123. D-MER: Negative Feelings Every Time You Breastfeed
Dysphoric Milk Ejection Reflex can be a lonely road. Most don't reach out for help because they feel guilty about their negative feeling surrounding breastfeeding. Let's follow the journey of a mom dealing with these negative feelings and you'll find you aren't alone.
Dysphoric milk ejection reflex: A case report
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Welcome to the Breezy Babies podcast, where we talk about all things boobs, babies and breastfeeding. This is episode 123, negative Feelings every time you Breastfeed. I'm Bree the IBCLC and I made Breezy Babies with you in mind to help ease your transition into parenthood. Becoming a parent changes your life and every way imaginable. Bumps in the road are going to come up as you move into your new role, but my goal is to help smooth out those bumps and help you become the most confident parent you can be. With good education and support, I know you can meet your breastfeeding and parenting goals. Let's do this together. Hey there. So good to be back with you for another episode on the Breezy Babies podcast. Is perfect fall weather here in Utah. Right now I have my window open where I'm recording and right now it's just like cool breeze, birch chirping outside. Maybe a loud truck will drive by, will regret my decision to have the window open. But I just couldn't resist because sometimes here in Utah, I don't know how it is where you live, but sometimes our springs and falls just go by way too fast. Sometimes it just seems to go from hot to cold just like that. But we have had the most beautiful fall and now next week it's supposed to be down in the 40s. So I am just enjoying every minute of this perfect weather. It's like low 70s, it's just the most perfect weather. I hope you're having a great fall as well. Getting ready for Halloween. If you're listening to this episode at the time of it coming out, I am excited to talk to you today about a topic that was requested by one of my listeners. I'm excited to talk about this because I don't think this is a topic that is covered a lot, that's mentioned a lot that's even known about. To be honest, I had no idea it was a thing until I was an IBCLC. And even before that, I worked in the hospital and helped families with breastfeeding and lactation. This was not even on my radar, to tell you the truth. So I think this is going to be great. And I have to tell you that these episodes where we talk about things that are not really well known, really common, are some of my favorites. I recently received a direct message from one of my listeners and if you're listening, I know I haven't even responded to yet. Baby was napping, had to just record this. So I haven't asked your permission to share any details, so I won't say your name or anything specific, but one of you who listened sent me a direct message and said how much a podcast episode helped you out, where we talked about nursing aversion. So that was a podcast episode where I had a mom, just one of my followers, share about her experience, how she got through it this prolonged, you know, nursing strike from her baby, where her baby would not latch on and not feed for months and months and months. And what I love about that podcast episode is that McKelle is not a healthcare professional. She doesn't have any fancy certifications, and a lot of people would have said, oh, I don't have the expertise to share on that topic because I don't have a certification. But instead, Mikel was willing to share about her experience. And I know she has helped so many families because we recorded that podcast back in December of 2020. So at the time of this recording, almost a full two years ago, is when that podcast episode went live, which is so crazy to think about. I can't believe I've been doing this for that long. So even though that's almost a two year old podcast episode, I still get messages here and there about people saying, oh, my gosh, that helped me so much. I felt so lonely in the process. No one seemed to understand what I was going through. Can you please just tell Mikel that I really appreciate her doing that podcast episode? So I recently reached out on Instagram, and I'm going to ask you to do the same. If you're listening to this, would you be willing to share your experience? Right. If you have had any sort of special experience as you've dealt with pregnancy, baby lactation, returning to work, anything, I would love you to consider to be a guest here on my podcast. I know it's so scary. I know it seems a little daunting and a little overwhelming, but listen, your experience can help someone else, and sometimes you just have to put yourself out there. That's basically what I just do on this podcast episode. I just kind of wing it and just figure it out as I go along. And I know it's not perfect, but I know that it's helping families all over the world. So if you're up for that, send me a message on Instagram at Breezy Babies or you can email me email@example.com. I'd love for you to think about it. Okay, so today, similar topic to nursing aversion, but today we're going to talk about demur or negative feelings every time you breastfeed. So this is kind of an interesting topic. And most people who experience this, these negative feelings, every time they breastfeed, they rarely reach out for help. And again, most people don't even know that this is a thing. Often families who are dealing with this, they just feel really guilty, like, why do I have these negative feelings surrounding an event that should be happy and relaxing and fulfilling? Because that's what we imagine when we think of feeding our sweet little baby, right? Well, it doesn't always go like that. Yes, breastfeeding can be hard and frustrating, especially in the beginning stages when you're trying so hard to get your baby back to birth