D-MER - When Breastfeeding Really Sucks
You had images of curling up with your newborn in your arms as she drowsily feeds…but suddenly as your milk begins to flow you find yourself filled with feelings of anxiety, self loathing and disgust and want to crawl out of your skin. On good days a few moments later those feelings have passed but have left you feeling shocked, distraught and maybe even ashamed that you could feel like this - and wondering if you’re having some kind of break down or are suffering from postpartum depression.
If you experience overwhelming negative thoughts and feelings during the first few moments of breastfeeding you may have a condition called Dysphoric Milk Ejection Reflex (D-MER).
First things first.
You’re not a bad mom.
You’re not losing your mind and you’re probably not depressed.
It’s quite likely a misfiring of neurotransmitters (hormones) in the brain.
"Until now I never realized anyone else had this issue - I would feel profoundly depressed at time of letdown and my doctor and pediatrician both dismissed my complaints."***
If these feelings continue throughout the feed you may be experiencing a phenomena known as breastfeeding aversion agitation but in this blog we’ll focus on D-MER.
For the majority of new moms once you get through the first 6 weeks or so of breastfeeding and figure out a comfortable latch and a few different positions things start to fall into place. That initial bleary eyed steep learning curve is usually replaced with a sense of contentment when you nurse your baby (accompanied by a raging thirst) - courtesy of the wonderful hormones oxytocin and prolactin. From an evolutionary perspective breastfeeding is supposed to be enjoyable otherwise the human race would never have survived.
But for a small percentage of mothers during those first few minutes between the milk let down and baby starting to feed those hormones can cause overwhelming negative feelings ranging from sadness to suicidal thoughts. These feelings may last a few weeks to months and cause some mothers to wean early as there’s so little known about this condition in mainstream medicine and midwifery.
What Causes D-MER?
Misfiring hormones in the brain seem to be the culprit.
Oxytocin is considered a bonding hormone and the hormone of love - it can act as a buffer to stress it’s released in enjoyable social interactions, when we eat good food, have a massage, even playing with your dog releases oxytocin. Like a see-saw, when oxytocin goes up stress tends to go down but only under certain conditions.
There’s also a dark side to oxytocin one that doesn’t get as much airplay as the feel good hormone of love focus. When oxytocin is released into the brain it can activate the amygdala that acts as our ‘threat radar’ triggering feelings of aggression (so you’ll protect your baby). Only if your brain perceives a threat. Again if we look at this from an evolutionary perspective it makes sense that our hormones can drive us to protect our babies. Thousands of years ago when we lived in small groups in caves your loving murmurings of oxytocin bliss wouldn’t have protected you or your baby from a hungry predator - the flip side of feel good oxytocin can be aggression.
In a 2017 study, mothers who had synthetic oxytocin (Syntocinon/Pitocin) during their labour had significantly more postpartum anxiety and depression compared with mothers who did not have synthetic oxytocin (Kroll-Desrosiers et al., 2017). When we introduce these synthetic hormones or an epidural our own natural oxytocin is blocked and the risk of dysregulation of hormones is more common. There’s also some suggestions in case studies that dopamine which which is associated with prolactin may play a role (dopamine is part of the reward circuitry of the brain and helps to regulate prolactin levels).
No doubt you’ve had other stressful events in your life and know that whenever you experienced that stressful event the critical thinking part of the brain went temporarily off line so making rational thinking/planning/etc was probably difficult. That’s simply because our old cavewoman brain redirects resources (blood flow) to that threat radar in the mistaken belief that a tiger has just walked into your kitchen.
One mother’s experience of D-MER.
“In addition to the invariable emotional sinking that accompanied D-MER, AH's ability to concentrate faltered with each episode. Simple math was temporarily impossible; she experimented with mentally reciting the times tables as a distraction, and stalled at 2 × 3. AH was given a brief, affirming statement to read to herself during a D-MER. She could neither read it easily, nor believe it at all, until the feelings passed.”***
So it’s almost impossible to talk yourself out of this intense emotional state but you can learn to ride the sensations knowing they will pass and nothing is wrong with you.
What Makes D-MER Worse?
For a lot of moms tiredness, hunger and illness exacerbates the feelings (and who’s NOT tired as and hungry as a breastfeeding mom) so anything you can do to rest (without guilt) will help.
Some moms also experience more symptoms of D-MER around the time of their period.
