How To Cope With D-MER, From A Mom Who's Been There

When I gave birth to my son, things were perfect. My labor was short. My contractions were straightforward. My abdomen compressed regularly, and rhythmically. 90 seconds on. 60 seconds off. And he was healthy. Clear skin. Clear lungs. Strong heart. I couldn’t have asked for a better birth experience. The doctors were patient and supportive. My wishes were seen and heard.

I also had one hell of an epidural. My body was numb from the waist down.

But the best part was my son’s demeanor. He was a happy baby. A calm baby. An easy baby, which is to say he slept well and nursed often. He latched moments after I placed him on my chest and bare breast. And it seemed breastfeeding him would be a breeze. But after a few weeks, things changed. My relationship with him and breastfeeding changed, and I became anxious.

I didn’t know who was more upset: me or the red-faced baby in my arms.

Now I know what you’re thinking: It is normal to be overwhelmed. Parenthood is hard, breastfeeding is hard, and sleep deprivation is brutal. The first few weeks are particularly trying. But there was more to my emotional instability than exhaustion. I was suffering from something called D-MER, or dysphoric milk ejection reflex.

Of course, many people do not know what D-MER is. In fact, the term is rarely used — and the condition is misunderstood. However, according to D-MER.org, an awareness-based website managed by mom and lactation consultant Alia Macrina Heise, dysphoric milk ejection reflex is “a condition affecting lactating women that is characterized by an abrupt dysphoria, or negative emotions, that occur just before milk release and continuing not more than a few minutes.”

To put it another way, D-MER is a negative emotional response to the physical act of your milk letting down.

“D-MER presents itself with slight variations depending on the mother experiencing it,” Heise writes, “but it has one common characteristic — a wave of negative or even devastating emotions just prior to letdown.” And that was the case with me.

My stomach hardened and sank. I could feel the milk rushing forward, and the bile rushing up. An acute wave of depression took control of my body. I felt distant, absent. My face flushed with warmth and tears, and I became afraid of a monster I could not see, of a threat which did not exist.

The good news is the anxiety and sadness only lasted a few moments. The feelings disappeared as abruptly as they come on. But for two or three minutes, I felt lost in my own body. My legs shook. My arms felt leaden, not solid but heavy. Like molten metal, they lacked stability and support. And I felt nauseous. I wanted to run. I was scared.

So how did I cope? How can you cope?

Here’s the best way to manage D-MER if you want to keep breastfeeding.

Acknowledge your feelings, don’t avoid them.

The first and most important step toward managing D-MER is to understand it. After all, once you recognize there is a correlation between your physical being and your emotional one, you will know what to expect. My son fed every two hours and when I felt “on edge,” I looked at the clock. Realizing I was about to let down was very helpful. I also knew I could count through it. Before I got to 200, the feelings would likely pass. That said, 200 seconds can feel like an eternity when your body is restless and your mind is depressed. As such, it is imperative you implement coping strategies like…

Busying yourself or your hands, with exercise, food, and/or fidget devices.

While snacking may sound silly, food can help you focus on something outside of yourself. It is also easy to do while feeding your babe. Not on the couch yet? Get up and move. Running in place can (and will) burn off nervous energy.

Practice relaxation techniques, like meditation and deep breathing.

I’ve never been very good at meditating, but many people are. They find the practice centers them — and grounds them. As such, you may want to have a guided meditation at the ready, like those on Calm, Headspace, and 10% Happier.

Use the ABCs to control anxiety.

Pick a broad category of things and/or objects — like colors, desserts, or cars — and make an alphabetical list in your head. Colors, for example, would look something like this: amber, blue, cobalt, etc. If your anxiety is still elevated when you get to “z,” pick a new category and start again. The point isn’t what you pick (or how far you get), it’s that you distract your mind long enough to work through any uncomfortable or dysphoric feelings.

Text a friend or make a phone call.

Connecting with another person won’t just help your D-MER, it will help you feel less isolated and alone (which, as any new parent can tell you, is super important).

Recognize it can and will get better.

You’ve been here before — and worked through these feelings before — and you can do it again. Take it one minute and second at a time.

That said, if you are overwhelmed by D-MER and/or if these thoughts do not dissipate, you should speak to your OBGYN or another trained professional, as these feelings can also be symptoms of perinatal mood disorders.