weight and not get sore nipples and get a deep latch every time. It's a lot. And honestly, I don't know if I've ever just felt blue skies and rainbows in those very beginning stages. It's kind of hard to remember because you're so tired after giving birth. You're recovering, you're still bleeding, you hardly have time to even feed yourself. So that's not a perfect setting for falling in love with breastfeeding immediately. So if you're listening to this and you didn't love breastfeeding from the beginning either, or maybe you're pregnant and you're worried that you're not going to love breastfeeding from the beginning, that's okay. I think that's pretty normal. I always tell my clients that I meet with prenatally before they even have their baby, that the first three to four weeks of breastfeeding is hard. It's an uphill battle. You're going to want to quit. You're going to want to give up. And that's only if things went smooth with your labor and delivery process. Add in something unexpected like a C-section or a NICU stay, or a large amount of blood loss, or a hard labor with tearing, or your baby having jaundice or low blood sugar, basically anything extra that you weren't planning on, then give yourself even more time than that first month to get things done with breastfeeding. PS. Next week's episode is going to be about surviving the NICU. I have a special guest who actually is a NICU nurse. You're not going to want to miss it just in case your baby ends up there, or you just want to feel prepared for it. Just in case. Subscribe to this podcast. You don't want to miss it. You can follow here on Apple podcasts and it will alert you every time a new episode comes out. Anyway, all this to say that things aren't always sunshine and rainbows from the beginning with breastfeeding. Not always, but that does not mean that you have DMER, which is what we're talking about today. If you've never heard of DMER, then I'm not too surprised. It's not commonly known, it's not commonly talked about. Like I mentioned in the beginning, many who experience it don't even know what's happening or that it's even a thing. Now, you might still be thinking, okay, what is this? Hang with me. We'll kind of work through this as we talk through my top three tips. Let's move into tip number one. Tip one is having a hard adjustment to breastfeeding or just not liking it is not DMER. OK, so let's actually define DMER. Today I'm going to be referencing a study. It's called dysphoric milk ejection reflex. A case report. This is a little bit of an older case study. It's from June 6, 2011, but still very relevant. I will link it in the show notes if you want to look at it yourself. I'll be pulling some information from it today, but I really liked what it said at the beginning of this study it said Dysphoric milk ejection reflex, which is what DMER stands for. Dysphoric milk ejection reflex. Super long name, but basically what it means is an abrupt emotional drop that occurs in some women just before milk release and continues for not more than a few minutes. The brief negative feelings range in severity from wistfulness to self loathing and appear to have a physiological cause. So I also am going to be referencing some information from DMER.org and I really like how on that website they really spell out that DMER is not a physiological response to breastfeeding. Sorry, let me start that over. DMER is not a psychological response to breastfeeding. It's actually a physiological response to milk release. So this is also not nausea with let down. This very specifically is a negative emotional component above everything else. Okay? So if you're feeling nauseous during let down, that is something different altogether. That's not what we're talking about today. But keep listening because you're going to learn some tips and tricks that can still help you to manage if you do have some feelings of not liking breastfeeding. So DMER, they continue on the dimer.org that it's not postpartum depression, it's not a postpartum mood disorder, it's not a general dislike of breastfeeding, it's not being impatient with your baby at the breast, it's not irritability from nipple pain, it's not sadness during pumping because of separation from your baby. None of those things are DMER, it's not breastfeeding aversion okay, none of those things. So what this is, is this is feeling a bad feeling. They call it Dysphoria that you can feel that comes on very suddenly right before your letdown and lasts about 30 seconds to 2 minutes. Okay? So you start to feel this bad feeling right before that let down sensation, okay? Right before all those little milk ducks squeeze in your breast and that milk comes out, you actually feel these bad feelings rush in. They go on to say and DMER.org is that often by the end of the first letdown she feels fine again. The Dysphoria is gone. It can happen for the first let down of a feeding or for all let downs in a feeding because remember, you do have multiple let downs in one feed, even on one breast and that just depends on the intensity of the DMER. So a lot of good information here. Going back to the study, there is a little part that I want to read to you. It says, the authors suggest there are two authors for the study that I am linking for you today. The author suggests that an abrupt drop in dopamine may occur when milk releases triggered, resulting in a real or relative brief dopamine deficit for affected women. Clinicians can support women with DMER in several ways. Often simply knowing that it is a recognized phenomenon makes the condition tolerable further study is needed, which is kind of the case with all things lactation. Further study is needed. But I love how it says just acknowledging that this is a thing is the first huge step in getting past this hurdle. OK? They go on to say because successful milk feeding is vital to mammalian