D-MER and Mindful Acceptance
The brain is working against itself but there are ways we can reduce the feelings of powerlessness. The famous Guest House poem by Rumi reflects how we can learn to be with whatever feelings show up at the door without trying to change them or suppress them (not an easy thing to do). Practicing mindful acceptance or allowing means we put out the welcome mat for all feelings. This can sound a little ridiculous when you have D-MER but bear with me.
These aren’t wispy ethereal emotions gently tapping on the door waiting for you to allow them in - for a mother with D-MER it feels like they’re kicking the door in.
The Neuroscience of Mindfulness
Your mind is the closest to you, yet it’s very likely know more about your partner, a work colleague or even more about the Kardashians than you do about what’s going on between your two ears (likewise for most of the planet). Isn’t it time to see what’s actually going on in there and get to know it a little better?
“My definition of mindfulness is noticing your thoughts and feelings without kicking your own ass while you’re doing it” - Ruby Wax
Like an electrician that made some mistakes with your house wiring, mindfulness can help us spot rooms in our minds that seem to be misfiring due to some bad wiring in the brain. Think of mindfulness like hiring a very helpful skilled kind electrician in to sort out the wiring in your ‘oxytocin’ house.
These thoughts and emotions are not you - they are passing mental and emotional events caused by a misfiring of the brain chemical oxytocin. It those thoughts were you how can you also notice that you’re having them? It’s also helpful to remember that thoughts are not facts. You don’t need to believe everything you think or feel. Let that sink in for a minute. But like any other mental event or emotion they are transient. Think back to a time when you had a particularly awful day, when it was happening if felt like it would never end. When it was happening you had no perspective of the fact that it could end. When the stress response is activated the part of your brain that controls rational thinking is off line so you’re at the mercy of that misfiring.
Neuroscientist Rick Hanson describes how the brain leans towards remembering negative events. For survival it’s far better for your brain to remember where you met that scary bear than to take up mental resources remembering the sweet smelling flowers you saw just before you met the bear. Negative thoughts and experiences are like velcro to the brain and positive ones act like Teflon…they wont’ stick so we have to make a conscious effort to bring to mind pleasant emotions and bask in them. The brain can’t tell the difference between an external experience or an internal one so the more positive memories we remember the more feel good hormones the brain releases.
When we activate the same cells in the brain repeatedly (intentionally such as mindfulness or unintentionally by repeated negative habits of thought) they form a network of connections and they become ‘glued’ together. You’ve probably heard the saying ‘what fires together wires together’. Our brains are quite ‘plastic’ and even more so during pregnancy and postpartum so we can literally change how our brain works with just a few minutes practice each day - it’s a trainable skill.
Mindfulness practice also help to regulate our emotions. Simply put you to take a step back and widens the zoom lens so you can see how the mind works. One of my tutors Choden suggests imagining your mind like the attic. It’s quite a dark place with lots of stuff we don’t use anymore. When we’re being mindful it’s like we’re turning up a dimmer switch in that attic with a kind curiosity to see what’s there. Sometimes we might not like what we find so we always approach the mind with an attitude of curiosity and acceptance of whatever we find there.
With practice this often leads us to start to notice unhelpful patterns of thoughts we may have about ourselves (I’m a crap mom, I’m not skinny enough etc…). But D-MER is a little different it’s not a habit of thought that we can wrestle to the ground and retrain. But we can see it for what it is. A hugely important aspect of a mindful approach is acceptance of things we have no control over no matter how much we want things to be different. If we can’t control it what else can we do when acceptance is all there is? (Trust me I’m not saying this is any way easy but there’s not much else we can do).
“Acceptance is the ‘shit happens’ school of enlightenment” - Ruby Wax
There’s a million benefits to cultivating a simple mindfulness practice as a new mom. A few minutes of mindfulness each day regulates your stress response and increases areas of the brain associated with positive mood while also ‘decoupling’ those connections in the brain. Several studies report that mindfulness reduces the risk of depression and anxiety outside of pregnancy and now we’re seeing more research that supports this research in pregnancy too. And it doesn’t take hours of sitting crosslegged in a dark room it can be a simple as paying attention to what you’re doing. Even 10 minutes of some practices can change your mood significantly.
"My feelings during D-MER could best be described as self-disgust and hopelessness. I don't feel my case is especially severe and for the most part, understanding that these feelings are just the D-MER and dismissing them (vs. dwelling on them) has been sufficient for me." ***
Try some of these approaches today and see if they help.
