After a somewhat challenging pregnancy and a long, intense labour, my beautiful boy was born, and our breastfeeding journey began. Like many feeding mothers, we’ve tackled some hurdles - sore nipples, a poor latch, and an oversupply however, with some small changes to the way we do things, we’ve worked through them.
One unexpected challenge, however, was something called Dysphoric Milk Ejection Reflex (D-MER).
So, what is D-MER? D-MER is a condition where negative emotions—such as sadness, anxiety, or even anger—suddenly occur right before or during the milk let down. These feelings are involuntary, often intense, and typically last only a few minutes. D-MER is not the same as postpartum depression or general anxiety; it's a physiological response triggered by the milk ejection reflex.
Why does D-MER occur? D-MER is thought to be related to the abrupt drop in dopamine levels that occurs during a milk let down. In mothers with D-MER, this drop is more pronounced or occurs more rapidly than normal, resulting in feelings of dysphoria. The severity of D-MER can vary from mild discomfort to severe distress, and it can manifest as a range of negative emotions, from anxiety and irritability to feelings of doom or panic. These emotions usually last from 30 seconds to a few minutes and typically resolve on their own as the feeding continues.
On day 5 post birth, I was having a discussion with one of my midwife colleagues (and dear friend) about how my breastfeeding journey was going. I shared with her that when I started feeding, I’d feel thirsty, tired, and anxious, with a sinking feeling in my stomach. It would quickly pass, but it was overwhelming while it lasted. She suggested I look into D-MER, as my symptoms seemed to align.
I didn’t think much of it at the time, but I noticed the intensity of the feeling increasing when feeding, particularly overnight when I was exhausted. The beautiful thing about oxytocin is that it makes you forget (everything) so I would forget about the feeling until I needed to feed again.
After some research, listening to podcasts, and discussing further with my midwife, it became apparent I was experiencing D-MER. One of the podcasts I listened to (see below – very much worth a listen) discussed the difference between D-MER and breastfeeding aversion which was very helpful. It also highlighted the challenge of discussing D-MER with healthcare professionals, as it’s often misdiagnosed as Postnatal Depression (PND) or other mental health conditions.
Unfortunately, there isn’t much research on how to manage D-MER, but here’s what helped me:
Distraction - Keeping myself occupied when initially putting my baby to the breast—whether through conversation, mindfulness, scrolling my phone, or even snacking—occasionally helped ease the intensity of the feelings.
Knowledge is power - Understanding that D-MER is a biological response helped me feel less confused or guilty.
Find your triggers – Fatigue is a major trigger for me, and while I can’t always avoid it, being aware of it helps me prepare mentally.
Boosting dopamine – I’m unsure if this has worked for me but finding ways to increase your dopamine through simple actions like skin to skin, sipping coffee or drinking coke can counteract the dopamine drop.
Talk about it! I felt so confused about why I felt the way I did. By talking about it, I understood what it was and why I felt the way I did.
Another condition that effects breastfeeding that can be confused with D-MER is breastfeeding aversion. Unlike D-MER, breastfeeding aversion typically involves negative feelings throughout the entire feeding session, not just at the moment of let down. The causes of breastfeeding aversion also vary.
At times I have felt guilty for not loving every moment of breastfeeding, especially when I’ve had minimal other complications. I’ve also felt isolated at times because no one understands the feelings you experience. Or no one talks about it. In saying that, the more that I’ve spoken about it with other breastfeeding women, the more common I realise it is. It seems many women potentially are experiencing or have experienced D-MER but have been unable to term it.
As a midwife, I’ve supported countless women through breastfeeding challenges, and I’ve always felt fortunate to be able to feed my baby. Still, this experience has been both difficult and isolating at times and continues on.
I’m sharing my journey not just as a reflection, but to raise awareness. If you’re experiencing D-MER, know that you are not alone, and it doesn’t mean there’s something wrong with you. D-MER is a recognised condition, and it doesn’t reflect your love for your baby or your commitment to breastfeeding.
Remember, every breastfeeding journey is unique, and seeking help when needed is always okay.
Disclaimer: This is my personal experience with D-MER and not meant to be taken as medical advice.
Podcast: The Midwives’ Cauldron – Breastfeeding aversion, agitation and dysphoric milk ejection reflex – An interview with Zainab Yate
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