newborn survival, it is essential that the mother be john to provide it and that it feels both comfortable and desirable when milk flows efficiently and effectively. Oxytocin, which is central to milk release, is described as a hormone of calm and connection. Okay, so that kind of introduces dopamine to us, that also introduces oxytocin to us, which are two important hormones that are very closely related to demur and what's happening here. Okay, let's move into tip number two. And that is you can still breastfeed even with DMER. So in this study, I want to read you a case study, but first let me read this part to you. They said dimer probably results in unwanted cessation of breastfeeding. At times that means you wean before you wanted to, you wean before meeting your lactation goals. You stopped breastfeeding before you were planning to. They go on to say, for all affected mothers, it is a troubling, lonely experience. So if you're dealing with this and you hear that, hopefully that gives you a little bit of peace of mind that you are not alone in this. OK, I want to read you this case study. It's about a lady that we will call Ah, and you're also going to hear the initials D. W. Which is one of the authors of this study. Her name is Diane. OK, but first let's talk about oh. She was a breastfeeding counselor in the United States Department of Agriculture WIC program. She had had two previous unremarkable pregnancy and lactation experiences. Her third child was born at home with no interventions and a smooth transition to the breast, they go on to say within two weeks, however, Ah wondered if she might be suffering from postpartum depression for the first time. The rosy glow of the early days was interjected with periods of extreme unhappiness. She soon realized that her symptoms occurred only when her milk was about to release, continuing for perhaps 90 seconds to 2 minutes, ending as quickly as they began, but recurring with the next milk release. Certain that her problem was hormonal, she could neither find information about it nor talk herself out of it. Between milk releases, she felt extremely happy and well bonded to her baby. Just before each milk release, however, and despite her best efforts, she felt helpless, hopeless, worthless. Her milk supply was excellent, tending towards oversupply, as it had with her first but not her second child. Direct nipple stimulation was not needed for the onset of negative emotions. Anything that caused a milk release expected or unexpected breastfeeding mechanical or manual milk expression. So that means like, even when she used a breast pump, the release of milk caused by thinking about her baby or by breast fullness generated the same negative feelings. Ah experienced very frequent, spontaneous, with no nipple stimulation milk releases during the early months if she was shopping. When a spontaneous milk release occurred, she suddenly felt 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. During her daughter's later infancy, she averaged perhaps five spontaneous milk releases per day. By 18 months to two years, she experienced one to two per day. Each one of these involved a DMER. They were often worse than those that occurred during breastfeeding, perhaps because at those times she was caught unaware and there was no baby to offer a distraction. They go on to say, in addition to the invariable emotional sinking that accompanied DMER, ah's ability to concentrate faltered with each episode. Simple math was temporarily impossible. She experimented with mentally reciting the times table as a distraction, and she stalled at two times. Three. H was given a brief, affirming statement to read to herself during a deeper she could neither read it easily nor believed it at all until the feelings passed. H also felt a physical undertone with milk relief in the form of hollowness in the pit of her stomach. And while she did not become nauseated, food and drink felt abruptly and briefly disgusting. However, her primary feelings were emotional. She was overwhelmed by feelings of low self worth guilt, hopelessness, shame, and a desire to hide from the world. The emotions were directed towards herself, not towards her child. Her bond with this child following a good birth was her strongest yet. However, she anticipated feedings not with pleasure or indifference, but with certain dread. OK, this is the last paragraph. Stick with me. When her baby was seven months old, Ah emailed DW Diane, the coauthor of this, who lived in another city. DW's email response, like several of the other IBCLCs and physicians that she had contacted before, was nothing more than a general reassurance and a suggestion that postpartum depression might be involved. Two months later, Ah tried again. Do you love how she didn't give up, by the way? And this time, she tried calling the author. This time DW listened. She learned that Ah's DMER, unlike depression, could quickly be improved, worsened, or even briefly eliminated by very specific environmental or chemical changes. So what's really cool is H did listen to herself and was like, no, something is wrong here. I need help. And I love that Diane listened to her, and I actually worked together to notice what activities could help, what activities could make this worse. So I'm going to present a couple of those to you. But first of all, let's look again at dopamine and oxytocin, because that's going to be very important. So dopamine is the hormone that's responsible for allowing you to feel pleasure, satisfaction, motivation, any time that you feel good that you achieve something, it's because you have a surge of dopamine in your brain. Now, Deemer has been linked to an inappropriate drop in dopamine that occurs whenever milk is released. And a mother with DMER at the time of let down, dopamine falls inappropriately, causing negative feelings. Okay, so