When Breastfeeding Becomes a Challenge: Understanding D-MER

pregnant woman sitting on bed in blue dress with coffee mug

The condition that can turn feeding your baby into an overwhelming experience.

Written by Sarah Blake
June 23, 2022

Finding Relief

For some mothers, breastfeeding can trigger intense anxiety, which is known as dysphoric milk ejection reflex, or D-MER. Here, Rebecca James—a mother of two—shares her journey with writer Sarah Blake.

A distressing phenomenon affects nearly 10% of breastfeeding mothers: dysphoric milk ejection reflex (D-MER). During the moments surrounding milk letdown, this condition can evoke feelings of profound despair. As a mental health professional for over a decade, I had never encountered anything like it—until I became part of that 10%.

I vividly remember my first experience with D-MER. Everything was fine at the hospital, and after returning home, I settled on the couch with my three-day-old daughter, preparing to breastfeed. Having had a C-section, my husband was assisting me in getting comfortable. Once she latched on, I felt the familiar pins-and-needles sensation signaling my milk letdown, quickly followed by an overwhelming sense of dread.

The best way I can describe it is like receiving devastating news. It’s the kind of anguish you feel when learning that a loved one is seriously ill or facing job loss. Picture the anxiety that grips you when you know a phone call is about to deliver terrible news—the pit in your stomach as you anticipate it.

Confused and uncertain, I thought perhaps I was just overwhelmed by the responsibilities of parenthood. My husband planned to mow the lawn after helping me get set up, and I wondered if my anxiety stemmed from the fear of being alone with my newborn. It felt like a sensation I shouldn’t be experiencing, so I kept silent, unable to articulate my feelings to my husband.

This continued for the first several months of my daughter’s life; I felt too ashamed to speak up. The dread would start about 15 to 30 seconds into a letdown and last anywhere from 30 seconds to a minute. While that might not seem long, it stretches on like an eternity when you’re grappling with a feeling akin to impending doom. At first, I didn’t connect my feelings to the milk letdown, as the frequency of nursing blurred the lines of my emotional state.

However, when I wasn’t experiencing a letdown, I felt completely fine—classic D-MER. During my checkups with my obstetrician, I would declare, “Everything is great!” even though only moments earlier, I had felt as if my world was collapsing.

The breakthrough moment came when I read a post in a mothers’ group on Facebook that mirrored my own experiences. Someone wrote, “Do you ever feel a sense of doom while nursing? That indescribable anxiety? You might have D-MER!” I clicked on the link immediately.

While the exact cause of D-MER remains elusive, it is believed to have a physiological basis, linked to a temporary drop in hormones during milk letdown.

Suddenly, I had a name for what I was experiencing, and I realized I wasn’t alone. Understanding D-MER helped me manage my feelings; it was reassuring to know my distress wasn’t just typical anxiety. However, realizing that it was a hormonal response didn’t make it any less challenging.

I tried various remedies suggested by others—drinking cold water, watching TV, eating chocolate, staying hydrated—but nothing truly alleviated the feelings, except focusing on my baby and reminding myself that it was a temporary phase.

I breastfed my daughter for seven months, and it wasn’t D-MER that led me to stop; it was her teething and my fatigue from pumping at work. After weaning, I believed I had left D-MER behind. It was like giving birth—after the pain fades, you think you’ll never do it again, but time dulls the memory.

Two years later, I had a son, and as soon as my milk came in, D-MER returned, this time even more intense. Along with the anxiety, I experienced severe nausea. It felt as though I might vomit, and then the letdown sensation would hit, triggering the anxiety.

I could have quit—I understood it wouldn’t improve—but my son was very attached to breastfeeding. He needed that closeness for comfort.

There were days I’d wake up thinking, “Today is the last day,” only to feel his warmth and give in again. Each day passed, and I set small goals, ultimately surpassing them. I felt envious of those who didn’t experience D-MER. I yearned for a positive breastfeeding experience, while at the same time, when not nursing, I would romanticize the act, thinking, “I love nursing! I could never give this up!” But then, in the moment, I would remember the dread.

Before I knew it, my son was seven months old and starting to bite just like his sister. I recently stopped nursing and felt a wave of relief. Even though I still experience an occasional letdown, I am grateful to have moved past that chapter. I can hardly believe I endured D-MER for a total of 14 months. It was by far the most challenging experience of my life. To this day, I haven’t met an OB who knows what D-MER is. If I hadn’t stumbled upon that Facebook post, I might never have realized what I was going through.

This experience inspired me to seek certification in perinatal mood disorder treatment. I now help mothers who are struggling and have been able to assist some in recognizing that their challenges stem from D-MER. It’s come full circle.

My daughter just turned three, and my son is seven months old. We are done having children—mainly due to age and finances, but D-MER is a significant factor. When I think about it rationally, I know I cannot go through that again.

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Summary

Dysphoric milk ejection reflex (D-MER) is a condition affecting about 10% of breastfeeding mothers, characterized by intense anxiety and dread during milk letdown. Rebecca James shares her personal experiences with D-MER, detailing how it impacted her breastfeeding journey with both of her children. Understanding D-MER helped her cope, but the feelings persisted despite various coping strategies. Ultimately, she found closure after weaning her son and has since dedicated herself to helping other mothers recognize and address D-MER.

Keyphrase: Dysphoric Milk Ejection Reflex

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