Have you, or someone you know ever experience negative emotions or feelings while
breastfeeding? Dysphoric milk ejection reflex (D-MER) might be the cause of these feelings.
Defining and understanding D-MER
To truly understand Dysphoric milk ejection reflex (D-MER), it is important to note that D-MER comes as waves of negative emotions that usually start prior to the initial milk ejection in a feeding session, lasting around 2 minutes or until the infant starts feeding vigorously and the ejection reflex has passed (Cox, 2010; Heise, n.d.; Ureno, et al., 2019).
In many cases these feelings return once again just prior to the following let-down (Heise, n.d.). Many mother expressed that these feelings last around 3 months, although studies have shown that these symptoms can continue throughout the breastfeeding journey (Cox, 2010).
These brief emotions can range in their severity, from regretfulness, a pitting feeling in the mothers stomach, anxiety, sadness, dread, introspectiveness, nervousness, anxiety, becoming emotionally upset, angst, irritability, hopelessness, and general negative emotions (Heise, n.d.). These emotions are all rooted from a physiological cause. A study by Heise & Wiessinger (2011), suggests that there is a sudden drop in dopamine in the mothers who are experiencing D-MER. This drop in dopamine is triggered when the milk is released from the ducts. This sudden drop puts the mother experiencing the phenomena in a dopamine deficit. These feelings and emotions are unavoidable. A mother can feel them coming but
can’t stop them from taking control. They are usually accompanied with each letdown,
and sometimes just with the first letdown. Interestingly these feelings pass after a minute or two. These emotions are so powerful, but disappear just as quickly as they appeared.
Level of severity
D-mer has a spectrum of symptoms, and differing levels of intensity. Those who experience feelings of depression, wistfulness, homesickness, and apprehension are considered to be experiencing a mild case, which usually corrects itself with in the first three months postpartum. If a parent feels anxious, or dread in addition to the previous stated symptoms, they would be categorized in the moderate level of intensity which usually lasts between 6 and 12 months. A parent experiencing a severe level of intensity would be experiencing all the mentioned symptoms in addition to anger, suicidal thoughts and tension. These feelings reoccur during the breastfeeding journey until the child is weaned (Ureno, et al., 2019).
At first glance these symptoms may appear psychological. However there is a considerable amount of information that directs us in a physiological source. Evidence has show us that those suffering from D-MER suffer from feelings of dysphoria, which is only present during a milk release. These mothers feel absolutely normal prior to the milk flowing. Interesting this dysphoria doesn’t not need to be initiated by a suckle or stimulating, rather the mere fact that there is a milk ejection reflex. It is important to note that this is not connected to postpartum depression (PPD). Many mothers feel perfectly fine prior to the ejection reflex. If a mother has a previous diagnosis of PPD it will be harder to experience these symptoms (Heise, n.d.). A previous life trauma will not contribute to D-MER, but D-MER can strengthen and create a déjàvu like experience with those traumatic memories because of the drop in dopamine during both experiences.
D-MER can also occur suddenly, and intensely after having a number of normal lactations. Which can be influenced quickly or after a period of time by circumstances that effect dopamine regulation. Most women find that these feelings gradually get better over time. Although, those that have more severe symptoms early on in their breastfeeding experience are more likely to have these symptoms last (Tankard, 2020).
D-MER is thought to be triggered by a drop in dopamine when having a milk ejection reflex. Many studies attributed this experience to environmental factors, for example; a deficiency in her hormones or nutrition. Alternatively many explored the connection between the receptor sites in the brain for mutations, or a predisposition to abnormal dopamine activity. There are still many researchers trying understand the complexity of these symptoms, and much more research is necessary to help us understand the predispositions for D-MER.
In another study conducted by Hillerer et al. (2011), the researchers found that oxytocin was highly correlated with the human stress response. The human body is usually able to up-regulate oxytocin, when it is not going through a stressful situation. Conversely, when a person goes through a stressful experience, oxytocin is down regulated. Those who experience D-MER appears to have their oxytocin up-regulating
their stress response while breastfeeding. Stress during pregnancy can trigger this defensive response. Animal studies have found that stress during pregnancy can reverse the suckling-related positive effects of
oxytocin release and lead to negative, inhibitory effects. Additionally, the synthetic oxytocin used during labor can actually block the naturally occurring oxytocin causing more pain, and enhancing the level of stress during labour and postpartum. This research is linked to an increased risk in PPD (Kendall-Tackett, Cong, & Hale, 2015).
How can a healthcare professionals help
When a health care provider initiates an appointment with open-ended questions, they allow the mother to open up and express her feelings. This allows the health care provider to provide guidance when needed. There are a number of unreported cases of D-MER symptoms. This is common due to the fact many mothers feel embarrassed or nervous that they may be prescribed medication. As well, these mothers don’t want to be seen as different, they may be embarrassed for not having a positive breastfeeding experience.
