As we close out World Breastfeeding Week 2018 today, Mindy Cockeram examines a little-known phenomenon called Dysphoric Milk Ejection Reflex and talks about the impact this has on a new parent and their breastfeeding relationship. - Sharon Muza, Community Manager, Science & Sensibility.

With my newly accredited Certified Lactation Educator's certification in hand, I began teaching our "Breastfeeding for Success" class about eighteen months ago. Breastfeeding is a deeper dive than I ever expected and I'm always shocked to learn how much more there is to know about a topic on which I thought I was knowledgeable. After a recent class, a person (let's call them Mary) stayed behind to talk to me about their previous breastfeeding experience. Mary told me that when breastfeeding their first child, they would experience a short-lived feeling of dread with each feed. They said that when their milk let down, they suddenly felt 'very negative emotions'. I'd never heard of such a reaction.

My immediate thought was of a perinatal mood disorder setting in but they assured me the feeling had only lasted a minute or two and then their normal happy returned. Mary's body made milk just fine and the baby fed well and gained weight adequately. After a few weeks of breastfeeding, Mary returned to work and was unable to pump during the day. Their supply started to dwindle and they moved on to artificial baby milk. With this 2^nd baby, they were keen to breastfeed longer, especially as they were no longer working outside of the home. But they wondered if the feelings of dread might repeat. I had no answer for them.

Six months later I stumbled upon a post advertising a podcast for birth professionals: "Hey there birth professionals - I thought this episode might be useful for breastfeeding or pumping mamas. It's all about D-MER."

The podcast opened my eyes to the little-known phenomenon of Dysphoric Milk Ejection Reflex (abbreviated D-MER). I scoured the 6^th Edition of Counseling the Nursing Mother and Myles Textbook for Midwives and found nothing on the topic. Turning to the internet, I found much more information dated 2008 onwards. D-MER is described as an anomaly of the milk release mechanism in lactating women. A lactating woman who has D-MER experiences a brief dysphoria just prior to the milk ejection reflex (Lawrence & Lawrence, 2010). I found mention of D-MER in a Science & Sensibility post from January 2017. A further case study in the International Journal of Breastfeeding (Heise A, Wiessinger D, 2011) shed more light:

Reading the case study with fervor, I quickly learned that people can experience a spectrum of emotions with D-MER ranging from mild self-correcting symptoms often lasting less than three months (homesickness, hopelessness, depression) to moderate ones that may carry on for 6-12 months or more (panic, agitation, paranoia). The mother in the case study also reported examples of D-MER during episodes of spontaneous letdown: 'If she was shopping when a spontaneous milk release occurred, she suddenly felt that she was choosing ugly clothes. If she was cooking, she knew instantly that she was preparing a meal that her family would hate. If she was doing nothing at all when one occurred, she immediately believed herself to be worthless or worse.'

Although a sudden drop in dopamine (triggered by the let-down/milk ejection reflex) is thought to be the culprit, possible solutions are not as easy to identify. The woman in the case study first used the dopamine reuptake inhibitor Bupropion with great results but ceased using it due to side effects. She turned to the Siberian herb Rhodiola (Arctic Root) in capsule form to prevent the breakdown of dopamine with great success (although research on the herb while breastfeeding is limited). Just recognizing the condition seems the first step in helping people deal with the psychology of the syndrome. Asking open-ended questions and supporting people emotionally certainly helps. Finally, a few resources and support groups have sprung up including www.D-MER.org and' the Facebook support group associated with the website. The founder of the D-MER website (Alia Heise) went on to write a book on the topic in 2017 called Before The Letdown: Dysphoric Milk Ejection Reflex and the Breastfeeding Mother.

A few weeks ago, I went back through all my CLEC notes from class. On the corner of one of the 200 pages, I'd written D-MER. It must have been mentioned in class but with the steep learning curve and five days of intensive lecture, I'd completely forgotten all about it. We live and learn. Have you or anyone in your classes heard of or experienced D-MER previously? Do you have other suggestions for combating or supporting people experiencing D-MER? Please share in the comments below.

References

Heise A. www.D-MER.org Accessed July 2018.

Heise A, Wiessinger D. Dysphoric Milk Ejection Reflex - A Case Study Report. Published online 2011, Intl Bfg J, Jun 6. doi: 10.1186/1746-4358-6-6Intl

Karraa, W. Bottled Up: An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals. Accessed July 2018. https://www.scienceandsensibility.org/p/bl/et/blogid=2&blogaid=516

Lawrence, R. A., Lawrence, R.M., "Breastfeeding A guide for the Medical Profession" Saunders. 2011.

About Mindy Cockeram, LCCE

Mindy Cockeram is a Certified Lamaze Childbirth Educator working with a large hospital chain in Southern California where she's been teaching for six years. She trained initially through the UK's National Childbirth Trust in Wimbledon, England in 2006 after a career in the financial markets industry in London. She graduated from Villanova University in 1986 with a bachelor's degree in Communications and a minor in Business Studies. Mindy is the author of "Cut Your Labor in Half: 19 Secrets to a Faster and Easier Birth".  She resides in Redlands, California with her British husband and two children.

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