Experiencing a surge of emotions when breastfeeding?

Breastfeeding and sad, depressed, anxious feelings. What do new moms know better than doctors?

Alia Macrina Heise knew something wasn’t right with the way her body responded around the “letdown” of milk.  She had breastfed before; this was her third child.  Yet, she was baffled by what she was feeling.  Postpartum depression was not responsible; she knew that for sure.  

Professionally, she was an International Board Certified Lactation Counselor, so she also had this perspective on breastfeeding her newborn. Unfortunately, her professional knowledge did not help her here.  It didn’t give her any explanation for her emotions.

In 2007, in a post in a natural parenting forum she described her experience like this:  

It’s a sickening feeling in the pit of my stomach. There is a strong aversion to food. I don’t feel sad, but I feel “icky and yucky.” It is a feeling I seem to have associated with strong feelings of worry and guilt in the past because when I first started experiencing the sensation, I kept searching for what I was feeling guilty or worried about. It turns out that there was nothing. It was just that same sinking feeling in the pit of my stomach that makes me lose my appetite that I had experienced in the past for these other reasons.

She began to pay closer attention to what was happening in her body.  She determined that this wave of emotions would occur just before letdown.  It signaled that the letdown was about to happen.  The emotions would rise and crash along with the letdown and the entire event lasted about 2 minutes.  Most of the time she lost her appetite.

Heise continued her personal research and collected similar stories of other women on breastfeeding forums.  Next, she enlisted the help of a fellow International Board Certified Lactation Consultant, Diane Wiessinger, MS, to untangle what was happening physically and emotionally to her and many other women.

What is Dysphoric Milk Ejection Reflex or D-MER?

Together, Heise and Wiessinger investigated what made Heise feel better or feel worse.  Here Heise explains how she named the physical and emotional sensations she had:

The word “dysphoria” is a medical term and means an unpleasant or uncomfortable mood, such as sadness (depressed mood), restlessness, anxiety, or irritability. Etymologically, it is the opposite of euphoria. This described it perfectly. Because the condition was directly related to the milk ejection reflex, or let-down, we chose the term dysphoric milk ejection reflex (D-MER)

This team of lactation specialists came to believe that breastfeeding women with D-MER experienced a huge drop in dopamine just prior to mild ejection or letdown.  In order for the hormone prolactin (the hormone responsible for milk production) to rise, the body must lower the level of dopamine.  

Dopamine, a neurotransmitter, plays a huge role in the brain’s reward system.  It helps you to stay motivated and focused on something you believe will bring you pleasure.   Yet, women with D-MER, they suspected, had dopamine levels which dropped too low and brought on feelings of sadness, anxiety and irritability. A few minutes after beginning to breastfeed these feelings went away for most women.  

What women along with Heise found most comforting is that the strong emotions they felt had a purely physical trigger.  The feelings did not stem from an unresolved trauma or any sort of postpartum depression. They gained much comfort in knowing that their emotions were not “all in their heads” and did not signal that they thought of themselves as “poor mothers”.  

Women with D-MER share their stories 

I interviewed three women that kindly agreed to share their stories and experiences with you.  For privacy reasons, I have changed their names.  

General Information

Jennifer, Emily, and Jessica were all in their 30’s at the time of having D-MER. Two of them struggled to conceive.  All three women had challenges during pregnancy. Jennifer delivered twins early due to concerns about their size. Placental abruption caused Emily to give birth six weeks shy of full term. Jessica dealt with gestational hypertension.  

Breastfeeding

The women had vastly different preparation for breastfeeding. Jessica shared that she had no preparation aside from what she learned in a birthing class before delivery. Emily felt prepared for breastfeeding. She had done some reading on her own and remembers someone coming to speak with her after delivering. Jennifer had researched, watched videos, read, and talked to friends and family.  

Jennifer’s Breastfeeding Journey

“Everything was so overwhelming in the beginning, that I almost didn’t recognize the negative feelings. I just thought it was because my babies had trouble latching, and I struggled to produce.

I didn’t have a chance to share the emotions with my doctor because my regular postpartum appointment got canceled and changed to a telephone check-in. I did share the emotions with my therapist a few months down the line, and she was concerned that a drop in my hormones might be triggering the waves of emotion.

I just tried to push through and told myself that breastfeeding was not an easy journey. I thought pumping and feeding more would help to make the negative thoughts go away. 

But, all of the negative feelings just got to be too much. Also, I had trouble producing enough milk for both of my kids. I was so stressed with my kids not eating, that I stopped breastfeeding at about 2-3 months.  

I didn’t feel like I had postpartum depression, but the D-MER did kind of make me feel that way.  

After Googling, I found out about D-MER. It was so good to know that everything wasn’t “all in my head,” and I wasn’t going crazy. I felt validated. The more I read, the more I learned there was no sure treatment. I almost felt like about that time I gave up on breastfeeding and pumping.  

Emily’s Breastfeeding Journey

I don’t remember having any negative thoughts. I did have these pangs, feelings of intense sadness that came over me when milk started to flow. It was just a physical sensation with no thoughts attached to it. I think it happened pretty much every time I nursed. It would leave as suddenly as it came.

I didn’t talk to my doctor about it. I just thought it was because I always felt tired. I have experienced anxiety and depression, so I thought what I was feeling was related.

I breastfed for about nine months. Maybe I stopped breastfeeding because of the physical sensations, or maybe I just stopped because I was feeding my baby more solid foods. I didn’t really like nursing; though it was easier than cleaning bottles. It's just weird how you forget what physical pain feels like. but I can remember what this [the D-MER] feels like so clearly.

I came across D-MER in an article or on social media.  When I learned about it, I felt like it wasn't just me being a failure or broken, I guess? Like I wasn't a great mom since I didn't enjoy nursing. I mean I guess in a way I am broken, but there are others out there like me.

I am so glad my therapist is bringing attention to this problem.

Jessica’s Breastfeeding Journey

I had to start pumping while I was still in the hospital. My baby had issues latching, so I pumped and supplemented. I noticed the negative thoughts when I pumped while I was in the hospital. I thought I was just experiencing hormonal symptoms after giving birth.  

I talked with my OB about it. She encouraged me that I was doing the right thing by talking myself through negative feelings. She also said there wasn’t much to do. We talked about the options of doing formula exclusively.  

I have a strong internal monologue when experiencing negative thoughts. I remind myself that the feelings are only temporary. I will also keep the baby close when pumping, especially, so I can interact with her as a distraction. 

Another thing I do to help myself is to be alone when I am breastfeeding or pumping. I get really agitated when the negative thoughts come. I don’t want anyone around me then, except my baby.  

My baby is five weeks old, and I am still breastfeeding. I have been supplementing with formula more frequently. My lack of desire for pumping and breastfeeding has decreased my milk production. 

On my own, I researched the symptoms I was having. I knew something wasn’t right. I talked to my OB about it, and she confirmed my self-diagnosis.

I was so relieved when I found out about D-MER. I had never heard anything about it.  My agitation when feeding or pumping was causing some minor issues with my husband.  Everything has now been resolved since we both know what I am experiencing.

I felt so much better knowing that I did not have postpartum depression or postpartum anxiety. I am very happy that there is a name for the symptoms that I have had.

What about you?

Do any of these women’s stories ring true for you, too?  Please reach out.  Help is here for you.