Discussing and talking about these symptoms allows the mother to feel comfortable with the fact that they are not alone. Many women are comforted with the knowledge that they are experiencing a recognized phenomenon.
How to ease and treat these symptoms
Although there is no cure to D-MER at this time, many mothers find that there are some small distractions that ease the experience. Such comforts include music, or aromatherapy. A small percentage of mothers opt for a prescription to help them through this uncomfortable experience ( Heise, & Wiessinger, 2011). In addition, educating parents about the symptoms and triggers will help them to validate their lived experience. Those parents who had self care routines, mediated, took Vitamins B and D, magnesium, probiotics, and drank cold water with the letdown saw a dramatic improvement in their symptoms associated with D-MER.
What are possible triggers that contribute to D-MER
There are some triggers that seem to increase dopamine levels, and cause them to crash later on. These triggers include highly caffeinated drinks, foods high in sugar, and nicotine. Additionally, a lack of education, as well as isolation, stress, touch, birth control, long breaks between feedings, and an unhealthy environment can all alter the mothers response to dopamine. Staying away from these items will decrease the chance of having a crashing dopamine high (Heise,n.d. ; Tankard, 2020).
Those experiencing D-MER have enlightened the breastfeeding community that there is still much to learn about lactation. Additionally, it is important that those experiencing D-MER have the opportunity to unpair the stress response from their milk ejection reflex. This can be achieved by up-regulating the oxytocin by promoting safety, having skin to skin time with the infant, meditating, having a clean and organized environment, including more self care, and nutrition in to their routine.
Mothers who experience unsafe environments can have their fight or flight response triggered, which contributes to D-MER symptoms. It is important to have people you trust near, so that you can access their help. Mother’s who are able to initiate skin to skin with their infant will have benefits for not only them but their infants as well. The stress response will decrease substantially. The heart rate, and temperature are linked to the sympathetic nervous system and can be lessened with these actions
(Bystrova et al., 2003). Skin to skin contact was also seen to have countering effects on these negative emotions and feelings associated D-MER.
Meditation is another great tool which provides a break from other stimuli and clutter that often occurs in our minds. By focusing on aspects such as breathing or being present, the mothers will be able to take hold of the moment and control their thoughts and feelings. It is imperative that these mothers keep in mind that these emotions are fleeting and will soon dissipate. This is a very powerful way to down regulate the stress response.
Eating well, and self care can help maintain the mothers blood sugar. By including more protein and decreasing the amount of carbohydrates regularly eaten, this improved diet can dramatically change how the mother may feel during a letdown. The combination of self-care and protein were seen to help a number of mothers symptoms to improve (Uvnas-Moberg, & Kendall-Tackett, 2018).
Each of these steps will have a strong impact reprogramming the oxytocin imbalance. D-MER is a mystery to many, and is very difficult for those who are experiencing it in real time. We hope that a better understanding, and remedy are on the forefront of research. In the meantime we urge you to reach out to us at Mamas Au Lait for assistance by creating a plan that works best for you.
Book an appointment with us here.
By Deena Zacks.
REFERENCES:
Bystrova, K., Widström, A. M., Matthiesen, A. S., Ransjö-Arvidson, A. B., Welles-Nyström, B., Wassberg, C., ... & Uvnäs-Moberg, K. (2003). Skin-to-skin contact may reduce negative consequences of “the stress of being born”: a study on temperature in newborn infants, subjected to different ward routines in St. Petersburg. Acta paediatrica, 92(3), 320-326.
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. (n.d.). Welcome to d-mer.org. D-MER.org. Retrieved November 13, 2022, from https://d-mer.org/
Heise, A. M., & Wiessinger, D. (2011). Dysphoric milk ejection reflex: A case report. International breastfeeding journal, 6(1), 6. https://doi.org/10.1186/1746-4358-6-6
Hillerer, K. M., Reber, S. O., Neumann, I. D., & Slattery, D. A. (2011). Exposure to chronic pregnancy stress reverses peripartum-associated adaptations: implications for postpartum anxiety and mood disorders. Endocrinology, 152(10), 3930–3940. https://doi.org/10.1210/en.2011-1091
Kendall-Tackett, K., Cong, Z., & Hale, T. W. (2015). Birth interventions related to lower rates of exclusive breastfeeding and increased risk of postpartum depression in a large sample. Clinical Lactation, 6(3), 87-97.
Tankard, Z. (2020). What is D-mer? La Leche League International. Retrieved November 13, 2022, from https://www.llli.org/what-is-d-mer/
Ureno, T. L., Berry-Cabán, C. S., Adams, A., Buchheit, T. L., & Hopkinson, S. G. (2019).
Dysphoric milk ejection reflex: a descriptive study. Breastfeeding Medicine, 14(9), 666-673.
Uvnas-Moberg, K., & Kendall-Tackett, K. (2018). The Mystery of D-MER: What Can Hormonal Research Tell Us About Dysphoric Milk-Ejection Reflex?. Clinical Lactation, 9(1), 23-29.
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