What is D-MER? When breastfeeding makes you sad.
Dysmorphic milk ejection reflex, or D-MER is a physiological condition affecting some lactating women. It is characterized by the abrupt onset of negative emotions (dysphoria) just before milk let down and continues for no more than a few minutes.
Women may experience 30 to 90 seconds of anxiety, anger or sadness as the baby latches. D-MER.org describes the sensation as "feeling like there is something in the pit of the stomach or an emotional churning in the stomach."
There is no known predisposition or cause for it, but we do know that experiencing it once can increase the chances of having it again in the future.
We don't know how common D-MER is at this point, as the conversation around it is still relatively new. Though some awareness and education related to the condition started showing up in the postpartum community about 12 years ago, there are still many women who suffer from D-MER and have no idea what is going on.
That's exactly what happened to me.
As a labor and delivery nurse, I have spent countless hours championing mamas in their desires to breastfeed: assisting with that first latch, setting up pumps for the first time and teaching hand-expression to wide-eyed and exhausted parents. There is something so rewarding about getting the tiny baby latched and witnessing the mama's eyes light up as she realizes that maybe, just maybe, breastfeeding is going to work out.
With my first daughter, I found the nuances of breastfeeding relatively easy. Of course, there were many aches and pains, but we figured it out together and I got to spend a year sharing that time and space with her.
When my second daughter was born, I assumed our breastfeeding journey would be similar—but it was so much harder. I have a vivid memory of being four weeks postpartum, feeling utterly exhausted with two under 2, and my husband saying to me, "It just seems like you hate breastfeeding."
I was so mad at him for voicing that out loud, for being willing to acknowledge the very real possibility that I didn't love something that everyone says you're supposed to love.
And I was confused, too. I was a specialty-certified labor nurse. I had breastfed my first child for 13 months with no issues. I had championed so many mamas on their own journey. Why did I have no idea what was wrong with me?
My husband wasn't wrong. The second time around, I didn't like breastfeeding because I didn't like the way it made me feel.
I was overcome with sadness every time I nursed, constantly fighting back tears. As quick as the feelings came on, they were gone, only to return the next time I fed her. The emotional roller coaster left me feeling guilty, ashamed and confused—and ultimately, like a bad mother.
It turns out that I had a medical condition known as dysmorphic milk ejection reflex (D-MER).
If you have D-MER, here are six important concepts to understand:
1. D-MER is not a postpartum mood disorder.
During my own research, I was concerned that I was ignoring the signs of postpartum depression or anxiety. D-MER is not a symptom of either of those psychological conditions, but it can be harder to treat if a mama is suffering from one of them, as well.
One of the biggest differences between D-MER and postpartum depression is the relationship to breastfeeding. If a mama is suffering only from D-MER, she should not feel her physical symptoms throughout her day. They should come with let down, but then they should go away. Postpartum depression or postpartum anxiety do not have a timeline like D-MER. The mama's feelings can come and go at any time, often without any rhyme or reason.
If you are experiencing any symptoms of intense anxiety, sadness or anger, speak with your provider. They can help you differentiate between D-MER and a postpartum mood disorder, and help you find treatment for whichever you are experiencing. Don't wait, mama. Help is available and effective.
2. D-MER is a reflexive action in your body.
D-MER is a physiological condition related to an inappropriate drop in dopamine that happens during milk release. When you tell someone what is going on, their natural inclination may be to tell you to "think happy thoughts" (i.e. to avoid it). You cannot do this, mama. The negative emotions are a result of a hormonal shift and you cannot control it or stop it.
3. D-MER is not nausea or aversion to breastfeeding.
Many women experience occasional nausea when breastfeeding or a lack of desire to breastfeed. This can result from the age of the nursling, nipple issues, latch issues, teething, nursing while pregnant or weaning. These situations may cause significant aversion to breastfeeding, but they are not components of D-MER.
D-MER is always classified by its negative emotional component as the baby latches and your milk is let down.
4. D-MER looks different for everyone.
All too often, our tendency as mamas is to compare experiences in order to determine what is going on. While this can be helpful at times, know that there is a spectrum of intensity and emotions related to D-MER (mild to severe), as well as different experiences related to non-nursing situations like pumping or spontaneous letdown.
Again, talking to your provider can help you get clear on what you are experiencing.
5. D-MER needs more attention.
We need to talk about D-MER more—providers need to tell their patients about it, and to the extent that women are comfortable doing so, we need to talk about it in the postpartum community.
It's okay to bring D-MER up in a prenatal or postpartum appointment. Ask about your symptoms. Find someone who understands what you are feeling, who can look at you and say "what you are feeling is real" and "you are not a bad mother."
When my midwife validated what I was feeling, confirmed that it was a real diagnosis and was supportive of what I chose to do going forward, it completely changed how I felt. I still had D-MER, but I felt supported and understood, which went a long way in helping me deal with what was going on.
6. Education, lifestyle changes, natural remedies and/or medication may be able to alleviate some of the symptoms of D-MER.
Current anecdotal evidence reports that stress, dehydration and caffeine may worsen D-MER symptoms. Natural remedies that some also suggest include placenta encapsulation (for the mama who anticipates having D-MER again), rhodiola, evening primrose oil, ginkgo, B-complex and fava beans (or other dopamine increasing foods). Be sure to talk to your provider before starting any new supplements or medications.
If D-MER is making breastfeeding too hard or leading you to consider weaning earlier than you want, please talk to your provider about things you can potentially try first. It is possible there are things in your life you could eliminate or add that may help lessen the severity of your symptoms.
And if you think you (or a friend) may be suffering from D-MER, know this. You don't hate breastfeeding; you hate how it makes you feel. You are not alone. You are not sick. And you are not a bad mama.
If you want help, it's out there. Please ask. And if you need to be done nursing, that's okay too.
Whatever choices you need to make, whatever road D-MER leads or led you down, you are a very good mama.