When breastfeeding is rage-inducing
I had just brought my second child home from the hospital and was settling into those early, fuzzy, tiring but exhilarating days of figuring out my life with a toddler and a new baby when something strange started to happen. While I was breastfeeding, I started feeling an intense and overwhelming sadness and anger which came on very quickly and lingered for several minutes. It was almost like rage. I felt so uncomfortable having those feelings with my baby in my arms. Certainly, the last thing I would want to feel was furious when I was with my baby and I felt so confused by what was happening. Due to the shame and discrepancy between how I thought I should feel and how I actually felt, I quickly decided to exclusively pump and bottle feed. I was so confused as to why this was happening, and why I felt this feeling that hadn’t happened with my first child’s breastfeeding experience.
Like most people, I started a search for answers by googling “feeling awful during breastfeeding.” This query took a bit of a deep dive to become productive, but it finally brought me to a term I’d never heard of – Dysphoric Milk Ejection Reflex or D-MER. At that time, in 2017, there were only a scant few articles I could find on google scholar, but looking at those articles I realized I was experiencing what they described. I had D-MER for the first time as a second time mom.
What is D-MER?
D-MER is a condition in which a breastfeeding person feels a wave of strong negative emotions in the moments before and after the letdown reflex. It can last for mere seconds or linger for the whole breastfeeding/pumping session, or even beyond. Up to 25% of breastfeeding people report experiencing D-MER. There haven’t been many studies that look at D-MER, so we can’t say for sure what causes it, but there are several hypotheses. It is hypothesized to be a neuroendocrine condition. More specifically, some scientists think that the shift in oxytocin during letdown may turn on the stress response in some people, and that dopamine may be temporarily disrupted during this letdown period. Both or either of these chemical changes may contribute to these feelings of doom, gloom, guilt and sadness. In other words, this is a physiological & biological syndrome.
What does D-MER feel like?
Many people describe a range of emotions such as feelings of sadness, discomfort, anger, or frustration or even rage, like I felt. You may feel worthless, depressed, guilty, or confused. You might feel restless or a need to get up and move around, dizziness or tightness in your chest. Some people even experience suicidal thoughts during the waves of intense physical sensations. Heise and Wiessinger (2011) describe one woman’s experience as “between milk releases, she felt extremely happy and well-bonded to her baby. Just before each milk release, however, and despite her best efforts, she felt helpless, hopeless, worthless.”
Challenges of D-MER
Obviously one of the biggest challenges in D-MER is how to manage the emotional swings. The feelings come on like a strong wave and can be overpowering and scary to a parent, especially if they are holding their child at the time.
Often, D-MER may lead to early cessation of breastfeeding in order to stop the feelings, which may lead to personal disappointment. In fact, it seems like as many as 45% of people who experience D-MER stop breastfeeding, whether they wanted to breastfeed for longer or not, due to the negative body and mood symptoms.
Further, D-MER may be mistaken for PPD (postpartum depression). Although the two can coincide, they are not the same thing and efforts should be taken to discern the difference.
How can I manage D-MER?
Frustratingly, there has not been enough research to truly give us answers. However, anecdotally it seems like there are things that can help someone who has D-MER. First of all, just knowing that this has a name and is a real condition helps. Once you know what something is, you can start to figure out what you need. Many women find that exercise and healthy food and sleep are part of a baseline of mental and physical health that we should always mention. Beyond that, having a thorough discussion of different options to breastfeed, pump, or wean can be supportive. Increasing skin-to-skin with baby, relaxation techniques, and mental distractions are all potentially helpful as well.
Tell someone about what you are experiencing - it could be a friend, but even better if you can tell your doctor, pediatrician, or a therapist. D-MER is not caused by psychological issues, but through biological, physiological patheways. You didn’t do anything wrong. You may experience it with each pregnancy or with one and not another. The reason it is helpful to talk about it is because it can change the way you see yourself as a person, as a mother, and it may impact your thoughts. Therapy can help by giving you more information and perspective, as well as helping you focus on the aspects of mothering that are meaningful to you.
I ultimately chose to pump/bottle feed, and even though that hadn’t been my goal, I supplemented by making sure to get plenty of cuddle time and bonding moments in other ways. Eventually, I was able to breastfeed a little without a strong sensation but it took months and was never the same as I had felt with my first. There was sadness and grief for me in realizing that my experience wouldn’t be the way I had pictured. This can be heartbreaking for new parents. Ultimately, I was able to get through that time with support, and time has helped me to understand the situation and not blame myself. I have a story I tell now, about how I learned of D-MER and have made it my goal to educate others so that they do not feel alone and confused the way I did.
If you have found this article helpful, I wrote it for you! I hope you will share this information with friends and other people who can benefit from this. It is a tragedy and a policy-level failure that there aren’t more studies being funded for women’s health and reproductive issues. Hopefully we will have more answers in the future.
At The Centered Space, we specialize in perinatal issues and are well-versed in conditions like D-MER so that we can help you identify the problem and get support and treatment for any related thoughts or feelings that you experience along with those conditions. Book a consultation with one of our therapists today for more information.
Citations:
Heise, A.M., Wiessinger, D. (2011) Dysphoric milk ejection reflex: A case report. Int Breastfeed Journal, 6(6). https://doi.org/10.1186/1746-4358-6-6
Ahmed, M., Mahmud, A., Mughal, S., & Shah, H. H. (2024). Dysphoric milk ejection reflex - call for future trials. Archives of gynecology and obstetrics, 310(1), 627–630. https://doi.org/10.1007/s00404-024-07503-4