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D-MER: The Great Letdown We Aren't Talking About

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Even for women who badly want to breastfeed, there can be a slew of obstacles, from mastitis to latch issues. For Meghan Wooldridge, mother of three, the breastfeeding itself seemed to be going okay, but something else was going on. “It took everything in me not to shove my baby off of me” when she felt a dip in her emotions at the beginning of a nursing session. She looked for reasons to stop nursing daily, because she was so utterly miserable. Wooldridge realized that the feelings were less when she pumped instead of nursed, so began to pump and then bottle feed. “The [negative] feelings were most intense with my letdown, so with pumping there was only one letdown.”

Becca Thorpe, mother to two boys, experienced similar feelings while nursing. As she would sit down with her baby she would get an overwhelming feeling of her confidence taking a “nosedive.” The negative emotions would flood her senses, just at the moment when her milk let down. Thorpe felt as if she was being demeaned or degraded; the rush of emotion when nursing was that intense. “Sometimes these feelings would wash over me if I even heard another baby crying in a restaurant.” The sensation did not last longer than a minute or two, but its lingering effects caused harm.

Both women were eventually diagnosed with dysphoric milk ejaculation reflex, or D-MER. The D-MER organization describes the condition as such:

D-MER presents itself with slight variations depending on the mother experiencing it, but it has one common characteristic - a wave of negative or even devastating emotion just prior to letdown. This emotional response is the consistent key component in D-MER. The breastfeeding mother experiences this surge of negative emotions about 30-90 seconds prior to her milk release when breastfeeding, pumping or with spontaneous MER.

Neither women had heard about this condition before experiencing it, and would have likely ended their breastfeeding journey if the condition had not been identified and normalized by lactation consultants.

Ngozi Walker-Tibbs, lactation consultant and owner of Sankofa Childbirth Education and Lactation Services, has studied the condition while pursuing her Master's of Public Health. “It is probably more common that we think, but women are afraid to come forward. They feel ashamed. Afraid to think that something is wrong with them,” she tells me over the phone. Walker-Tibbs was able to talk a recent client through exactly what she was experiencing, and help her realize that the feelings would pass. Typically once a baby is suckling the intense feelings do pass for most moms, but those initial moments of each feeding session can be so intense that many mothers become turned off to breastfeeding in general.

“It takes an experienced breastfeeding mom to recognize this,” says Dr Jacqueline Saladino, a newborn hospitalist at UPMC Children’s Hospital of Pittsburgh and a certified lactation consultant (IBCLC) herself. Dr. Saladino believes that there may be a whole population of mothers experiencing D-MER without even realizing what it is. She notes that breastfeeding as a science is in its relative infancy, so there are not many studies on this condition. One case study published in Midwifery looked at the way that these intense emotions can affect a mother’s breastfeeding experience in an effort to inform care providers. More in-depth quantitative studies have not been completed, and so it is difficult to assess just how many women are actually experiencing D-MER.

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From a mental health standpoint, even less is understood. Dr. Rebecca Weinberg, psychologist for West Penn Hospital Women’s Behavioral Health department, concurs with Walker-Tibbs and Saladino that numbers are likely under-reported. “The thing is, it’s not really a mental health disorder. It is physiological. I didn’t learn about it during graduate school. Lactation consultants hear about it more than mental health professionals.”

Do they stop nursing just because they do not like the way that it feels, without realizing that it is not typical?

Weinberg notes that while it is not listed as a primary concern for many of their patients, that does not mean it is not contributing to perinatal mental health concerns. Perinatal mood and anxiety disorders are often associated with a difficult breastfeeding journey. But then, Weinberg says, her program is assessing the women often after they have stopped breastfeeding due to these struggles- including physiological struggles such as D-MER. She wonders how many women actually realize that D-MER is not how every woman feels during breastfeeding. “Do they stop nursing just because they do not like the way that it feels, without realizing that it is not typical?” More research needs to be done in this area, including on the link between the physical condition D-MER and its link to maternal mental health.

While both Thorpe and Wooldridge persisted in their breastfeeding journeys despite D-MER, they are they exception rather than the rule. The support they received from their mothering community and lactation consultants was key to their success. Dr. Weinberg notes that there is a pretty large gap in identifying women who are struggling in the perinatal period, but she sees the tides shifting in this area.

“Only 3-5 percent of women are treated in the perinatal period. The U.S. tends to be behind the rest of the world in mother-baby care.”

In the UK and Australia, mother-baby centers are common for assessing and treating concerns that affect mood such as D-MER. Six new mother-baby centers have opened in the U.S. just in 2018, so there is hope that more women struggling with these overwhelming and intense feelings will not have to navigate this journey alone.