My daughter was 5 weeks old, and we’d managed the brave feat as first time parents of making it out of the house to a family member’s engagement party. As I sat feeding her and chatting with the various people who came up to admire my beautiful baby, someone made a passing comment. “Breastfeeding always made me feel really sad, just for a couple of minutes.” I didn’t think much of it, but later on the way home I mulled it over. Wasn’t that how I felt every time Ada first latched? Not quite. I would have described it as a feeling of overwhelming dread, like something very, very bad was about to happen. At first I thought it was because I was anticipating the toe curling pain, but as our breastfeeding challenges resolved along with my nipple damage, the feeling didn’t go away. I was still dreading each feed and the awful sensation of anxiety that came with it for a minute or so.

I headed to Google. “Breastfeeding sad anxiety when baby first latches.” Up popped a term I had never heard before – ‘D-MER’ or Dysphoric Milk Ejection Reflex. The Australian Breastfeeding Association website stated, “Negative emotions that occur with your letdown reflex. Yes, it’s a real thing and help is available.” I was flooded with relief.

Not much is known about D-MER but we do know that most women with D-MER will experience, depending on the severity, a combination of feelings such as sadness, anxiety, dread, wistfulness, nervousness, hopelessness, self-hate, irritability, anger, a ‘sinking’ feeling, and in some cases even suicidal thoughts. Some describe it just as a ‘sigh’, and it lasts most commonly from 30 seconds – 2 minutes, prior to a letdown. Once I understood my D-MER, I could always tell when a let down was happening. I might be standing in the supermarket when my baby was due for a feed and I would be suddenly overwhelmed by a feeling that the world was an awful place and everything was hopeless. “Oh, I’m about to get a let down” I’d say to my husband, and sure enough, 30 seconds later my breasts would be filled with the prickling sensation of my milk ejection reflex. 

So what causes D-MER? Very little research has been conducted, but it’s generally understood to be the result of a sharp drop in dopamine levels. Prolactin, the breastfeeding hormone, and oxytocin are released in combination in order to create a let down. Oxytocin is a dopamine suppressant, so it’s suspected that in some breastfeeding mothers this release of oxytocin and subsequent fast decrease of dopamine, creates a brief dopamine deficit resulting in negative feelings or ‘dysphoria’. 

It’s important to note that D-MER is an entirely physiological condition, and has no relation to postnatal depression or anxiety. The danger of D-MER is a lack of education and understanding, leading to loneliness and confusion that might leave breastfeeding mothers wondering if they do have PND or ceasing their breastfeeding journey before they are ready. In most mild cases of D-MER, the negative sensations will resolve by 3 months, in moderate cases 9 months, and in some more severe cases they may continue for the duration of the breastfeeding relationship. Once I knew what my D-MER was, I developed several coping strategies:

• Deep breathing

• Distraction
• Drinking cold water before/during a letdown

Other recommendations include increasing skin to skin contact, remaining hydrated, and experimenting with Vitamin B complex, Vitamin D, or Magnesium supplementation.

So what else can be done to support mothers experiencing D-MER? Education and knowledge is, of course, key. I had never heard of D-MER, and I considered myself fairly well educated about breastfeeding. Neither had anyone else I spoke to after my Googling, except for my IBCLC GP who was able to give me some recommendations and much needed validation. Just knowing that it was a real, physiological condition gave me so much relief. Second time round, I felt fully prepared for the feeling of dread and anxiety that I experienced with each letdown, and felt much more able to manage them, knowing that after 6 months or so they would be gone. Sharing our stories and increasing the education of the healthcare providers who support mothers and babies is an important first step. 

By Jayne Pigou

References and additional resources:

Dysphoric Milk Ejection Reflex (D-MER)   https://my.clevelandclinic.org/health/diseases/24879-dysphoric-milk-ejection-reflex#symptoms-and-causes

Sadness When Breastfeeding – D-MER.org   https://d-mer.org/

Dysphoric Milk Ejection Reflex (D-MER)  https://www.breastfeeding.asn.au/resources/d-mer