocin causes your breast tissue to contract and let milk down into the ducts and out the nipple. It’s during this letdown that some women experience a severe dip in their mood. “Some people feel so depressed all of a sudden,” says Verity Livingstone, a medical doctor and a Fellow of the Academy of Breastfeeding Medicine who runs the Vancouver Breastfeeding Clinic. “Other mothers experience a much less profound sense of doom and gloom, but just a strong sense of sadness, or fear, or anxiety.” After the letdown reflex is over, the sensation fades away, with the whole thing generally lasting from about 30 seconds to a minute. But the sensation can happen each time a woman’s milk lets down—which is often multiple times in a feed. “If you could imagine a mother who's breastfeeding eight times a day, she may be having 8, 10, or 20 letdowns in a 24-hour day,” says Livingstone.
D-MER likely has to do with hormonal changes that happen during breastfeeding. Since the condition has only recently been recognized by the medical community, research on it is limited so far. But it’s thought to be related to dopamine, which controls the production of the hormone prolactin. Prolactin, in turn, stimulates the production of milk. However during letdown there is a sudden drop of dopamine in the blood, which then quickly bounces back—coinciding with the feeling fading away. D-MER is a physiological response, not a psychological response, says Livingstone. “It’s not just something in a woman’s head—it’s a real, true feeling.”
While D-Mer is generally thought of as a rare condition, Livingstone says it might actually be more common than thought as more people become aware of it. “I've been running my medical breastfeeding clinic for almost 40 years and I might see somebody with D-MER every three to six months,” says Livingstone. Because it’s not well studied or understood, there’s virtually no statistics on how many women are affected by D-Mer.
For some, D-MER gets better as their baby grows and breastfeeding is more established. “It happened during every letdown at the beginning, but happened less and less as time went on,” says Walker. Now that her daughter is 13 months old, she generally only experiences the feeling if she waits too long in-between feeds. For some women, the sensations can get less intense, says Livingstone, but for others, it can last until they wean their baby.
You can try to make breastfeeding more pleasant by using self-calming techniques during breastfeeding to help you push through the sensation or recover afterwards. Try things like deep breathing, watching a distracting television show, or asking a loved one like your partner to sit with you while you experience it, or keep older children occupied elsewhere, like in another room if possible. Livingstone also recommends finding a D-MER support group to have someone to talk to and a community that can recommend different strategies to help.
If the sensation is severe or you’re experiencing thoughts of harming yourself or your baby, go to your doctor ASAP. It could be more than just D-MER, or D-MER could be exacerbating a condition like postpartum depression and anxiety. Because this sensation can feel very overwhelming, it’s worth speaking to a professional to see if they can help and they may be able to prescribe antidepressants or other medications, though because the condition isn’t fully understood there’s also no proven treatments yet.
You should be prepared that your doctor might not know about it. There’s still not a lot of medical awareness and knowledge about D-MER. “I bet you'll find that if you ask 100 doctors, 99 of them would have never heard of this,” says Livingstone. That was the case in Walker’s situation. She told her doctor and didn’t really get any understanding or help so she turned to an online support group.
Walker started dreading nursing her daughter because she was worried about feeling that horrible sensation. “I really wanted to stop because I thought, I shouldn't do this because it's emotionally damaging me. And everybody tells you oh, breastfeeding is such a wonderful experience that I felt like, okay, well, I'm doing something wrong then, like there's something about this that's not working,” she says. But knowing what was happening and that it was temporary helped a lot, and she continued to breastfeed, and eventually the feelings improved.
D-MER does generally go away when women stop breastfeeding so if it’s very severe, in some cases Livingstone will recommend that a mother wean early. “Because the risks to the mother are worse than not breastfeeding her baby,” she says.
Unfortunately, if you have D-Mer with one child there’s a good chance you’ll have it with subsequent children as well.