Mindfulness Exercise
As you settle in with your baby just before a feed start by bringing your attention to the physical sensations happening in your body right now. Notice if there’s tension anywhere. Can you find the points of contact between your body and the chair or bed. Notice the warmth between your baby’s body and yours. We’re just checking in with what’s happening right now in your body.
As your baby starts to nurse focus all of your attention on your breathing. Follow several long satisfying breaths in and out of your body. Try not to think about breathing instead experience the feeling of the breath as it moves in and out. As those feelings start to show up (kick in your door) see them for what they are just mistaken brain firings, it’s nothing personal it’s a chemical misfiring. See if you can let them rise while you remain curious about where they feel most intense in your body. Look at your baby. Sometimes noting those sensations as they begin to rise and saying something to yourself like “oh here you are again - there’s no tigers here but my baby and I really appreciate your concern” Keep looking at your baby and breathe her in…remind yourself of how she’s growing and thriving on your breastmilk something you should be incredibly proud of given the difficulties you’re facing and remind yourself “I did that”!! Those feelings of pride can help increase dopamine levels. The more you can intentionally bring up positive memories just before the let down will trigger more positive emotions and counter the challenging ones.
As those distressing thoughts and feelings begin to subside congratulate yourself for staying on the sidelines as your brain produced this unnecessary drama.
Distraction
Smart phone games are designed to trigger dopamine release which makes them so appealing (and addictive). Give Candy Crush a whirl or Sonic. Try choosing a game that requires your full attention and needs quick reactions rather than a game with that needs strategy and planning. The brain has limited bandwidth so let’s give it something else to do for those first few minutes as your milk lets down.
Affirmations
When we’re stressed the language center of the brain can be harder to access so write out an affirmation that makes you feel good and have it nearby so you can see it. Try something like “I can do anything for a minute” or any positive statement and inspires you. Even mentally tracing your handwriting on that piece of paper can give the brain something else to focus on.
Music
Play a favorite piece of music on your phone as you’re getting ready to feed? Ideally it will be a song or music that brings up really positive memories for you so the brain can create new associations that nursing being a less stressful experience. Some moms like to sing or say a nursery rhyme as a way to focus.
Food
Foods containing tyrosine which are the building blocks of dopamine may help but there’s no research on D-MER and nutrition yet. Foods such as almonds, fruits and eggs are nutritious too - chocolate can also temporarily raise dopamine levels. There is good evidence that our gut microbes affect our mood too so talk to your careprovider about adding a probiotic to your diet (when we’re tired, run down and not eating well our microbes change)
Support for Mom’s Experiencing D-MER
https://d-mer.org/
https://www.llli.org/what-is-d-mer/
I’d love to hear your experiences of this little known but very challenging complication of breastfeeding.
Tracy
Start your free trial of the GentleBirth App today and learn simple meditation and breathing techniques for a positive birth and postpartum.
Mindful Pregnancy is available in hard cover and as an audio book.
Resources
Sbrilli, M.D., Duncan, L.G. & Laurent, H.K. Effects of prenatal mindfulness-based childbirth education on child-bearers’ trajectories of distress: a randomized control trial. BMC Pregnancy Childbirth 20, 623 (2020).
Sheydaei H, Ghasemzadeh A, Lashkari A, Kajani PG. The effectiveness of mindfulness training on reducing the symptoms of postpartum depression. Electron Physician. 2017;9(7):4753-4758. Published 2017 Jul 25.
Heise AM, Wiessinger D. Dysphoric milk ejection reflex: A case report. Int Breastfeed J. 2011;6(1):6. Published 2011 Jun 6. doi:10.1186/1746-4358-6-6
Yate ZM. A Qualitative Study on Negative Emotions Triggered by Breastfeeding; Describing the Phenomenon of Breastfeeding/Nursing Aversion and Agitation in Breastfeeding Mothers. Iran J Nurs Midwifery Res. 2017;22(6):449-454.
Willem Kuyken et al (2010). How does mindfulness-based cognitive therapy work? Behaviour Research and Therapy, Volume 48, Issue 11.
Levin ME, Luoma JB, Haeger JA. Decoupling as a mechanism of change in mindfulness and acceptance: a literature review. Behav Modif. 2015 Nov;39 (6):870-911.