that's what's going on with dopamine. Now, oxytocin, I'm sure you've heard me talk about that on this podcast episode. That is the love or the feelgood hormone. So what they did is they looked at different activities and they noticed what was happening with dopamine. They noticed what was happening with oxytocin, and they observed just the overall effect on this mom's DMER symptoms. So they looked at one serving of alcohol. You can look at this chart yourself on the study that I have linked in the show notes, they looked at one serving of alcohol, and they found no changes in dopamine, no changes in oxytocin, and there really was no changes on her DMERsymptoms. They looked at smoking two to five cigarettes in rapid successes, so all in a row, and they found that dopamine increased, but oxytocin decreased. But they did find overall, that her DMER symptoms were improved. Now, I don't recommend smoking. Don't take up smoking just for that. Now, they looked at some other things, like, they looked at Wellbutrin, which is an antidepressant. They found that it increased dopamine. They didn't really notice an effect on oxytocin, but they did find that her overall symptoms improved. They looked at chocolate ice cream, and they found that both dopamine and oxytocin increased, and that improved her symptoms as well. They found things like caffeine, acute stress, things like that, worsened her DMER symptoms that she was experiencing. So just realizing that these bad feelings were connected to her milk releases really helped her to take the next step. So that takes us into tip number three. So tip number three is I want you to notice what triggers your DMER. So on the DMERr.org website, they say for mothers with mild DMER, education goes a long way in treatment. Many find their symptoms more easily managed once they are aware that it's a medical problem, not an emotional problem. Okay, so for mild symptoms, just even knowing that this is a thing could be enough to help get you through. Now, there's different levels of DMER. So that was mild that we just mentioned, but let's talk about moderate DMER. Now, education is also helpful to reduce symptoms. But if that's not enough, what you can do is track your deeper in a log, kind of like I was mentioning before, and start noticing things that aggravate your symptoms or make it worse, like stress, not drinking enough water, caffeine. And then you also want to notice things that help relieve the symptoms, like getting extra rest, drinking more water, exercising. So adding in lifestyle changes and natural remedies can help you through. Now there's also severe DMER. And these moms may need a prescription in order to manage your DMER. Now, what that looks like will look different from person to person. But again, they have found that sometimes the medication can be helpful, but also education, natural remedies and lifestyle changes are also a big part if you do have severe DMER. So what might help you? Consider the following educating yourself validating that this is a real experience connecting with other moms, other families who are experiencing DMER. Taking care of yourself deep breathing vitamin D, magnesium, vitamin B probiotics focusing on your breastfeeding goals. Ignoring the feelings of DMER. Remember that this is transient. It's not going to last forever. Distract yourself, drink cold water. Any of these could be viable options. Now you might be wondering, will I have this forever? Probably not. Mild DMER is often self corrected in the first three months. That's what they tell us on DMER.org. Moderate usually lasts for about nine months and severe sometimes doesn't correct until after the first year or later, which maybe not until you wean. So, surprise, surprise. I want to tell you that ah in the study actually stands for let's see if I can say her name correctly. Alia Macarna Heist. I don't know if that's how you pronounce her name, but that is her real name is Leah Heiss. A. She is an IBCLC. No, I don't know if she was at the time that she was experiencing this, but she is the one who actually put together DMER.org. Isn't that so cool? All the way back in 2007 when she was suffering from DMER breastfeeding her third child, she didn't know what to do. And now she's an international speaker and published writer on this topic. I really liked what she said at the very end on her website. She said, if you read Harry Potter, they talk about the creatures that suck the soul out of you. And when they are around, it makes and when they are around, it makes you cold. And you start to focus on negative things and fall into this abyss of negative thoughts. That is how DMER was for me at times. I hope the research you are doing helps you come to some conclusions. Please let me know if there's anything else I can do. I love that. That was a really good thing that we can relate to. Like those Death Eaters, right? That's what they're called. My kids are actually reading Harry Potter. My husband's reading it out loud to them right now. So I know this was a long podcast episode. There was a lot to unpack with this, but I hope you're feeling a little bit more confident. If you know of someone who might be struggling with this, share this podcast episode with them. They probably feel very lonely and very isolated. Again. My top three tips for managing negative feelings every time you breastfeed is number one. Having a hard adjustment to breastfeeding or just not liking it is not DMER that's something all. Something different altogether. Tip number two is you can still breastfeed even with DMER. And tip number three is notice what triggers your DMER. So there you have it. I hope you have such a great day. Come back next Tuesday for a fresh new podcast episode. And of course. I'm going to leave you with. You are strong. You are smart. You are beautiful. Your good friend. All. See you next Tuesday.