Once moms get over the initial hurdles of learning to breastfeed, most find breastfeeding fairly pleasant while it’s happening. But that is not the case for a small minority of breastfeeding women who experience a medical condition called D-MER (dysphoric milk ejection reflex).
Women who have D-MER experience feelings of depression, anxiety, dread, and even full-blown panic attacks for a minute or so right before their milk lets down (the duration of the symptoms can last from 30 seconds to up to 2 minutes). After the letdown, things return to normal, but with something this intense happening every time a mother nurses — which can be as many as 12 times a day — the disorder can certainly take its toll on a woman’s mental/emotional health.
It makes mothers downright miserable.
D-MER is a physiological condition. It’s not a mental illness, postpartum mood disorder, or an aversion or dislike of breastfeeding. It’s a hormonal response to the mechanism of breastfeeding. According to the International Breastfeeding Journal, D-MER occurs because of an “abrupt drop in dopamine […] when milk release is triggered, resulting in a real or relative brief dopamine deficit for affected women.”
And while D-MER is relatively uncommon, those who have experienced it describe it pretty much as a horror show.
“In my experience, it was a full-on panic attack with each letdown. Like what I imagine I’d feel if I knew an axe murderer was breathing down my neck,” says Rita Templeton, who experienced D-MER to varying degrees with three out of her four sons. “I ended up actually hurting myself, wrenching my neck from tensing up so hard. It was so scary, but even more frightening was the fact that I was convinced there was something terribly wrong with me — that I was somehow messed up in the head.”
Like Templeton, many moms find relief once they finally know what the heck is going on — that what they are experiencing is not their fault or something that they can control, but rather a physiological reflex, like when the doctor hits your knee with a hammer and your knee jerks. This knowledge alone — coupled with the fact that D-MER sometimes (but not always) dissipates to some extent after the first three months — can help mothers get through it and continue nursing (if they wish) despite the challenges D-MER presents.
Templeton says that once she found out that her experience had a name and wasn’t “all in her head,” she was able to manage it much better. She did end up weaning her second son because of D-MER (she hadn’t yet learned what it was), but successfully breastfed her third and fourth sons into the toddler years despite the D-MER being just as intense with them in the early months (it continued to some extent throughout her nursing experience, but was more bearable as time went on).
“Sure enough, between my second and third sons’ births, the condition had been officially ‘discovered’ and given a name,” Templeton shares with Scary Mommy. “I cried with relief to know that I wasn’t alone. … The symptoms didn’t magically go away, of course, but the knowledge of knowing what caused them was powerful. … When I felt those first surges of panic, I’d say to myself, ‘Okay, this is just the fluctuation of your hormone levels. Hold on, and it’ll be over soon.’’’
Besides positive self-talk and other psychological coping mechanisms, some moms have found relief with herbal remedies as well as lifestyle changes like making sure to eat well, staying hydrated, and getting as much rest as possible (which is obviously difficult when you are the mother of an infant). Only in the past few years have medical solutions to the problem been investigated. According to D-MER.org, some mothers have been successfully treated with prescription medications that increase their dopamine levels.
But such treatment wasn’t available for Lea Grover back in 2012 when her third daughter was born. Grover experienced a very severe case of D-MER — one that took four long, dreadful months to diagnose and led to a postpartum mood disorder for her.
“Out of nowhere, it was like the whole world went black. I felt like I couldn’t breathe, like I was falling, like I couldn’t move,” Grover says. “I was sure I was dying, but it only lasted about 30 seconds. Then, my milk let down, and the feeling went away. The panic attacks lasted from about 30 seconds to about 2 minutes, EVERY SINGLE TIME I had a letdown. So that’s about 10 times a day, around the clock.”
Grover started to believe that something was severely wrong with her, and although she could link it to nursing, it wasn’t clear where it was coming from at first and Grover found herself lost in a spiral of panic and depression that made it too difficult for her to function at times.
“Everything would start fading to white, and I’d start hyperventilating and crying, and my 2-year-old twins would sit next to me and say, ‘Don’t cry, Mommy,’ and I just wanted to die,” recalls Grover. “It was the worst feeling, knowing I couldn’t take care of my kids, and that my toddlers were trying so hard to take care of me. I was terrified they would resent their baby sister forever for what was happening to me, because they knew when I had a panic attack I needed to feed the baby.”
Once she finally learned what the condition was via her doula friend, she found some solace in knowing that it had a name. But that knowledge wasn’t enough to cure her. Plus, at the time, there were no real medical treatments out there like there are today. Eventually, Grover had to wean her daughter, though she had to do it slowly because her daughter would not take a bottle and because Grover found that weaning too abruptly made the D-MER symptoms worse.
Luckily, Grover has some good memories of nursing her daughter, at the very end when she was only nursing her once a day, and most of the symptoms of D-MER had dissipated somewhat (again, many moms find that D-MER gets a little better as the months go on). Still, Grover looks back on those months of nursing her daughter as among the worst months of her life. Of her D-MER experience, Grover says: “I wouldn’t wish it upon my worst enemy.”
Grover’s case is among the most severe example of D-MER. And while all mothers have their own individual experience of it, the bottom line is that it is a really, really difficult disorder to have and can make moms truly miserable, especially if they aren’t sure what is causing the misery. That is why all moms who experience it deserve to be listened to and cared for without judgment and with compassion.
Most of all, we need to shed light, and bring awareness to, this issue so that health care professionals and others who care for postpartum moms know about it so that no mom ever feels any shame in bringing up the issue, and all moms get the treatment they need to make breastfeeding the positive experience it has the potential to be.