DMER: Why Breastfeeding Sometimes Brings Negative and Unpleasant Feelings
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5 min
The birth and arrival of a new baby is an exciting time, and many mothers eagerly anticipate bonding with their new baby through a breastfeeding relationship. You have probably read books, talked with friends or other family members about their breastfeeding experiences, and taken a prenatal breastfeeding class to prepare for breastfeeding. These are great ways to learn about what to expect and glean insight about tips and tricks for positioning, latching, pumping milk, and breastfeeding. During this preparation time, you will also likely hear about and your doctor may screen for potential concerns for different mood disorders like postpartum depression or anxiety. Dysphoric Milk Ejection Reflex, often shortened to DMER, is not a condition that can be screened for during the prenatal period, and is often shocking and confusing when it is experienced postpartum. In this article, we will explore what DMER is, why it happens, and how to get relief.
What is Dysphoric Milk Ejection Reflex?
Dysphoric milk ejection reflex (DMER) is a condition that causes a range of negative feelings and emotions in the moments before the milk ejection reflex, sometimes called the milk letdown, and lasts anywhere from 30 seconds to several minutes. (1) Dysphoria is a state of unease, dissatisfaction, and discomfort in one’s body. DMER is different from postpartum depression or postpartum anxiety and is isolated to just before and during the milk ejection reflex. It is not breastfeeding aversion or a dislike of breastfeeding; however, it can create significant challenges for breastfeeding when knowing unease or other symptoms might be elicited shortly after beginning to feed your baby or pump your milk.
During breastfeeding, the hormone oxytocin is a hormone that is released during nipple stimulation from the baby sucking or can be stimulated by using a breast pump to remove milk. When oxytocin increases, another hormone called dopamine decreases. The drop in dopamine signals prolactin to be released, which stimulates milk production. (2)
When oxytocin is released in response to the baby nursing, it causes the myoepithelial cells to contract around the alveoli in the breast, squeezing milk into the milk ducts to flow and release out through the nipple. (3) Some people feel pressure, tingling, or similar sensations during the milk ejection reflex along with a sense of relaxation and comfort, but for others, this oxytocin reflex and drop in dopamine results in immediate unpleasant symptoms, which is the case with DMER. The unpleasant symptoms may be mild, moderate, or severe and can occur during only the first letdown or all letdowns during a nursing or pumping session.
DMER may affect approximately 25% of women, or 1 in 4 women, postpartum. (5)
Unfortunately, many women are not educated by their care providers about the signs and symptoms of DMER. DMER can have significant impacts on the breastfeeding relationship, and some women stop altogether due to the negative feelings and sensations they experience. With such a high percentage of women experiencing DMER, improvements in parental education for the signs, symptoms, and treatment of DMER are much needed. As many as 45% of women experiencing DMER ended their breastfeeding journey because of it. (6)
Symptoms of DMER (4)
Anxiety
Sadness or a feeling of dread
Irritability or nervousness
A hollow feeling in the stomach or nausea
Feeling hopeless or a sense of doom
Anger
Restlessness
Panic
Dizziness
Feeling of emptiness, worthlessness, guilt, or shame
Physical discomfort
Who is at risk for DMER?
Some people are at greater risk for DMER, including people with a mood disorder prenatally or a history of mental health conditions. If you have experienced postpartum depression, your risk for DMER increases. Other populations of people with a higher risk of DMER are those with higher levels of education or an immigration background. (7)
Finding relief for DMER
Education - learning about the symptoms and how to reduce the negative symptoms, as well as informing others how to best support you. DMER is a medical issue and not a psychological problem.
Rhodiola - this herb is often used for reducing anxiety and alleviating stress and fatigue, and may help reduce the symptoms of DMER. Rhodiola acts as a monoamine oxidase inhibitor and inhibits the breakdown of dopamine, therefore lessening the severity of DMER’s symptoms. (9)
B complex vitamin supplement - may help improve mood and increase dopamine levels. (12)
CBD oil - the endocannabinoid system has some control over the neurotransmission of dopamine and may help increase dopamine levels. (10) Because of the lack of published research on the effects of CBD on infants who breastfeed, you should discuss its use with your doctor before using CBD. (11)
Gut health - to support the endocrine balance of oxytocin and dopamine. Your gut microbiome communicates with your brain and provides information for releasing hormones, including oxytocin. (13)
Mindfulness, deep breathing, and distraction - deep breathing, listening to music, or other distractions can help take your mind off the negative experience. While it may not eliminate the symptoms, reducing them can greatly help.
Support from your partner - this is one of the most effective ways to cope with DMER. (7)
Getting enough rest and sleep - everyone functions better when they feel rested and have quality sleep. Napping when your baby naps or going to bed an hour earlier may help your body feel more rested.
Drinking cold water or a carbonated drink during the DMER experience
Increase intervals between milk removals if possible, while still meeting the caloric needs of your baby
IBCLC - Talk with your International Board Certified Lactation Consultant (IBCLC) and doctors about your experience and what might be a good strategy for you to manage the DMER symptoms you have.
What to avoid if you experience DMER (7)
Stress
Caffeine
Dehydration
Becoming overtired
Isolation, loneliness, or lack of support
How long does DMER last?
During nursing or pumping, the symptoms of DMER last a short period of time, typically just before and during the milk ejection reflex or letdown, and subside after a few minutes. Some people only experience the symptoms during the first letdown, while others have negative symptoms recur during subsequent letdowns.
People who experience mild DMER often have symptoms resolve around 3 months postpartum. The more significant someone’s symptoms, the longer DMER may continue to occur. Moderate DMER may last 9 months postpartum, and severe DMER may last beyond the first year postpartum or until weaning. (8)
While DMER can be challenging and even distressing, learning about its causes, symptoms, and management strategies can help you feel more empowered and less alone. With support, education, and self-care, many parents can continue their breastfeeding journey with greater confidence. There are options for decreasing the effects of DMER while breastfeeding. Talking with your IBCLC and care providers can assist you in choosing the best options for you and your baby.
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